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Lopressor

Lopressor
Lopressor is indicated for hypertension, tachycardia, ischemic heart disease, prevention of angina attacks, heart rhythm disturbances, prevention of migraine attacks.

Brand: Metoprolol

Availability: In Stock
Average Delivery Time: 9 Days
Exp. Date: November 2023
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Package Price Per pill Save Order
Lopressor 100 mg
270 pills - 100 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$161.55 $0.60 $161.82 Add to cart
180 pills - 100 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$115.92 $0.64 $99.66 Add to cart
120 pills - 100 mg $86.95 $0.72 $56.77 Add to cart
90 pills - 100 mg $71.99 $0.80 $35.80 Add to cart
60 pills - 100 mg $55.95 $0.93 $15.91 Add to cart
30 pills - 100 mg $35.93 $1.20 No Add to cart
Lopressor 50 mg
270 pills - 50 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$103.65 $0.38 $165.45 Add to cart
180 pills - 50 mg $77.95 $0.43 $101.45 Add to cart
120 pills - 50 mg $61.93 $0.52 $57.67 Add to cart
90 pills - 50 mg $52.91 $0.59 $36.79 Add to cart
60 pills - 50 mg $44.93 $0.75 $14.87 Add to cart
30 pills - 50 mg $29.90 $1.00 No Add to cart
Lopressor 25 mg
180 pills - 25 mg $75.99 $0.42 $79.95 Add to cart
120 pills - 25 mg $57.97 $0.48 $45.99 Add to cart
90 pills - 25 mg $47.95 $0.53 $30.02 Add to cart
60 pills - 25 mg $39.99 $0.67 $11.99 Add to cart
30 pills - 25 mg $25.99 $0.87 No Add to cart
Lopressor 12.5 mg
270 pills - 12.5 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$187.55 $0.69 $145.36 Add to cart
180 pills - 12.5 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$131.33 $0.73 $90.61 Add to cart
120 pills - 12.5 mg $93.93 $0.78 $54.03 Add to cart
90 pills - 12.5 mg $74.95 $0.83 $36.02 Add to cart
60 pills - 12.5 mg $55.99 $0.93 $17.99 Add to cart
30 pills - 12.5 mg $36.99 $1.23 No Add to cart

Product description

Pharmacological action of the drug Lopressor 

Buy lopressor in Canada

Cardioselective beta1-blocker. It does not have a membrane stabilizing effect and does not have internal MCA. It has hypotensive, antiangial and antiarrhythmic effects.

Blocking in low doses the beta1-adrenergic receptors of the heart, reduces the formation of cAMP from ATP stimulated by catecholamines, reduces the intracellular Ca2 + current, has a negative chrono-, dromo-, batmo- and inotropic effect (reduces heart rate, inhibits conductivity and excitability, reduces myocardial contractility).

OPSS at the beginning of the use of beta-blockers (in the first 24 hours after oral administration) increases (as a result of a reciprocal increase in the activity of alpha-adrenergic receptors and elimination of stimulation of beta2-adrenergic receptors), which returns to the initial value after 1-3 days, and decreases with prolonged administration.

The hypotensive effect is due to a decrease in IOC and renin synthesis, inhibition of the activity of the renin-angiotensin system (it is more important in patients with initial hypersecretion of renin) and the central nervous system, restoration of the sensitivity of the aortic arch baroreceptors (there is no increase in their activity in response to a decrease in blood pressure) and, as a result, a decrease in peripheral sympathetic influences. Reduces high blood pressure at rest, during physical exertion and stress. The hypotensive effect develops rapidly (systolic blood pressure decreases after 15 minutes, maximum - after 2 hours) and lasts for 6 hours, diastolic blood pressure changes more slowly: a stable decrease is observed after several weeks of regular intake.

The antianginal effect is determined by a decrease in myocardial oxygen demand as a result of a decrease in heart rate (lengthening of diastole and an improvement in myocardial perfusion) and contractility, as well as a decrease in myocardial sensitivity to the effects of sympathetic innervation. Reduces the number and severity of angina attacks and increases exercise tolerance. Due to an increase in the end-diastolic pressure in the LV and an increase in the stretching of the muscle fibers of the ventricles, it can increase the demand for oxygen, especially in patients with CHF.

