Control of patients taking beta-blockers includes regular monitoring of heart rate and blood pressure, blood glucose concentration in patients with diabetes mellitus.
If necessary, for patients with diabetes mellitus, a dose of insulin or hypoglycemic drugs prescribed inside, 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.
It is possible to increase the severity of allergic reactions (against the background of a burdened allergic medical history) and the lack of the effect of the administration of usual doses of epinephrine (adrenaline).
In elderly patients, it is recommended that the kidney function is monitored (once every 4-5 months). It can intensify the symptoms of peripheral arterial circulation.
Cancellation of the drug is carried out gradually, reducing the dose for 10 days.
With arterial hypertension, the effect occurs after 2-5 days, a stable effect is observed 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.
Metoprolol may mask certain clinical manifestations of thyrotoxicosis (eg, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated, since it can strengthen symptoms.
In diabetes mellitus can mask tachycardia caused by hypoglycemia.
In contrast to non-selective beta-blockers, it does not substantially increase insulin-induced hypoglycemia and does not delay the restoration of glucose concentration in the blood to a normal value.
If it is necessary to appoint patients with bronchial asthma as a concomitant therapy, use beta2-adrenomimetics; at pheochromocytoma - alpha-adrenoblockers.
If it is necessary to perform a surgical procedure, it is necessary to warn the anesthesia doctor about taking Metoprolol (choice of a means for general anesthesia with minimal negative inotropic effect), the drug cancellation is not recommended.
Reciprocal activation n.vagus can be eliminated in / in the administration of atropine (1-2 mg).
In the case of an increasing bradycardia (less than 50 beats per minute), arterial hypotension (systolic blood pressure below 100 mmHg) AV blockade, bronchospasm, ventricular arrhythmias, severe impairment of liver and kidney function, it is necessary to reduce the dose or stop treatment.
It is recommended to stop therapy with skin rashes and the development of depression caused by the use of beta-blockers.
With a sharp cessation of treatment, there may be a "cancellation" syndrome (increased angina attacks, increased blood pressure). Special attention should be paid to stenocardia when the drug is withdrawn.
Patients using contact lenses should take into account,that against the background of treatment with beta-blockers may reduce the production of tear fluid.