Metoprolol tartrate 25 mg tab
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Metoprolol Tartrate 25 mg Tablets: Clinical Efficacy and Safety
Introduction to Metoprolol Tartrate
Metoprolol tartrate is a beta1-selective adrenergic receptor blocker commonly used in the management of hypertension, angina pectoris, and heart failure. This article synthesizes research findings on the clinical efficacy, safety, and comparative performance of metoprolol tartrate, particularly in its 25 mg tablet form.
Clinical Efficacy in Hypertension
Blood Pressure Control
Metoprolol tartrate has been shown to be effective in reducing both systolic and diastolic blood pressure in patients with mild hypertension. A study comparing conventional metoprolol tartrate tablets (12.5 mg twice daily, increased to 25 mg twice daily) with metoprolol succinate sustained-release tablets found no significant difference in the rate of achieving target blood pressure goals between the two formulations1. Both groups exhibited significant reductions in blood pressure, indicating the efficacy of metoprolol tartrate in managing hypertension.
Heart Rate Variability
In the same study, heart rate variability, as measured by SDNN, RMSSD, and PNN50, was significantly higher in the sustained-release group compared to the conventional group, suggesting that while both formulations are effective, the sustained-release form may offer additional benefits in terms of heart rate stability1.
Hemodynamic Effects in Heart Failure
Hemodynamic Stability
Research comparing the hemodynamic effects of metoprolol tartrate (25 mg twice daily) and metoprolol succinate (100 mg once daily) in patients with congestive heart failure found that both formulations produced similar hemodynamic and clinical benefits over a three-month period2. However, both groups experienced adverse hemodynamic effects upon readministration of the full dose, including decreased cardiac index and stroke volume index, and increased systemic vascular resistance2.
Heart Rate Reduction
In patients with chronic congestive heart failure, metoprolol tartrate (25-50 mg daily) was found to be less effective in reducing average heart rate compared to metoprolol succinate sustained-release tablets3. This suggests that while metoprolol tartrate is effective, the sustained-release formulation may offer superior heart rate control in this patient population.
Comparative Efficacy with Carvedilol
Beta1-Blockade and Exercise Heart Rate
A study comparing the beta1-blockade effects of metoprolol tartrate (50 mg) and carvedilol (25 mg) in healthy subjects found that metoprolol tartrate produced a higher degree of beta1-blockade, as evidenced by a greater reduction in exercise heart rate4. This indicates that metoprolol tartrate may be more effective in situations requiring significant beta1-blockade.
Mortality and Morbidity in Heart Failure
The COMET trial compared the effects of metoprolol tartrate (50 mg twice daily) and carvedilol (25 mg twice daily) on clinical outcomes in patients with chronic heart failure. The study found that carvedilol significantly reduced all-cause mortality and cardiovascular death compared to metoprolol tartrate6 8. This suggests that while metoprolol tartrate is effective, carvedilol may offer superior survival benefits in heart failure patients.
Bioavailability and Administration
Oral and Rectal Bioavailability
A study on the bioavailability of metoprolol tartrate found that both domestic and exotic formulations are bioequivalent, with no significant differences in pharmacokinetic parameters5. Additionally, metoprolol tartrate administered rectally showed considerable bioavailability and was absorbed quickly, making it a viable alternative for patients unable to take oral medication7.
Conclusion
Metoprolol tartrate 25 mg tablets are effective in managing hypertension and heart failure, offering significant reductions in blood pressure and heart rate. While it performs comparably to metoprolol succinate in many aspects, the sustained-release formulation may provide additional benefits in heart rate variability and control. In comparison to carvedilol, metoprolol tartrate is effective but may not offer the same level of mortality reduction in heart failure patients. Overall, metoprolol tartrate remains a valuable option in the therapeutic arsenal for cardiovascular conditions.
Sources and full results
Most relevant research papers on this topic
Clinical comparison between two formulations of metoprolol in the treatment of mild hypertension
Metoprolol sustained-release form effectively reduces peak morning blood pressure and increases heart rate variability compared to metoprolol tartrate form in treating mild hypertension.
RCTHemodynamic comparison of twice daily metoprolol tartrate with once daily metoprolol succinate in congestive heart failure.
Metoprolol tartrate and metoprolol succinate both produce similar hemodynamic and clinical effects in congestive heart failure patients, with once daily metoprolol succinate offering a faster initiation and potentially better treatment outcomes.
RCTASSA14-07-02 Comparision of metoprolol succinate sustained-release tablets and metoprolol tartrate tablets on cardiac function in patients with chronic congestive heart failure
Metoprolol succinate sustained-release tablets decreased average heart rate in chronic congestive heart failure patients compared to Metoprolol Tartrate tablets, with equal effects on cardiac and renal function.
Observational Study
Rigorous JournalRandomized, double-blind comparison of acute beta1-blockade with 50 mg metoprolol tartrate vs 25 mg carvedilol in normal subjects.
50 mg metoprolol tartrate achieves a higher degree of beta1-blockade compared to 25 mg carvedilol in healthy subjects.
RCTBioequivalence of metoprolol tartrate tablets in healthy volunteers
Domestic and exotic metoprolol tartrate tablets are bioequivalent in healthy volunteers.
RCTComparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial
Carvedilol extends survival in chronic heart failure patients compared to metoprolol, with similar side-effect profiles and drug withdrawals.
RCT
Large Human TrialRigorous Journal
Highly CitedThe relative bioavailability of metoprolol following oral and rectal administration to volunteers and patients
Metoprolol suppositories are an effective, safe, and suitable alternative for patients unable to take oral medication due to instable angina pectoris.
Non-RCTEffects of metoprolol and carvedilol on cause-specific mortality and morbidity in patients with chronic heart failure--COMET.
Carvedilol reduces cardiovascular mortality, sudden death, circulatory failure deaths, strokes, and fatal and nonfatal myocardial infarctions in patients with chronic heart failure compared to metoprolol tartrate.
RCTLarge Human TrialHighly CitedComparative Bioavailability of Metoprolol Tartrate after Oral and Transdermal Administration in Healthy Male Volunteers
Transdermal drug delivery systems (TDDSs) provide 3-fold improved bioavailability compared to oral therapy, enabling 2-day hypertension management with a single patch, improving patient compliance.
RCTImpact of CYP2D6 polymorphisms on clinical efficacy & tolerability of metoprolol tartrate
CYP2D6 polymorphisms significantly affect heart rate response to metoprolol tartrate, but not blood pressure response or adverse effect rates.
Non-RCTRigorous JournalHighly Cited