Metoprolol and alcohol
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Metoprolol and Alcohol: Interactions and Effects
Solubility of Metoprolol in Alcohols
Metoprolol succinate, a cardioselective β1 adrenergic receptor blocker, exhibits varying solubility in different alcohols. Research indicates that its solubility increases with temperature and follows the order: methanol > ethanol > n-butanol > n-propanol > isopropanol > acetone > ethyl acetate. This solubility pattern is primarily due to the intra- and intermolecular hydrogen bonds formed between metoprolol succinate and the alcohol solvents.
Acute Interaction of Metoprolol and Alcohol on Blood Pressure
A study examining the acute effects of alcohol consumption after a single dose of metoprolol (200 mg) found that alcohol did not negate the antihypertensive effect of metoprolol on supine systolic blood pressure in healthy men. However, the interaction between alcohol and antihypertensive drugs like metoprolol requires further investigation, especially in hypertensive patients who consume alcohol regularly, as they tend to have less adequate blood pressure control.
Metoprolol's Impact on Ethanol Elimination
Research on the elimination kinetics of ethanol in the presence of metoprolol shows that metoprolol does not significantly increase the rate of ethanol elimination. However, long-term administration of metoprolol can lead to a steeper rise and delayed decrease in blood alcohol concentration, suggesting that simultaneous intake of high doses of metoprolol and alcohol should be avoided.
Metoprolol and Ethanol-Induced Cardiac Hypertrophy
In animal studies, metoprolol has been shown to suppress the development of ethanol-induced cardiac hypertrophy. Ethanol stimulates the peripheral sympathetic nervous system, leading to increased adrenaline and noradrenaline excretion and rapid cardiac hypertrophy. High doses of metoprolol (100 mg/kg) can reduce adrenal catecholamine content and cardiac weight, counteracting the hypertrophic effects of ethanol.
Adverse Effects and Overdose Risks
There are documented cases where metoprolol, in combination with alcohol, has led to severe adverse effects. For instance, a patient with a history of alcohol abuse experienced delirium and hallucinations, which resolved upon discontinuation of metoprolol. Additionally, a fatality was reported due to an intentional overdose of metoprolol, with a significant blood ethanol concentration detected.
Conclusion
The interaction between metoprolol and alcohol is complex and multifaceted. While metoprolol does not significantly alter the elimination of ethanol, its long-term use can affect blood alcohol levels. Moreover, metoprolol can mitigate ethanol-induced cardiac hypertrophy but may also lead to severe adverse effects when combined with alcohol. Therefore, caution is advised when consuming alcohol while on metoprolol therapy, and further research is needed to fully understand these interactions.
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