Metoprolol succinate twice daily
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Twice-Daily Metoprolol Succinate: Efficacy and Comparison with Other Formulations
Introduction to Metoprolol Succinate and Tartrate
Metoprolol is a beta-blocker commonly used to treat conditions such as hypertension, heart failure, and myocardial infarction. It is available in two formulations: metoprolol tartrate (MT) and metoprolol succinate (MS). While MT is typically administered twice daily, MS is often prescribed once daily due to its extended-release properties. This article explores the efficacy and hemodynamic effects of twice-daily metoprolol succinate compared to other dosing regimens and formulations.
Hemodynamic Effects in Heart Failure
A study comparing the hemodynamic effects of twice-daily MT and once-daily MS in patients with congestive heart failure found that both formulations produced similar functional, exercise, and hemodynamic benefits over three months of therapy. Despite the different dosing schedules, both MT and MS resulted in significant decreases in cardiac index and stroke volume index, and increases in systemic vascular resistance. This suggests that the hemodynamic response to metoprolol is consistent regardless of the formulation or dosing frequency.
Pharmacokinetic and Pharmacodynamic Properties
The pharmacokinetic and pharmacodynamic properties of MS, particularly its controlled-release (CR) formulation, offer advantages over conventional MT tablets. Studies have shown that MS provides more stable plasma concentrations throughout the day, reducing peak plasma levels and maintaining higher concentrations at the end of the dosing interval. This results in a more consistent beta1-blocking effect, which is beneficial for managing conditions like hypertension and heart failure.
Clinical Efficacy in Hypertension
Several studies have compared the efficacy of once-daily MS with twice-daily MT in treating hypertension. One study found that both formulations were equally effective in reducing systolic and diastolic blood pressure, with no significant differences in heart rate or adverse effects. Another study confirmed that once-daily MS was as effective as twice-daily MT in controlling blood pressure over a 24-hour period . These findings suggest that MS can be a convenient and effective alternative to MT for hypertension management.
Mortality and Hospitalization in Heart Failure
In patients with chronic systolic heart failure, once-daily MS has been shown to significantly reduce total mortality and hospitalizations compared to placebo. The benefits were particularly notable in reducing sudden death and mortality from worsening heart failure. These results highlight the potential of MS to improve long-term outcomes in heart failure patients.
Post-Myocardial Infarction Outcomes
A comparison of immediate-release MT and extended-release MS in post-myocardial infarction patients revealed that both formulations were associated with similar reductions in mortality over a five-year period. This indicates that MS, with its once-daily dosing, can provide the same protective benefits as the more frequently administered MT.
Conclusion
Twice-daily metoprolol succinate offers comparable hemodynamic and clinical benefits to once-daily metoprolol succinate and twice-daily metoprolol tartrate. The extended-release properties of MS provide stable plasma concentrations and consistent therapeutic effects, making it a convenient and effective option for managing hypertension, heart failure, and post-myocardial infarction outcomes. These findings support the use of MS in various clinical settings, offering flexibility in dosing without compromising efficacy.
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