Cairns JA, Theroux P, Lewis D et al. Antithrombotic agents in coronary artery disease. Chest. Griffiths, E. and Humphreys, J. Bacteriostatic effect of human milk and bovine colostrum on Escherichia coli: importance of bicarbonate. Infect. IV atropine; if bradycardia is refractory to atropine, discontinue metoprolol and consider cautious administration of isoproterenol or use of a cardiac pacemaker. Wilmington, DE: AstraZeneca: 2005 Sep. From FDA website. provera purchase online canada
Asunaprevir: May increase the serum concentration of CYP2D6 Substrates. The precise mechanism of action of Metoprolol in patients with suspected or definite myocardial infarction is not known. Important: The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, blogs, or WebMD Answers are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions.
Anilidopiperidine Opioids: May enhance the bradycardic effect of Beta-Blockers. Anilidopiperidine Opioids may enhance the hypotensive effect of Beta-Blockers. The 25 mg tablets are white film-coated, round, scored tablets debossed with M over 18 on one side of the tablet and scored on the other side. Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Your dose may need to be changed several times in order to find out what works best for you.
I'd gotten this before when I was stressed out a couple of years ago, and knew to lie down. I did lie down for about half an hour, only to have the pain come back not long after I got up again. It ended up lasting for several hours. Three days later, I had an appt with my Dr, told her of this and she did an ekg, which came back abnormal. I now have an echocardiogram scheduled for next week. Discuss specific use of drug and side effects with patient as it relates to treatment. HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Yu, H. Insulin-like growth factor-I and prostate cancer: a meta-analysis.
CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness eg, operating machinery, driving. Use with caution. May make these conditions worse. Go AS, Bauman MA, Coleman King SM et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. Lanoxin. There are no adequate studies of Toprol XL in pregnant women and is secreted in human breast milk. Helzlsouer, K. J. Premenopausal levels of circulating insulin-like growth factor I and the risk of postmenopausal breast cancer. The MIAMI Trial Research Group. Mortality. Am J Cardiol. Cobicistat: May increase the serum concentration of CYP2D6 Substrates. Therapeutic Equivalence-Related Terms, Pharmaceutical Equivalents generally will be coded AB if a study is submitted demonstrating bioequivalence. Alpha1-Blockers: Beta-Blockers may enhance the orthostatic hypotensive effect of Alpha1-Blockers. The risk associated with ophthalmic products is probably less than systemic products. Have your blood pressure and pulse heart rate checked regularly while taking this medication. Learn how to check your own blood pressure and pulse at home, and share the results with your doctor. Both digitalis glycosides and beta-blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia. Monitor heart rate and PR interval. Adenosine is handled and stored by a health care provider. You will not store it at home. Keep all medicines out of the reach of children and away from pets. Shand DG. State-of-the-art: comparative pharmacology of the β-adrenoceptor blocking drugs. Drugs.
Middleton B, Bates DW. Drug-drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records. This drug passes into breast milk. Discuss the risks and benefits with your doctor before breast-feeding. Tapentadol can cause constipation. Talk to your doctor before using a laxative or stool softener to treat or prevent this side effect. There is very limited experience with the use of hemodialysis to remove metoprolol, however metoprolol is not highly protein bound. Diarrhea has occurred in about 5 of 100 patients. Nausea, dry mouth, gastric pain, constipation, flatulence, and heartburn have been reported in about 1 of 100 patients. Vomiting was a common occurrence. Post-marketing experience reveals very rare reports of hepatitis, jaundice and nonspecific hepatic dysfunction. Isolated cases of transaminase, alkaline phosphatase, and lactic dehydrogenase elevations have also been reported. The following adverse reactions have been identified during post-approval use of Toprol-XL or immediate-release metoprolol. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Respiratory: Wheezing bronchospasm dyspnea. rifampicin
