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Drug Design, Development and Therapy 2020To assess gender-, age-, and the dose-related influence of metoprolol on cardiac function, motor function, quality-of-life (QoL), and mental status in Chinese chronic...
PURPOSE
To assess gender-, age-, and the dose-related influence of metoprolol on cardiac function, motor function, quality-of-life (QoL), and mental status in Chinese chronic heart failure (CHF) patients.
PATIENTS AND METHODS
This single-center, prospective study enrolled CHF patients with resting heart rate (HR) >80 bpm and used metoprolol continuous release tablets. Patients were initiated with 12.5-mg metoprolol. All patients were assessed for change in cardiac function, motor function, QoL, and mental status according to gender (men vs women), age (<60 vs ≥60 years), and metoprolol dose administered (47.5 mg [n=37], 71.25 mg [n=7], 118.75 [n=74], and 142.5 mg [n=19]).
RESULTS
Overall, 154 CHF patients (101 men and 53 women), with median age 66.39 years, were enrolled. In total, 116 and 38 patients were aged ≥60 and <60 years, respectively. We observed a slight decrease in systolic blood pressure (SBP) in women compared with men. HR had increased with an increase in ejection fraction (EF) from baseline to 1 month (35.24±6.15 and 34.79±6.25) and increased to 50.00±4.45 and 50.72±4.09 among both the genders. Cardiac index (CI) and motor function had improved along with better QoL after metoprolol treatment in both the genders. In both age groups (<60 and ≥60 years), improvement in cardiac function, motor function, and QoL was observed; however, there was a difference in mental status. The dose effect of metoprolol on cardiac function, motor function, QoL, and mental status showed a gradual decrease in EF with dose increments, with no change in CI. Motor function, QoL, and mental status did not show much difference with uptitration of metoprolol dose.
CONCLUSION
Psychological responses to metoprolol treatment differ with gender, with no age-related changes in terms of cardiac function, motor function, QoL, or mental status, except increases in depression, burnout, and anxiety.
Topics: Administration, Oral; Aged; Asian People; Chronic Disease; Female; Heart Failure; Humans; Male; Metoprolol; Motor Activity; Prospective Studies; Quality of Life; Stroke Volume; Surveys and Questionnaires
PubMed: 32921985
DOI: 10.2147/DDDT.S263026 -
Aging Oct 2018
Topics: Aging; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Humans; Metoprolol; Propranolol
PubMed: 30368231
DOI: 10.18632/aging.101620 -
Basic Research in Cardiology Aug 2020
Topics: Humans; Ischemia; Metoprolol; Myocardial Reperfusion Injury
PubMed: 32748009
DOI: 10.1007/s00395-020-0814-2 -
AAPS PharmSciTech Dec 2012Sustained-release matrix tablets based on Eudragit RL and RS were manufactured by injection moulding. The influence of process temperature; matrix composition; drug...
Sustained-release matrix tablets based on Eudragit RL and RS were manufactured by injection moulding. The influence of process temperature; matrix composition; drug load, plasticizer level; and salt form of metoprolol: tartrate (MPT), fumarate (MPF) and succinate (MPS) on ease of processing and drug release were evaluated. Formulations composed of 70/30% Eudragit RL/MPT showed the fastest drug release, substituting part of Eudragit RL by RS resulted in slower drug release, all following first-order release kinetics. Drug load only affected drug release of matrices composed of Eudragit RS: a higher MPT concentration yielded faster release rates. Adding triethyl citrate enhanced the processability, but was detrimental to long-term stability. The process temperature and plasticizer level had no effect on drug release, whereas metoprolol salt form significantly influenced release properties. The moulded tablets had a low porosity and a smooth surface morphology. A plasticizing effect of MPT, MPS and MPF on Eudragit RS and Eudragit RL was observed via DSC and DMA. Solubility parameter assessment, thermal analysis and X-ray diffraction demonstrated the formation of a solid solution immediately after production, in which H-bonds were formed between metoprolol and Eudragit as evidenced by near-infrared spectroscopy. However, high drug loadings of MPS and MPF showed a tendency to recrystallise during storage. The in vivo performance of injection-moulded tablets was strongly dependent upon drug loading.
