The following provides information on contraindications to the use of metoprolol in general, in pregnancy & amp; Breastfeeding and children. Please note that the contraindications may vary depending on the dosage form of a drug (eg tablet, syringe, ointment).
When should Metoprolol not be used?
The active substance must not be taken at
- Hypersensitivity to metoprolol or other beta-blockers
- inadequately treated myocardial insufficiency (decompensated heart failure)
- a shock caused by heart failure (cardiogenic shock)
- Stimulation conduction disturbances to the heart (sinus node syndrome), slowed heart rate (bradycardia), an interruption of stimulation in the area of the sinus node (sinoatrial block) or severe irritant conduction disorders to the heart muscle (AV block II and III degrees)
- Patients with low blood pressure (hypotension with a systole value below 100 millimeters of mercury)
- severe bronchial asthma or severe, chronic lung disease
- Circulatory disorders in late-stage peripheral arterial disease or Raynaud’s syndrome
- Disorders of the acid-base balance or overacidification of the body (metabolic acidosis)
- untreated disease of the adrenal medulla (pheochromocytoma).
Only after careful risk-benefit assessment by the physician may the drug be given at
- Patients with convulsions of the bronchial muscles (bronchospasm)
- Diabetes mellitus with high blood sugar levels
- Mild cardiac arrhythmia (AV block I degree)
- Psoriasis in the personal or family history
- impaired kidney function
- Frequent recurrent cardiac circulatory problems with tightness (Prinzmetal’s angina)
Thyroid hyperfunction (hyperthyroidism)
ongoing desensitization therapy (therapy to reduce allergic reactions or allergies).
What should you watch out for during pregnancy and lactation?
Knowledge of metoprolol use during pregnancy is not sufficient. Therefore always the resulting benefit (treatment of the mother) or the risk (risk to the unborn child) should be carefully weighed up by a doctor.
There are indications that the drug reduces blood flow to the baby’s stomach (placenta) and may lead to growth disorders in the child. In clinical trials with other beta-blockers, miscarriages, premature births, and stillbirths occurred during their use.
If metoprolol is used during pregnancy, the active substance should be discontinued at least a few days before the birth. If this is not possible, the newborn must be carefully monitored by the doctor for the first 72 hours.
Metoprolol passes into breast milk. Breastfed infants should therefore monitor the attending physician for signs of beta-blockage (slowing of the heartbeat, low blood pressure, low blood sugar). After taking Metoprolol should be breastfed after three to four hours, because then the concentration of metoprolol is reduced by the degradation in the maternal body again.
What should be considered in children?
In children, the efficacy and safety of Metoprolol has not been established.
Warnings and Precautions
- While taking the medicine, the patient should monitor blood pressure and heart rate regularly and the doctor should check the heart activity.
- Regular medical checks on blood sugar levels, blood lipid levels and liver enzymes are necessary for long-term treatment.
- In patients with severe renal impairment or hepatic dysfunction, regular medical checks on renal function and liver function are necessary.
- Therapy with the drug should be stopped only slowly (creeping), otherwise there is a risk of excessive blood pressure increase.
- In diabetics, warning signs of hypoglycaemia (eg increased heart rate, muscle tremors) may be obscured by the drug.
- The drug is on the doping list. It is prohibited in sports where concentration and calmness play a role (for example, shooting, fencing, air sports, alpine skiing).
- Ingestion of the drug interferes with the ability to react so that driving, machine guidance and working without secure hold are dangerous. This is especially true in conjunction with alcohol.
- The drug reduces the amount of tear fluid, which may affect the wearing of contact lenses.
- Reduced reactivity may occur especially at the start of treatment or when changing the preparation.
Sometimes medications release allergic reactions.
If you notice signs of allergic reaction, tell your doctor or pharmacist immediately.