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Background: Beta-blockers are widely used, with continuously updated clinical recommendations. However, their application faces challenges in personalized treatment and safety. The study aimed to investigate the frequency and patterns of prescribing beta-blockers in China and to explore potential adverse event risk signals associated with beta-blockers, providing reference for rational medication use in clinical settings. Methods: Prescription data for beta-blockers from January 2018 to June 2023 were extracted through the Hospital Prescription Analysis Collaborative Project in China to analyze clinical usage trends. While adverse drug reaction reports for beta-blockers were obtained from the FDA Adverse Event Reporting System (FAERS) database. The classification and standardization of adverse drug event (ADE) reports were based on the preferred terms (PT) and corresponding system organ classes (SOC) from the Medical Dictionary for Regulatory Activities (MedDRA). Signal detection utilized a proportion imbalance method. Results: In clinical practice, metoprolol dominated beta-blocker prescriptions in China, accounting for 62.2%. Beta-blockers were primarily prescribed to the elderly (65.7%) and male patients (57.0%). However, off-label use of beta-blockers was relatively widespread. For instance, sotalol was prescribed for hypertension at 18.25%, while esmolol was used for angina and heart failure at rates of 12.94% and 14.98%, respectively. In addition, we identified newly discovered adverse reactions associated with beta-blockers, such as BRASH syndrome (metoprolol: n = 186, ROR = 391.285; carvedilol: n = 72, ROR = 256.459), acute kidney injury (bisoprolol: n = 247, ROR = 5.641), premature baby (labetalol: n = 110, ROR = 91.385), and sleep disorder (propranolol: n = 254, ROR = 10.98). Conclusions: Metoprolol led the beta-blocker market in China. Attention was warranted regarding the newly discovered adverse reactions, such as the risk of acute kidney injury with bisoprolol and the potential for BRASH syndrome with metoprolol and carvedilol. [ABSTRACT FROM AUTHOR]

Background: Metoprolol is commonly administered to critically ill patients; however, its effect on mortality in patients with sepsis-induced cardiomyopathy (SICM) remains uncertain. This study aimed to investigate the relationship between metoprolol use and mortality in patients with SICM. Methods: Adults with SICM were identified from the MIMIC-IV database. The exposure of interest was metoprolol treatment. The outcomes assessed were 30-day mortality, 1-year mortality, and in-hospital mortality. Kaplan–Meier survival analysis evaluated the effect of metoprolol on these outcomes. Multivariable Cox proportional hazards and logistic regression analyses were performed to determine the correlation between metoprolol treatment and mortality in patients with SICM. Results: 1163 patients with SICM were identified, with 882 receiving metoprolol treatment (MET group) and 281 not receiving metoprolol treatment (NOMET group). Overall, the 30-day, 1-year, and in-hospital mortality rates were 10.2%, 18.2%, and 8.9%, respectively. Significant differences in mortality existed between the groups. Multivariable Cox analysis revealed that patients in the NOMET group had a higher risk of 1-year mortality (adjusted hazard ratio [HR] 2.493; 95% confidence interval [CI] 1.800–3.451; P < 0.001) and 30-day mortality (adjusted HR 4.280; 95%CI 2.760–6.637; P < 0.001). Metoprolol treatment was associated with lower in-hospital mortality (odds ratio [OR] 5.076; 95% CI 2.848–9.047; P < 0.001). Subgroup analysis supported these findings. Conclusion: Metoprolol treatment is associated with reduced all-cause mortality in patients with SICM. Prospective studies are required to validate these findings. [ABSTRACT FROM AUTHOR]

