Met XL 100

Met XL 100 which contains Metoprolol Succinate which is an antihypertensive agent belonging to the beta-blocker class and is approved for use in the following clinical indications:

• High Blood Pressure: Beta-blocking medications' antihypertensive effects still lack a precise mechanism of action. However, several potential methods have been put forth: reduced cardiac output due to competing antagonistic interactions between catecholamines at peripheral (mainly cardiac) adrenergic neuron locations; decreased sympathetic outflow to the periphery due to a significant influence; and suppression of renin activity.
• Angina Pectoris: Met XL 100 is helpful in the long-term therapy of angina pectoris because it lowers the oxygen demands of the heart at any given amount of effort.
• Migraine: Beta-blockers alleviate that pain by telling your blood vessels to relax so that the blood can flow normally.
• Congestive heart failure: Met XL 100 CR/XL is beneficial in treating individuals with ischemic or dilated cardiomyopathy who have stable mild to moderate (NYHA functional class II or III) chronic heart failure caused by left ventricular systolic dysfunction by reducing mortality and improving clinical status.

Met XL 100 contains Metoprolol Succinate (100mg) which is an antihypertensive agent belonging to the beta-blocker class.

It is available in tablet, capsule, and capsule forms. The method of administration of Met XL 100 for various treatment are as follow: -

• High Blood Pressure: 12.5 to 100 mg daily in a single dose are the recommended starting doses for hypertension, depending on the patient's response. (The treating physician's clinical judgment should guide the dosage and length of the course of treatment.)
• Angina pectoris: The initial dosage in hypertension is 50mg night and morning, increasing to 100 or 200mg per dose depending on the response. (The treating physician's clinical judgment should guide the dosage and length of the course of treatment.)
• Migraine: The initial migraine dosage was 12.5-50mg/day, which was then increased to 50 mg per dose depending on the response. (The treating physician's clinical judgment should guide the dosage and length of the course of treatment.)
• Congestive Heart failure: During up-titration, the dosage must be customized and continuously monitored. Diuretics, ACE inhibitors, and digitalis (if used) dosage should be stabilized before starting the Met XL 100 extended-release pill. For patients with NYHA Class II heart failure, the starting dose of Met XL 100 extended-release tablet is 50 mg once a day for two weeks, and for patients with more severe heart failure, the starting dose is 12.5 mg once daily. The dose should subsequently be doubled every two weeks to the largest dosage the patient can bear, which is 200 mg of the extended-release pill Met XL 100. Increased diuretic dosages may be used to treat the transitory worsening of heart failure, and it may also be essential to reduce the dose of Met XL 100 extended-release.

Met XL 100 should be used in the treatment of high blood pressure, angina pectoris, migraine, and congestive heart failure along with appropriate dietary restrictions.

• High Blood Pressure:

It has been observed that the low-salt Dietary Approach to Stop Hypertension (DASH) diet lowers blood pressure. Sometimes after a few weeks, its effects on blood pressure become noticeable.

• Angina Pectoris:

Avoid foods that are high in saturated fat and hydrogenated or partially hydrogenated fats. Reduce your intake of dairy products including cheese, cream, and eggs.

• Migraine:

Some commonly triggered diets include Baked food with yeast, such as sourdough bread, bagels, doughnuts, coffee cake, Chocolate, Cultured dairy products (like yogurt and kefir), Tomatoes, Vegetables like onions, pea pods, some beans, corn, and sauerkraut, Vinegar and Alcohol must be avoided.

• Congestive Heart Failure:

Avoid salt intake food as it can result in fluid retention. In those with heart failure, excess sodium can cause serious complications. It can also worsen high blood pressure, which can exacerbate existing heart failure.

Highly processed grains, like white bread, white rice, white pasta, and many sugar-sweetened breakfast cereals, have been stripped of their fiber. That’s especially problematic for people with heart failure because it often co-exists with conditions like Type 2 diabetes and high cholesterol. Avoid any sort of processed and cured meats; they contain a lot of salt.

Even without seasoning, burgers and steaks pose a risk of clogged arteries due to their high-fat content.

The contraindications of Met XL 100 containing Metoprolol Succinate (100mg) which is an antihypertensive agent belonging to the beta-blocker class. are indicated as:

• Patient having High blood pressure and angina:

Met XL 100 should not be taken if you have sinus bradycardia, a first-degree heart block, cardiogenic shock, or overt cardiac failure.