This effect can happen at any time while taking this drug but is more likely if you take it for a long time. Arsura EL, Solar M, Lefkin AS et al. Metoprolol in the treatment of multifocal atrial tachycardia. Crit Care Med. What should I discuss with my healthcare provider before taking Toprol-XL metoprolol? Petschow BW, Talbott RD. Reduction in virus-neutralizing activity of a bovine colostrum immunoglobulin concentrate by gastric acid and digestive enzymes. The only histologic changes that appeared to be drug related were an increased incidence of generally mild focal accumulation of foamy macrophages in pulmonary alveoli and a slight increase in biliary hyperplasia. Comments: This drug has been used without apparent harmful effects in the nursing infant. Take tapentadol exactly as prescribed. Follow all directions on your prescription label. Tapentadol can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never take tapentadol in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain. Amgen Inc. Corlanor ivabradine tablets prescribing information. Thousand Oaks, CA; 2015 Apr. Frishman WH. Clinical differences between beta-adrenergic blocking agents: implications for therapeutic substitution. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Beta-adrenergic blockade may mask certain clinical signs of hyperthyroidism, such as tachycardia. Abrupt withdrawal of beta-blockade may precipitate a thyroid storm. dramamine allergy canada dramamine
Food does not affect bioavailability of extended-release tablets. Dumesnil J, Turgeon J. Significant interaction between the nonprescription antihistamine diphenhydramine and the CYP2D6 substrate metoprolol in healthy men with high or low CYP2D6 activity. Serious. These medicines may interact and cause very harmful effects. Kakehi, K. Capillary affinity electrophoresis using lectins for the analysis of milk oligosaccharide structure and its application to bovine colostrum oligosaccharides. Anal. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Metoprolol is primarily metabolized by CYP2D6. Metoprolol is a racemic mixture of R- and S- enantiomers, and when administered orally, it exhibits stereoselective metabolism that is dependent on oxidation phenotype. CYP2D6 is absent poor metabolizers in about 8% of Caucasians and about 2% of most other populations. Undergoes first-pass metabolism in the liver by CYP2D6 to inactive metabolites. Hammarstrom, L. Bovine anti-Helicobacter pylori antibodies for oral immunotherapy. Individualize the dosage of Metoprolol tartrate tablets. Metoprolol tartrate tablets should be taken with or immediately following meals. Wilmington, DE: AstraZeneca; 2005 Sep. From FDA website. Bretzel RG, Voit K, Schatz H et al. The United Kingdom Prospective Diabetes Study UKPDS: implications for the pharmacotherapy of type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes. Adenosine is given as an injection at your doctor's office, hospital, or clinic. Contact your health care provider if you have any questions. Wright JT, Bakris G, Greene T et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. Initially, low doses may be appropriate to establish response Huckleberry 2003; however, although not routine, up to 15 mg administered as frequently as every 3 hours has been employed in patients with refractory tachycardia. Pitt B, Zannad F, Remme WJ et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. tricor order online shopping usa
Educate patient about signs of a significant reaction eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat. Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Metoprolol is also used to treat severe chest pain angina and lowers the risk of repeated heart attacks. It is given to people who have already had a heart attack. In addition, metoprolol is used to treat patients with heart failure. Frishman WH, Furberg CD, Friedewald WT. β-Adrenergic blockade for survivors of acute myocardial infarction. N Engl J Med. Rehnqvist N, Olsson G, Erhardt L et al. Metoprolol in acute myocardial infarction reduces ventricular arrhythmias both in the early stage and after the acute event. Int J Cardiol. The presence of other medical problems may affect the use of this medicine. In general, administration of a beta-blocker should be withheld before dipyridamole testing, with careful monitoring of heart rate following the dipyridamole injection. Do not start, stop, or change the dosage of any medicine before checking with them first. Dipyridamole: May enhance the bradycardic effect of Beta-Blockers. An increase in the toxic effects of lidocaine may occur. Herbs Hypertensive Properties: May diminish the antihypertensive effect of Antihypertensive Agents. Toprol-XL and PLENDIL are trademarks of the AstraZeneca group of companies. McLean AJ, Knight R, Harrison PM et al. Clearance-based oral drug interaction between verapamil and metoprolol and comparison with atenolol. Am J Cardiol. Cushman WC, Ford CE, Cutler JA, et al. Success and predictors of blood pressure control in diverse North American settings: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ALLHAT. J Clin Hypertens Greenwich. AU TGA pregnancy category C: Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details. Prophylaxis of migraine headache; not recommended for the treatment of a migraine attack that has already started. Disopyramide: May enhance the bradycardic effect of Beta-Blockers. Beta-Blockers may enhance the negative inotropic effect of Disopyramide.
