Lopressor injection: Difference between revisions

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==Overview==
==Overview==


[[Lopressor injection]] is a anti-[[angina|anginal]], [[antiarrhythmic]], [[beta-adrenergic blocker]] drug that is FDA approved for the treatment of [[acute myocardial infarction|acute myocardial infarction (AMI)]]. There is a ''Black Box Warning'' for this drug as shown <span style="background:#000000; font-weight: bold;">[[{{PAGENAME}}#Black Box Warning|{{fontcolor|#FF0000|here}}]]</span>. Common adverse reactions include [[bradyarrhythmia]], [[constipation]], [[depression]], [[diarrhea]], [[dizziness]], [[dyspnea]], [[fatigue]], [[headache]], [[heart block]], [[heart failure]], [[hypotension]], [[indigestion]], [[nausea]], [[pruritus]], [[rash]], and [[wheezing]].
[[Lopressor injection]] is a anti-[[angina|anginal]], [[antiarrhythmic]], [[beta-adrenergic blocker]] drug that is FDA approved for the treatment of [[acute myocardial infarction|acute myocardial infarction (AMI)]]. Common adverse reactions include [[bradyarrhythmia]], [[constipation]], [[depression]], [[diarrhea]], [[dizziness]], [[dyspnea]], [[fatigue]], [[headache]], [[heart block]], [[heart failure]], [[hypotension]], [[indigestion]], [[nausea]], [[pruritus]], [[rash]], and [[wheezing]].


==Adult Indications and Dosage==
==Adult Indications and Dosage==
Line 40: Line 40:
====Guideline-Supported Use====
====Guideline-Supported Use====


=====Condition 1=====
=====[[Atrial Fibrillation]], Rate Control=====


* Developed by: (Organisation)
* Developed by: [[American College of Cardiology|American College of Cardiology (ACC)]] and [[American Heart Association|American Heart Association (AHA)]]


* Class of Recommendation: (Class) (Link)
* Class of Recommendation: [[ACC AHA guidelines classification scheme#Class I: Benefit >>> Risk|Class I]]


* Strength of Evidence: (Category A/B/C) (Link)
* Level of Evidence: [[ACC AHA guidelines classification scheme#Level of Evidence B:|Level B]]


* Dosing Information
* Dosing Information


:: (Dosage)
:: Acute Setting: [[Lopressor injection]] 2.5—5 mg IV bolus over 2 min; up to 3 doses<ref name="Fuster-2006">{{Cite journal  | last1 = Fuster | first1 = V. | last2 = Rydén | first2 = LE. | last3 = Cannom | first3 = DS. | last4 = Crijns | first4 = HJ. | last5 = Curtis | first5 = AB. | last6 = Ellenbogen | first6 = KA. | last7 = Halperin | first7 = JL. | last8 = Le Heuzey | first8 = JY. | last9 = Kay | first9 = GN. | title = ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). | journal = Eur Heart J | volume = 27 | issue = 16 | pages = 1979-2030 | month = Aug | year = 2006 | doi = 10.1093/eurheartj/ehl176 | PMID = 16885201 }}</ref>


=====Condition 2=====
In the absence of [[preexcitation]], [[intravenous]] administration of [[beta blockers]] ([[esmolol]], [[metoprolol]], or [[propranolol]]) or nondihydropyridine [[calcium channel antagonist]]s ([[verapamil]], [[diltiazem]]) is recommended to slow the ventricular response to [[atrial fibrillation]] in the acute setting, exercising caution in patients with [[hypotension]] or [[heart failure]].<ref name="Wann-2013">{{Cite journal  | last1 = Wann | first1 = LS. | last2 = Curtis | first2 = AB. | last3 = Ellenbogen | first3 = KA. | last4 = Estes | first4 = NA. | last5 = Ezekowitz | first5 = MD. | last6 = Jackman | first6 = WM. | last7 = January | first7 = CT. | last8 = Lowe | first8 = JE. | last9 = Page | first9 = RL. | title = Management of patients with atrial fibrillation (compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations): a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. | journal = Circulation | volume = 127 | issue = 18 | pages = 1916-26 | month = May | year = 2013 | doi = 10.1161/CIR.0b013e318290826d | PMID = 23545139 }}</ref>
 
