With arterial hypertension, the effect occurs after 2-5 days, a stable condition occurs after 1-2 months.
With angina pectoris, the selected dose of the drug should provide a heart rate at rest within 55-60 beats / min, with a load - no more than 110 beats / min.
In smokers, the effectiveness of beta-blockers is lower.
Control of patients taking beta-blockers includes monitoring heart rate and blood pressure (at the beginning of the procedure - every day, then every 2 to 4 months), blood glucose in diabetic patients (once every 4-5 months).
If necessary, for patients with diabetes mellitus, the dose of insulin or hypoglycemic drugs administered orally should be selected individually.
It is necessary to teach the patient how to calculate heart rate and instruct about the need for medical consultation at a heart rate of less than 50 beats per minute.
In elderly patients, it is recommended that kidney function is monitored (once every 4-5 months).
May enhance the symptoms of peripheral arterial circulation.
The withdrawal of the drug is carried out gradually, reduce the dose for 10 days, under the supervision of a doctor. With a sharp cessation of treatment, there may be a "cancellation" syndrome (increased angina attacks, increased blood pressure). Particular attention should be paid to patients with angina when the drug is withdrawn.
Patients using contact lenses should take into account that against the background of drug treatment Metoprolol it is possible to reduce the production of tear fluid.
Metoprolol may mask certain clinical manifestations of hyperthyroidism (eg, tachycardia). Sharp abolition in patients with thyrotoxicosis is contraindicated, since it can strengthen symptoms.
With diabetes mellitus Metoprolol can mask tachycardia caused by hypoglycemia. In contrast to nonselective beta-blockers, it does not substantially increase insulin-induced hypoglycemia and does not delay the restoration of blood glucose to an optimal level.
In elderly patients it is recommended to regularly monitor liver function.
Correction of the dosing regimen is required only if elderly patients develop an increasing bradycardia (less than 50 beats per minute), a marked decrease in blood pressure (systolic blood pressure below 100 mm Hg), atrioventricular blockade, bronchospasm, ventricular arrhythmias, severe liver dysfunction; sometimes you need to stop treatment.
Special monitoring should be carried out on the condition of patients with depressive disorders receiving Metoprolol; In the case of development of depression caused by the use of beta-blockers, it is recommended to stop therapy.
A few days before the anesthesia with chloroform or ether should stop taking the drug. If it is necessary to perform a surgical procedure, it is necessary to warn the anesthesia about the therapy (choice of a means for general anesthesia with minimal negative inotropic action), the drug cancellation is not recommended.
With combined therapy with clonidine, the latter should be discontinued a few days after metoprolol withdrawal in order to avoid a hypertensive crisis.
At a dose above 200 mg / day, cardioselectivity decreases.
It is possible to increase the severity of the reactions of hypersensitivity (against a background of a burdened allergic anamnesis) and the absence of the effect of the administration of usual doses of epinephrine.
In case of necessity of carrying out of surgical operation, including stomatologic, it is necessary to inform the doctor about application of a preparation Metoprolol.
During treatment with metoprolol, appropriate clothing should be worn, since the drug may cause skin allergy to sunlight.
If it is necessary to prescribe to patients with bronchial asthma, as a concomitant therapy, beta2-adrenostimulators, with pheochromocytoma - alpha-adrenoblockers.
Reciprocal activation of the vagus nerve can be eliminated in \ in the administration of atropine (1-2 mg).