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Pt is on digoxin for CHF and left ventricular dysfunction, on metoprolol for HTN and HTN is well controlled. I'm trying to dose metoprolol XL for chronic Afib but have a few questions:
1. Koda Kimble says that beta blockers are generally contraindicated in HF patients, but it seems as if the only real contraindication seems to be that if the patient is not already on a beta blocker, agressive dosing required for afib is not recommended because of the negative inonotropic effects. But if the patient is already on a sufficient dose of beta blocker - 100 mg qd, it should be ok, right because they will tolerate it fairly well ? Plus, it's a first line therapy for chronic afib.
2. What is the nature of beta blocker dosage adjustment for someone who is on digoxin ? Pt has no renal impairement.
Thank you in advance if you take the time.
1. Koda Kimble says that beta blockers are generally contraindicated in HF patients, but it seems as if the only real contraindication seems to be that if the patient is not already on a beta blocker, agressive dosing required for afib is not recommended because of the negative inonotropic effects. But if the patient is already on a sufficient dose of beta blocker - 100 mg qd, it should be ok, right because they will tolerate it fairly well ? Plus, it's a first line therapy for chronic afib.
2. What is the nature of beta blocker dosage adjustment for someone who is on digoxin ? Pt has no renal impairement.
Thank you in advance if you take the time.