Topics: Acrylic Resins; Biological Availability; Chemistry, Pharmaceutical; Citrates; Delayed-Action Preparations; Drug Carriers; Drug Compounding; Drug Stability; Kinetics; Metoprolol; Plasticizers; Polymers; Porosity; Solubility; Tablets; Temperature
PubMed: 22965662
DOI: 10.1208/s12249-012-9848-6 -
Scientific Reports Jul 2018Ventricular arrhythmias (VAs) are the leading cause of sudden cardiac death in patients with myocardial infarction (MI). We sought to compare effects of renal... (Comparative Study)
Comparative Study
Ventricular arrhythmias (VAs) are the leading cause of sudden cardiac death in patients with myocardial infarction (MI). We sought to compare effects of renal denervation (RDN) and metoprolol on VAs after MI. Fifty-four male Sprague-Dawley rats underwent ligation of left anterior descending coronary artery to induce MI, while 6 rats served as Control. Metoprolol was given 20 mg/kg/day for 5 weeks after MI surgery. RDN/Sham-RDN procedure was performed at 1 week after MI. At 5 weeks after MI, electrical programmed stimulation (EPS) was performed in all groups for evaluation of VAs. After EPS, heart and kidneys were harvested. Compared with MI group, RDN and metoprolol significantly decreased the incidence of VAs, and RDN is superior to metoprolol. Compared with metoprolol group, Masson staining showed that RDN significantly reduced the myocardial fibrosis. Both RDN and metoprolol decreased the protein expression of connexin43 (Cx43) compared with MI group, while only RDN lighted this decrease remarkably. Immunohistochemical staining of Tyrosine hydroxylase (TH) and growth associated protein 43 (GAP43) revealed that RDN and metoprolol had similar effect on reducing densities of sympathetic nerve in infarction border zone. According to this study, RDN is more effective in reducing VAs than metoprolol in ischemic cardiomyopathy model.
Topics: Animals; Arrhythmias, Cardiac; Connexin 43; Denervation; Disease Models, Animal; Drug Administration Schedule; Electric Stimulation; Kidney; Male; Metoprolol; Myocardial Infarction; Rats; Rats, Sprague-Dawley; Sympathetic Nervous System; Treatment Outcome
PubMed: 29976952
DOI: 10.1038/s41598-018-28562-z -
British Journal of Clinical Pharmacology Apr 2015To investigate the influence of gestational diabetes mellitus (GDM) on the kinetic disposition and transplacental and amniotic fluid distribution of metoprolol and its... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To investigate the influence of gestational diabetes mellitus (GDM) on the kinetic disposition and transplacental and amniotic fluid distribution of metoprolol and its metabolites O-desmethylmetoproloic acid and α-hydroxymetoprolol stereoisomers in hypertensive parturients receiving a single dose of the racemic drug.
METHODS
The study was conducted on hypertensive parturients with well-controlled GDM (n = 11) and non-diabetic hypertensive parturients (n = 24), all receiving a single 100 mg oral dose of racemic metoprolol tartrate before delivery. Serial maternal blood samples (0-24 h) and umbilical blood and amniotic fluid samples were collected for the quantitation of metoprolol and its metabolite stereoisomers using LC-MS/MS or fluorescence detection.
RESULTS
The kinetic disposition of metoprolol and its metabolites was stereoselective in the diabetic and control groups. Well-controlled GDM prolonged tmax for both enantiomers of metoprolol (1.5 vs. 2.5 h R-(+)-MET; 1.5 vs. 2.75 h S-(-)-MET) and O-desmethylmetoproloic acid (2.0 vs. 3.5 h R-(+)-AOMD; 2.0 vs. 3.0 h S-(-)-OAMD), and for the four stereoisomers of α-hydroxymetoprolol (2.0 vs. 3.0 h for 1'S,2R-, 1'R,2R- and 1'R,2S-OHM; 2.0 vs. 3.5 h for 1'S,2S-OHM) and reduced the transplacental distribution of 1'S,2S-, 1'R,2R-, and 1'R,2S-OHM by approximately 20%.
CONCLUSIONS
The kinetic disposition of metoprolol was enantioselective, with plasma accumulation of the S-(-)-MET eutomer. Well-controlled GDM prolonged the tmax of metoprolol and O-desmethylmetoproloic acid enantiomers and the α-hydroxymetoprolol stereoisomers and reduced by about 20% the transplacental distribution of 1'S,2S-, 1'R,2R-, and 1'R,2S-OHM. Thus, well-controlled GDM did not change the activity of CYP2D6 and CYP3A involved in metoprolol metabolism.
Topics: Adult; Antihypertensive Agents; Diabetes, Gestational; Female; Fetal Blood; Humans; Hypertension; Infant, Newborn; Metoprolol; Parturition; Placenta; Pregnancy; Stereoisomerism; Tissue Distribution
PubMed: 25291152
DOI: 10.1111/bcp.12523 -
Journal of Advanced Research Jul 2022Pharmacokinetic variability in disease state is common in clinical practice, but its underlying mechanism remains unclear. Recently, gut microbiota has been considered...
