In patients with esophageal varices, is there any harm or decreased benefit to using B1-selective beta blockers with easier dosing schedules (such as metoprolol XL) over propranolol? Chiefs’ Inquiry Corner — 7/26/21 – Clinical Correlations Clinical Correlations * AboutAboutAwardsPeer Review * CategoriesBedside RoundsChiefs' Inquiry CornerCORE IM PodcastDiseases 2.0EthicsEvolution (such as metoprolol XL) over propranolol? Nonselective beta blockers (specifically propranolol) were first studied in the early 1980s as agents that may have a role in decreasing portal venous pressure with the downstream effect of reducing re-bleeding events in patients with cirrhosis presenting with gastrointestinal hemorrhage. Cardioselective beta-blockers have been shown to be less effective (in small studies
Primary care: Metoprolol is not effective for preventing acute exacerbations in COPD Metoprolol is not effective for preventing acute exacerbations in COPD ====================================================================== * Igho J Onakpoya * clinical trials * thoracic medicine *Results of observational studies suggest that beta-blockers have a role in preventing acute exacerbations of COPD -blockers may be beneficial in the management of COPD.2 3 The BLOCK COPD (Beta-Blockers for the Prevention of Acute Exacerbations of COPD) study was a multicentre, randomised, placebo-controlled clinical trial (n=532) that assessed the effectiveness of extended-release metoprolol (a beta-1 selective adrenergic receptor blocker) in preventing acute exacerbations in adults with moderate or severe COPD (aged
Metoprolol You need to be logged in to see the full monograph.LoginUSE OF METOPROLOL IN PREGNANCYDate of issue: November 2020, Version: 3A corresponding patient information leaflet on USE OF METOPROLOL IN PREGNANCY is available.Metoprolol is a cardioselective beta blocker licensed for the treatment of hypertension, angina pectoris, cardiac arrhythmias, myocardial infarction, adjunctive management of thyrotoxicosis, and prophylaxis of migraine.There are no published data on overall rates of congenital malformation following metoprolol use in pregnancy. Single case-control studies found no associations between first trimester metoprolol exposure and hypospadias and posterior cleft palate respectively. Further studies are required to corroborate these findings.The limited available data currently provide
Multivariate predictive model of the therapeutic effects of metoprolol in paediatric vasovagal syncope: a multi-centre study. Metoprolol therapy for paediatric vasovagal syncope (VVS) has yielded inconsistent results, necessitating predictive markers. We aimed to develop and validate models to identify paediatric VVS patients likely to benefit from metoprolol. 478 metoprolol-treated paediatric patients with VVS were enrolled from three syncope units and divided into retrospective training (March 2017-March 2023, n = 323) and prospective validation cohorts (April 2023-March 2024, n = 155). Fourteen patients (2.9%) were excluded for lacking follow-up data. Patients were classified as responders or non-responders based on symptom improvement after 1-3 months of metoprolol therapy. Univariate
ECTOPIC trial: The efficacy of flEcainide Compared To metOprolol in reducing Premature ventrIcular Contractions: A randomized open-label crossover study in pediatric patients. Frequent premature ventricular contractions (PVCs) in children are usually considered benign. Symptoms and left ventricular dysfunction are indications for treatment with antiarrhythmic drugs. This study aimed to evaluate the efficacy of flecainide vs metoprolol in reducing PVCs in children. A randomized open-label crossover trial was conducted of children with a PVC burden of >15% on Holter monitoring successively treated with metoprolol and flecainide, or vice versa, with a drug-free interval of at least 2 weeks. Holter measurements were repeated before and after the start of the antiarrhythmic drug. Sixty patients were
Pharmacokinetics and bioequivalence of two metoprolol succinate extended release tablets in healthy Chinese subjects under fasting and fed conditions. The aims of this study were to evaluate and compare the pharmacokinetic profiles and establish bioequivalence of test and reference metoprolol succinate extended-release (ER) tablets in healthy Chinese subjects under fasting and fed conditions . Subjects were randomly assigned to either the fasting or the fed group and also to one of the two treatment sequences (test-reference or reference-test), according to which they received a single 47.5-mg dose of the test or reference metoprolol ER tablet in the study periods. During each period, blood samples were collected at pre-dose and at intervals up to 48 hours after dosing. Plasma concentrations
