WebMD provides common contraindications for Metoprolol Succinate Oral. Br J Clin Pract 40 Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Metoprolol Succinate ER is used to treat angina (chest pain) and hypertension (high blood pressure). In general, the dosage required to achieve therapeutic blood concentrations in such patients may be higher than that required in euthyroid patients and should be individualized. Clipboard, Search History, and several other advanced features are temporarily unavailable. Close monitoring is recommended during and after therapy withdrawal. Moderate Potential Hazard, Moderate plausibility. Lederle Laboratories, Wayne, NJ. "Product Information. Crean PA, Williams DO "Effect of intravenous and oral acebutolol in patients with bundle branch block." Therapeutic implications." N Engl J Med 293 J Clin Pharmacol 27 Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to exacerbate these conditions. Therapy with beta-blockers should be administered cautiously in patients with diabetes or predisposed to spontaneous hypoglycemia. Bausch and Lomb, Tampa, FL. (1997): 955-9, Velde TM, Kaiser FE "Ophthalmic timolol treatment causing altered hypoglycemic response in a diabetic patient." Cardiology 82 Suppl 3 Metoprolol succinate ER is a long-acting, once daily form of metoprolol 7. (1998): 1184-91, Australia-New Zealand Heart Failure Research Collaborative Group. The release date on the recall is Dec. 8, 2008. Because of the relative beta-1 selectivity, cardioselective beta-blockers may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Moderate Potential Hazard, Moderate plausibility. The primary endpoint wasmedian time until a COPD exacerbation. I went to the doctor yesterday and he took me off the Metoprolol and put me on 100 mg of Losartan. Highly clinically significant. Acta Med Scand 215 J Cardiovasc Pharmacol 18 Suppl 4 Lainscak M, Podbregar M, Kovacic D, Rozman J, von Haehling S. Respir Med. We comply with the HONcode standard for trustworthy health information -, Drug class: cardioselective beta blockers. Metoprolol Succinate Extended Release/Hydrochlorothiazide is indicated for the treatment of … Lancet 347 A double-blind comparison of metoprolol and xamoterol: echocardiographic results from the Metoprolol and..." Eur Heart J 17 Applies to: Peripheral Arterial Disease. The frequency and/or severity of attacks may be increased during beta-blocker therapy. To fill this gap in knowledge, this study aims to compare the survival and the risk of heart failure, chronic obstructive pulmonary disease, diabetes mellitus, hypoglycemia, and renal failure hospitalizations in geriatric patients with heart failure, chronic obstructive pulmonary disease, and diabetes mellitus exposed to carvedilol or metoprolol. Eur J Clin Pharmacol 26 Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to further depress cardiac output and blood pressure, which can be detrimental in these patients. Metoprolol is used to treat angina (chest pain) and hypertension (high blood pressure). Pulmonary embolism is found among people who take Metoprolol succinate, especially for people who are female, 60+ old, have been taking the drug for 1 - 6 months. 10-12 Notably, metoprolol succinate and bisoprolol lose their cardio-selectivity in doses over 100 mg and 20 mg, respectively. (1996): 2793-9, Macdonald PS, Keogh AM, Aboyoun CL, Lund M, Amor R, McCaffrey DJ "Tolerability and efficacy of carvedilol in patients with New York Heart Association class IV heart failure." Major Potential Hazard, High plausibility. (1996): 1318, Bristow MR, Gilbert EM, Abraham WT, et al. Patients with bronchospastic disease, should, in general, not receive beta blockers, including cardioselective beta-blockers. (1996): 1310-20, Adams KF Jr "Current perspectives on B-receptor antagonists in the treatment of symptomatic ventricular dysfunction." (1999): 924-31, CIBIS-II Investigators and Committees. (1987): s63-4, Rossner S, Weiner L "Atenolol and metoprolol: comparison of effects on blood pressure and serum lipoproteins, and side effects." (1986): 