It may be necessary to lower the dose of Toprol-XL or temporarily discontinue it. Such episodes do not preclude subsequent successful titration of Toprol-XL. Moderate. These medicines may cause some risk when taken together. TOPROL-XL or immediate-release metoprolol. Thadani U. Beta blockers in hypertension. Am J Cardiol. Freedman DJ, Tacket CO, Delehanty A, et al. Milk immunoglobulin with specific activity against purified colonization factor antigens can protect against oral challenge with enterotoxigenic Escherichia coli. Start patients with contraindications to treatment during the early phase of suspected or definite myocardial infarction, patients who appear not to tolerate the full early treatment, and patients in whom the physician wishes to delay therapy for any other reason on Metoprolol tartrate tablets, 100 mg twice daily, as soon as their clinical condition allows. Continue therapy for at least 3 months. Although the efficacy of Metoprolol beyond 3 months has not been conclusively established, data from studies with other beta-blockers suggest that treatment should be continued for 1 to 3 years. It is very soluble in water; freely soluble in methylene chloride, in chloroform, and in alcohol; slightly soluble in acetone; and insoluble in ether. What other drugs will affect Toprol-XL metoprolol? Arsura EL, Scher DL. Verapamil and multifocal atrial tachycardia. Ann Intern Med. Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. F. Protect from moisture. The usual initial dosage of Metoprolol tartrate tablets is 100 mg daily in single or divided doses, whether used alone or added to a diuretic. Increase the dosage at weekly or longer intervals until optimum blood pressure reduction is achieved. In general, the maximum effect of any given dosage level will be apparent after one week of therapy. The effective dosage range of Metoprolol tartrate tablets is 100 mg to 450 mg per day. Dosages above 450 mg per day have not been studied. While once daily dosing is effective and can maintain a reduction in blood pressure throughout the day, lower doses especially 100 mg may not maintain a full effect at the end of the 24-hour period, and larger or more frequent daily doses may be required. This can be evaluated by measuring blood pressure near the end of the dosing interval to determine whether satisfactory control is being maintained throughout the day. Beta 1 selectivity diminishes as the dose of Metoprolol tartrate tablets is increased. Fisher ML, Gottlieb SS, Plotnick GD et al. Beneficial effects of metoprolol in heart failure associated with coronary artery disease: a randomized trial. J Am Coll Cardiol. Hepatic impairment: Use with caution in patients with hepatic impairment. Kidney Disease: Improving Global Outcomes KDIGO Blood Pressure Work Group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl. Several cases of overdosage have been reported, some leading to death. buy generic nitrofurantoin from india online
AHA guidelines for the management of STEMI recommend the use of IV metoprolol at the time of presentation only in patients with STEMI who are hypertensive or have ongoing ischemia without contraindications. Oral metoprolol immediate release initiated within the first 24 hours is recommended in all other patients. XL randomized intervention trial in heart failure MERIT-HF. Am J Cardiol. Appropriate studies have not been performed on the relationship of age to the effects of metoprolol tablets in the pediatric population. Safety and efficacy have not been established. Regorafenib: May enhance the bradycardic effect of Beta-Blockers. Bronchospastic disease: In general, patients with bronchospastic disease should not receive beta-blockers; however, metoprolol, with B 1 selectivity, has been used cautiously with close monitoring. Check with your pharmacist about how to dispose of unused medicine. Influence of hydroxychloroquine on the bioavailability of oral metoprolol. Pedersen TR for the Norwegian Multicenter Study Group. Six-year follow-up of the Norwegian multicenter study on timolol after myocardial infarction. N Engl J Med. Corlanor may cause dizziness or vision changes, which could impair your thinking or reactions. Be careful if you drive especially at night or do anything that requires you to be alert and able to see clearly. Possible bradycardia and depressed SA node automaticity. This medication is a beta-blocker used to treat chest pain angina heart failure, and high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Lercanidipine: May enhance the hypotensive effect of Metoprolol. Metoprolol may decrease the serum concentration of Lercanidipine. trusty pharmacy comprar budecort spain budecort