[Calcium Dibutyryl Adenosine Cyclophosphate Enhances the Effect of Metoprolol in Treating Older Adults With Heart Failure Combined With Arrhythmia]. To explore the effect and safety of calcium dibutyryl adenosine cyclophosphate (dbcAMP-Ca) combined with metoprolol in the treatment of older adults with heart failure combined with arrhythmia. A total of 102 elderly patients with heart failure group were given metoprolol at an initial dose of 6.25 mg/d, which was gradually increased to the target dose of 25 mg/d. Patients in the experimental group were given 40 mg of dbcAMP-Ca once a day via intravenous drip in addition to the treatment given to the control group. Both groups were treated for 4 weeks. The rate of effective response to clinical treatment (the number of cases achieving
Napex acupoint thread-embedding combined with metoprolol tartrate tablet for prophylactic treatment of migraine without aura: a randomized controlled trial. To observe the efficacy of napex acupoint thread-embedding combined with metoprolol tartrate tablet for prophylactic treatment of migraine without aura, and to compare its efficacy with simple napex acupoint thread-embedding and simple metoprolol tartrate tablet. A total of 105 patients with migraine without aura were randomized into a combination group (35 cases, 5 cases dropped out), a thread-embedding group (35 cases, 4 cases dropped out) and a western medication group (35 cases, 2 cases dropped out). In the thread-embedding group, napex acupoint thread-embedding was applied at bilateral Fengchi (GB 20) and points of 1.5 nearby
A higher peak heart rate during head-up tilt test predicts the therapeutic efficacy of metoprolol in vasovagal syncope. Although beta blockers, such as metoprolol, have been widely used in the management of vasovagal syncope (VVS), their efficacy remains debated, with larger studies showing limited benefit. Identifying patient-specific characteristics that predict a positive response to metoprolol could optimize its use. This study aims to investigate the key factors that may determine which VVS patients are suitable candidates for metoprolol treatment. This retrospective study was conducted at a single center. Patients diagnosed with VVS and treated with metoprolol for a minimum of three months were included. A 50% reduction in syncope symptom score (SS) after three months of metoprolol
Metoprolol use is associated with improved outcomes in patients with sepsis-induced cardiomyopathy: an analysis of the MIMIC-IV database. Metoprolol is commonly administered to critically ill patients; however, its effect on mortality in patients with sepsis-induced cardiomyopathy (SICM) remains uncertain. This study aimed to investigate the relationship between metoprolol use and mortality in patients with SICM. Adults with SICM were identified from the MIMIC-IV database. The exposure of interest was metoprolol treatment. The outcomes assessed were 30-day mortality, 1-year mortality, and in-hospital mortality. Kaplan-Meier survival analysis evaluated the effect of metoprolol on these outcomes. Multivariable Cox proportional hazards and logistic regression analyses were performed to determine
Tongmai Yangxin Pill combined with metoprolol or metoprolol alone for the treatment of symptomatic premature ventricular complex: a multicenter, randomized, parallel-controlled clinical study. To investigate the effects of Tongmai Yangxin Pill (TMYXP) combined with metoprolol tartrate or metoprolol alone for the treatment of premature ventricular complex (PVC) in patients with symptomatic frequent PVC. A total of 584 patients with symptomatic frequent PVC were randomly assigned (in a 1:1 ratio) into two groups: study group [ = 292, TMYXP (40 pills twice/day, orally) combined with metoprolol tartrate (25 mg twice/day, orally)] and control group [ = 292, metoprolol tartrate (25 mg twice/day, orally) plus placebo pill (40 pills twice/day, orally)]. The total treatment period was eight weeks
Effect of Carvedilol Versus Metoprolol on Contrast-Induced Nephropathy in Patients with Acute Coronary Syndrome Undergoing Percutaneous Intervention Therapy. Carvedilol can inhibit inflammation, vasoconstriction, and oxidative stress, which play important roles in the development and progression of contrast-induced nephropathy (CIN). To the best of our knowledge, no studies have investigated prospectively. Overall, 100 and 219 patients were assigned to the carvedilol and metoprolol groups, respectively. The prevalence of CIN was significantly lower in the carvedilol group (6.0%) than in the metoprolol group (18.3%; P = .003). Multivariate analysis revealed that carvedilol use (odds ratio [OR] .250, 95% confidence interval [CI] .092-.677, P = .006), amount of contrast agent (OR 1.004, 95% CI 1.000
Improvement in hemodynamics of amlodipine besylate combined with metoprolol in patients with hypertension complicated by heart failure. To observe the effect of amlodipine besylate combined with metoprolol in treating hypertension and heart failure. Total number of patients with hypertension combined with HF admitted to our hospital was One hundred and fifty from May 2017 to May 2022 selected for the study and they were distributed into single drug group and combination group by the method of random number table, with the total number of 75 cases in every group. Metoprolol treatment was given to the single drug group and metoprolol combined with amlodipine besylate treatment was given to the combination group. Both groups' scientific outcomes were compared, including their ventricular function
