40 Ms. Chen, who is in her 340s, is the boss of a company. She is busy with work pressure and often needs to go out for social events. This leads to her suffering from chronic diseases such as hypertension, coronary heart disease, , and hyperlipidemia very early. She feels chest tightness and palpitations as soon as she is tired, but she usually takes some quick-acting heart-saving pills to relieve it.
In the past month, due to the decline in the company's performance, Ms. Chen stayed up late and worked overtime more and more times, and often needed to go out to drink and eat. One day after going out for social events, Ms. Chen felt that she was very panicked and accompanied by severe chest tightness. As soon as her family tested her blood pressure reached 180/100mmHg, her family quickly sent her to the hospital. The doctor immediately performed an electrocardiogram examination and blood pressure monitoring on Ms. Chen. The results of found that her heart rate reached 140 beats per minute, her blood pressure was as high as 190/110mmHg, and it was accompanied by a large area of myocardial ischemia , so she was diagnosed with coronary heart disease, hypertension level III and sinus tachycardia , so she prescribed a drug called metoprolol sustained release tablet , saying that this medicine can not only lower blood pressure, but also lower heart rate, and instructed her to take it regularly, pay attention to monitoring changes in blood pressure and heart rate during the period.
After taking it for a period of time, Ms. Chen's blood pressure and heart rate were well controlled, and her palpitations and chest tightness gradually decreased. However, as the medication time was longer, Ms. Chen found that her heart rate was gradually slowing down. After one month, she was only 50-60 times per minute, which was a lot worse than the previous 100 times per point. Ms. Chen was a little scared, so she consulted a doctor. The doctor asked Ms. Chen in detail about her daily situation. It turned out that Ms. Chen herself was mildly anxious, so she usually had the habit of taking sertraline . After hearing this, the doctor told Ms. Chen not to take metoprolol, and adjusted metoprolol to bisoprolol . Ms. Chen was puzzled. Are they all the same medicine? Doctor explained that although bisoprolol and metoprolol are the same drugs, the metabolic pathways are very different. Metoprolol will be affected by sertraline and lead to metabolic abnormalities, which will cause heart rate hypertension. Therefore, it is necessary to adjust the medication regimen . After adjusting the medication plan, Ms. Chen's heart rate returned to about 80 beats per minute.
1. Metoprolol mechanism and metabolic characteristics of
Metoprolol is a cardiac selective β-receptor blocking drug, also known as betaxel in clinical practice. has a highly effective and selective blocking effect on the β1-receptor on the cardiovascular system. This blocking is reversible and partial, and it will not over-inhibit the heart beat. Therefore, the clinical efficacy is good and there are fewer side effects. is often used in clinical practice to treat cardiovascular diseases such as hypertension, angina pectoris, sinus tachycardia, chronic heart failure, etc. .
β1-receptor is one of the main receptors distributed on the heart. It belongs to excitatory receptors. When stimulated, it will have a stimulating effect on the heart, which will lead to myocardial contraction, accelerated heartbeat, vasoconstriction and other effects. Therefore, when the β1-receptor on the heart is blocked, it will effectively inhibit its excitatory effect . Pharmacological studies show that METC can effectively block β1-receptors on the heart, produce pharmacological effects such as slowing heart rate, inhibiting cardiac contraction, and reducing self-discipline, thereby effectively reducing blood pressure and reducing heart load ; it is worth mentioning that since meTC itself is highly selective for β1-receptors on the heart, has little impact on blood vessels and bronchials, and it will hardly react to blood vessels and airways.
Pharmacokinetics study shows that metoprolol is a fat-soluble β1-blocker. It is absorbed very quickly after oral administration, and the bioavailability reaches 90%. It only takes 1-2 hours to exert the efficacy of pharmacokine ; metoprolol is metabolized very quickly and can be completely metabolized in only 3-5 hours. , but metoprolol in clinical practice Er sustained release tablets can slow down this process, thereby extending the therapeutic effect of drugs ; the liver is the main metabolic organ of metoprolol, . The CYP2D6 enzyme in the liver plays a crucial role in the metabolism of metoprolol. Therefore, in clinical practice, drugs that have an effect on the CYP2D6 enzyme will have an inhibitory effect on the metabolism of metoprolol, which in turn leads to an increase in the concentration of metoprolol in the blood , resulting in adverse reactions.