* Developed by: (Organisation)
 
* Class of Recommendation: (Class) (Link)
 
* Strength of Evidence: (Category A/B/C) (Link)
 
* Dosing Information
 
:: (Dosage)


====Non–Guideline-Supported Use====
====Non–Guideline-Supported Use====


=====[[Atrial flutter]]=====
=====[[Atrial flutter]]=====
* Dosing Information
:: [[Lopressor injection]] dose range: 2—15 mg<ref name="Amsterdam-1991">{{Cite journal  | last1 = Amsterdam | first1 = EA. | last2 = Kulcyski | first2 = J. | last3 = Ridgeway | first3 = MG. | title = Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias. | journal = J Clin Pharmacol | volume = 31 | issue = 8 | pages = 714-8 | month = Aug | year = 1991 | doi =  | PMID = 1880230 }}</ref>
=====[[Atrial fibrillation]]=====


* Dosing Information
* Dosing Information
Line 162: Line 146:
==Contraindications==
==Contraindications==


* Condition 1
*[[Ventricular fibrillation]]
* Condition 2
*Hypersensitivity to digoxin
* Condition 3
* Condition 4
* Condition 5


==Warnings==
==Warnings==
Line 497: Line 478:


{{Drugbox2
{{Drugbox2
| verifiedrevid =  
| verifiedrevid = 459444186
| IUPAC_name =  
| IUPAC_name = (''RS'')-1-(Isopropylamino)-3-[4-(2-methoxyethyl)phenoxy]propan-2-ol
| image =  
| image = 2000px-Metoprolol structure.svg.png
| drug_name =  
| drug_name = Metoprolol


<!--Clinical data-->
<!--Clinical data-->
| tradename =  
| tradename = Lopressor, Toprol XL, Toprolxl XL
| MedlinePlus =  
| MedlinePlus = a682864
| licence_US =  
| licence_US = Metoprolol
| pregnancy_AU =  
| pregnancy_AU = C
| pregnancy_US =  
| pregnancy_US = C
| legal_status =  
| legal_status = Rx-only
| routes_of_administration =
| routes_of_administration = Oral, [[Intravenous|IV]]


<!--Pharmacokinetic data-->
<!--Pharmacokinetic data-->
| bioavailability =  
| bioavailability = 12%
| metabolism =  
| metabolism = [[Liver|Hepatic]] via [[CYP2D6]], [[CYP3A4]]
| elimination_half-life =  
| elimination_half-life = 3-7 hours
| excretion =  
| excretion = [[Kidney|Renal]]


<!--Identifiers-->
<!--Identifiers-->
| CAS_number_Ref =  
| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number =  
| CAS_number = 51384-51-1
| ATC_prefix =  
| ATC_prefix = C07
| ATC_suffix =  
| ATC_suffix = AB02
| PubChem =  
| PubChem = 4171
| IUPHAR_ligand =  
| IUPHAR_ligand = 553
| DrugBank_Ref =  
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank =  
| DrugBank = DB00264
| ChemSpiderID_Ref =  
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID =  
| ChemSpiderID = 4027
| UNII_Ref =  
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII =  
| UNII = GEB06NHM23
| KEGG_Ref =  
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG =  
| KEGG = D02358
| ChEBI_Ref =  
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI =  
| ChEBI = 6904
| ChEMBL_Ref =  
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL =  
| ChEMBL = 13