The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP content, arterial hypertension), a decrease in the rate of spontaneous excitation of sinus and ectopic pacemakers and a slowdown in AV conduction (mainly in the antegrade and to a lesser extent in the retrograde directions through the AV node ) and along additional paths.

With supraventricular tachycardia, atrial fibrillation, sinus tachycardia in functional heart diseases and thyrotoxicosis, it slows down the heart rate or may even lead to the restoration of sinus rhythm.

Prevents the development of migraines.

In contrast to non-selective beta-blockers, when administered in medium therapeutic doses, it has a less pronounced effect on organs containing beta2-adrenergic receptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi and uterus) and on carbohydrate metabolism; the severity of atherogenic action does not differ from the action of propranolol. When taken for many years, it reduces the concentration of cholesterol in the blood. When used in large doses (more than 100 mg / day), it has a blocking effect on both subtypes of beta-adrenergic receptors.

Indications for the drug Lopressor 

Lopressor for high blood pressure

  • arterial hypertension (as monotherapy or in combination with other antihypertensive drugs), incl. hyperkinetic type, tachycardia;
  • ischemic heart disease: myocardial infarction (secondary prevention-complex therapy), prevention of angina attacks;
  • heart rhythm disturbances (supraventricular tachycardia, ventricular premature beats);
  • hyperthyroidism (complex therapy);
  • prevention of migraine attacks.

How to use Lopressor : dosage and course of treatment

Orally, with food or immediately after a meal, the tablets can be divided in half, but not chewed and washed down with liquid, for long-acting dosage forms - swallow whole, do not crush, do not break (except for metoprolol succinate and tartrate), do not chew.

  • With arterial hypertension, the average dose is 100-150 mg / day in 1-2 doses, if necessary - 200 mg / day.
  • With angina pectoris - 50 mg 2-3 times a day.
  • With hyperkinetic cardiac syndrome (including thyrotoxicosis) - 50 mg 1-2 times a day.
  • With tachyarrhythmias - 50 mg 2-3 times a day, if necessary - 200-300 mg / day.
  • Secondary prevention of myocardial infarction - 200 mg / day.
  • Prevention of migraine - 100-200 mg / day in 2-4 doses.

For relief of paroxysmal supraventricular tachycardia, it is administered parenterally, in a hospital setting. Enter slowly, a dose of 2-5 mg (1-2 mg / min). If there is no effect, the administration can be repeated after 5 minutes. An increase in the dose over 15 mg usually does not lead to a more pronounced effect. After the arrest of the arrhythmia attack, patients are transferred to oral administration in a dose of 50 mg 4 times a day, and the first dose is taken 15 minutes after the termination of intravenous administration.

In the acute stage of myocardial infarction immediately after hospitalization of the patient (with constant monitoring of hemodynamics: ECG, heart rate, AV conduction, blood pressure), a bolus of 5 mg IV should be administered, the administration should be repeated every 2 minutes until a total dose of 15 mg is reached. With good tolerance, after 15 minutes - by mouth, 25-50 mg every 6 hours, for 2 days. Patients who do not tolerate the full IV dose should begin oral administration starting with a half dose. Supportive therapy continues at doses of 200 mg / day (in 2 doses) for 3 months-3 years.

Elderly patients are advised to start treatment with 50 mg / day.

Renal failure does not require dose adjustment. In liver failure, it is advisable to prescribe other beta-blockers that are not metabolized in the liver.

 

Special instructions

Control over patients taking beta-blockers includes monitoring heart rate and blood pressure (at the beginning of admission - daily, then once every 3-4 months), blood glucose concentration in diabetic patients (once every 4-5 months) ... The patient should be trained in the method of calculating the heart rate and instructed on the need for medical advice if the heart rate is less than 50 / min.

It is possible that the severity of allergic reactions (against the background of a burdened allergic history) and the lack of effect from the introduction of conventional doses of epinephrine are possible.

In elderly patients, it is recommended to monitor kidney function (once every 4-5 months). May exacerbate symptoms of impaired peripheral arterial circulation. Patients with cardiac arrhythmias whose systolic blood pressure is below 100 mm Hg should be administered intravenously only with special precautions (there is a risk of further lowering blood pressure). Cancellation of the drug is carried out gradually, reducing the dose within 10 days.

With arterial hypertension, the effect occurs after 2-5 days, a stable effect is noted after 1-2 months.

