Apo-Metoprolol, Betaloc , Lopressor, Norometoprol , Toprol XL
autonomic nervous system agent; beta-adrenergic antagonist (sympatholytic); antihypertensive
Prototype: Propranolol
Pregnancy Category: C


Assessment & Drug Effects

  • Take apical pulse and BP before administering drug. Report to physician significant changes in rate, rhythm, or quality of pulse or variations in BP prior to administration.
  • Monitor BP, HR, and ECG carefully during IV administration.
  • Expect maximal effect on BP after 1 wk of therapy.
  • Take several BP readings close to the end of a 12 h dosing interval to evaluate adequacy of dosage for patients with hypertension, particularly in patients on twice daily doses. Some patients require doses 3 times a day to maintain satisfactory control.
  • Observe hypertensive patients with CHF closely for impending heart failure: Dyspnea on exertion, orthopnea, night cough, edema, distended neck veins.
  • Lab tests: Obtain baseline and periodic evaluations of blood cell counts, blood glucose, liver and kidney function.
  • Monitor I&O, daily weight; auscultate daily for pulmonary rales.
  • Withdraw drug if patient presents symptoms of mental depression because it can progress to catatonia. Possible symptoms of depression: disinterest in people, surroundings, food, personal hygiene; withdrawal, apathy, sadness, difficulty in concentrating, insomnia.
  • Monitor patients with thyrotoxicosis closely since drug masks signs of hyperthyroidism (see Appendix F). Abrupt withdrawal may precipitate thyroid storm.

Patient & Family Education

  • Learn how to take radial pulse before each dose. Report to physician if pulse is slower than base rate (e.g., 60 bpm) or becomes irregular. Consult physician for parameters.
  • Reduce insomnia or increased dreaming by avoiding late evening doses.
  • Monitor blood glucose (diabetics) for loss of glycemic control. Drug may mask some symptoms of hypoglycemia (e.g., BP and HR changes) and prolong hypoglycemia. Be alert to other possible signs of hypoglycemia not affected by metoprolol and report to physician if present: Sweating, fatigue, hunger, inability to concentrate.
  • Protect extremities from cold and do not smoke. Report cold, painful, or tender feet or hands or other symptoms of Raynaud’s disease (intermittent pallor, cyanosis or redness, paresthesias). Physician may prescribe a vasodilator.
  • Report immediately to physician the onset of problems with vision.
  • Learn measures to relieve dry mouth; rinse mouth frequently with water, increase noncalorie liquid intake if inadequate, suck sugarless gum or hard candy.
  • Relieve eye dryness by using sterile artificial tears available OTC.
  • Do not drive or engage in potentially hazardous activities until response to drug is known.
  • Do not alter established dosage regimen; compliance is very important.
  • Reduce dosage reduced gradually over a period of 1–2 wk when drug is discontinued. Sudden withdrawal can result in increase in anginal attacks and MI in patients with angina pectoris and thyroid storm in patients with hyperthyroidism.
  • Do not breast feed while taking this drug without consulting physician.


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