33-4. Glaxo Wellcome, Research Triangle Park, NC. (1994): 1774-80, Phillips KA, Shlipak MG, Coxson P, et al. "Health and economic benefits of increased B-blocker use following myocardial infarction." Ann Ophthalmol 17 (1985): 211-2, Berstein LP, Henkind P "Additional information on adverse reactions to timolol." Switching from beta1-selective beta-blockers to carvedilol causes short-term reduction of central augmented pressure and N-terminal pro-hormone brain natriuretic peptide. (1986): 119-26, Mashford ML, Coventry D, Hecker R, et al. Blurred vision 2. chest pain or discomfort 3. confusion 4. dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position 5. slow or irregular heartbeat 6. sweating 7. unusual tiredness or weakness Beta-blocker choice and exchangeability in patients with heart failure and chronic obstructive pulmonary disease: an Italian register-based cohort study. Wyeth-Ayerst Laboratories, Philadelphia, PA. Kholeif M, Isles C "Profound hypotension after atenolol in severe hypertension." eCollection 2017. The name brand is Lopressor as mentioned in the above post. It is freely soluble in water; soluble in methanol; sparingly soluble in ethanol; slightly soluble in dichloromethane and 2-propanol; practically insoluble in ethyl-acetate, acetone, diethylether and heptane. In pts with CAD on BB, ie., metoprolol, with newly diagnosed severe COPD, what is the appropriate recommendation for BB therapy.Should patient be tapered and switched to diltiazem/verapamil or continued? Select one or more newsletters to continue. Subjects received each beta-blocker, dose-matched, for 6 weeks before resuming their original beta-blocker. "Product Information. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. Comparison of Long-Term Clinical Implications of Beta-Blockade in Patients With Obstructive Airway Diseases Exposed to Beta-Blockers With Different β1-Adrenoreceptor Selectivity: An Italian Population-Based Cohort Study. Sandoz Pharmaceuticals Corporation, East Hanover, NJ. 1. "Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF)." New York, NY: McGraw-Hill Health Professionals Division Caution should be taken in the administration of these agents to patients suspected of having pheochromocytoma.  |  Circulation 94 Brevibloc (esmolol)." This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. (1996): 1318-20, Hart SM "Influence of B-blockers on mortality in chronic heart failure." Metoprolol succinate (Toprol-XL) belongs to a group of drugs called beta-blockers 2 3 7. Allergan Inc, Irvine, CA. (1996): 69-77, Krum H, Sackner-Bernstein JD, Goldsmith RL, et al. In patients with pheochromocytoma, an alpha-blocking agent should be initiated prior to the use of any beta-blocking agent. Bristol-Myers Squibb, Princeton, NJ. (1993): 1188-95, Holti G "A double-blind study of the peripheral vasoconstrictor effects of the beta-blocking drug penbutolol in patients with Raynaud's phenomenon." (1987): 345-64, Herishanu Y, Rosenberg P "Beta-blockers and myasthenia gravis." Applies to: Diabetes Mellitus. Moderate Potential Hazard, Moderate plausibility. "Product Information. (2000): 2748-54, Michelson EL, Frishman WH, Lewis JE, et al "Multicenter clinical evaluation of long-term efficacy and safety of labetalol in treatment of hypertension." To minimize this risk, cessation of beta-blocker therapy, when necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks.  |  Beta-adrenergic blockade in patients with Wolff-Parkinson-White syndrome and tachycardia has been associated with severe bradycardia requiring treatment with a pacemaker. Cartrol (carteolol)." Eur J Clin Pharmacol 30 Acta Med Scand 677 Therapy with metoprolol should be administered cautiously in patients with liver disease. Inderal (propranolol)." (1987): 475-80, Leren P, Foss PO, Nordvik B, Fossbakk B "The effect of enalapril and timolol on blood lipids." N Engl J Med 339 While we encourage individuals to share their personal experiences with COPD, please consult a physician before making changes to your own COPD management plan. Mechanism of