Acute rate control with metoprolol versus diltiazem in atrial fibrillation with heart failure with reduced ejection fraction. Compare heart rate control between parenteral metoprolol and diltiazem and identify safety outcomes in the acute management of atrial fibrillation (AFib) with rapid ventricular response (RVR) in patients with heart failure with reduced ejection fraction (HFrEF ). This retrospective, single-center, cohort study included adult patients with HFrEF who received intravenous (IV) metoprolol or diltiazem for AFib RVR in the emergency department (ED). The primary outcome was rate control defined as HR <100 bpm or a HR reduction ≥20% within 30 min of first dose administration. The secondary outcomes included rate control within 60 min and 120 min from first dose, need for repeat
Metoprolol Improves Left Ventricular Longitudinal Strain at Rest and during Exercise in Obstructive Hypertrophic Cardiomyopathy. Patients with obstructive hypertrophic cardiomyopathy (HCM) often experience symptoms of heart failure upon exertion despite having normal left ventricular (LV) ejection fractions. Longitudinal strain (LS) may be a more sensitive marker of systolic dysfunction trial. Patients received metoprolol 150 mg or placebo for two consecutive 2-week periods in random order. Echocardiographic assessment with speckle-tracking-derived LS was performed at rest and during peak exercise at the end of each treatment period. During placebo treatment, resting values of segmental LS showed an apical-basal difference of -10.3% (95% CI, -12.7% to -7.8%; P < .0001
Enantiospecific Uptake and Depuration Kinetics of Chiral Metoprolol and Venlafaxine in Marine Medaka (Oryzias melastigma): Tissue Distribution and Metabolite Formation. The increasing use of chiral pharmaceuticals has led to their widespread presence in the environment. However, their toxicokinetics have rarely been reported. Therefore, the tissue-specific uptake and depuration kinetics of two pairs of pharmaceutical enantiomers, -(-)-metoprolol versus -(+)-metoprolol and -(+)-venlafaxine versus -(-)-venlafaxine, were studied in marine medaka () during a 28-day exposure and 14-day clearance period. The toxicokinetics of the studied pharmaceuticals, including uptake and depuration rate constants, depuration half-life (), and bioconcentration factor (BCF), were reported for the first time
Metoprolol for prevention of bucking at orotracheal extubation: a double-blind, placebo-controlled randomised trial. Respiratory responses to extubation can cause serious postoperative complications. Beta-blockers, such as metoprolol, can interfere with the cough pathway. However, whether metoprolol can effectively control respiratory reflexes during extubation remains unclear. The objective of this study is to evaluate the efficacy of intravenous metoprolol in attenuating respiratory responses to tracheal extubation. Randomized, double-blinded, placebo-controlled trial. Tertiary referral center located in Brasília, Brazil. Recruitment: June 2021 to December 2021. 222 patients of both sexes with an American Society of Anesthesiologists (ASA) physical status I-III aged 18-80 years. Patients were
Effect of metoprolol in hypertrophic obstructive cardiomyopathy patients after alcohol septal ablation. The use of beta-blockers in hypertrophic obstructive cardiomyopathy (HOCM) patients after alcohol septal ablation (ASA) lacks data support. We aimed to evaluate the effect of metoprolol on exercise capacity, hemodynamic and laboratory parameters, and quality of life in HOCM patients after ASA . This was a prospective randomized single-center open-label crossover trial in 21 HOCM patients after ASA. Patients received metoprolol and no beta-blocker for two periods of three months. The endpoints were: peak oxygen uptake (pVO), maximal left ventricular outflow tract (LVOT) pressure gradient at peak exercise, a ratio of mitral peak velocity of the early filling (E) to early diastolic mitral annular velocity (e
Randomized Trial of Metoprolol in Patients With Obstructive Hypertrophic Cardiomyopathy The use of β-adrenergic receptor blocking agents in symptomatic patients with obstructive hypertrophic cardiomyopathy (HCM) rests on clinical experience and observational cohort studies. This study aimed to investigate the effects of metoprolol on left ventricular outflow tract (LVOT) obstruction, symptoms , and exercise capacity in patients with obstructive HCM. This double-blind, placebo-controlled, randomized crossover trial enrolled 29 patients with obstructive HCM and New York Heart Association (NYHA) functional class II or higher symptoms from May 2018 to September 2020. Patients received metoprolol or placebo for 2 consecutive 2-week periods in random order. The effect parameters were LVOT gradients, NYHA