With angina pectoris, the selected dose of the drug should provide a resting heart rate within 55-60 beats / min, with a load - no more than 110 beats / min. In "smokers" the effectiveness of beta-blockers is lower.

When combined therapy with clonidine , the latter should be discontinued a few days after discontinuation of metoprolol, in order to avoid a hypertensive crisis. Above 200 mg / day, cardioselectivity decreases.

Metoprolol can mask some of the clinical manifestations of thyrotoxicosis (eg, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated, since it can aggravate the symptoms.

In diabetes mellitus, it can mask tachycardia caused by hypoglycemia. Unlike nonselective beta-blockers, it practically does not increase insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentration to normal levels.

If necessary, appointments to patients with bronchial asthma are used as concomitant therapy with beta2-adrenostimulants; with pheochromocytoma - alpha-blockers.

If it is necessary to carry out a surgical intervention, it is necessary to warn the anesthesiologist about the therapy (the choice of drugs for general anesthesia with a minimal negative inotropic effect), the withdrawal of the drug is not recommended.

Reciprocal activation of n.vagus can be eliminated byadministration of intravenousatropine (1-2 mg).

Drugs that reduce the supply of catecholamines (for example, reserpine) can enhance the effect of beta-blockers, therefore, patients taking such drug combinations should be under constant medical supervision for detecting an excessive decrease in blood pressure or bradycardia.

If elderly patients develop bradycardia (less than 50 / min), arterial hypotension (systolic blood pressure below 100 mm Hg), AV blockade, bronchospasm, ventricular arrhythmias, severe hepatic and renal dysfunction, it is necessary to reduce the dose or stop treatment ... It is recommended to discontinue therapy with the appearance of skin rashes and the development of depression caused by the intake of beta-blockers.

Cancellation of the drug is carried out gradually, reducing the dose within 10 days. With an abrupt termination of treatment, a "withdrawal" syndrome may occur (increased angina attacks, increased blood pressure). When discontinuing the drug, special attention should be paid to patients with angina pectoris.

Patients using contact lenses should take into account that during treatment with beta-blockers, it is possible to reduce the production of tear fluid.

During pregnancy, it is prescribed only for strict indications (in connection with the possible development of bradycardia, hypotension, hypoglycemia and respiratory paralysis in a newborn). Treatment should be interrupted 48-72 hours before delivery. In cases where this is not possible, it is necessary to ensure strict observation of the newborn for 48-72 hours after delivery.

During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.

Interaction

Allergens used for immunotherapy or allergen extracts for skin tests increase the risk of severe systemic allergic reactions or anaphylaxis in patients receiving metoprolol. Iodine-containing X-ray contrast drugs for intravenous administration increase the risk of developing anaphylactic reactions.

Phenytoin when administered intravenously, drugs for inhalation general anesthesia (hydrocarbon derivatives) increase the severity of the cardiodepressant effect and the likelihood of lowering blood pressure.

Changes the effectiveness of insulin and oral hypoglycemic drugs, masks the symptoms of developing hypoglycemia (tachycardia, increased blood pressure).

Reduces the clearance of lidocaine and xanthines (except diphylline) and increases their plasma concentration, especially in patients with an initially increased clearance of theophylline under the influence of smoking.

The antihypertensive effect is weakened by NSAIDs (Na + delay and blockade of Pg synthesis by the kidneys), corticosteroids and estrogens (Na + delay).

Cardiac glycosides, methyldopa, reserpine and guanfacine, BMCC (verapamil, diltiazem), amiodarone, and other antiarrhythmic drugs increase the risk of developing or worsening bradycardia, AV blockade, cardiac arrest and heart failure. Nifedipine can lead to a significant decrease in blood pressure.

Diuretics, clonidine, sympatholytics, hydralazine, and other antihypertensive drugs can lead to an excessive decrease in blood pressure.

Prolongs the action of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins.

Tri- and tetracyclic antidepressants, antipsychotic drugs (antipsychotics), ethanol, sedative and hypnotic drugs increase CNS depression.

Simultaneous use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect, the break in treatment between taking MAO inhibitors and metoprolol should be at least 14 days.

Unhydrogenated ergot alkaloids increase the risk of developing peripheral circulatory disorders.

