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Metoprolol: The Risk of the Drug That Include the Side Effects

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Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The adverse reaction information from clinical trials does, however, provide a basis for identifying the adverse events that appear to be related to drug use and for approximating rates.

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Beta-blockers are a medication used to treat high blood pressure and heart problems. They are used by millions of people around the world everyday. In 2004, they were the fifth most widely prescribed class of medicine. Beta-blockers are effective, life-saving medicines with more than 25 years of widespread and generally safe use. There are fourteen beta-blockers are currently available. These included Acebutolol, Atenolol, Betaxolol, Bisoprolol, Carvedilol, Esmolol, Labetalol, Metoprolol, Nadolol, Penbutolol, Pindolol, Propranolol, and Timolol. Beta-blockers are just one class of prescription medicine used to treat high blood pressure and heart disease. Four other classes are commonly used to treat high blood pressure, for example

These include the diuretics, calcium channel blockers, ACE inhibitors, and angiotensin-receptor blockers. These four plus beta blockers are often used in combination, two or more at a time. Indeed, many people with high blood pressure will require two or more high blood pressure medicines to bring their blood pressure down to a normal and healthy range. Although they are used primarily to treat people with high blood pressure, they are also used to treat other heart conditions. These include angina (heart or chest pain), abnormal heart rhythms, coronary artery blockages, and heart failure. They are also used, along with other treatments, to help prevent repeat heart attacks in people who have already had one, to prevent migraine headaches, and to treat performance or stage-fright anxiety. High blood pressure is one of the most significantly and persistently under-diagnosed and under-treated medical conditions. It raises your risk of heart disease, heart attack, heart failure, stroke, dementia, vision loss, and kidney failure. In most who have high blood pressure, it is a lifelong condition. Yet studies show that only 30% of people with high blood pressure getting the medicines, care, and blood pressure control they need. Uncontrolled high blood pressure is a leading cause of death. Because it has no symptoms and often goes undetected, high blood pressure is often called the nation’s leading “silent killer.” Beta-blockers work by blocking adrenaline in the heart and blood vessels. Adrenaline speeds up the heart rate, makes the heart muscle contract more strongly, and constricts arteries throughout the body. All these raise blood pressure. In blocking adrenaline, beta-blockers slow down the heart and reduce its workload. That helps to decrease blood pressure.

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Complexes can considerably reduce the bioavailability of drugs. The bisphosphonates used in osteoporosis, such as alendronate, have a very low bioavailability of only 0.5% to 2% (Klein CE, Chiu YL, 2008). Calcium ions in mineral water or milk reduce this markedly still further. Multivalent cations can also form complexes with tetracycline or quinolones and also reduce the bioavailability of levothyroxine; simultaneous intake of calcium-containing foods or neutralizing antacids containing aluminum or magnesium ions, must therefore be avoided. Recently, a reduction of the protective properties of alendronate with reference to avoiding hip fractures was observed when proton pump inhibitors were given at the same time

Multidrug efflux transporters such as P-glycoprotein (P-gp, ABCB1) were first described as one of the causes of chemotherapy resistance in tumors. P-glycoprotein is expressed in many tissue barriers such as intestine, liver, kidney, and blood–brain barrier, and in the placenta, testis, lymphocytes, and tumor cells, and extrudes predominantly lipophilic connections/bindings from inside the cell via the apical membranes of epithelial or endothelial cells. Inhibition of this efflux transporter could therefore help to overcome chemoresistance. P-gp-mediated efflux transport also contributes to reducing the responsiveness of lymphocytes to HIV protease inhibitors. Ritonavir, which causes many side effects at high doses, simultaneously inhibits P-gp and also the drug-metabolizing cytochrome P450 3A4 (CYP3A4). The fixed combination of ritonavir with, for example, 200 mg lopinavir improves the bioavailability of the protease-inhibiting substance and the efflux of lopinavir out of the lymphocytes, thus reducing the breakdown in the liver. So far, however, the attempt to overcome the chemoresistance of tumors by inhibiting efflux transporters, especially by means of P-glycoprotein, has been unsuccessful (Rocha A, Coelho EB, 2010).

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On the whole, although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below

The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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Rocha A, Coelho EB, Sampaio SA, Lanchote VL. Omeprazole preferentially inhibits the metabolism of (+)-(S)-citalopram in healthy volunteers. Br J Clin Pharmacol. 2010;70:43–51.

Steinijans VW, Huber R, Hartmann M, et al. Lack of pantoprazole drug interactions in man. Int J Clin Pharmacol Ther. 1994;32:385–399.

Rost KL, Brosicke H, Brockmoller J, Scheffler M, Helge H, Roots I. Increase of cytochrome P450IA2 activity by omeprazole: evidence by the 13C-[N-3-methyl]-caffeine breath test in poor and extensive metabolizers of S-mephenytoin. Clin Pharmacol Ther. 1992;52:170–180.

Klein CE, Chiu YL, Cai Y, Beck K, King KR, Causemaker SJ, et al. Effects of acid-reducing agents on the pharmacokinetics of lopinavir/ritonavir and ritonavir-boosted atazanavir. J Clin Pharmacol. 2008

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