2. These four types of drugs should not be combined with metoprolol
metoprolol itself has better safety, but because its efficacy is strong and its metabolism is affected by the CYP2D6 enzyme activity in the liver, it will have cross-reactions with some drugs in clinical practice. Therefore, metoprolol should not be combined with the following 4 drugs, which is prone to adverse reactions.
1, serotonin reuptake inhibitor
5-serotonin reuptake inhibitor is one of the common drugs for clinical treatment of depression and anxiety disorders. represents drugs such as paroxetine , fluoxetine , sertraline, escitalopram and other . These drugs are mainly It is also through liver metabolism. has a significant inhibitory effect on the activity of CYP2D6 enzymes, which can easily lead to a decrease in metoprolol metabolism and an increase in the concentration of drugs in the blood, which will lead to adverse reactions such as bradycardia and hypotension . Therefore, if these drugs are combined in clinical practice, the dosage of metoprolol must be adjusted, or it must be adjusted to similar drugs such as that are less dependent on liver enzymes, such as .
2, prostaglandin synthetase inhibitor combined with
Prostaglandin synthesis inhibitor is an anti-inflammatory analgesic drug, also clinically known as non-steroidal anti-inflammatory drug . Commonly used drugs include aspirin, ibuprofen , indomethacin and other . These drugs will reduce the inhibitory effect of metoprolol on β-receptors, and then reduce the effect of metoprolol on blood pressure and heart rate . Therefore, when using the above drugs together, you must monitor blood pressure and heart rate regularly, and the medication regimen can be adjusted if necessary.
3, barbiturate drugs
Barbiturate drugs are one of the commonly used central sedative hypnosis drugs in clinical practice. Representative drugs of include phenobarbital, isoprenalbarbital, scobarbital and other . Pharmacological studies have shown that barbiturate drugs have a promoting and activate effect on the activity of CYP2D6 enzymes, resulting in a rapid metabolic rate of metoprolol , which is likely to lead to a decrease in the efficacy of metoprolol.
4, insulin
Insulin is one of the commonly used antidiabetic drugs for patients with diabetes . is mainly aimed at patients with type I diabetes and patients with type II diabetes who have poor oral medications , but pharmacological studies have shown that 3 Metoprolol increases the body's insulin resistance reaction through the blocking effect of β receptors, which in turn causes the hypoglycemic effect of insulin to weaken . Therefore, when combined, it is necessary to monitor blood sugar levels regularly and adjust the insulin dosage; secondly, metoprolol often covers hypoglycemia reactions, such as palpitations, palpitations, , etc. Therefore, when combined, it is not only necessary to observe body changes, but also to actively monitor blood sugar levels , and it is important to find that hypoglycemia reactions are the key.
3. Metoprolol is commonly used in clinical treatment and treatment of these 4 diseases
Currently, metoprolol is divided into two types: sustained-release tablets and conventional tablets. The efficacy of sustained-release tablets can last up to 24 hours. It is often used in clinical practice to treat a variety of cardiovascular diseases, but the medication plan for different diseases is different. It is recommended that patients in need take the medicine under the guidance of a doctor.
1, sinus tachycardia
Sinus tachycardia is one of the common clinical arrhythmia , which is defined as a comorbidity of coronary heart disease and angina pectoris. Metoprolol is one of the commonly used drugs for the treatment of sinus tachycardia. clinical studies show that oral administration of 50mg metoprolol can effectively slow down the sinus rhythm of . At the same time, since metoprolol does not completely block the effect of β receptors, it has a small impact on normal heart rate .
2, hypertension
3 metoprolol is one of the commonly used antihypertensive drugs in clinical practice. It can lower blood pressure by inhibiting heart contraction, reducing heart blood volume, and slowing heart rate. is often used in clinical practice to treat patients with hypertension combined with angina pectoris, chronic heart failure and other diseases. Clinical studies have shown that oral administration of 100-200 mg metoprolol per day can effectively reduce blood levels, protect heart function, and improve disease prognosis .
3, chronic heart failure
3 clinically treats chronic heart failure, the principles of cardiac strengthening, diuretic and dilating blood vessels, and metoprolol is one of the common drugs for the treatment of chronic heart failure, and is often used in combination with diuretics, cardiac strengthening agents, ACER drugs, etc. Studies have shown that chronic heart failure can cause sympathetic nerve excitation , leading to faster heartbeat and increased contraction, which in turn increases the heart load and induce heart failure . orally taking 25-50mg of metoprolol per day can effectively reduce sympathetic nerve excitation, reduce heart burden, and improve disease prognosis. However, it should be noted that patients will have discomfort reactions in the early stage of taking the medicine. It is necessary to start from a small dose and gradually increase the dosage .
