Metoprolol 23,75 mg – Burra (2023)

FAQs

Why is nadolol used for portal hypertension? ›

Propranolol and nadolol, which are non-selective beta blockers, reduce portal pressure via two mechanisms: 1) Cardiac output is reduced by blocking β1 adrenergic receptors, 2) Splachnic vasoconstriction by blocking β2 receptors (vasodilators).

In view of its wide scale use, metoprolol induced liver injury is exceedingly rare. The typical liver injury associated with beta-blockers has a latency to onset of 2 to 12 weeks and a hepatocellular pattern of liver enzyme.

If you're taking it for anxiety, there do not seem to be any lasting harmful effects if you take it for several months or years. But it's best to take propranolol only for as long as you need it.

Propranolol is a noncardioselective beta-blocker that reduces portal pressure through the reduction of portal and collateral blood flow.

Portal hypertension is one of the most serious complications of advanced liver disease. Scar tissue in your liver (cirrhosis) compresses the blood vessels running through it and reduces their blood flow. This affects many other organs throughout your body. It can cause serious internal bleeding and other problems.

Pharmacologic therapy for portal hypertension includes the use of beta-blockers, most commonly propranolol and nadolol. Brazilian investigators have suggested that the use of some statins (eg, simvastatin) may lower portal pressure and potentially improve the liver function.

Metoprolol may worsen the symptoms of heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort, dilated neck veins, extreme fatigue, irregular breathing or heartbeat, swelling of the face, fingers, feet, or lower legs, trouble breathing, or weight gain.

Common side effects

Headaches usually go away after the first week of taking metoprolol. Talk to your doctor if the headaches are severe or last longer than a week. If metoprolol makes you feel dizzy or weak, stop what you're doing, and sit or lie down until you feel better.

Metoprolol works as well as other beta blockers for reducing high blood pressure, but is less likely to cause side effects. That's because metoprolol works mainly on the heart. Other beta blockers, such as propranolol, work on the heart but affect other parts of the body as well.

For the uninitiated, beta-blockers are drugs that ease anxiety, keep blood pressure in check and control heart rate. Apart from the Kardashians, Katy Perry as well as Blair Tindall also use these meds to reduce anxiety and stage fright. In fact, Tindall has been rather vocal about the use of beta-blockers.

Can you eventually get off beta-blockers? ›

Although it's rare in the US for someone who's had a heart attack or who suffers from dangerously high blood pressure to get off medications, including beta blockers, completely, it's not impossible.

In people who have had a heart attack, beta blockers help reduce the risk of further ones. Guidelines recommend that all patients who have had a heart attack should be prescribed a beta blocker before hospital discharge as part of a package of risk reduction measures. Treatment should usually continue for life.

Portal hypertension is difficult to treat or cure. For that reason, your doctor will focus on preventing and managing complications and trying to reduce the pressure in your portal vein.

Among newer agents, labetalol, carvedilol, and nebivolol have been approved for use in the United States. Nebivolol possesses both beta1-selectivity and nitric oxide-mediated vasodilatory effects, while carvedilol has attractive effects on insulin resistance and exhibits antioxidant effects.

In the stage of advanced liver disease, mostly fixed structural changes, such as fibrosis or the formation of regenerative nodules, are responsible for developing and sustaining portal hypertension.

Portal hypertension is elevated pressure in your portal venous system. The portal vein is a major vein that leads to the liver. The most common cause of portal hypertension is cirrhosis (scarring) of the liver.

The results suggest that treatment with metoprolol may be of value in patients with portal hypertension secondary to cirrhosis of the liver. However, to eliminate non-responders the pressure has to be measured repeatedly.

There are two stages in cirrhosis: compensated and decompensated. Compensated cirrhosis: People with compensated cirrhosis do not show symptoms, while life expectancy is around 9–12 years. A person can remain asymptomatic for years, although 5–7% of those with the condition will develop symptoms every year.

What is the blood pressure for portal hypertension? ›

A pressure gradient of 6 mmHg or more between the portal and hepatic veins (or inferior vena cava) suggests the presence of portal hypertension in most cases. [1] When the pressure gradient is greater than 10 mmHg, portal hypertension becomes clinically significant.

Metoprolol may worsen the symptoms of heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort, dilated neck veins, extreme fatigue, irregular breathing or heartbeat, swelling of the face, fingers, feet, or lower legs, trouble breathing, or weight gain.