Action: Metoprolol Tartrate is a beta1-selective (cardioselective) adrenergic receptor blocker. (1975): 834-5, Confavreux C, Charles N, Aimard G "Fulminant myasthenia gravis soon after initiation of acebutolol therapy." Apparently the product in question is Metoprolol Succinate ER. Br J Clin Pharmacol 24 Sessa M, Mascolo A, Scavone C, Perone I, Di Giorgio A, Tari M, Fucile A, De Angelis A, Rasmussen DB, Jensen MT, Kragholm K, Rossi F, Capuano A, Sportiello L. Front Pharmacol. However, therapy with beta-blockers may be beneficial and can be administered cautiously in some CHF patients provided they are well compensated and receiving digitalis, diuretics, an ACE inhibitor, and/or nitrates. There are 477 drug interactions with Metoprolol Succinate ER (metoprolol), There are 4 alcohol/food interactions with Metoprolol Succinate ER (metoprolol). "Effects of carvedilol, a vasodilator-B-blocker, in patients with congestive heart failure due to ischemic heart disease." ICN Pharmaceuticals Inc, Cost Mesa, CA. Circulation 90 The use of beta-adrenergic receptor blocking agents (aka beta-blockers) in patients with a history of allergic reactions or anaphylaxis may be associated with heightened reactivity to culprit allergens. Acta Med Scand 700 There are no known differences here between carvedilol and metoprolol, and more research is needed to see which one is better at protecting the heart in these cases. (1995): 257, Verkijk A "Worsening of myasthenia gravis with timolol maleate eyedrops." Applies to: Cardiogenic Shock, Hypotension. It is also used to lower your risk of death or needing to be hospitalized for heart failure. I picked up my script last week of metoprolol tartrate 50 mg. and no mention of it getting recalled. Metoprolol Succinate ER is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins). (1985): 1-48, Breckenridge A, Roberts DH "Antihypertensive treatment in concomitant peripheral vascular disease: current experience and the potential of carvedilol." Moderately clinically significant. Would you like email updates of new search results? Eur Neurol 30 (1981): 375-88, Johnson JA, Burlew BS "Metoprolol metabolism via cytochrome p4502d6 in ethnic populations." Acupress (carteolol ophthalmic)." Therapy with beta-adrenergic receptor blocking agents (aka beta-blockers) should be administered cautiously in patients requiring hemodialysis. "Product Information. The phase IV clinical study is created by eHealthMe based on reports of 41,270 people who have side effects when taking Metoprolol succinate from the FDA, and is updated regularly. Cardioselective beta-blockers (Includes Metoprolol Succinate ER) ↔ asthma/COPD. Clin Med Insights Cardiol. Central augmented pressure, a measure of pulsatile afterload, was lowest with carvedilol (carvedilol 9.9 [95% CI: 7.7 to 12.2] mm Hg; metoprolol 11.5 [95% CI: 9.3 to 13.8] mm Hg; bisoprolol 12.2 [95% CI: 9.6 to 14.7] mm Hg; p < 0.05). J Cardiovasc Pharmacol 15 14th ed." It seems unlikely that the risks of worsening asthma or COPD outweigh the potential benefits of beta blocker use, in these patients. (1990): 911-7, Terent A, Ribacke M, Carlson LA "Long-term effect of pindolol on lipids and lipoproteins in men with newly diagnosed hypertension." Am J Cardiol 67 Conclusions: Administration of beta-blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta-mediated vasodilatation in skeletal muscle. This is due to the fact that metoprolol is able to block receptors in the breathing passages, narrowing them and worsening any breathing problems you may have. A randomized, open label, triple-crossover trial involving 51 subjects receiving optimal therapy for CHF was conducted in 2 Australian teaching hospitals. Find out what health conditions may be a health risk when taken with Metoprolol Succinate Oral Am Heart J 104 Clin Pharmacokinet 13 (1995): 47-52, Miki S, Masumura H, Kaifu Y, Yuasa S "Pharmacokinetics and efficacy of carvedilol in chronic hemodialysis patients with hypertension." Heard that COPD can cause some heart irregularities. "Product Information. Systemic beta-adrenergic receptor blocking agents (aka beta-blockers) may lower intraocular pressure. (1982): 473-8, Szecsi E, Kohlschutter S, Schiess W, Lang E "Abrupt withdrawal of pindolol or metoprolol after chronic therapy." 