INTRODUCTION
Pharmacokinetic variability in disease state is common in clinical practice, but its underlying mechanism remains unclear. Recently, gut microbiota has been considered to be pharmacokinetically equivalent to the host liver. Although some studies have explored the roles of gut microbiota and host Cyp450s in drug pharmacokinetics, few have explored their effects on pharmacokinetic variability, especially in disease states.
OBJECTIVES
In this study, we aim to investigate the effects of gut microbiota and host Cyp450s on pharmacokinetic variability in mice with non-alcoholic steatohepatitis (NASH), and to elucidate the contribution of gut microbiota and host Cyp450s to pharmacokinetic variability in this setting.
METHODS
The pharmacokinetic variability of mice with NASH was explored under intragastric and intravenous administrations of a cocktail mixture of omeprazole, phenacetin, midazolam, tolbutamide, chlorzoxazone, and metoprolol, after which the results were compared with those obtained from the control group. Thereafter, the pharmacokinetic variabilities of all drugs and their relations to the changes in gut microbiota and host Cyp450s were compared and analyzed.
RESULTS
The exposures of all drugs, except metoprolol, significantly increased in the NASH group under intragastric administration. However, no significant increase in the exposure of all drugs, except tolbutamide, was observed in the NASH group under intravenous administration. The pharmacokinetic variabilities of phenacetin, midazolam, omeprazole, and chlorzoxazone were mainly associated with decreased elimination activity in the gut microbiota. By contrast, the pharmacokinetic variability of tolbutamide was mainly related to the change in the host Cyp2c65. Notably, gut microbiota and host Cyp450s exerted minimal effects on the pharmacokinetic variability of metoprolol.
CONCLUSION
Gut microbiota and host Cyp450s co-contribute to the pharmacokinetic variability in mice with NASH, and the degree of contribution varies from drug to drug. The present findings provide new insights into the explanation of pharmacokinetic variability in disease states.
Topics: Animals; Chlorzoxazone; Gastrointestinal Microbiome; Metoprolol; Mice; Midazolam; Non-alcoholic Fatty Liver Disease; Omeprazole; Pharmaceutical Preparations; Phenacetin; Tolbutamide
PubMed: 35777915
DOI: 10.1016/j.jare.2021.10.004 -
Journal of Cardiovascular Pharmacology Apr 2020Pharmacologic management of atrial fibrillation (AF) is a pressing problem. This arrhythmia afflicts >5 million individuals in the United States and prevalence is... (Review)
Review
Pharmacologic management of atrial fibrillation (AF) is a pressing problem. This arrhythmia afflicts >5 million individuals in the United States and prevalence is estimated to rise to 12 million by 2050. Although the pill-in-the-pocket regimen for self-administered AF cardioversion introduced over a decade ago has proven useful, significant drawbacks exist. Among these are the relatively long latency of effects in the range of hours along with potential for hypotension and other adverse effects. This experience prompted development of a new strategy for increasing plasma concentrations of antiarrhythmic drugs rapidly and for a limited time, namely, pulmonary delivery. In preclinical studies in Yorkshire pigs, intratracheal administration of flecainide was shown to cause a rapid, reproducible increase in plasma drug levels. Moreover, pulmonary delivery of flecainide converted AF to normal sinus rhythm by prolonging atrial depolarization, which slows intra-atrial conduction and seems to be directly correlated with efficacy in converting AF. The rapid rise in plasma flecainide levels optimizes its anti-AF effects while minimizing adverse influences on ventricular depolarization and contractility. A more concentrated and soluble formulation of flecainide using a novel cyclodextrin complex excipient reduced net drug delivery for AF conversion when compared to the acetate formulation. Inhalation of the beta-adrenergic blocking agent metoprolol slows ventricular rate and can also terminate AF. In human subjects, oral inhalation of flecainide acetate with a hand-held, breath-actuated nebulizer results in signature prolongation of the QRS complex without serious adverse events. Thus, pulmonary delivery is a promising advance in pharmacologic approach to management of AF.
