metoprolol
succinate
Toprol-XL
metoprolol tartrate
Apo-Metoprolol (CAN), Betaloc (CAN),
Betaloc Durules (CAN), Lopresor (CAN),
Lopresor SR (CAN), Lopressor,
Novometoprol (CAN)
Nursing Considerations
• Use metoprolol with extreme caution in
patients with bronchospastic disease who
don’t respond to or can’t tolerate other
antihypertensives. Expect to give smaller
doses more often to avoid the higher plasma
levels in longer dosage intervals.
• Use cautiously in patients with hypertension
or angina who have congestive heart
failure because beta blockers such as
metoprolol can further depress myocardial
contractility, worsening heart failure.
• For patient with acute MI who can’t tolerate
initial dosage or who delays treatment,
start with maintenance dosage, as prescribed
and tolerated.
• Before starting therapy for heart failure,
expect to give a diuretic, an ACE inhibitor,
and digoxin to stabilize patient.
• If patient has pheochromocytoma, alpha
blocker therapy should start first, followed
by metoprolol to prevent paradoxical
increase in blood pressure from attenuation
of beta-mediated vasodilation in
skeletal muscle.
• Be aware that metoprolol dosage for heart
failure is highly individualized.Monitor
patient for evidence of worsening heart
failure during dosage increases. If heart
failure worsens, expect to increase diuretic
dosage and possibly decrease metoprolol
dosage or temporarily discontinue drug, as
prescribed.Metoprolol dosage shouldn’t
be increased until worsening heart failure
has been stabilized.
• If patient with heart failure develops
symptomatic bradycardia, expect to
decrease the metoprolol dosage.
WARNING If dosage exceeds 400 mg daily,
monitor patient for bronchospasm and
dyspnea because metoprolol competitively
blocks beta2-adrenergic receptors in
bronchial and vascular smooth muscles.
WARNING When substituting metoprolol for
clonidine, expect to gradually reduce
clonidine and increase metoprolol dosage
over several days. Given together, these
drugs have additive hypotensive effects.
• Patients who take metoprolol may be at
risk for AV block. If AV block results from
depressed AV node conduction, prepare to
give appropriate drug, as ordered, or assist
with insertion of temporary pacemaker.
• Check for signs of poor glucose control in
patient with diabetes mellitus. Metoprolol
may interfere with therapeutic effects of
insulin and oral antidiabetic drugs. It also
may mask evidence of hypoglycemia, such
as palpitations, tachycardia, and tremor.
•Monitor patient with peripheral vascular
disease for evidence of arterial insufficiency
(pain, pallor, and coldness in affected
extremity) Metoprolol can precipitate or
aggravate peripheral vascular disease.
WARNING Expect to taper dosage over 1 to
2 weeks when drug is discontinued; stopping
abruptly can cause myocardial
ischemia, MI, ventricular arrhythmias, or
severe hypertension, especially in patients
with cardiac disease. Abrupt withdrawal
also may cause thyroid storm in a patient
with hyperthyroidism or thyrotoxicosis.
PATIENT TEACHING
• Instruct patient to take metoprolol with
food at the same time each day—once
daily for E.R. tablets. Explain that he may
halve tablets but not chew or crush them.
• Advise patient to notify prescriber if pulse
rate falls below 60 beats/minute or is significantly
lower than usual.
• Urge diabetic patient to check blood glucose
level often during therapy.
• Caution patient not to stop drug abruptly.
