Metocard – composition, action, indications, contraindications, side effects

Proven content

Metocard is one of the drugs used in the treatment of high blood pressure. The active substance of this preparation is metoprolol. How does Metocard work? What are the indications and contraindications for its use? What side effects can it cause? How to properly dose and take it? What drugs should not be used with this preparation?

Hypertension is a very common disease of civilization, occurring in highly developed countries and societies. This condition is dangerous because it may not cause any disturbing symptoms for a long time. In mild hypertension, treatment involves lifestyle changes. On the other hand, if the measures taken so far are ineffective, pharmacological treatment is initiated. One of the drugs used in the treatment of hypertension is Metocard,

Metocard – drug characteristics

Metocard is a beta-blocker drug which reduces the heart rate and the force of its contraction, and lowers blood pressure. The international name for Metocard is Metoprololi tartras. This drug is available only in stationary pharmacies upon presentation of a prescription. It is available under two trade names in several forms with different doses of the active substance – metoprolol.

Under the name Metocard it is sold in the form of:

1. tablets 50 mg, 30 pieces;
2. tablets 100 mg, 30 pieces;
3. 1 mg / 1 ml solution for injection, 5 ampoules of 5 ml.

In the case of Metocard ZK it is sold in the form of:

1. prolonged-release tablets 23,75 mg, 28 pcs;
2. prolonged-release tablets 47,5 mg, 28 pcs;
3. prolonged-release tablets 95 mg, 28 pcs.

The price of the drug Metocard subject to 100% reimbursement for persons over 75 years of age, as recommended and indicated in the SPC. Price without refund it ranges from PLN 5 to PLN 9 depending on the packaging.

The pharmaceutical form of Metocard are white, round, biconvex tablets with a score line. The tablets are packed in A1 / PVC foil blisters in a cardboard box.

The drug should be stored at a temperature not higher than 25 degrees Celsius, in the original packaging, not exposing the drug to light and moisture.

The marketing authorization holder for Metocard is Zakłady Farmaceutyczne POLPHARMA SA, which is the leader of the Polish pharmaceutical market and one of the main pharmaceutical manufacturers in the region of Central and Eastern Europe, Central Asia and the Caucasus. The company has been operating since 1935 and thanks to dynamic development, foreign expansion and capital investments, it has become a strong, international pharmaceutical group appreciated by doctors and pharmacists.

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Metocard – composition and mode of action of the drug

The composition of the drug Metocard differs depending on the chosen variant of the drug. The active substance may be metoprolol tartrate or metoprolol succinate. In both variants, the composition also includes various auxiliary substances.

One Metocard tablet contains 50 or 100 mg of metoprolol tartrate and excipients such as: rice starch, microcrystalline cellulose, lactose monohydrate, povidone, talc and magnesium sterate.

One ampoule of Metocard contains 5 mg of metoprolol tartrate and excipients such as sodium chloride and water for injections.

While one tablet of Metocard ZK prolonged release contains 23,75 or 47,5 or 95 mg metoprolol succinate, which corresponds to 25, 50 and 100 mg of metoprolol tartrate and excipients: rice starch, microcrystalline cellulose, lactose monohydrate, povidone, talc and magnesium sterate.

Action of the drug Metocard is due to the presence of metoprolol in the medicine, which belongs to a group of medicines called beta-blockers (another name used is beta-blockers). This substance reduces or inhibits the stimulating effect of catecholamines (released especially under physical or mental stress) on the heart.

The action of the drug is to block beta adrenergic receptors. These receptors are found on the surface of nerve, muscle or gland cells in numerous tissues and organs. Under physiological conditions, these receptors are stimulated by adrenaline or noradrenaline released upon activation of the sympathetic nervous system.

Adrenaline increases the heart rate and causes the peripheral blood vessels to contract. The blocking of beta receptors is possible pharmacologically due to the action of metoprolol, which reduces the heart rate and the strength of its contraction, reduces the stroke volume and lowers blood pressure.

Metocard is rapidly and almost completely absorbed after oral administration. In the case of prolonged-release tablets, metoprolol is released in a controlled and continuous manner over 20 hours. In contrast, Metocard administered intravenously is distributed in the body within 5-10 minutes. Regardless of the form of the preparation, the active substance is metabolized in the liver and excreted in the urine.