• Patient with Hypersensitivity to other beta-blockers:

Met XL 100 and similar derivatives, or any of the excipients (cross-sensitivity between beta-blockers can occur), sick-sinus syndrome, and severe circulation problems can occur in the peripheral arteries.

For using Met XL 100 containing Metoprolol Succinate (100mg) which is an antihypertensive agent belonging to the beta-blocker class. The following warnings and precautions must be taken.

The treating physician must closely monitor the patient and keep pharmacovigilance as follows:

• Ischemic Heart Disease:

When treating patients with coronary artery disease with Met XL 100, do not stop the medication suddenly. Following the abrupt termination of beta-blocker therapy, individuals with coronary artery disease have experienced severe exacerbations of angina, myocardial infarction, and ventricular arrhythmias.

• Bronchospastic Diseases:

Beta-Blockers should not be given to patients with bronchospastic diseases in general. However, Met XL 100 extended-release tablet should be used cautiously in patients with bronchospastic illness who do not respond to, or cannot tolerate, alternative antihypertensive medication due to its relative beta1-selectivity. A beta2-stimulating medication should be taken concurrently because beta1- selectivity is not absolute. Additionally, the lowest dose of Met XL 100 extended-release tablets should be used.

• Diabetes and Hypoglycemia:

If a beta-blocker is needed, diabetic patients should utilize Met XL 100 extended-release tablets with caution. While tachycardia brought on by hypoglycemia may be concealed by beta-blockers, other symptoms like perspiration and dizziness might not be severely impacted.

• Thyrotoxicosis:

Beta-adrenergic blockade may conceal some clinical indications of hyperthyroidism, such as tachycardia. Care should be taken while managing patients who may be developing thyrotoxicosis to prevent sudden beta-blockade withdrawal, which could set off a thyroid storm.

• Peripheral Vascular Disease:

Beta-blockers can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. Caution should be exercised in such individuals.

Risk of Anaphylactic Reactions:

Patients who have previously experienced severe anaphylactic reactions to a range of allergens may be more sensitive to repeated challenges while using beta-blockers, whether they are accidental, diagnostic, or therapeutic. These people might not respond to the standard epinephrine dosages used to treat allergic reactions.

Until the patient's response to treatment with Met XL 100 has been determined, advise patients to refrain from operating vehicles, machinery, or engaging in other activities that call for attention; the patient should call their physician if they experience any breathing problems, and they should let their dentist or physician know before having any type of surgery that they are on Met XL 100.

The Adverse Reaction of Met XL 100 for various treatment are as follow:

• Common adverse effects:

Depression, slow heart rate, low blood pressure, dizziness etc. Other less severe expression is abnormal sexual function, itching, drowsiness, low energy, skin rashes, trouble breathing and diarrhea.

• Infrequent adverse effect:

Chronic Heart Failure, Constriction of blood vessels of the extremities, worsening asthma, bronchospasm, constipation, difficulty in sleeping, nausea

• Rare adverse effects:

Low Platelet count and bleeding from immune response and very low levels of granulocytes ( a type of white blood cells), blurred vision, etc

The clinically relevant drug interactions of Met XL 100 containing Metoprolol Succinate (100mg) which is an antihypertensive agent belonging to the beta-blocker class are briefly summarized as:

Several cases of overdosage have been reported, some leading to death.

Oral LD 50’s (mg/kg): mice, 1158-2460; rats, 3090-4670

The following signs and symptoms of Met XL 100 overdose are possible:

• Bradycardia, Hypotension, Bronchospasm, Myocardial infarction, Cardiac failure, and Death.

There is no specific antidote. In general, patients with acute or recent myocardial infarction may be more hemodynamically unstable than other patients and should be treated. The following general steps should be taken in light of Met XL 100’s pharmacologic effects:

• Elimination of the Drug: Lavage of the stomach is necessary. Other clinical overdose signs should be treated symptomatically using current intensive care techniques.
• Hypotension: It is necessary to deliver a vasopressor, such as levarterenol or dopamine.
• Bronchospasm: A beta-stimulating agent and/or a theophylline derivative should be administered.
• Cardiac Failure: It is necessary to administer a diuretic and a digitalis glycoside. Administration of dobutamine, isoproterenol, or glucagon may be considered in shock brought on by inadequate cardiac contractility.