4, stable angina pectoris
Metoprolol is often combined with vascular dilated drugs, nutritional myocardial drugs, lipid-lowering and stable plaque drugs, etc., to jointly treat stable angina pectoris. clinical studies show that oral administration of 50-100 mg of metoprolol per day can effectively reduce the number of angina pectoris attacks, reduce heart load, delay the development of the disease, and can effectively reduce sudden cardiac death, improve patient prognosis .
4. The following points should be paid attention to when taking metoprolol scientifically
metoprolol is a commonly used antihypertensive and heart rate-lowering drug in clinical practice. However, due to its unique pharmacological characteristics, if used improperly, it is easy to cause multiple adverse reactions, especially for patients who need to take them for a long time. Therefore, the following points should be paid attention to when taking metoprolol scientifically.
First, pay attention to the dosage and method of taking drugs
Clinically, metoprolol mainly includes two major categories: Metoprolol succinate sustained release tablets and metoprolol tartarate tablets .
Among them, amber Metoprolol cerate sustained release tablets are a sustained release tablet, with a dose of 47.5 mg per tablet. The conventional method is 1 tablet per time. Only one time a day needs to be taken, but the medication plan can be adjusted according to the disease needs, such as half a tablet or 2 tablets of ;
Metoprolol tartarate is a conventional tablet, with a dose of 50 mg per tablet, and the conventional method is 1 tablet per time, but the metabolic cycle is short, and it needs to be taken 2-3 times a day. The maximum dose should not exceed 200mg per day.
Therefore, in clinical practice, must choose drugs according to needs. It is recommended to take sustained-release tablets for chronic diseases such as hypertension and chronic heart failure. It is recommended to use conventional tablets for tachycardia, angina pectoris, etc., because it is easier to adjust the dosage of .
Second, pay attention to the adverse reactions of drugs
The most common adverse reactions of metoprolol are blood pressure drop and heart rate slowdown , which is more common in the early stage of taking medication, but most patients can tolerate it and can be relieved by reducing the dose of drugs; secondly, Since metoprolol can penetrate the blood-brain barrier, it is easy to inhibit the central nervous system , , will experience dizziness, fatigue, headache, and insomnia. Adverse reactions such as dopants ; third, are prone to gastrointestinal reactions during metoprolol, such as abdominal pain, nausea, constipation, etc., but most do not affect the use of medicine; fourth, long-term oral metoprolol should be monitored to monitor liver and kidney function, which may cause damage to the improvement of function and lead to increased liver enzymes; Finally, Men will have sexual dysfunction after taking metoprolol, such as being unable to wait for erectile dysfunction, and most of them can be relieved by reducing the dose of drugs or changing other drugs.
3. Pay attention to the medication for special populations
Pregnant women are forbidden to because metoprolol can pass through the placental barrier and affect fetal heart development; lactation , women are forbidden to , metoprolol will be secreted through milk; hypotension , cardiogenic shock and heart failure Patients with decompensated periods of are prohibited from using , which will aggravate heart failure and induce hypotensive reactions; , use with caution for chronic asthma and obstructive pulmonary disease, which can easily induce disease attacks. , requires combined tracheal dilator ; , patients with chronic arrhythmia and atrioventricular block, which will aggravate the condition and even induce sinus arrest of .
Fourth, pay attention to gradually reducing the dosage when stopping the drug
If patients who have long-term use of metoprolol need to adjust the medication plan and plan to interrupt the treatment, they must gradually reduce the dosage. For example, reduce 25 mg each time and gradually remove it within 7-10 days, otherwise it will easily lead to drug withdrawal reactions, inducing various adverse reactions such as angina pectoris, tachycardia, myocardial infarction, etc. Therefore, be sure to pay attention to gradually reducing the dosage of drugs , and do not withdraw the drug suddenly.
5. Summary
To sum up, metoprolol is a common drug for the treatment of cardiovascular diseases such as hypertension and tachycardia, but it is not suitable for use with paroxetine, fluoxetine, sertraline, aspirin, etc. If used in combination, you must monitor the changes in blood pressure and heart rate, and adjust the drug dosage according to the changes, or change the medication plan; secondly, you must pay attention to the two different oral dosage forms of metoprolol, each dosage has its own advantages and disadvantages. It is recommended that everyone use the medication standardized under the guidance of a doctor; finally, you must pay attention to adverse reactions during the medication period, and if they occur, respond to the doctor in a timely manner.
