Can a patient be prescribed Beloc (Metoprolol)?

Can Beloc (Metoprolol) Be Prescribed?

Yes, Beloc (metoprolol) can be prescribed for multiple cardiovascular indications, but only after confirming the patient is hemodynamically stable and has no absolute contraindications. The decision depends on the specific clinical indication, patient stability, and absence of contraindications.

Absolute Contraindications That Prohibit Metoprolol Use

Before prescribing metoprolol, you must rule out these conditions 1, 2:

• Decompensated heart failure with signs of low cardiac output or fluid overload 1, 2
• Cardiogenic shock or increased risk factors (age >70 years, systolic BP <120 mmHg, heart rate >110 bpm or <60 bpm) 1
• Second or third-degree heart block or sick sinus syndrome without a permanent pacemaker 2, 1
• Severe bradycardia (<50 bpm) 2
• Active asthma or reactive airway disease (note: COPD is not an absolute contraindication) 2, 1
• Symptomatic hypotension 1

Primary Indications for Metoprolol

Heart Failure with Reduced Ejection Fraction (HFrEF)

Metoprolol succinate (sustained-release) is a Class I recommendation for all stable patients with HFrEF and LVEF ≤40%. 2

• Must use sustained-release metoprolol succinate specifically—this formulation is proven to reduce mortality 2
• Start at 12.5-25 mg once daily in stable patients 2, 3
• Titrate every 2 weeks to target dose of 200 mg once daily 2, 3
• Patients must be clinically stable with no recent decompensation, not requiring IV inotropes, and with minimal fluid overload 2
• Can be initiated cautiously before hospital discharge in recently decompensated patients if they have improved and can be observed for at least 24 hours 2

Hypertension

Metoprolol is effective as monotherapy or combination therapy 4, 5:

• Metoprolol tartrate: Start 25-50 mg twice daily, maximum 200 mg twice daily 1
• Metoprolol succinate: Start 50 mg once daily, maximum 400 mg once daily 1
• Titrate every 1-2 weeks based on blood pressure response 1

Acute Coronary Syndrome and Post-Myocardial Infarction

Oral metoprolol should be initiated within the first 24 hours in stable patients without contraindications. 2

• Avoid early IV metoprolol in hemodynamically unstable patients—this increases cardiogenic shock risk by 11 per 1000 patients treated 1
• For stable patients: Start metoprolol tartrate 25-50 mg orally every 6 hours, then transition to 100 mg twice daily 2, 4
• Target resting heart rate 50-60 bpm 2
• Post-MI maintenance therapy reduces 3-month mortality by 36% 4

Angina Pectoris

Metoprolol reduces angina attacks and increases exercise tolerance 4, 5:

• Dosage range: 100-400 mg daily in divided doses 4
• Titrate to symptom control and target heart rate 2

Atrial Fibrillation Rate Control

For hemodynamically stable patients with rapid ventricular response 1:

• IV metoprolol: 5 mg slow IV bolus over 1-2 minutes, repeat every 5 minutes up to maximum 15 mg total 1
• Oral metoprolol tartrate: 25-100 mg twice daily 1
• Oral metoprolol succinate: 50-400 mg once daily 1

Critical Safety Considerations

Monitoring Requirements

During initiation and titration 2, 1:

• Blood pressure and heart rate at each visit
• Continuous ECG monitoring during IV administration 2
• Auscultation for rales (pulmonary congestion) and bronchospasm 2
• Watch for symptomatic bradycardia (HR <60 bpm with dizziness) 1
• Assess for hypotension (systolic BP <100 mmHg with symptoms) 1

Common Pitfalls to Avoid

• Never give IV metoprolol to decompensated heart failure patients—this significantly increases cardiogenic shock risk 1
• Never abruptly discontinue metoprolol—this causes 2.7-fold increased 1-year mortality risk and can precipitate severe angina, MI, or ventricular arrhythmias 1
• Do not use immediate-release metoprolol tartrate for heart failure—only sustained-release metoprolol succinate has mortality benefit 2
• Avoid IV metoprolol in early acute MI if patient has risk factors for shock 1

Special Populations

Women may require 50% lower doses than men due to 50-80% higher drug exposure, achieving similar efficacy with reduced adverse effects 1

Elderly patients should start at low doses with cautious titration due to decreased hepatic and renal function 4

Hepatic impairment requires low initial doses with gradual titration as blood levels increase substantially 4

When to Reduce or Hold Metoprolol

Reduce dose by 50% if 1:

• Heart rate 45-49 bpm (hold for 12 hours) 1
• Symptomatic bradycardia with HR <60 bpm 1
• Systolic BP approaches 100 mmHg with symptoms 1

Hold completely if 1:

• Heart rate consistently <45 bpm 1
• Systolic BP <100 mmHg with signs of hypoperfusion 1
• Development of decompensated heart failure 2
• High-grade AV block develops 1