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Metocard – dosage and method of admission

Always take Metocard exactly as your doctor has told you. The dosage of the drug depends on the patient’s individual tolerance, the condition being treated and the form in which the preparation will be administered. These factors determine the dose, frequency and duration of drug therapy.

In the case of Metocard 50 and 100 mg tablets are dosed as follows:

1. for the treatment of high blood pressure, the recommended dose is 100 to 400 mg daily in one dose or in two divided doses. Therapy is started at a daily dose of 100 mg, which may be increased in steps of 100 mg at weekly intervals, not exceeding 400 mg per day. If this dosing regimen is ineffective, it is recommended to additionally administer a diuretic or other drug that lowers blood pressure;
2. in the case of angina, Metocard is used in a dose of 50 to 100 mg administered 2 to 3 times a day;
3. in cardiac arrhythmias, the recommended dose is 50-100 mg administered 2 or 3 times a day, and when the dose is not sufficient, a maximum of 300 mg a day can be used, dividing it into smaller doses;
4. in hyperthyroidism, the dose should be 50 mg administered 4 times a day, and in the event of euthyroidism, the dose should be reduced;
5. following an acute myocardial infarction treatment with Metocard should be started within 15 minutes of the last intravenous injection of metoprolol. The recommended dose is 48 mg every 50 hours during the first 6 hours of treatment. If the drug administered intravenously was not tolerated by the body, the dose of Metocard tablets should be reduced by half, i.e. 25 mg. The recommended maintenance dose is 200 mg of the active ingredient divided into smaller doses.

Dosage method Metocard in the form of tablets release depends on the condition and the age of the patient. Adults in the treatment of mild or moderate arterial hypertension should be started with a single daily dose of 47,5 mg, and if this is not sufficient, it can be increased from 95 mg to 190 mg, or another drug used to lower blood pressure may be added additionally.

In the treatment of angina pectoris and heart rhythm disturbances, in the prophylaxis of migraine, a dose of 95 to 190 mg per day is administered, and after a myocardial infarction prophylactically the patient is given 190 mg of the drug once a day.

Prolonged-release Metocard ZK for children and adolescents aged 6-18 years is only given for the treatment of high blood pressure. The recommended dose is calculated based on the patient’s weight and is 0,5 mg / kg. metoprolol tartrate, corresponding to 0,48 mg / kg. metoprolol succinate once daily. The dose may be increased to 1 mg metoprolol tartrate per kg body weight (0,95 mg / kg bw of metropolol succinate), not exceeding 50 mg / kg bw. metoprolol tartrate during the day.

In contrast, Metocard injection should only be given by experienced healthcare professionals.

In some cases, such as the elderly age of the patient, severe liver failure, impaired renal function, consultation with a doctor will be required, who will individually determine the dose of Metcard for the patient.

If you take more than the prescribed dose, inform your doctor or go to the nearest hospital as soon as possible. The first symptoms of overdose appear between 20 minutes and 2 hours after taking the drug.

If you have forgotten to take one dose, skip that dose and take the next dose at the right time. Never take a double dose to make up for a forgotten dose.

In addition, you should not stop treatment suddenly or change the dosage yourself without consulting your doctor. Sudden withdrawal of beta-blockers may exacerbate heart failure and increase the risk of myocardial infarction and sudden death.

It is important that if you have any doubts regarding the use of Metocard, ask your doctor or pharmacist and never exceed the recommended doses, as this will not increase the effectiveness of the drug and may be harmful to your health and life.

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Metocard – indications for the use of the drug

Metocard is a prescribed medicine. This preparation is indicated in the treatment of diseases such as:

1. arterial hypertension (also in children and adolescents from 6 to 18 years of age);
2. angina;
3. arrhythmias, especially supraventricular tachycardia;
4. palpitations caused by functional disorders;
5. stable symptomatic heart failure in NYHA class II-IV.

Metocard is also indicated prophylactically in people with migraine and as an alternative in people with hyperthyroidism. The preparation is used in the early initiation of treatment after the acute phase of myocardial infarction in order to reduce the area of ​​necrosis and the risk of ventricular fibrillation.

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Metocard – contraindications to the use of the drug

Metocard, although there are indications for its use, may not always be used in every patient.

The main contraindication to the use of this drug is showing hypersensitivity, i.e. allergy to the active substance, other β-blockers or other substances present in the composition.