<!--Chemical data-->
<!--Chemical data-->
| C= | H= | N= | O=  
| C=15 | H=25 | N=1 | O=3
| molecular_weight =  
| molecular_weight = 267.364&nbsp;[[gram|g]]/[[Mole (unit)|mol]]
| smiles =  
| smiles = O(c1ccc(cc1)CCOC)CC(O)CNC(C)C
| InChI =  
| InChI = 1/C15H25NO3/c1-12(2)16-10-14(17)11-19-15-6-4-13(5-7-15)8-9-18-3/h4-7,12,14,16-17H,8-11H2,1-3H3
| InChIKey =  
| InChIKey = IUBSYMUCCVWXPE-UHFFFAOYAN
| StdInChI_Ref =  
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI =  
| StdInChI = 1S/C15H25NO3/c1-12(2)16-10-14(17)11-19-15-6-4-13(5-7-15)8-9-18-3/h4-7,12,14,16-17H,8-11H2,1-3H3
| StdInChIKey_Ref =  
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey =  
| StdInChIKey = IUBSYMUCCVWXPE-UHFFFAOYSA-N
| melting_point =  
| melting_point = 120
}}
}}



Latest revision as of 15:16, 26 March 2014

Lopressor injection®
Black Box Warning
Adult Indications and Dosage
Pediatric Indications and Dosage
Contraindications
Warnings
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration and Monitoring
IV Compatibility
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient information
Precautions with Alcohol
Look-Alike Drug Names
Drug Shortage Status
Price

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

For information about metoprolol, click here.

Disclaimer

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Black Box Warning

FDA Package Insert for Lopressor injection contains no information regarding Black Box Warning.

Overview

Lopressor injection is a anti-anginal, antiarrhythmic, beta-adrenergic blocker drug that is FDA approved for the treatment of acute myocardial infarction (AMI). Common adverse reactions include bradyarrhythmia, constipation, depression, diarrhea, dizziness, dyspnea, fatigue, headache, heart block, heart failure, hypotension, indigestion, nausea, pruritus, rash, and wheezing.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Acute Myocaridal Infarction
  • Dosing Information

Lopressor injection is indicated in the treatment of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality when used in conjunction with oral Lopressor maintenance therapy. Treatment with Lopressor injection can be initiated as soon as the patient’s clinical condition allows.

Early Treatment: During the early phase of definite or suspected acute myocardial infarction, initiate treatment with Lopressor injection as soon as possible after the patient’s arrival in the hospital. Such treatment should be initiated in a coronary care or similar unit immediately after the patient’s hemodynamic condition has stabilized. Begin treatment in this early phase with the intravenous administration of three bolus injections of 5 mg of Lopressor injection each; give the injections at approximately 2-minute intervals. During the intravenous administration of Lopressor, monitor blood pressure, heart rate, and electrocardiogram.

In patients who tolerate the full intravenous dose (15 mg), initiate Lopressor tablets, 50 mg every 6 hours, 15 minutes after the last intravenous dose and continue for 48 hours. Thereafter, the maintenance dosage is 100 mg orally twice daily. Start patients who appear not to tolerate the full intravenous dose on Lopressor tablets either 25 mg or 50 mg every 6 hours (depending on the degree of intolerance) 15 minutes after the last intravenous dose or as soon as their clinical condition allows. In patients with severe intolerance, discontinue Lopressor (see Warnings).[1]

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Atrial Fibrillation, Rate Control
  • Dosing Information
Acute Setting: Lopressor injection 2.5—5 mg IV bolus over 2 min; up to 3 doses[2]

In the absence of preexcitation, intravenous administration of beta blockers (esmolol, metoprolol, or propranolol) or nondihydropyridine calcium channel antagonists (verapamil, diltiazem) is recommended to slow the ventricular response to atrial fibrillation in the acute setting, exercising caution in patients with hypotension or heart failure.[3]

Non–Guideline-Supported Use

Atrial flutter
  • Dosing Information
Lopressor injection dose range: 2—15 mg[4]
Multifocal atrial tachycardia
  • Dosing Information
Lopressor injection dose range: 2—15 mg[4]
Supraventricular tachycardia
  • Dosing Information
Lopressor injection dose range: 2—15 mg[4]
Injection Site Pain Associated with Propofol Use
  • Dosing Information
Pretreatment with Lopressor injection 2 mg.[5]

