QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tangeman, H. J Articles by Patterson, J H. Search for Related Content PubMed PubMed Citation Articles by Tangeman, H. J Articles by Patterson, J H.

CARDIOLOGY

Extended-Release Metoprolol Succinate in Chronic Heart Failure

Cardiovascular Specialty Resident, School of Pharmacy, University of North Carolina, Chapel Hill, NC; now, Medical Information Scientist, Glaxo-SmithKline, Research Triangle Park, NC

J Herbert Patterson, PharmD FCCP BCPS

Associate Professor of Pharmacy and Research Associate Professor of Medicine, School of Pharmacy, University of North Carolina

Reprints: J Herbert Patterson PharmD FCCP BCPS, School of Pharmacy, University of North Carolina, CB #7360 Beard Hall, Chapel Hill, NC 27599-7360, FAX 919/962-0644, E-mail hpatterson{at}unc.edu

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and tolerability of extended-release (ER) metoprolol succinate and its role in the management of chronic heart failure.

DATA SOURCES: A MEDLINE search of English-language literature (1990–October 2002) was conducted using congestive heart failure and metoprolol CR/XL or metoprolol CR/ZOK as search terms to identify pertinent studies.

STUDY SELECTION/DATA EXTRACTION: All of the articles identified from the data sources were evaluated, with priority given to randomized, double-blind, placebo-controlled studies.

DATA SYNTHESIS: ER metoprolol succinate is a controlled-release tablet designed to produce even and consistent ß₁-blockade throughout the 24-hour dosing interval, with less fluctuation in metoprolol plasma concentrations compared with immediate-release metoprolol. Three randomized, double-blind, placebo-controlled trials have evaluated the efficacy of ER metoprolol succinate in the treatment of patients with chronic heart failure. The MERIT-HF (Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure) study, the largest of these trials and the largest randomized mortality trial with ß-blockers in heart failure to date, demonstrated that ER metoprolol succinate reduced the relative risk of all-cause mortality by 34% versus placebo. Furthermore, the relative risk of the combined endpoint of mortality plus all-cause hospitalizations was reduced by 19% and sudden death was reduced by 41%. The benefits of therapy were evident in various patient subgroups, including elderly patients and those with diabetes mellitus. ER metoprolol succinate was generally well tolerated, with a similar proportion of patients discontinuing therapy due to adverse events relative to placebo (9.8% and 11.7%, respectively).

CONCLUSIONS: ER metoprolol succinate therapy provides substantial mortality and morbidity benefits in patients with New York Heart Association class II and III heart failure who are stabilized on angiotensin-converting enzyme inhibitors and diuretics. ER metoprolol succinate is administered once daily, is well tolerated, and provides consistent ß₁-blockade over the 24-hour dosing interval.

Key Words: congestive heart failure, extended-release metoprolol succinate, MERIT-HF

Published Online, April 2, 2003. www.theannals.com, DOI 10.1345/aph.1C286

This article has been cited by other articles:

				J. L. Bauman and R. L. Talbert Pharmacodynamics of{beta}-Blockers in Heart Failure: Lessons from the Carvedilol Or Metoprolol European Trial Journal of Cardiovascular Pharmacology and Therapeutics, April 1, 2004; 9(2): 117 - 128. [Abstract] [PDF]