Contraindications to the use of Metocard also include certain diseases and circumstances that may require you to completely abandon the drug or change the dosage of the preparation.

The use of Metocard may require certain check-ups and a careful medical history.

Neither form of Metocard should be used if the patient has:

1. metabolic acidosis;
2. clinically significant sinus bradycardia;
3. cardiogenic shock;
4. sick sinus syndrome;
5. severe circulatory disorders of the peripheral arteries;
6. 2nd and 3rd degree AV block;
7. suspected myocardial infarction, if the heart rate is less than 45 beats per minute, the systolic blood pressure is less than 100 mmHg or the PQ interval is greater than 0,24 s;
8. untreated heart failure with pulmonary edema, hypotension or organ ischemia;
9. untreated phaeochromocytoma;
10. Treatment with products that increase cardiac contractility (inotropic β-adrenergic agonists), both short-term and long-term.

In addition, the use of the drug in the form of tablets is not advisable in the case of:

1. hypotension;
2. severe bronchial asthma;
3. chronic obstructive pulmonary disease;
4. severe disturbance of peripheral arterial circulation;
5. simultaneous use of MAO inhibitors other than MAO-B inhibitors;
6. except in the ICU – simultaneous intravenous administration of calcium channel blockers of the verapamil or diltiazem group and other antiarrhythmic drugs (such as disopyramide).

This preparation is also contraindicated during pregnancy, unless, in the doctor’s opinion, it is absolutely necessary. In addition, Metocard is also contraindicated during breastfeeding.

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Metocard – possible side effects

Metocard, like all medicines, can cause side effects that do not have to be experienced by every person using this medicine. After authorization of the medicinal product, it is important to report any suspected adverse reactions so that the benefit / risk balance of the medicinal product can be monitored.

The general classification of the frequency of adverse body reactions (ADRs) is based on the following principles: very common (≥1 / 10), common (≥1 / 100 to <1/10), uncommon (≥1 / 1 to <000/1), rare ( ≥100 / 1 to <10 / 000), very rare (<1 / 1), not known (cannot be estimated from the available data).

The side effects are usually mild and transient, and the expected benefits of the drug are usually greater than the harm resulting from the side effects.

Listed below side effects after using Metocard have occurred in clinical trials or during medical use.

If you experience an allergic reaction such as itchy skin, redness, swelling of the face, lips, tongue and larynx, difficulty breathing and swallowing, stop using Metocard immediately and contact your doctor.

The possible side effects that may occur as a result of the use of Metocard include:

1. very often (occurs in at least 1 in 10 people): fatigue;
2. frequent (may affect up to 1 in 10 people): slow heart rate, difficulty in balance, palpitations, dizziness, headache, nausea, diarrhea, constipation, abdominal pain, shortness of breath due to strenuous exercise, shortness of breath, feeling cold in the hands and Stop;
3. not very common (may affect up to 1 in 100 people): temporary worsening of symptoms of heart failure, disturbances in stimulating conduction in the heart, fluid retention (edema), chest pain, tingling and pricking sensations on the skin, cold hands and feet, muscle spasms , vomiting, weight gain, depression, decreased concentration, insomnia, nightmares, shortness of breath, rash, increased sweating;
4. rare (may affect up to 1 in 1000 people): worsening of diabetes, nervousness, tense, blurred vision, dry or irritated eyes, conjunctivitis, impotence, Peyronie’s disease (plastic hardening of the penis), irregular heartbeat, heart conduction disturbance, dry mouth , runny nose, hair loss, changes in liver function tests;
5. very rare (may affect up to 1 in 10 people): decreased number of white blood cells or platelets, memory impairment, confusion, hallucinations, mood disturbances, tinnitus, hearing disturbances, taste disturbances, hepatitis, photosensitivity reactions, worsening of psoriasis or new onset of psoriasis, muscle weakness, joint pain, tissue necrosis in patients with severe circulatory disorders.

The list of side effects that may be caused by Metocard is provided in the package leaflet. Before starting the therapy, the patient is obliged to become familiar with it. If any of the above side effects or other effects not mentioned above occur, please inform your doctor or pharmacist immediately.

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Metocard – influence on fertility, pregnancy and lactation

If you are pregnant or breastfeeding, consult your doctor before taking any medication to explain all the potential risks and benefits of any medication.