Contraindications

Hypersensitivity, cardiogenic shock, stage II-III AV block, SA block, SSSU, sinus bradycardia (heart rate less than 50 / min), acute heart failure or decompensated heart failure, Prinzmetal's angina, arterial hypotension, acute myocardial infarction (PQ more than 0.24 s or systolic blood pressure less than 100 mm Hg); lactation period, concomitant administration of MAO inhibitors or simultaneousadministration of verapamil.intravenousC with caution. Diabetes mellitus, metabolic acidosis, bronchial asthma, COPD (pulmonary emphysema, chronic obstructive bronchitis), liver failure, chronic renal failure, myasthenia gravis, pheochromocytoma, thyrotoxicosis, depression (including in history), psoriasis, obliterating peripheral vascular disease (" "lameness, Raynaud's syndrome), pregnancy, childhood (efficacy and safety not determined), advanced age."

 

Side effects

From the nervous system: increased fatigue, weakness, headache, slowing down of the speed of mental and motor reactions. Rarely: paresthesias in the extremities (in patients with "intermittent" claudication and Raynaud's syndrome), tremors, convulsions, depression, anxiety, decreased attention, drowsiness, insomnia, "nightmares", confusion or short-term memory loss, hallucinations, asthenia, myasthenia gravis ...

From the senses: rarely - decreased vision, decreased secretion of lacrimal fluid, dry and sore eyes, conjunctivitis, tinnitus, hearing loss.

From the CVS: sinus bradycardia, lowering blood pressure, orthostatic hypotension (dizziness, sometimes loss of consciousness). Rarely - a decrease in myocardial contractility, the development (worsening) of CHF (edema, swelling of the feet and / or lower legs, shortness of breath), cardiac arrhythmias, manifestation of angiospasm (increased peripheral circulation disorders, cooling of the lower extremities, Raynaud's syndrome), myocardial conduction disturbances, cardialgia. Very rarely - aggravation of pre-existing abnormalities of AV conduction.

From the digestive system: nausea, vomiting, abdominal pain, dry mouth, constipation or diarrhea, in some cases - impaired liver function (dark urine, yellowness of the sclera or skin, cholestasis), changes in taste.

On the part of the skin: skin rashes (exacerbation of psoriasis), psoriasis-like skin reactions, skin hyperemia, exanthema, photodermatosis, increased sweating, reversible alopecia.

Respiratory system: nasal congestion, bronchospasm when administered in high doses (loss of selectivity and / or in predisposed patients), shortness of breath.

From the endocrine system: hyperglycemia (in patients with non-insulin dependent diabetes mellitus), hypoglycemia (in patients receiving insulin), hypothyroidism.

Allergic reactions: urticaria, pruritus, rash.

Laboratory indicators: thrombocytopenia (unusual bleeding and hemorrhage), agranulocytosis, leukopenia, increased activity of "liver" enzymes, hyperbilirubinemia.

Effect on the fetus: intrauterine growth retardation, hypoglycemia, bradycardia.

Others: back pain or joint pain, weight gain, decreased libido and / or potency, with abrupt cessation of treatment - "withdrawal" syndrome (increased angina attacks, increased blood pressure). Overdose. Symptoms: severe severe sinus bradycardia, dizziness, AV block (up to the development of complete transverse blockade and cardiac arrest), decreased blood pressure, fainting, arrhythmia, ventricular extrasystole, HF, cardiogenic shock, cardiac arrest, bronchospasm, loss of consciousness, coma, nausea , vomiting, cyanosis. The first signs of an overdose appear 20 minutes to 2 hours after taking the drug.

Treatment: gastric lavage and the appointment of adsorbing drugs; symptomatic therapy: with a pronounced decrease in blood pressure - the patient should be in the Trendelenburg position; in the case of an excessive decrease in blood pressure, bradycardia and heart failure - IV, with an interval of 2-5 minutes, beta-adrenostimulants - until the desired effect is achieved, or 0.5-2 mg of atropine sulfate IV. In the absence of a positive effect, dopamine, dobutamine, or norepinephrine. As a follow-up, it is possible to prescribe 1-10 mg of glucagon, staging a transvenous intracardiac pacemaker. In case of bronchospasm, intravenous beta2-adrenergic receptor stimulants should be administered. With convulsions - slowadministration of intravenousdiazepam. Hemodialysis is ineffective.