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Condition 1
  • Dosing Information
(Dosage)
Condition 2
  • Dosing Information
(Dosage)

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Condition 1
  • Developed by: (Organisation)
  • Class of Recommendation: (Class) (Link)
  • Strength of Evidence: (Category A/B/C) (Link)
  • Dosing Information
(Dosage)
Condition 2
  • Developed by: (Organisation)
  • Class of Recommendation: (Class) (Link)
  • Strength of Evidence: (Category A/B/C) (Link)
  • Dosing Information
(Dosage)

Non–Guideline-Supported Use

Condition 1
  • Dosing Information
(Dosage)
Condition 2
  • Dosing Information
(Dosage)
Condition 3
  • Dosing Information
(Dosage)

Contraindications

Warnings

Conidition 1

(Description)

Conidition 2

(Description)

Conidition 3

(Description)

Adverse Reactions

Clinical Trials Experience

Condition 1
Central Nervous System
(list/description of adverse reactions)
Cardiovascular
(list/description of adverse reactions)
Respiratory
(list/description of adverse reactions)
Gastrointestinal
(list/description of adverse reactions)
Hypersensitive Reactions
(list/description of adverse reactions)
Miscellaneous
(list/description of adverse reactions)
Condition 1
Central Nervous System
(list/description of adverse reactions)
Cardiovascular
(list/description of adverse reactions)
Respiratory
(list/description of adverse reactions)
Gastrointestinal
(list/description of adverse reactions)
Hypersensitive Reactions
(list/description of adverse reactions)
Miscellaneous
(list/description of adverse reactions)

Postmarketing Experience

(Description)

Drug Interactions

  • Drug 1
  • Drug 2
  • Drug 3
  • Drug 4
  • Drug 5
Drug 1

(Description)

Drug 2

(Description)

Drug 3

(Description)

Drug 4

(Description)

Drug 5

(Description)

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): X
Pregnancy Category (AUS): X

(Description)

Labor and Delivery

(Description)

Nursing Mothers

(Description)

Pediatric Use

(Description)

Geriatric Use

(Description)

Gender

(Description)

Race

(Description)

Renal Impairment

(Description)

Hepatic Impairment

(Description)

Females of Reproductive Potential and Males

(Description)

Immunocompromised Patients

(Description)

Administration and Monitoring

Administration

(Oral/Intravenous/etc)

Monitoring

Condition 1

(Description regarding monitoring, from Warnings section)

Condition 2

(Description regarding monitoring, from Warnings section)

Condition 3

(Description regarding monitoring, from Warnings section)

IV Compatibility

Solution

Compatible

  • Solution 1
  • Solution 2
  • Solution 3

Not Tested

  • Solution 1
  • Solution 2
  • Solution 3

Variable

  • Solution 1
  • Solution 2
  • Solution 3

Incompatible

  • Solution 1
  • Solution 2
  • Solution 3

Y-Site

Compatible

  • Solution 1
  • Solution 2
  • Solution 3

Not Tested

  • Solution 1
  • Solution 2
  • Solution 3

Variable

  • Solution 1
  • Solution 2
  • Solution 3

Incompatible

  • Solution 1
  • Solution 2
  • Solution 3

Admixture

Compatible

  • Solution 1
  • Solution 2
  • Solution 3

Not Tested

  • Solution 1
  • Solution 2
  • Solution 3

Variable

  • Solution 1
  • Solution 2
  • Solution 3

Incompatible

  • Solution 1
  • Solution 2
  • Solution 3

Syringe

Compatible

  • Solution 1
  • Solution 2
  • Solution 3

Not Tested

  • Solution 1
  • Solution 2
  • Solution 3

Variable

  • Solution 1
  • Solution 2
  • Solution 3

Incompatible

  • Solution 1
  • Solution 2
  • Solution 3

TPN/TNA

Compatible

  • Solution 1
  • Solution 2
  • Solution 3

Not Tested

  • Solution 1
  • Solution 2
  • Solution 3

Variable

  • Solution 1
  • Solution 2
  • Solution 3

Incompatible

  • Solution 1
  • Solution 2
  • Solution 3

Overdosage

Acute Overdose

Signs and Symptoms

(Description)