Pharmacodynamics:

The following examples show relative beta1 selectivity:

• Met XL 100 is unable to counteract epinephrine's beta 2-mediated vasodilating effects in healthy individuals. As opposed to the nonselective effect (beta1 plus beta2) beta-blockers, which completely reverse the vasodilating effects of epinephrine.
• In asthmatic patients, Met XL 100 reduces FEV1 and FVC significantly less than a nonselective beta-blocker, propranolol, at equivalent beta1-receptor blocking doses.
• Met XL 100 lacks intrinsic sympathomimetic activity, and membrane-stabilizing activity is detectable only at doses much greater than required for beta blockade. Experiments on animals and people show that Met XL 100 lowers AV nodal conduction and reduces the sinus rate.
• Within an hour of oral treatment, there is a significant beta-blocking effect (measured by a decrease in exercise heart rate), and the duration is dose-related. In the case of single oral dosages of 20, 50, and 100 mg, the maximal impact was reduced by 50% at 3.3, 5.0, and 6.4 hours, respectively, in healthy volunteers. Exercise-induced systolic blood pressure significantly decreased after several oral administrations of 100 mg twice daily at 12 hours. Maximum beta-blockade was reached after 20 minutes in normal participants when the medication was given over a 10-minute interval.In a ratio of around 2.5:1, oral and intravenous dosages have equivalent maxima
• The drop-in exercise heart rate and the log of plasma levels are correlated linearly. However, plasma levels do not seem to be correlated with antihypertensive action. Choosing the right dosage necessitates individual titration due to the varied plasma levels reached with a given dose and the lack of a consistent link between dose and antihypertensive action.
• Stroke volume, diastolic blood pressure and pulmonary artery end-diastolic pressure remained unchanged.
• Plasma concentration at one hour is linearly proportional to the oral dose between 50 and 400 mg in angina pectoris patients. Exercise-induced heart rate and systolic blood pressure are decreased in proportion to the oral Met XL 100 dose logarithm. The relationship between the oral dose's logarithm and the improvement in exercise capacity and decrease in left ventricular ischemia is particularly noteworthy.

Pharmacokinetics:

A controlled-release medication called extended-release (ER) Met XL 100 is created to administer Met XL 100 at a nearly constant rate for about 20 hours regardless of meal intake or gastrointestinal pH. Even plasma concentrations over a 24-h period are produced by a once-daily dosage of ER Met XL 100 12.5-200 mg, without the distinct peaks and troughs often seen with the immediate-release (IR) formulation.

• Absorption:

Due to pre-systemic metabolism, which is saturable and causes a non-proportionate rise in exposure with higher doses, the estimated oral bioavailability of immediate-release Met XL 100 is roughly 50%.

• Distribution:

With a reported volume of distribution of 3.2 to 5.6 L/kg, Met XL 100 is widely dispersed. Met XL 100 is ten percent bound to serum albumin in plasma. Met XL 100 has been identified in breast milk and is known to cross the placenta. Following oral administration, Met XL 100 is also known to penetrate the blood-brain barrier, and CSF concentrations that are comparable to those seen in plasma have been documented. Met XL 100 is not a significant P-glycoprotein.

• Metabolism:

CYP2D6 is the enzyme that largely breaks down Met XL 100. When taken orally, Met XL 100, a racemic combination of R- and S- enantiomers, displays stereoselective metabolism that is reliant on oxidation phenotype. Only 2% of the majority of other populations and 8% of Caucasians are poor metabolizers of CYP2D6. Poor CYP2D6 metabolizers have plasma concentrations of Met XL 100 that are many times higher than those of extensive metabolizers with normal CYP2D6 activity, which reduces the cardioselectivity of Met XL 100.

• Elimination:

Met XL 100 is primarily eliminated through the liver's biotransformation process. Met XL 100 has an average half-life of 3 to 4 hours for elimination; in people who have weak CYP2D6 metabolism, the half-life may be 7 to 9 hours. The majority of the dose—about 95%—can be retrieved in urine. Less than 5% of an oral dose and less than 10% of an intravenous dose are eliminated as unmodified pharmaceuticals in the urine in the majority of people (extensive metabolizers). Poor metabolizers may excrete up to 30% or 40% of oral or intravenous doses unaltered; the remaining portion is eliminated by the kidneys as metabolites that don't seem to have any beta-blocking effects. The stereoisomers renal clearance does not show stereo-selectivity in renal excretion.