Background: Although beta blockers, such as metoprolol, have been widely used in the management of vasovagal syncope (VVS), their efficacy remains debated, with larger studies showing limited benefit. Identifying patient-specific characteristics that predict a positive response to metoprolol could optimize its use. This study aims to investigate the key factors that may determine which VVS patients are suitable candidates for metoprolol treatment. Methods: This retrospective study was conducted at a single center. Patients diagnosed with VVS and treated with metoprolol for a minimum of three months were included. A 50% reduction in syncope symptom score (SS) after three months of metoprolol treatment was used to define metoprolol responders, while those who did not achieve this reduction were classified as non-responders. After a three-month follow-up, patients were divided into two groups: responders and non-responders. Baseline data—including age, gender, comorbidities, laboratory tests, and the type of VVS—were analyzed for each patient. Changes in heart rate (HR) and blood pressure during the head-up tilt test (HUTT) were also evaluated between the two groups. Logistic regression analysis was performed to identify potential predictors of metoprolol response, and receiver operating characteristic (ROC) curve analysis was used to assess the value of these predictors in selecting potential responders. Results: A total of 168 VVS patients were enrolled between January 2016 and December 2020. Of these, 100 patients responded positively to metoprolol, while 68 did not. No significant differences in baseline characteristics or HUTT results were observed between the two groups (p > 0.05). However, responders exhibited a significantly higher peak HR compared to non-responders during the HUTT (120.13 ± 19.33 vs. 106.60 ± 22.32, p < 0.001). The increase in HR was also more pronounced in responders (0.60 ± 0.23 vs. 0.41 ± 0.25, p < 0.001). Additionally, HR variability was significantly greater in responders than in non-responders (16.18 ± 5.51 vs. 12.61 ± 5.50, p < 0.001). Conclusion: Higher peak HR, larger increases in HR, and greater HR variability during the HUTT may serve as reliable predictors of a positive response to metoprolol in patients with VVS. [ABSTRACT FROM AUTHOR]

Background: Functional endoscopic sinus surgery (FESS) is one of the most performed surgical procedures and requires minimal bleeding during the procedure. The success of surgeries is largely dependent on the surgical field, where the presence of significant bleeding is an important factor. Aims and Objectives: The objectives of this study were to evaluate the clinical efficacy of oral clonidine and metoprolol following their pre-medication for induced hypotension during FESS and to assess hemodynamic stability, surgical field quality, and sedation score. Materials and Methods: This is an observational hospital-based study conducted on 60 patients, aged 18-60 years old for FESS assigned by randomization method in two groups including clonidine or metoprolol. Heart rate (HR) and arterial blood pressure are measured after induction, during and end of the surgery. Assessment of bleeding was done by a surgeon who was blinded. Surgical field quality, satisfaction level of the surgeon, Aldrete score, and any side effects were observed. Results: There was no significant difference seen in HR in patients of Group C and Group M in the pre-operative period, after loading the dose of the drug, at extubation (P>0.05). A significant difference was seen in HR with lower mean values in Group C compared to Group M after induction (77.23±12.23), 10 min after induction (69.47±11.99), 20 min after induction (65.63±8.66), 30 min after induction (64±8.32), 40 min after induction (63.77±7.61), and 60 min after induction (63.63±7.89). A significant difference was seen in blood pressure, after loading the dose of the drug, after induction, during surgery monitored every 10 min, at extubation, after extubation monitored every hour for 6 h. Quality of surgical field and surgeon's satisfaction was better in patients who received clonidine than in those who received metoprolol. Conclusion: Both clonidine and metoprolol can be effectively used for induced hypotension in FESS. Clonidine is better than metoprolol with respect to intraoperative hemodynamics, quality of the surgical field, and surgeon's satisfaction with the added advantage of sedation, reduced analgesia requirement, and other anesthetic drugs. [ABSTRACT FROM AUTHOR]

Background: Otosclerosis is one of the most frequent causes of conductive hearing loss in adults. Surgical treatment is considered to be the gold standard for this disease. Endoscopic stapedectomy is a new approach for the treatment of otosclerosis that requires a bloodless field. Aim of the Study: To determine whether the routine use of β blockers as a premedication can improve the operative field in endoscopic stapedectomy or not. Patients and Methods: Sixty patients aged from 18 to 50 years, undergoing endoscopic stapedectomy, were included in this prospective, randomized, double blinded, placebo-controlled study. Patients were randomly assigned to receive either metoprolol 100 mg (group 1) or a placebo, vitamin tablet, (group 2) 60 min before surgery. Results: The age, gender, body weight and ASA physical status were comparable between the two groups. The average blood loss in the placebo group was significantly greater than in the metoprolol group, but the time of operation in the metoprolol group was not significantly shorter. The surgical field was assessed using the Fromme-Boezaart scale, and those who received metoprolol had considerably cleaner (p0.001) surgical fields. The mean arterial pressure (MAP) didn't differ statistically significant at basal measurement up to 30 min after anesthesia induction while it was significantly lower in the metoprolol group after 30 min of induction up to end of surgery (p < 0.001). The heart rate was also significantly lower (p < 0.001) in patients who received metoprolol from prior to anesthesia induction up to end of surgery. Conclusion: metoprolol significantly improves visual clarity and hemodynamics during endoscopic stapedectomy. [ABSTRACT FROM AUTHOR]

