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cardiogenic shock in patients with acute myocardial infarction
gangrene in patients with pre-existing severe peripheral circulatory disorders
hepatitis
reversible mental depression progressing to catatonia, an acute reversible syndrome characterised by disorientation for time and place, short-term memory loss, emotional lability, slightly clouded sensorium, and decreased performance in neuropsychometrics
Curated subset. The full adverse-effect list is in the TGA Product Information; click any citation above to open it.
known hypersensitivity to metoprolol and related derivatives
hypersensitivity to any of the excipients in Metoprolol
sensitivity to other beta-blockers (cross-sensitivity between beta-blockers can occur)
atrioventricular block of second or third degree
congestive heart failure
sinus bradycardia (less than 45 to 50 beats/minute)
§04
Mechanism & pharmacology
“Metoprolol, the active substance of METOPROLOL-WGR, is a relatively cardioselective beta-blocker, i.e. it acts on beta1-receptors mainly located in the heart at lower doses than those needed to influence the beta2-receptors mainly located in the bronchi and peripheral vessels.”
shock (including cardiogenic and hypovolaemic shock)
myocardial infarction patients with a heart rate of < 45 beats/min., a P-R interval of > 0.24 sec., a systolic blood pressure of <100 mm Hg, and/or moderate to severe heart failure
right ventricular failure secondary to pulmonary hypertension
significant right ventricular hypertrophy
hypotension
untreated phaeochromocytoma (see section 4.4 Special warnings and precautions for use )
Continuous or intermittent inotropic therapy acting through β-receptor agonism
allergic disorders (including allergic rhinitis) which may suggest a predisposition to bronchospasm
severe bronchial asthma or history of severe bronchospasm. Beta-adrenergic blockade of the smooth muscle of bronchi and bronchioles may result in an increased airways resistance. These drugs also reduce the effectiveness of asthma treatment. This may be dangerous in susceptible patients. Therefore, beta-blockers are contraindicated in any patient with a history of airways obstruction or a tendency to bronchospasm. Use of cardioselective beta-blockers can also result in severe bronchospasm. Metoprolol should not be used in patients with severe bronchospastic disease (see section 4.4 Special warnings and precautions for use ).
“The oxidative metabolism of metoprolol is under genetic control with a major contribution of the polymorphic cytochrome P450 isoform 2D6 (CYP2D6).”