메토프롤롤
Metoprolol
Metoprolol tartrate, Metoprolol succinate
다른 이름: Lopressor · Toprol XL · CGP-2175E · H-93/26
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| For rate control in chronic atrial fibrillation | 0.25-1 mg/kg PO q1224h. | PO | q1224h | — | 🌎 NA |
| For CHF (early/mild or well-controlled) | 0.2 mg/kg PO twice daily, with slow titration upwards every 2-3 weeks up to 0.4-6.6 mg/kg PO three times a day. | PO | BID to TID | — | 🌎 NA |
| To decrease the incidence of atrial fibrillation and flutter in dogs undergoing valve surgery | 0.4-1 mg/kg PO q24h | PO | q24h | — | 🌎 NA |
- For rate control in chronic atrial fibrillation: Note: 'q1224h' is transcribed exactly as it appears in the source text, likely a typo for q12-24h.
- For CHF (early/mild or well-controlled): Many dogs will not tolerate this upward titration.
- To decrease the incidence of atrial fibrillation and flutter in dogs undergoing valve surgery: Using sustained release metoprolol (ToprolXR) administered before and as soon as feasible after surgery.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| As an oral beta blocker | 2-15 mg (total dose) PO q8h | PO | q8h | — | 🌎 NA |
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
메토프롤롤(Metoprolol)은 심장 선택성(베타1-특이적) 아드레날린 수용체 차단제로, 수의학에서 다양한 심혈관계 질환 관리에 널리 사용됩니다.
주요 임상 적용 분야는 다음과 같습니다:
- 상심실성 빈맥 및 심실 조기 수축(PVCs/VPCs) 관리.
- 전신성 고혈압 치료.
- 고양이의 비대성 심근병증(HCM) 치료 (동적 좌심실 유출로 폐쇄를 줄이고 이완기 충만 시간을 개선하는 데 도움을 줌).
상대적인 베타1-선택성 때문에 기관지 수축성 질환(예: 고양이 천식)을 동반한 환자에서 비선택성 베타 차단제(예: 프로프라놀롤)보다 일반적으로 더 안전한 것으로 간주되지만, 고용량에서는 선택성이 소실될 수 있으므로 여전히 주의가 필요합니다.
작용 기전
Metoprolol competitively blocks beta1-adrenergic receptors located primarily in the myocardium.
Mechanism Pathway: Blockade of beta1-receptors → decreased activation of adenylyl cyclase → reduced intracellular cAMP → decreased intracellular calcium influx.
This results in:
- Negative chronotropy: Decreased sinus heart rate.
- Negative dromotropy: Slowed atrioventricular (AV) conduction.
- Negative inotropy: Decreased myocardial contractility and cardiac output.
- Decreased myocardial oxygen demand and reduced blood pressure.
Clinical Pearl: Metoprolol lacks intrinsic sympathomimetic activity (ISA) and membrane-stabilizing activity. At higher dosages, its cardioselectivity diminishes, leading to beta2-receptor blockade in bronchial smooth muscle → potential bronchoconstriction.
안전성·주의사항
금기사항
- Overt or unstable heart failure
- Hypersensitivity to beta-blockers
- Greater than first-degree heart block
- Sinus bradycardia
부작용
- Bradycardia
- Lethargy and depression
- Impaired AV conduction
- Congestive heart failure (CHF) or worsening of heart failure
- Hypotension
- Hypoglycemia
- Bronchoconstriction (at high doses)
- Syncope
- Diarrhea
주의
Withdrawal Warning: Do not abruptly discontinue metoprolol therapy in chronic users. Abrupt cessation can lead to rebound tachycardia and exacerbation of clinical signs; taper the dose gradually.
- Respiratory Disease: Use with caution in patients with bronchospastic lung disease, even though it is relatively beta1-selective.
- Hepatic Impairment: Use cautiously in patients with significant hepatic insufficiency due to extensive hepatic metabolism.
- Endocrine: Can mask clinical signs of hypoglycemia and thyrotoxicosis. Use cautiously in labile diabetic patients as it can cause hypoglycemia or hyperglycemia.
- Cardiac: Use cautiously in patients with sinus node dysfunction or compensated CHF.
약물 상호작용
Increased risk for heart failure and hypotension due to additive myocardial depressant effects.
Concurrent use should be done with caution; additive negative inotropic and chronotropic effects, particularly in patients with preexisting cardiomyopathy or CHF.
May increase negative effects on SA or AV node conduction.
May increase the hypotensive effect of metoprolol.
May increase the risks for pulmonary hypertension in uremic patients.
May increase metoprolol plasma concentrations.
Potential for additive effects including hypotension and bradycardia.
May increase metoprolol plasma concentrations.
May have their actions blocked by metoprolol, and they may in turn reduce the efficacy of the beta-blocker.
모니터링
- Cardiac function
- Pulse rate
- ECG (if necessary)
- Blood pressure (if indicated)
- Signs of toxicity (bradycardia, hypotension, lethargy)
약동학
반감기
흡수
Rapidly and nearly completely absorbed from the GI tract, but undergoes a high first-pass effect (50%), reducing systemic bioavailability.
분포
Very low protein binding (5-15%). Distributes well into most tissues. Crosses the blood-brain barrier (CSF levels are ~78% of serum levels). Crosses the placenta, and milk concentrations are 3-4 times higher than plasma.
대사
Primarily biotransformed in the liver.
배설
Unchanged drug and metabolites are principally excreted in the urine.
과다투여
Overdosage primarily results in extensions of the drug's pharmacologic effects: hypotension, bradycardia, bronchospasm, cardiac failure, and potentially hypoglycemia.
Treatment:
- Decontamination: If recent oral ingestion, consider emptying the gut and administering activated charcoal. Caution: Inducing emesis can be risky as coma and seizures may develop rapidly.
- Monitoring: Continuous ECG, blood pressure, blood glucose, and potassium.
- Cardiovascular Support: Treat symptomatically. Use IV fluids and pressor agents for hypotension.
- Bradycardia: Treat with atropine. If atropine fails, isoproterenol may be given cautiously. A transvenous pacemaker may be necessary.
- Cardiac Failure: May be treated with digitalis glycosides, diuretics, and oxygen.
- Antidote: Glucagon (5-10 mg IV - human dose) may increase heart rate and blood pressure and reduce the cardiodepressant effects of metoprolol.
제품
제형
- Oral tablets (tartrate)
- Extended-release oral tablets (succinate)
- Injection (tartrate)
- Compounded oral suspension
인용의약품
- Metoprolol Tartrate Oral Tablets: 25 mg, 50 mg & 100 mg (Lopressor, generic)
- Metoprolol Succinate Extended-Release Tablets: 25 mg, 50 mg, 100 mg & 200 mg (Toprol XL, generic)
- Metoprolol Tartrate Injection: 1 mg/mL in 5 mL amps and Carpuject sterile cartridge units (Lopressor, generic)
규제 현황
규제 데이터 없음: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store all products protected from light. Store tablets in tight, light-resistant containers at room temperature. Avoid freezing the injection. Compounded oral suspensions (10 mg/mL) retain >95% potency for 60 days when stored at 4°C or 25°C and protected from light.
보호자 정보
반려동물 보호자를 위한 중요 정보
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