Metoprolol is a cardioselective beta-blocker drug often used to treat hypertension, but it is considered as a hazardous organic persistent contaminant in wastewater. In this study, a 2.5 L solution of metoprolol (50 mg/L) underwent electro-oxidation in a flow-by reactor using boron-doped diamond electrodes in the batch recirculation mode. The study used multi-objective optimization and multi-criterion decision-making to determine the optimal operating parameters. The response surface methodology and a central composite rotatable design were used with three factors (pH0: 5–8, I: 2.5–4 A, and Q: 0.8–1.7 L/min) to model the chemical oxygen demand's (COD's) removal efficiency and the total organic carbon's (TOC's) removal efficiency. The experimental responses were modeled by reduced third- and second-order polynomials with determination coefficients (R2) of 0.9816 and 0.9430. The optimal operating parameters were found to be pH0 5, an I value of 3.84 A, and a Q value of 0.8 L/min with an electrolysis time of 7.5 h, resulting in a maximum COD removal efficiency of 60.8% and a TOC removal efficiency of 90.1%. The specific energy consumption was calculated as 9.61 kWh/mg of TOC, with a total operating cost of 0.77 USD/L. In conclusion, this study showed that the electrochemical process is efficient and reliable for treating wastewater containing metoprolol. [ABSTRACT FROM AUTHOR]

Background: Patients who present to the emergency department (ED) with severe hypertension defined as a systolic blood pressure (SBP) ≥180 millimeters of mercury (mm Hg) or diastolic (DBP) ≥120 (mm Hg) without evidence of acute end-organ damage are often deemed high risk and treated acutely in the ED. However, there is a dearth of evidence from large studies with long-term follow-up for the assessment of major adverse cardiovascular events (MACE). We conducted the largest study to date of patients presenting with severe hypertension to identify predictors of MACE and examine whether blood pressure at discharge is associated with heightened risk. Methods: We enrolled ED patients with a SBP of 180–220 mm Hg but without signs of end-organ damage and followed them for one year. The primary outcome was MACE within one year of discharge. Secondarily, we performed a propensity-matched analysis to test whether SBP ≤160 mm Hg at discharge was associated with reduced MACE at 30 days. Results: A total of 12,044 patients were enrolled. The prevalence of MACE within one year was 1,865 (15.5%). Older age, male gender, history of cardiovascular disease, cerebrovascular disease, diabetes, smoking, presentation with chest pain, altered mental status, dyspnea, treatment with intravenous and oral hydralazine, and oral metoprolol were independent predictors for one-year MACE. Additionally, discharge with an SBP ≤160 mm Hg was not associated with 30-day MACE-free survival after propensity matching (hazard ratio 0.99, 95% confidence interval 0.78–1.25, P = 0.92). Conclusion: One-year MACE was relatively common in our cohort of ED patients with severe hypertension without acute end-organ damage. However, discharge blood pressure was not associated with 30-day or one-year MACE, suggesting that BP reduction in and of itself is not beneficial in such patients. [ABSTRACT FROM AUTHOR]

The biophysical properties of metoprolol are investigated by the full potential-linearized augmented plane wave method and molecular docking and molecular dynamic approaches. The exchange–correlation potentials are calculated by the Perdew–Burke–Ernzerhof generalized gradient approximation as implemented in the WIEN2k package. The electronic results show the insulator nature of metoprolol with the indirect bandgap of 3.74 eV between HOMO and LUMO states. In the density of state spectra, the p state of O, C, and N elements confirm the stability of metoprolol. Metoprolol exhibits a metallic behavior in the z direction, while it has a dielectric behavior in the x and y directions. The static refractive indices are obtained 1.49, 1.53, and 1.63 in the x, y, and z directions, respectively. It was found that the maximum reflectivity occurs at the ultraviolet region in the z-direction. The calculated absorption spectra also confirm the other's experimental results. The obtained results of molecular docking indicate the formation of hydrogen bonds between metoprolol and the beta-2 adrenergic receptors, and molecular dynamics showed a human beta-2 adrenoceptor either in its free state or in complex with a metoprolol molecule. The calculated binding energies of elements by molecular docking and the other biological properties of metoprolol by molecular dynamic are in close agreement with obtained Density Functional Theory (DFT) results for Pharmacia applications. [ABSTRACT FROM AUTHOR]

