Metoprolol is an fat-soluble , selective β1 receptor blocker. Fuwai Hospital of Chinese Academy of Medical Sciences Li Jing, Liu Jiamin and others, in conjunction with scholars from hospitals in many places, analyzed the prescriptions of more than 54,000 domestic metoprolol tartrate tablets and found that
metoprolol tablets are safe and most patients can continue to take the medicine even if their heart rate is 50 times/min after taking the medicine.
The risk of bradycardia after using metoprolol tartrate tablets is significantly increased, and special attention should be paid to monitoring the heart rate.
study showed that the incidence of safety adverse events in all prescriptions was 0.58%.
Among them, the most common safety adverse event is heart rate <50>
Among patients with a heart rate of 50 times/min after taking the medication, 70 (32.0%) returned to normal after maintaining the original dose, and 96 (43.8%) returned to normal after reducing the dose; only 24.2% stopped the medication.
There were 3 patients with asthma with metoprolol (0.03%).
study shows that metoprolol tartrate tablets lead to safety adverse events is most affected by the patient's heart rate before medication.
Compared with patients with basal heart rate ≥80 beats/min, the risk of safety adverse events in patients with basal heart rate of 60~69 beats/min and 60 beats/min increased to 2.12 times and 9.97 times, respectively.
In view of this, for patients whose heart rate is less than 70 beats/min before medication, pay attention to monitoring the heart rate when taking medication.
In terms of dose and safety, within the dose range recommended by the guidelines, the safety of metoprolol tablets is not related to the dose. This study did not observe an increased risk of safety adverse events in the high-dose group than in the low-dose group, nor did the dose response relationship be seen.
Previous studies have also reported that within the scope of reasonable medication, the incidence of adverse events in metoprolol is not directly related to the dose.
study found that the risk of safety adverse events after metoprolol tablets in diabetic patients is lower than that in non-diabetic patients, which may be related to the high incidence of cardiovascular autonomic neuropathy in diabetic patients.
In addition, it was found that the risk of safety adverse events in obese patients was increased by 35%.
According to reports, previous studies have shown that safe adverse events in metoprolol include cardiovascular events (bradycardia, blockade , etc.) and non-cardiovascular events (fatigue, dizziness, nausea, rash, etc.), with an incidence rate of 6% to 29%.
. In this study, the main safety adverse event was bradycardia, and the incidence was low, which may be related to low daily doses.
This study selected prescription and safety monitoring data from the ESPRIT trial from September 2019 to December 2021, including a total of 53,724 prescriptions containing metoprolol tablets.
study included the prescription of domestic metoprolol tartarate tablets ( Changzhou Siyao Pharmaceutical Co., Ltd. , dosage forms include 50 mg/tablet and 25 mg/tablet) used, including single or combined use. There were 6037 patients with hypertension and corresponding to the prescription.
In this study, the safety adverse events of metoprolol tartarate tablets include any of the following:
(1) Heart rate 50 times/min within 3 months after taking the medication;
(2) Discontinuation of medication due to side effects, including asthma, hypotension , allergies, bradycardia or conduction block and others.
The author also said that the study of metoprolol tartaric acid tablets produced in China came from a single manufacturer, but based on the requirements of consistency evaluation, it is speculated that the safety differences in drugs from different manufacturers are small. Second, the heart rate of patients in this study was obtained when blood pressure was measured, and regular electrocardiogram monitoring was not routinely performed, which may underestimate the incidence of mild atrioventricular block. Third, the study only analyzed the safety within 3 months of prescription use.
Source: Yan Xiaofang, Ge Jinzhuo, Li Jiaying, et al. Analysis of safety adverse events and influencing factors of domestic metoprolol tartarate tablets. Chinese Circulation Magazine , 2022, 37: 928-934. DOI: 10.3969/j.issn.1000-3614.2022.09.010. [ long press or scan the QR code to see the original text ]
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