Intravenous administration of verapamil should not be given to patients treated with beta-blockers.
Metoprolol may aggravate the symptoms of peripheral arterial circulatory disorders e.g. intermittent claudication. Severely impaired renal function. Serious acute conditions with metabolic acidosis. Combination treatment with digitalis.
Betaloc should not be given to patients with latent or manifested heart insufficiency without concomitant treatment. In patients with Prinzmetal's angina the frequency and the extent of angina attacks may increase due to alpha-receptor mediated contraction of the coronary vessels. For this reason non-selective beta-blockers must not be used in these patients. Beta1-selective receptor blockers should be used with caution.
In bronchial asthma or other chronic obstructive lung diseases, adequate bronchodilating therapy should be given concomitantly. The dose of beta2-stimulants may need to be increased.
During treatment with metoprolol the risk for interfering with carbohydrate metabolism or masking hypoglycaemia is less than with non-selective beta-blockers.
Very rarely, a pre-existing AV conduction disorder of moderate degree may become aggravated (possibly leading to AV block).
Treatment with beta-blockers may aggravate the treatment of an anaphylactic reaction. Adrenaline treatment in normal dose does not always give the expected therapeutic effect. If Betaloc is given to a patient with phaeochromocytoma, treatment with an alpha-blocker should be considered.
Withdrawal of Betaloc should, when possible, be done gradually over 2 weeks. The dose should be reduced gradually until a final dose of 25 mg is reached (half a 50 mg tablet). During this period especially patients with known ischemic heart disease should be kept under close surveillance. The risk for coronary events, including sudden death, may increase during withdrawal of beta-blockers.
Prior to surgery the anaesthetist should be informed that the patient is receiving Betaloc. It is not recommended to stop beta-blocker treatment in patients undergoing surgery. Acute initiation of high-dose metoprolol to patients undergoing non-cardiac surgery should be avoided, since it has been associated with bradycardia, hypotension and stroke including fatal outcome in patients with cardiovascular risk factors.
The tablet contains lactose. Patients with any of the following rare hereditary conditions should not use this medicine: galactose intolerance, total lactase deficiency or glucose-galactose malabsorption.
Effect on ability to drive and use machines: As dizziness and fatigue may occur in Betaloc treatment, this should be considered when strict attention is required, e.g. when driving or operating machines.