Metoprolol tartrate 25 mg
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Metoprolol Tartrate 25 mg: Clinical Insights and Comparisons
Hemodynamic Effects in Congestive Heart Failure
Hemodynamic Benefits and Adverse Effects
Metoprolol tartrate (MT) and metoprolol succinate (MS) have been studied for their hemodynamic effects in patients with congestive heart failure. Both forms of metoprolol, when administered at equivalent doses, produce significant functional, exercise, and hemodynamic benefits. However, during chronic therapy, both MT and MS exhibit parallel adverse hemodynamic effects, such as a decrease in cardiac index and stroke volume index, and an increase in systemic vascular resistance1.
Comparative Efficacy with Carvedilol
Beta1-Blockade and Exercise Heart Rate
A study comparing the acute beta1-blockade effects of 50 mg metoprolol tartrate versus 25 mg carvedilol in healthy subjects found that metoprolol tartrate achieved a higher degree of beta1-blockade. This was evidenced by a more significant reduction in exercise heart rate and peak oxygen consumption2.
Long-Term Clinical Outcomes
In the Carvedilol Or Metoprolol European Trial (COMET), metoprolol tartrate was compared with carvedilol in patients with chronic heart failure. The study concluded that carvedilol extended survival more effectively than metoprolol tartrate. Specifically, all-cause mortality was lower in the carvedilol group, and there were fewer cardiovascular deaths, sudden deaths, and deaths caused by circulatory failure or stroke3 5.
Bioavailability and Administration Routes
Oral vs. Rectal Administration
The bioavailability of metoprolol tartrate was studied in both oral and rectal forms. Rectal administration showed considerable bioavailability and was absorbed quickly, making it a viable alternative for patients unable to take oral medication. Both administration routes resulted in a significant drop in heart rate and blood pressure4.
Impact of CYP2D6 Polymorphisms
Efficacy and Tolerability
The efficacy and tolerability of metoprolol tartrate can be influenced by CYP2D6 polymorphisms. Poor and intermediate metabolizers of CYP2D6 showed a greater reduction in heart rate compared to extensive metabolizers. However, blood pressure response and adverse effect rates did not significantly differ among the different CYP2D6 phenotypes7.
Conclusion
Metoprolol tartrate 25 mg is effective in managing heart rate and blood pressure in various clinical settings, including congestive heart failure. While it offers significant hemodynamic benefits, it also shares adverse effects with other beta-blockers like metoprolol succinate. Comparatively, carvedilol may offer superior long-term survival benefits in chronic heart failure patients. Additionally, the route of administration and genetic polymorphisms can influence the drug's efficacy and tolerability, highlighting the need for personalized treatment approaches.
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Most relevant research papers on this topic
Hemodynamic 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.
RCTRandomized, 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.
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 Trial
Rigorous 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 CitedASSA14-07-02 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 StudyRigorous JournalImpact 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 CitedThe effect of age on the pharmacokinetics of metoprolol and its metabolites.
Age has a less pronounced effect on the pharmacokinetics of metoprolol and its metabolites than for other drugs.
Non-RCTHighly CitedBioequivalence of metoprolol tartrate tablets in healthy volunteers
Domestic and exotic metoprolol tartrate tablets are bioequivalent in healthy volunteers.
RCT