Topics: Administration, Inhalation; Animals; Anti-Arrhythmia Agents; Atrial Fibrillation; Disease Models, Animal; Drug Compounding; Flecainide; Heart Rate; Humans; Metoprolol; Nebulizers and Vaporizers; Treatment Outcome
PubMed: 32032206
DOI: 10.1097/FJC.0000000000000804 -
British Journal of Clinical Pharmacology Dec 19931 The metabolism of metoprolol depends in part on the genetically determined activity of the CYP2D6 isoenzyme. In vitro studies have shown that nicardipine is a potent... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
1 The metabolism of metoprolol depends in part on the genetically determined activity of the CYP2D6 isoenzyme. In vitro studies have shown that nicardipine is a potent inhibitor of CYP2D6 activity. Since the combination of metoprolol and nicardipine is likely to be used for the treatment of hypertension, we examined the interaction between these two drugs at steady-state. 2 Fourteen healthy volunteers, seven extensive and seven poor metabolisers of dextromethorphan were studied in a double-blind, randomised cross-over four-period protocol. Subjects received nicardipine 50 mg every 12 h, metoprolol 100 mg every 12 h, a combination of both drugs and placebo during 5.5 days. Steady-state pharmacokinetics of nicardipine and metoprolol were analyzed. Beta-adrenoceptor blockade was assessed as the reduction of exercise-induced tachycardia. 3 During treatment with metoprolol, alone or in combination with nicardipine, its steady-state plasma concentrations were higher in subjects of the poor metaboliser phenotype than in extensive metabolisers. Beta-adrenoceptor blockade was also more pronounced in poor metabolisers than in extensive metabolisers of dextromethorphan during treatment with metoprolol alone or in combination with nicardipine (24.0 +/- 2.4% vs 17.1 +/- 3.5% and 24.1 +/- 2.5% vs 15.4 +/- 2.7% reduction in exercise trachycardia, respectively, P < 0.01 in each case). 4 Nicardipine produced a small increase in plasma metoprolol concentration in extensive metabolisers from 35.9 +/- 16.6 to 45.8 +/- 15.4 ng ml(-1) (P < 0.02), but had no significant effect in poor metabolisers. However, nicardipine did not alter the R/S metoprolol ratio in plasma 3 h after dosing, the plasma concentration of S-(-)-metoprolol 3 h after dosing or the beta-adrenoceptor blockade produced by metoprolol in subjects of both phenotypes. The partial metabolic clearance of metoprolol to alpha-hydroxy-metoprolol was not altered significantly in extensive metabolisers. Plasma nicardipine concentration and beta-adrenoceptor blocking effects did not differ between the phenotypes and were not influenced by metoprolol. We conclude that beta-adrenoceptor blockade during repeated dosing with metoprolol is more pronounced in poor than in extensive metaboliser subjects, that nicardipine decreases a CYP2D6-independent route of metoprolol elimination but does not increase beta-adrenoceptor blockade during repeated dosing with metoprolol.
Topics: Adrenergic beta-Antagonists; Adult; Blood Pressure; Calcium Channel Blockers; Cross-Over Studies; Cytochrome P-450 CYP2D6; Double-Blind Method; Drug Combinations; Drug Interactions; Female; Heart Rate; Humans; Isomerism; Male; Metoprolol; Nicardipine; Phenotype
PubMed: 12959269
DOI: 10.1111/j.1365-2125.1993.tb00411.x -
AAPS PharmSciTech Jun 2000This study evaluated the effects of batch size on the in vitro dissolution and the in vivo bioavailability of immediate release formulations of propranolol hydrochloride... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
This study evaluated the effects of batch size on the in vitro dissolution and the in vivo bioavailability of immediate release formulations of propranolol hydrochloride and metoprolol tartrate. The formulations were manufactured as small and large batches (6 kg and 60 kg for propranolol; 14 kg and 66 kg for metoprolol), and dissolution was performed using USP Apparatus I at 100 rpm and pH 1.2. Two panels of 14 subjects each were randomly assigned to receive the small and large batches of either propranolol or metoprolol in an open, randomized single-dose study. Blood samples were collected over a 24-hour (propranolol) or 18-hour (metoprolol) period and analyzed by validated methods. As determined by the f2 metric (similarity factor), the dissolution of the small and large batches of propranolol and metoprolol was similar. The mean Cmax and AUC(inf) for the small batch of propranolol were 79.0 microg/L and 536 microg/L/hr, and for the large batch they were 83.5 microg/L and 575 microg/L/hr. Cmax and AUC(inf) for the small batch of metoprolol were found to be 95.5 microg/L and 507 microg/L/hr and for the large batch, 95.1 microg/L and 495 microg/L/hr. The 90% confidence intervals for the small and large batches were within the 80% to 120% range for lnCmax, and lnAUC(inf) for both the propranolol and metoprolol formulations. These results suggest that the scale-up process does not significantly affect the bioavailability of highly soluble, highly permeable drugs and in vitro dissolution tests may be useful in predicting in vivo behavior.
Topics: Adult; Biological Availability; Chemistry, Pharmaceutical; Cross-Over Studies; Delayed-Action Preparations; Drug Compounding; Fasting; Female; Humans; Male; Metoprolol; Propranolol; Solubility; Tablets; Therapeutic Equivalency; Weights and Measures
PubMed: 14727847
DOI: 10.1208/pt010214