Abstract Background Metoprolol is commonly administered to critically ill patients; however, its effect on mortality in patients with sepsis-induced cardiomyopathy (SICM) remains uncertain. This study aimed to investigate the relationship between metoprolol use and mortality in patients with SICM. Methods Adults with SICM were identified from the MIMIC-IV database. The exposure of interest was metoprolol treatment. The outcomes assessed were 30-day mortality, 1-year mortality, and in-hospital mortality. Kaplan–Meier survival analysis evaluated the effect of metoprolol on these outcomes. Multivariable Cox proportional hazards and logistic regression analyses were performed to determine the correlation between metoprolol treatment and mortality in patients with SICM. Results 1163 patients with SICM were identified, with 882 receiving metoprolol treatment (MET group) and 281 not receiving metoprolol treatment (NOMET group). Overall, the 30-day, 1-year, and in-hospital mortality rates were 10.2%, 18.2%, and 8.9%, respectively. Significant differences in mortality existed between the groups. Multivariable Cox analysis revealed that patients in the NOMET group had a higher risk of 1-year mortality (adjusted hazard ratio [HR] 2.493; 95% confidence interval [CI] 1.800–3.451; P

Abstract Background Although beta blockers, such as metoprolol, have been widely used in the management of vasovagal syncope (VVS), their efficacy remains debated, with larger studies showing limited benefit. Identifying patient-specific characteristics that predict a positive response to metoprolol could optimize its use. This study aims to investigate the key factors that may determine which VVS patients are suitable candidates for metoprolol treatment. Methods This retrospective study was conducted at a single center. Patients diagnosed with VVS and treated with metoprolol for a minimum of three months were included. A 50% reduction in syncope symptom score (SS) after three months of metoprolol treatment was used to define metoprolol responders, while those who did not achieve this reduction were classified as non-responders. After a three-month follow-up, patients were divided into two groups: responders and non-responders. Baseline data—including age, gender, comorbidities, laboratory tests, and the type of VVS—were analyzed for each patient. Changes in heart rate (HR) and blood pressure during the head-up tilt test (HUTT) were also evaluated between the two groups. Logistic regression analysis was performed to identify potential predictors of metoprolol response, and receiver operating characteristic (ROC) curve analysis was used to assess the value of these predictors in selecting potential responders. Results A total of 168 VVS patients were enrolled between January 2016 and December 2020. Of these, 100 patients responded positively to metoprolol, while 68 did not. No significant differences in baseline characteristics or HUTT results were observed between the two groups (p > 0.05). However, responders exhibited a significantly higher peak HR compared to non-responders during the HUTT (120.13 ± 19.33 vs. 106.60 ± 22.32, p

Background: Functional endoscopic sinus surgery (FESS) is one of the most performed surgical procedures and requires minimal bleeding during the procedure. The success of surgeries is largely dependent on the surgical field, where the presence of significant bleeding is an important factor. Aims and Objectives: The objectives of this study were to evaluate the clinical efficacy of oral clonidine and metoprolol following their pre-medication for induced hypotension during FESS and to assess hemodynamic stability, surgical field quality, and sedation score. Materials and Methods: This is an observational hospital-based study conducted on 60 patients, aged 18–60 years old for FESS assigned by randomization method in two groups including clonidine or metoprolol. Heart rate (HR) and arterial blood pressure are measured after induction, during and end of the surgery. Assessment of bleeding was done by a surgeon who was blinded. Surgical field quality, satisfaction level of the surgeon, Aldrete score, and any side effects were observed. Results: There was no significant difference seen in HR in patients of Group C and Group M in the pre-operative period, after loading the dose of the drug, at extubation (P>0.05). A significant difference was seen in HR with lower mean values in Group C compared to Group M after induction (77.23±12.23), 10 min after induction (69.47±11.99), 20 min after induction (65.63±8.66), 30 min after induction (64±8.32), 40 min after induction (63.77±7.61), and 60 min after induction (63.63±7.89). A significant difference was seen in blood pressure, after loading the dose of the drug, after induction, during surgery monitored every 10 min, at extubation, after extubation monitored every hour for 6 h. Quality of surgical field and surgeon’s satisfaction was better in patients who received clonidine than in those who received metoprolol. Conclusion: Both clonidine and metoprolol can be effectively used for induced hypotension in FESS. Clonidine is better than metoprolol with respect to intraoperative hemodynamics, quality of the surgical field, and surgeon’s satisfaction with the added advantage of sedation, reduced analgesia requirement, and other anesthetic drugs.