Metoprolol can interact with medications and other substances. Examples include digoxin, diphenhydramine, and certain calcium channel blockers. It can also interact with clonidine, certain antidepressants, and alcohol. Most commonly, you may experience dizziness and lightheadedness from a metoprolol interaction.

Metoprolol is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries.

Treatment with metoprolol is usually long term, possibly even for the rest of your life. Stopping metoprolol suddenly can make your condition worse, so talk to your doctor first. If you're bothered by any side effects, your doctor may be able to prescribe a different medicine for your heart problems.

Carvedilol lowers blood pressure more than metoprolol.

Fatigue, drowsiness and weakness: Metoprolol will slow your heart rate down by blocking the hormone adrenaline. This results in blood being transported to the brain and body at a slower pace, making some feel tired (reported in 1 to 10% of cases), drowsy and weak.

Theoretically metoprolol can cause all of the CNS side effects associated with beta-blockers, such as psychiatric conditions, bizarre and vivid dreams, sleep disturbances, delirium, psychosis, and visual hallucinations [1].

They also may act to reduce rhythm disturbances by counteracting adrenaline in the blood. A heart rate of 55-60 is not unusual in people taking metoprolol.

Beta blockers like propranolol

Top examples are metoprolol succinate (Toprol XL), carvedilol (Coreg), and propranolol. However, they can cause side effects — including sleep disturbances like insomnia and nightmares.

Which is the safest beta-blocker? ›

Heart conditions

For heart failure, research studies show that three beta blockers are considered first-choice options: carvedilol, metoprolol succinate (the long-acting form of metoprolol), and bisoprolol. These beta blockers can lower your risk of death from heart failure complications.

People who took their blood pressure medications at bedtime were 45% less likely to experience a major cardiovascular outcome, such as heart attack or stroke, compared with people who took them in the morning. Most blood pressure medications, diuretics aside, do not have a recommended time of administration.

Eat a balanced, nutrient-dense diet.

Consuming a diet low in ultra-processed foods and rich in whole, nutritious foods like vegetables, fruits, nuts, seeds, fish, and beans is one of the best ways to take care of your heart ( 15 ).

Long-term side effects of beta-blockers may include disorientation, short-term memory loss, emotional lability (rapid, extreme changes in mood), inability to concentrate or think clearly, and decreased performance on neuropsychological tests used to measure a psychological function.

Fish, garlic, berries, and certain vitamins and amino acids are all natural sources of beta-blockers. Doctors usually prescribe beta-blockers to treat cardiovascular conditions such as angina and hypertension, which is also known as high blood pressure.

You may feel tired or even exhausted. This may be most obvious when you first start taking beta-blockers or if your dose is increased. It usually gets better after a while.

The average age of people who had previously used beta-blockers was 65.1 ± 11.2 years for women and 65.0 ± 11.6 years for men. Among nonusers of beta-blockers, the average age was 60.3 ± 12.3 years for women and 60.7 ± 11.9 years for men.

The selective inhibitor, ivabradine, provides an alternative way of heart rate reduction in addition to beta-blockers and calcium channel blockers. This could become particularly useful in patients who are intolerant of beta-blockers, for example, in the presence of asthma or severe chronic obstructive airway disease.

Beta blockers generally aren't used in people with asthma because of concerns that the medication may trigger severe asthma attacks. In people who have diabetes, beta blockers may block signs of low blood sugar, such as rapid heartbeat.

The overall survival rate appeared to favor IPH (100% at 1 year, 92.9% at 3 and 5 years; P = 0.2) more than cirrhosis (87.7% at 1 year, 75.2% at 3 years, and 63.6% at 5 years), but did not reach statistical significance.

When is portal hypertension serious? ›

Portal hypertension is a dangerous condition with severe, life-threatening complications. Call your healthcare provider right away if you notice any of these symptoms: Yellowing of the skin. Abnormally swollen belly.

In adults with portal vein thrombosis, the 10-year survival rate has been reported to be 38-60%, with most of the deaths occurring secondary to the underlying disease (eg, cirrhosis, malignancy).

Your outlook depends on how severe your portal hypertension is and whether you have bleeding varices or other complications. The risk of death from your first episode of bleeding may be as high as 40%. If bleeding recurs after treatment, the risk of death from your next episode is close to 30%.

Varices can rupture or burst, especially where the esophagus and the stomach join. Bleeding from varices can be massive, causing patients to vomit blood, which is a major cause of death in patients with portal hypertension.