Management

(Description)

Chronic Overdose

Signs and Symptoms

(Description)

Management

(Description)

Pharmacology

Template:Px
Metoprolol
Systematic (IUPAC) name
(RS)-1-(Isopropylamino)-3-[4-(2-methoxyethyl)phenoxy]propan-2-ol
Identifiers
CAS number 51384-51-1
ATC code C07AB02
PubChem 4171
DrugBank DB00264
Chemical data
Formula Template:OrganicBox atomTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBox 
Mol. mass 267.364 g/mol
SMILES eMolecules & PubChem
Physical data
Melt. point 120 °C (248 °F)
Pharmacokinetic data
Bioavailability 12%
Metabolism Hepatic via CYP2D6, CYP3A4
Half life 3-7 hours
Excretion Renal
Therapeutic considerations
Licence data

US

Pregnancy cat.

C(AU) C(US)

Legal status

Template:Unicode Prescription only

Routes Oral, IV

Mechanism of Action

(Description)

Structure

(Description with picture)

Pharmacodynamics

(Description)

Pharmacokinetics

(Description)

Nonclinical Toxicology

(Description)

Clinical Studies

Condition 1

(Description)

Condition 2

(Description)

Condition 3

(Description)

How Supplied

(Description)

  • National Drug Code (NDC):
  • Storage:
  • Manufactured by:
  • Distributed by:

Images

Drug Images

(PillBox Images)

Package and Label Display Panel

(Package Images)

(Display Panel Images)

Patient Information

Patient Information from FDA

(Patient Counseling Information)

Patient Information from NLM

(Link to patient information page)

Precautions with Alcohol

Alcohol-Lopressor injection interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Look-Alike Drug Names

  • (Paired Confused Name 1a) — (Paired Confused Name 1b)
  • (Paired Confused Name 2a) — (Paired Confused Name 2b)
  • (Paired Confused Name 3a) — (Paired Confused Name 3b)

Drug Shortage Status

Price

References

  1. "LOPRESSOR (METOPROLOL TARTRATE) INJECTION, SOLUTION [NOVARTIS PHARMACEUTICALS CORPORATION]".
  2. Fuster, V.; Rydén, LE.; Cannom, DS.; Crijns, HJ.; Curtis, AB.; Ellenbogen, KA.; Halperin, JL.; Le Heuzey, JY.; Kay, GN. (2006). "ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation)". Eur Heart J. 27 (16): 1979–2030. doi:10.1093/eurheartj/ehl176. PMID 16885201. Unknown parameter |month= ignored (help)
  3. Wann, LS.; Curtis, AB.; Ellenbogen, KA.; Estes, NA.; Ezekowitz, MD.; Jackman, WM.; January, CT.; Lowe, JE.; Page, RL. (2013). "Management of patients with atrial fibrillation (compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations): a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines". Circulation. 127 (18): 1916–26. doi:10.1161/CIR.0b013e318290826d. PMID 23545139. Unknown parameter |month= ignored (help)
  4. 4.0 4.1 4.2 Amsterdam, EA.; Kulcyski, J.; Ridgeway, MG. (1991). "Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias". J Clin Pharmacol. 31 (8): 714–8. PMID 1880230. Unknown parameter |month= ignored (help)
  5. Aşik, I.; Yörükoğlu, D.; Gülay, I.; Tulunay, M. (2003). "Pain on injection of propofol: comparison of metoprolol with lidocaine". Eur J Anaesthesiol. 20 (6): 487–9. PMID 12803269. Unknown parameter |month= ignored (help)