It is recommended that if a woman is pregnant, suspects she may be pregnant or is planning to have a baby, she should inform the prescribing physician of this fact.

Due to the lack of adequately controlled studies on the use of metoprolol in pregnant women, Metocard should only be used during pregnancy if the benefit to the mother outweighs the risk to the embryo or fetus. Intrauterine developmental delay was observed in pregnant women with mild to moderate hypertension who used metoprolol for a long time.

Beta-blockers can reduce placental perfusion and cause fetal death and premature delivery, but they can also prolong labor and induce bradycardia in the fetus and newborn.

There have also been reports of hypoglycaemia, hypotension, increased bilirubinemia, and an impaired response to tissue hypoxia in the newborn.

If a pregnant woman is taking Metocard, treatment should be stopped 48 to 72 hours before due date, and if the drug cannot be discontinued, the newborn should be monitored for 48 to 72 hours after birth for signs and symptoms of beta-blockade. adrenergics (e.g. cardiac and pulmonary complications).

The use of Metocard should also be avoided during breast-feeding, as the concentration of the active substance metoprolol in milk is approximately three times higher than in plasma.

Studies have shown that, apart from women with slow metabolism, the effects on babies who are breastfed by mothers using this preparation are small, but they should be especially monitored and taken only when necessary, and the benefits for the patient outweigh the risks for the baby.

If you are pregnant, think you may be pregnant or are planning to have a baby, consult your doctor before taking this medicine, and always consult your doctor and explain beyond any doubt the potential risks and benefits of using Metocard.

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Metocard – interactions with other medicinal products

The initiation of treatment with Metocard requires a detailed history of all currently and recently taken medications, including over-the-counter medications.

The use of certain medications at the same time as taking Metocard can cause serious side effects.

Before taking the drug, tell your doctor or pharmacist about all the drugs you are taking, or have recently taken, and about the drugs you plan to start taking.

Particular care should be taken if Metocard is used in parallel with:

1. calcium antagonists (oral preparations) from the verapamil or diltiazem group– because it carries the risk of a decrease in the heart rate and the strength of its contraction, as well as atrioventricular conduction disturbances and the risk of significant arterial hypotension;
2. class I antiarrhythmic drugs (such as quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone) and amiodarone – atrioventricular conduction may be disturbed and the contraction force of the heart may be reduced;
3. centrally acting antihypertensive drugs (e.g. reserpine, clonidine, methyldopa, moxonidine, rilmenidine, guanfacine) – the heart rate may decrease and heart conduction disturbances may occur;
4. medicines for high blood pressure and other medicines that can lower your blood pressure (e.g. nitroglycerin, antidepressants, barbiturates, phenothiazines, baclofen, amifostine) – the risk of increased antihypertensive effect and hypotension is increased;
5. drugs that block the sympathetic ganglia (np. trimetafan);
6. preparations used for general anesthesiaas bradycardia and severe hypotension may be worsened;
7. sympathomimetic drugs – there is a risk of your blood pressure rising significantly;
8. clonidine (sudden discontinuation of clonidine during the period of beta-blocker use may cause a significant increase in blood pressure and be life-threatening);
9. insulin and oral antidiabetic drugsas your blood glucose control may be impaired; beta-blockers, including metoprolol, may mask the symptoms of hypoglycaemia;
10. indomethacin and other NSAIDs – the antihypertensive effect of beta-blockers, including metoprolol, may be reduced,
11. barbituranami;
12. other beta blockers (including topical application, such as, for example, timolol contained in eye drops used in the treatment of glaucoma) – the risk of increasing the systemic effects of the preparation;
13. preparations that affect the activity of the cytochrome P450 enzyme system (specifically on the 2D6 isoenzyme), which may alter blood levels of metoprolol (certain antidepressants such as paroxetine, fluoxetine, sertraline or bupropion, antipsychotics (thioridazine, chlorpromazine, triflupromazine, chloroprotixene), , amiodarone), antivirals (such as ritonavir), antihistamines (such as diphenhydramine) as well as hydroxychloroquine, terbinafine (an antifungal medicine), cimetidine, rifampicin, celecoxib, hydralazine)
14. lidocaine – metoprolol may reduce the excretion of lidocaine.

Always tell your doctor or pharmacist what prescription, over-the-counter or herbal products you are taking before using Metocard and your doctor will individually assess your risk and treatment options based on this.

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