Although many advances have been made in this field, the complications of portal hypertension (gastrointestinal hemorrhage, hepatic encephalopathy, hepatorenal syndrome, and ascites) continue to be the cause of significant morbidity and mortality.

In summary, beta-blockers are effective in preventing cardiovascular disease but are no longer suitable for routine initial treatment of hypertension because their cardiovascular protection and metabolic effects are worse than those of other antihypertensive drugs.

This drug, nicknamed the “triple pill” by the investigators, combines low doses of three existing drugs for blood pressure. Namely, these are: telmisartan (20 milligrams), amlodipine (2.5 milligrams), and chlorthalidone (12.5 milligrams).

Abstract. Nadolol, a nonselective beta-blocker, has been shown to decrease portal pressure in patients with cirrhosis at the same degree as propranolol. No data are available, however, about its effect on rebleeding rate and mortality in patients undergoing prevention of rebleeding from esophageal varices.

Beta blockers decrease pressure inside of the varices, which can reduce the risk of bleeding by 45 to 50 percent [1]. There are several forms of beta blockers. The two most commonly used beta blockers for prevention of bleeding are propranolol (sample brand name: Inderal) and nadolol (brand name: Corgard).

These drugs work in two ways: 1) by blocking beta1 receptors and reducing cardiac output, and 2) by blocking beta2 receptors, producing splanchnic vasoconstriction and reducing portal flow. Consequently, they reduce portal pressure.

Why is nadolol used for cirrhosis? ›

By slowing the heart rate and widening the blood vessels, beta-blocker medicines such as propranolol and nadolol appear to lower the blood pressure in varices that bypass the liver. In people who have esophageal varices, beta-blockers have been shown to reduce the risk of having a first episode of bleeding.

Nadolol may cause heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort; dilated neck veins; extreme fatigue; irregular breathing; an irregular heartbeat; shortness of breath; swelling of the face, fingers, feet, or lower legs; weight gain; or wheezing .

NADOLOL (nay DOE lole) treats high blood pressure and prevents chest pain (angina). It works by lowering your blood pressure and heart rate, making it easier for your heart to pump blood to the rest of your body. It belongs to a group of medications called beta blockers.

Nadolol, with a plasma half-life of 15.5 hours, had the most pronounced heart rate-lowering effect 24 hours after the daily dose compared to pindolol, which had a half-life of 5.5 hours. In a randomized, double-blind, crossover study, nadolol and atenolol had similar effects 3 to 4 hours after the daily dose.

Results: At the end of the study 60.1% of the patients had died at a median age of 69 years (range 26-95). Mortality of patients with gastro-oesophageal varices was significantly greater than that of the general pop- ulation.

Nadolol and atenolol are the least lipophilic of the β-blockers and therefore have less penetrance of the blood–brain barrier, yielding more peripheral as opposed to central effects. In contrast, propranolol and metoprolol are more lipophilic and therefore have relatively greater CNS effects.

You should not use nadolol if you are allergic to it, or if you have: asthma; a serious heart condition such as "AV block" (2nd or 3rd degree) or severe heart failure; or. if your heart cannot pump blood properly.

Liver transplantation is the only effective treatment for cirrhosis and portal hypertension. Liver transplantation means your diseased liver is replaced with a healthy one from deceased donors or living donors who donate portions of the liver.

Treatment. The main cause of portal hypertension is cirrhosis, which cannot be reversed. Because of this, the primary goal of treatment is to reduce and manage the effects of portal hypertension, such as internal bleeding.

Portal hypertension is elevated pressure in your portal venous system. The portal vein is a major vein that leads to the liver. The most common cause of portal hypertension is cirrhosis (scarring) of the liver.

What happens if you don't take nadolol? ›

Suddenly stopping treatment with nadolol can cause a heart attack, stroke, irregular heartbeat, or severe high blood pressure. Your doctor will decide if you need to stop taking nadolol.

Cirrhosis can be divided into 4 stages: stage 1, no varices, no ascites; stage 2, varices without ascites and without bleeding; stage 3, ascites+/-varices; stage 4, bleeding+/-ascites. Yearly mortality ranges from 1% in stage 1 to 57% in stage 4.

Nadolol undergoes rapid first pass metabolism by the liver, but has little or no effect on P450 activity. The reason why it rarely causes liver injury is unknown; other beta-blockers with similar chemical structures have been linked to cases of clinically apparent, idiosyncratic liver injury.