Tiredness has been reported in about 1 of 100 patients. Vertigo, sleep disturbances, hallucinations, headache, dizziness, visual disturbances, confusion, and reduced libido have also been reported, but a drug relationship is not clear. You should not stop using metoprolol suddenly. Stopping suddenly may make your condition worse. AHA stage C heart failure. Most adverse effects have been mild and transient. Remember that this medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, strokes, or kidney disease. Gheorghiade M, Schultz L, Tilley B et al. Effects of propranolol in non-Q-wave acute myocardial infarction in the beta blocker heart attack trial. Am J Cardiol. By blocking catecholamine-induced increases in heart rate, in velocity and extent of myocardial contraction, and in blood pressure, metoprolol reduces the oxygen requirements of the heart at any given level of effort, thus making it useful in the long-term management of angina pectoris. Lidocaine Systemic: Beta-Blockers may increase the serum concentration of Lidocaine Systemic. Beta-blockers may mask tachycardia occurring with hypoglycemia, but other manifestations such as dizziness and sweating may not be significantly affected. Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly. Selective Serotonin Reuptake Inhibitors: May increase the serum concentration of Beta-Blockers. Exceptions: Citalopram; Escitalopram; FluvoxaMINE. Blue No. 2 Aluminum Lake as coloring agents. Peak plasma concentrations are reached in about 90 minutes following a single oral dose as conventional tablets a or 7 hours following administration as extended-release tablets. Levine JH, Michael JR, Guarnieri T. Verapamil for multifocal atrial tachycardia. N Engl J Med. Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. mectizan
Methoxyflurane: May enhance the hypotensive effect of Beta-Blockers. Hg, or moderate to severe heart failure. Walley T, Piromohamed M, Proudlove C et al. Interaction of metoprolol and fluoxetine. Lancet. Lechat P, Packer M, Chalon S et al. Clinical effects of β-adrenergic blockade in chronic heart failure: a meta-analysis of double-blind, placebo-controlled, randomized trials. Circulation. The most common adverse reactions were tiredness, dizziness, depression, shortness of breath, bradycardia, hypotension, diarrhea, pruritus, and rash. While using metoprolol, you may need frequent blood tests at your doctor's office. Your blood pressure will need to be checked often. Do not keep outdated medicine or medicine no longer needed. Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Wallace, J. C. The relationship between the insulin content and inhibitory effects of bovine colostrum on protein breakdown in cultured cells. McMurray JJ, Packer M, Desai AS et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. Importance of taking metoprolol exactly as prescribed. How should I take Toprol-XL?
Clinical pharmacology studies have demonstrated the beta-blocking activity of Metoprolol, as shown by 1 reduction in heart rate and cardiac output at rest and upon exercise, 2 reduction of systolic blood pressure upon exercise, 3 inhibition of isoproterenol-induced tachycardia, and 4 reduction of reflex orthostatic tachycardia. The effects of Metoprolol on the fertility of humans have not been studied. Therapeutic Research Faculty 2009. Thomas G, Shishehbor M, Brill D et al. New hypertension guidelines: one size fits most? Bradycardia: Evaluate the need for atropine, adrenergic-stimulating drugs or pacemaker to treat bradycardia and conduction disorders. Please refer to the for information on shortages of one or more of these preparations. Mittal S et al. Silent ischemic interval on exercise test is a predictor of response to drug therapy: a randomized crossover trial of metoprolol versus diltiazem in stable angina. Clin Cardiol. Hepatic elimination; use with caution. Toprol-XL is indicated for the treatment of stable, symptomatic NYHA Class II or III heart failure of ischemic, hypertensive, or cardiomyopathic origin. It was studied in patients already receiving ACE inhibitors, diuretics, and, in the majority of cases, digitalis. In this population, Toprol-XL decreased the rate of mortality plus hospitalization, largely through a reduction in cardiovascular mortality and hospitalizations for heart failure. money order now sertraline uk
