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Pharmacy and Medications

Metoprolol Use in Patients with Asthma

11/28/2011

Question:

I am a 50 year old male with tachycardia and high blood pressure.  I have left dome elevation which occssionally causes shortness of breath.  I have MILD RRESTRICTION/OBSTRUCTION on my pulmonary function tests. Can metoprolol be prescribed to patient with mild asthma?

Answer:

Two types of beta blockers are currently available. These are non-selective and the relatively cardio-selective beta blockers.

Non-selective beta blockers block all beta receptors regardless of the type. The non-selective beta blockers commonly cause wheezing and other breathing difficulties in patients with asthma and other restrictive lung diseases.

The cardio-selective beta blockers work primarily on the heart and have very little effect on the airways. This is why we call them selective.

However, this selectivity is not absolute and patients with lung disease taking 100mg of metoprolol or more per day may develop breathing problems including wheezing and shortness of breath.

Low dose metoprolol may be used cautiously in patients with lung diseases if they have not tolerated or did not respond well to other medicines for tachycardia and increased blood pressure.

Other cardio-selective beta blockers include: atenolol, esmolol, bisoprolol, nebivolol and acebutolol. Most clinicians try to stay away from all beta blockers in patients with restrictive or obstructive lung disease.

However, if other medicines do not work well or cause undue side effects, low dose metoprolol might be a reasonable choice for you. You could experience increased lung problems even at low doses with metoprolol.

If you need higher doses to control your blood pressure and heart rate, you will need to watch for worsening wheezing and shortness of breath.

Your doctor is in the best position to determine which medicine is best for you. Continue to work with your physician to develop a treatment plan that works well for you.

This response was prepared in part by Jared Timmons, a PharmD candidate at the University of Cincinnati College of Pharmacy.

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Response by:

Robert James Goetz, PharmD, DABAT
Assistant Professor of Pharmacy Practice
College of Medicine
University of Cincinnati