Metoprolol diarrhea

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Metoprolol and Diarrhea: Understanding the Connection

Metoprolol Absorption in the Gastrointestinal Tract

Metoprolol, a beta-adrenoceptor blocker, is primarily absorbed in the small intestine. Studies have shown that metoprolol is not absorbed in the stomach but begins its absorption process in the duodenum, with approximately 60% of the drug being absorbed from this segment. Further absorption occurs in the jejunum, where about 50% of the drug leaving the duodenum is absorbed . This absorption process is consistent throughout the small intestine, including the ileum, indicating a first-order kinetic process .

Metoprolol and Gut Motility

Research indicates that metoprolol does not affect gut motility. This was observed in studies where metoprolol was perfused in the jejunum and ileum, showing no significant impact on the movement of the gastrointestinal tract . This suggests that any gastrointestinal side effects, such as diarrhea, are unlikely to be due to changes in gut motility caused by metoprolol.

Hepatic Metabolism and Excretion

Metoprolol is primarily metabolized by the liver, with less than 5% of an oral dose being excreted unchanged in the urine . In patients with hepatic cirrhosis, the pharmacokinetics of metoprolol are altered, leading to higher systemic availability and prolonged elimination half-life . However, these changes are related to liver function and do not directly explain gastrointestinal symptoms like diarrhea.

Conclusion

While metoprolol is absorbed in the small intestine and does not affect gut motility, its primary metabolism occurs in the liver. The available research does not directly link metoprolol to causing diarrhea. Any gastrointestinal side effects experienced may be due to individual patient responses or other underlying conditions rather than the direct action of metoprolol on the gastrointestinal tract. Further research may be needed to explore any indirect mechanisms that could contribute to such side effects.

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Most relevant research papers on this topic

Investigation of drug absorption from the gastrointestinal tract of man. I. Metoprolol in the stomach, duodenum and jejunum.

Metoprolol absorption in the gastrointestinal tract is mainly from the duodenum and jejunum, with delivery being the rate-limiting factor.

Non-RCTHighly Cited

1985·

91citations

·G. Jobinet al.

British journal of clinical pharmacology

Investigation of drug absorption from the gastrointestinal tract of man. II. Metoprolol in the jejunum and ileum.

Metoprolol is similarly absorbed in the jejunum and ileum, with absorption rates linearly related to perfusion rates and mean concentrations, indicating a first-order kinetic process.

Non-RCT

1985·

52citations

·N. Vidonet al.

British journal of clinical pharmacology

Pharmacokinetics of Metoprolol in Patients with Hepatic Cirrhosis

Impaired liver function does not significantly affect the pharmacokinetics of metoprolol, with total body clearance and half-life related to galactose clearance and serum bilirubin.

Non-RCT

1981·

67citations

·C. Regårdhet al.

Clinical Pharmacokinetics

B1 selective adrenoreceptor blockade for the long term management of variceal bleeding. A prospective randomised trial to compare oral metoprolol with injection sclerotherapy in cirrhosis.

Oral metoprolol is a less effective long-term treatment for variceal bleeding in cirrhosis patients compared to injection sclerotherapy, with a higher risk of bleeding episodes.

RCT

1985·

31citations

·D. Westabyet al.

Gut

Clinical Pharmacokinetics of Metoprolol

Metoprolol is a well-tolerated, well-absorbed, and well-metabolized drug with a long-lasting antihypertensive effect and significant antianginal effect for patients with atrial fibrillation.

Highly Cited

1980·

129citations

·C. Regårdhet al.

Clinical Pharmacokinetics

Metoprolol

Metoprolol is a well-established first-line drug for treating mild to moderate hypertension and stable angina, and is beneficial in post-infarction patients.

Literature ReviewHighly Cited

2012·

108citations

·P. Benfieldet al.

Drugs

Metoprolol for the Prevention of Acute Exacerbations of COPD.

Metoprolol treatment for moderate or severe COPD patients without established indications showed similar time to first exacerbation but more hospitalization for exacerbation.

RCTLarge Human TrialRigorous JournalHighly Cited

2019·

116citations

·M. Dransfieldet al.

The New England journal of medicine

Use of metoprolol in dogs with acquired cardiac disease.

Metoprolol is well-tolerated in most dogs with naturally occurring dilated cardiomyopathy or endocardiosis, but further studies are needed to determine its benefits and side effects.

Observational Study

2002·

12citations

·J. Rushet al.

Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology

Metoprolol

Metoprolol CR/XL effectively decreases mortality and improves clinical status in patients with stable mild to moderate chronic heart failure due to left ventricular systolic dysfunction, and is effective in patients with ischaemic or dilated cardiomyopathy.

RCT

2000·

21citations

·A. Prakashet al.

Drugs

Metoprolol in acute myocardial infarction (MIAMI). A randomised placebo-controlled international trial. The MIAMI Trial Research Group.

Metoprolol may reduce mortality in high-risk acute myocardial infarction patients, but its effect on overall mortality and morbidity remains unclear.

RCTLarge Human TrialHighly Cited

1985·

558citations

·J. Herlitzet al.

European heart journal

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