Do not stop taking any medications without consulting your healthcare provider. Double the dosage every 2 weeks to a dosage of 200 mg or until highest tolerated dosage is reached. There have been rare reports of reversible alopecia, agranulocytosis, and dry eyes. Discontinuation of the drug should be considered if any such reaction is not otherwise explicable. There have been very rare reports of weight gain, arthritis, and retroperitoneal fibrosis relationship to Metoprolol has not been definitely established. Patients at high risk for ischemic events should receive IV loading dose followed by conversion to an oral regimen; oral therapy is recommended for lower risk patients. Andler, W. Coenzyme Q10 in maternal plasma and milk throughout early lactation. Kurmis, A. P. Effect of bovine colostrum supplementation on the composition of resistance trained and untrained limbs in healthy young men. Eur. Colucci WS, Packer M, Bristow MR et al, for the US Carvedilol Heart Failure Study Group. Carvedilol inhibits clinical progression in patients with mild symptoms of heart failure. Circulation. Bayard, B. L. and James, M. A. Hyperimmune bovine colostrum inefficacious as multiple sclerosis therapy in double-blind study. Wheezing bronchospasm and dyspnea have been reported in about 1 of 100 patients see . Rhinitis has also been reported. Yamazaki, K. and Moriya, H. Isolation and purification of colostrokinin from bovine colostrum. Biochem. palim.info estrace
Meibohm B, Hamelin BA. Modulation of metoprolol pharmacokinetics and hemodynamics by diphenhydramine coadministration during exercise testing in healthy premenopausal women. Do not consider Communities as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately. The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. Bradycardia, including sinus pause, heart block, and cardiac arrest have occurred with the use of Metoprolol. Patients with first-degree atrioventricular block, sinus node dysfunction, or conduction disorders may be at increased risk. Monitor heart rate and rhythm in patients receiving Metoprolol. If severe bradycardia develops, reduce or stop Metoprolol. Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products. Initiate therapy and subsequent dosage adjustments in patients with heart failure under close medical supervision. MI, ischemic heart disease, heart failure for their use or as add-on therapy in those who do not respond adequately to the preferred drug classes ACE inhibitors, angiotensin II receptor antagonists, calcium-channel blockers, or thiazide diuretics. What are the possible side effects of metoprolol Lopressor, Metoprolol Succinate ER, Metoprolol Tartrate, Toprol-XL? micronase
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These two medicines are taken together to help lower your blood pressure. In some people, they may increase blood pressure. If you stop taking clonidine and continue taking your beta-blocker, or if you stop taking them both at the same time, your blood pressure may also increase. Supraventricular Arrhythmias Atrial Fibrillation. MAO inhibitors may have an additive effect when given with beta-blocking agents. Observe patients treated with Toprol-XL plus a catecholamine depletor for evidence of hypotension or marked bradycardia, which may produce vertigo, syncope, or postural hypotension. Toprol-XL is indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure lowers the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including metoprolol. flonase in new york
Use with caution in patients with bronchospastic disease; administer lowest effective dosage initially in 3 divided doses and with maximal therapy with a β 2-adrenergic agonist. Tacket CO, Losonsky G, Livio S, et al. Lack of prophylactic efficacy of an enteric-coated bovine hyperimmune milk product against enterotoxigenic Escherichia coli challenge administered during a standard meal. Herbs Hypotensive Properties: May enhance the hypotensive effect of Blood Pressure Lowering Agents. This information should not be used to decide whether or not to take adenosine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about adenosine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to adenosine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your health care provider for complete information about the risks and benefits of using adenosine.
If Toprol-XL is used in the setting of pheochromocytoma, it should be given in combination with an alpha blocker, and only after the alpha blocker has been initiated. Administration of beta-blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta-mediated vasodilatation in skeletal muscle. Beale, D. and Buttress, N. Structural studies on bovine immunoglobulin M. Biochim. Dahlof B, Lindholm LH, Hansson L et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension STOP-hypertension. Lancet.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Bretylium: May enhance the bradycardic effect of Bradycardia-Causing Agents. Bretylium may also enhance atrioventricular AV blockade in patients receiving AV blocking agents. Rivastigmine: May enhance the bradycardic effect of Beta-Blockers.