Toprol XL

[Metoprolol]

Previous hypertension
No previous hypertension

Total Mortality or All-Cause Hospitalization
(Time to First Event)
Total Mortality or Hospitalization
for Heart Failure (Time to First Event)

Favors Toprol-XL Favors Toprol-XL Favors Placebo

Text Continues Below

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Relative risk and 95% confidence interval
Favors Placebo Favors Placebo
EF: <0.25 (mean 0.20)
All
US
Non-US

HR: <76 (mean 72 bpm)

64200-00
Rev. 11/ 02

Major Surgery

The necessity or desirability of withdrawing beta-blocking therapy prior to major surgery is controversial; the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.

TOPROL-XL, like other beta-blockers, is a competitive inhibitor of beta-receptor agonists, and its effects can be reversed by administration of such agents, eg, dobuta-mine or isoproterenol. However, such patients may be subject to protracted severe hypotension. Difficulty in restarting and maintaining the heart beat has also been reported with beta-blockers.
Diabetes and Hypoglycemia: TOPROL-XL should be used with caution in diabetic patients if a beta-blocking agent is required. Beta-blockers may mask tachycardia occurring with hypoglycemia, but other manifestations such as dizziness and sweating may not be significantly affected.

Thyrotoxicosis

Beta-adrenergic blockade may mask certain clinical signs (eg, tachy-cardia) of hyperthyroidism. Patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of beta-blockade, which might precipitate 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.

Calcium Channel Blockers

Because of significant inotropic and chronotropic effects in patients treated with beta-blockers and calcium channel blockers of the verapamil and diltiazem type, caution should be exercised in patients treated with these agents concomitantly.

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