Globally, cardio vascular diseases (CVD) remain the primary cause of morbidity and mortality. Pharmacogenomics (PGxs) has profoundly changed how various drug classes are managed in CVDs. For example, genetic polymorphisms in genes such as SLCO1B1 impact how a person responds to statins such as rosuvastatin and atorvastatin, where as the interindividual variability in the reaction to statins (Fluvastatin)used in lipid-lowering therapy can be partly explained by genetic variations in genes encoding drug-metabolizing enzymes such cytochrome P450 and transporters like OATP1B1. Similarly, in antiplatelet therapy, polymorphisms in CYP2C19 affect clopidogrel metabolism, influencing its efficacy in preventing thrombotic events. Genes such as CYP2C9 and VKORC1 are crucial for the metabolism and response to acenocoumarol and warfarin during anticoagulant therapy and monitoring bleeding risk. Genetic variations in CYP2D6 affect the metabolism and effectiveness of propafenone and metoprolol. Understanding the PGx presumptions of these cardiovascular drugs may help develop personalized treatment strategies that lower the possibility of adverse drug reactions, obtain desired therapeutic outcomes, and improve patient compliance and safety with respect to each patient’s unique genetic makeup.

Background: Concentrations of metoprolol in exhaled breath condensate (EBC) have not been investigated. Herein, we aim to determine the metoprolol levels in EBC, plasma, and urine samples. Methods: Biological samples were collected from 39 patients receiving metoprolol. Metoprolol was determined using liquid chromatography mass spectrometery. The obtained metoprolol levels in biological fluids were investigated for possible inter-correlations. Results: Acceptable linearity was obtained with coefficient of determinations equal to 0.9998, 0.9941, and 0.9963 for EBC, plasma, and urine samples, respectively. The calibration curves were linear in the ranges of 0.6–500, 0.4–500, and 0.7–10,000 µg·L− 1 regarding EBC, plasma, and urine samples, respectively. The detection and quantification limits were (0.18, 0.12, and 0.21 µg·L− 1) and (0.60, 0.40, and 0.70 µg·L− 1) for EBC, plasma, and urine samples, respectively. The relative standard deviations for the intra- and inter-day replications were obtained between 5.2 and 6.1 and 3.3–4.6%, respectively. The obtained mean metoprolol levels in EBC, plasma, and urine samples of 39 patients were 5.35, 70.76, and 1943.1 µg·L− 1. There were correlations between daily dose and plasma and urinary concentrations of metoprolol in the investigated samples, whereas no significant correlation was observed for daily dose and EBC levels. The correlation among plasma-urine levels was significant, however, the non-significant correlation was obtained between plasma and EBC concentrations. Conclusion: Metoprolol levels varied widely due to the metabolic pattern of the Azeri population, different dosages received by the patients, formulation effects, age, sex, and interactions with the co-administered drugs. A poor correlation of EBC-plasma concentrations and a significant correlation of plasma-urine concentrations were observed. Further investigations are required to provide the updated services to personalized medicine departments. [ABSTRACT FROM AUTHOR]

Acute intermitttent porphyria belongs to a rare group of diseases hallmarked by deficient biosynthesis of heme. It carries a significant symptom burden, both physical and emotional,and therefore palliative care has emerged as an essential tool in the armamentarium of porphyria management. It takes care of the patient as a whole and caters to all aspects that the disease process demands. There are many lacunae in the literature regarding the palliative management of porphyria. We are reporting a case of a 16-year-old female who presented with severe abdominal pain, lower backache and symmetrical bilateral lower limb pain to the palliative ward referred by the neurology department for supportive care. This case describes the palliative care aspects of porphyria management which was successfully provided in the palliative care unit right from referral till the last. A multidisciplinary palliative care team managed the patient, and the necessary interventions were provided to the patient and family. Palliative acre in AIP needs to be emphasized, and palliative care services need to be utilized in these cases. The unavailability of specific treatment measure, heme, in countries like India further emphasizes the need for long-term supportive care for the patient and family. The case shows the importance of palliative care throughout the disease course as it is a chronic disease with significant morbidity and carries a heavy symptom burden. This case provides the insight that rather than conventional management alone for such chronic diseases, palliative care should be incorportated. Early integration with palliative care helps in exploring all the domains of disease. This is one of the first cases reported highlighting palliative care in porphyria , bridging the gap in the literature. [ABSTRACT FROM AUTHOR]