Lopressor QD vs. BID question?

[GreyFox2002]

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I see a lot of metoprolol tartrate QD, not BID, while interning. My pharmacist and I have both noticed it. I actually asked my cardiology professor about it, and she got a disgusted look on her face and said "thats just unacceptable."

What do you guys think? Do you see this a lot, and you to ever try to switch? Would physicians have reasoning to do Lopressor QD? Or do you they confuse Lopressor and/or generic equivalent with Toprol XL? If so, I'd like to start "educating" physicians on this.

Thanks for your input!

 

[prevacid]

its simple, its a lack of understanding on the PCP

 

[AminoAcid777]

You know, I have thought about that myself. I figure it maybe due to the alterations in blood pressure. A patient maybe hypertensive in the daytime and normotensive at night time and vice versa. Perhaps the once a day dosing is to target a certain time range, as well as to avoid fatigue, drowsiness, and other CNS symptoms that can occur with metoprolol as it penetrates the blood brain barrier.

 

[Old Timer]

its simple, its a lack of understanding on the PCP

Are you sure?

The usual initial dosage is 100 mg daily in single or divided doses, whether used alone or added to a diuretic. The dosage may be increased at weekly (or longer) intervals until optimum blood pressure reduction is achieved. In general, the maximum effect of any given dosage level will be apparent after 1 week of therapy. The effective dosage range is 100- 450 mg per day. Dosages above 450 mg per day have not been studied. While once-daily dosing is effective and can maintain a reduction in blood pressure throughout the day, lower doses (especially 100 mg) may not maintain a full effect at the end of the 24-hour period, and larger or more frequent daily doses may be required. This can be evaluated by measuring blood pressure near the end of the dosing interval to determine whether satisfactory control is being maintained throughout the day. beta1 selectivity diminishes as the dose of Lopressor is increased.

The Lopressor Package Insert

So the real question the clinical pharmacist should be asking is what is the diagnosis? When do you take the drug? When does the doctor check your BP? Do you monitor your BP at home? Do you always check it at the same time each day?

 

[WVUPharm2007]

lol...the elder sage with the 0wn4ge.

 

[StaviZFingerZ]

I actually asked my cardiology professor about it, and she got a disgusted look on her face and said "thats just unacceptable."


Thanks for your input!

Here is my input. Your professor is an idiot. Another academia nonsense. Ask her what she's done to control the use of dexmedetomidine in CABG at your hospital.

 

[prevacid]

Are you sure?

The Lopressor Package Insert

So the real question the clinical pharmacist should be asking is what is the diagnosis? When do you take the drug? When does the doctor check your BP? Do you monitor your BP at home? Do you always check it at the same time each day?

yes im sure, my only real interaction with lopressor was a bout 4 months ago when toprol xl went on long term back order, so we had to switch every1 to the lopressor....if some1 was on toprol xl 25 or 50 q day, they were switched lopressor 25 or 50 q day...then in the next 3 months or so, all those patients came back with new rx for lopressor 25 bid or lopressor 50 bid

so yea, Im in the rust belt, most docs here are hacks, i stick with my original statement

+ beta blockers are really overrated for use in htn, leave tat for another day

 

[Old Timer]

yes im sure, my only real interaction with lopressor was a bout 4 months ago when toprol xl went on long term back order, so we had to switch every1 to the lopressor....if some1 was on toprol xl 25 or 50 q day, they were switched lopressor 25 or 50 q day...then in the next 3 months or so, all those patients came back with new rx for lopressor 25 bid or lopressor 50 bid

so yea, Im in the rust belt, most docs here are hacks, i stick with my original statement

+ beta blockers are really overrated for use in htn, leave tat for another day

Just admit you are wrong. It is appropriate and may be beneficial due to increased compliance to dose Metoprolol tartratre once daily in patients with hypertension. Those docs may be hacks, but they appear to know more than you.

Now without the diagnosis you have no evidence to back up your claims. Pharmacy is an evidence based profession. You may be correct in that the majority of practitioners in your area are hacks, however you lack evidence to back up your claims.

 

[prevacid]

Just admit you are wrong. It is appropriate and may be beneficial due to increased compliance to dose Metoprolol tartratre once daily in patients with hypertension. Those docs may be hacks, but they appear to know more than you.

Now without the diagnosis you have no evidence to back up your claims. Pharmacy is an evidence based profession. You may be correct in that the majority of practitioners in your area are hacks, however you lack evidence to back up your claims.

admit im wrong, lol that just goes to show youre on a power trip 🙄

i didnt say anything that is blatantly wrong...the conversion table i use as a guide when i called the md office is the one i got from the local hospital pharmacy memo they sent out to their rph for their inpt toprol xl to lopressor switch (and it goes along line of previous post, basically watever xl dose is, cut in 1/2 and make it bid)...so using tat as a guide for suggestions, i feel fairly confident in the recs i made...geez, no need to make a big deal out of nothing

 

[Praziquantel86]

i didnt say anything that is blatantly wrong...the conversion table i use as a guide when i called the md office is the one i got from the local hospital pharmacy memo they sent out to their rph for their inpt toprol xl to lopressor switch (and it goes along line of previous post, basically watever xl dose is, cut in 1/2 and make it bid)...so using tat as a guide for suggestions, i feel fairly confident in the recs i made...geez, no need to make a big deal out of nothing

The guide you used is correct - for conversion of extended-release to regular. There are, however, scenarios when a single daily dose of IR would be appropriate.

Many, if not most, patients receiving metoprolol for blood pressure control will require multiple daily doses. But, like any rule, there are exceptions.

 

[AminoAcid777]

yes im sure, my only real interaction with lopressor was a bout 4 months ago when toprol xl went on long term back order, so we had to switch every1 to the lopressor....if some1 was on toprol xl 25 or 50 q day, they were switched lopressor 25 or 50 q day...then in the next 3 months or so, all those patients came back with new rx for lopressor 25 bid or lopressor 50 bid

so yea, Im in the rust belt, most docs here are hacks, i stick with my original statement

+ beta blockers are really overrated for use in htn, leave tat for another day

Metoprolol is not just used for HTN, it is first line for angina...

 

[prevacid]

Metoprolol is not just used for HTN, it is first line for angina...

yes i know, its the DOC for angina with htn...geez guess where that ? showed up for me🙂

i know it has uses in htn, angina, migraines, a fib, even chf, and some others

 

[Old Timer]

What power do I get? You miss the point. You have to have evidence to back up your recommendations or you are acting like the hack PCP's where you practice.

 

[AminoAcid777]

Well said...

 

[kvl1027]

What power do I get? You miss the point. You have to have evidence to back up your recommendations or you are acting like the hack PCP's where you practice.

I agree with Old Timer here.

Prevacid: Old Timer is not stating that you are wrong in your recommendation, only that you are wrong to state that someone else is wrong. If you can provide some kind of literature that says there is no benefit in using QD IR metoprolol for medical management of any condition whatsoever, then you would be grounded in your response. I have a feeling you will have a hard time finding such literature. In order to criticize someone's therapeutic recommendation you need to know why they are using that regimen. Without an indication it is hard to pass judgement.