2011 Oct;105 Suppl 1:S44-9. Impact of β-blocker selectivity on long-term outcomes in congestive heart failure patients with chronic obstructive pulmonary disease. J Am Coll Cardiol 33 It is freely The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Br J Clin Pharmacol 24 Metoprolol tartrate and metoprolol succinate belong to a class of drugs known as beta-blockers. I questioned starting off with such a high dose of Losartan. J Am Coll Cardiol 25 Close monitoring for progression of arterial obstruction is advised. (1982): s353-7, Coppeto JR "Transient ischemic attacks and amaurosis fugax from timolol." In several large clinical trials, metoprolol succinate, carvedilol, and bisoprolol have demonstrated a reduction in morbidity and mortality in patients with systolic HF when added to baseline angiotensin‐converting enzyme (ACE) inhibitor therapy. (1996): 741-9, Maisel AS "Beneficial effects of metoprolol treatment in congestive heart failure - reversal of sympathetic-induced alterations of immunologic function." Ann Neurol 17 Circulation 90 (1991): 590-6, Giugliano D, Acampora R, Marfella R, DeRosa N, Ziccardi P, Ragone R, DeAngelis L, DOnofrio F "Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension - A randomized, controlled trial." (1984): 244-5. The phase IV clinical study is created by eHealthMe based on reports of 41,270 people who have side effects when taking Metoprolol succinate from the FDA, and is updated regularly. Patients should be advised not to discontinue treatment without first consulting with the physician. Ann Pharmacother 34 Metoprolol is primarily metabolized by the liver. Its structural formula is: Metoprolol succinate is a white crystalline powder with a molecular weight of 652.8. Can be used in people between the ages of 6 through 16. Clin Pharmacokinet 8 Major Potential Hazard, High plausibility. The NYHA functional class, 6-min walk distance, and left ventricular ejection fraction did not change. Lopressor (metoprolol)." Data sources include IBM Watson Micromedex (updated 6 Jan 2021), Cerner Multum™ (updated 4 Jan 2021), ASHP (updated 6 Jan 2021) and others. Frishman WH "Carvedilol." I have COPD and something was aggravating my breathing problems. Metoprolol warning include: Asthma or chronic obstructive pulmonary disease (COPD): It is best not to take metoprolol if you are asthmatic or have other breathing related issues. Eur J Clin Pharmacol 52 In patients who experience an exacerbation of angina following discontinuation of beta-blocker therapy, the medication should generally be reinstituted, at least temporarily, along with other clinically appropriate measures. N Engl J Med 335 (1988): 321-6, Lithell H, Andersson PE "Metabolic effects of carvedilol in hypertensive patients." In one case, this result was reported after an initial dose of 5 mg propranolol. (1982): 515-20, Rangno RE, Langlois S "Comparison of withdrawal phenomena after propranolol, metoprolol, and pindolol." The purpose of this study was to determine the respiratory, hemodynamic, and clinical effects of switching between beta1-selective and nonselective beta-blockers in patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Have read that metoprolol succinate (which I am taking) may create more problems with the lungs which may lead to more heart events. Am Heart J 128 10,11 Furthermore, patients with COPD … Background: Beta-adrenergic receptor blocking agents (aka beta-blockers) may alter serum lipid profiles. COVID-19 is an emerging, rapidly evolving situation. Trandate (labetalol)." Br J Clin Pharmacol 13 OptiPranolol (metipranolol)." Betagan Liquifilm (levobunolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA. "Product Information. Cessation of beta-blocker therapy, whenever necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks in patients with coronary insufficiency. Clin Pharmacokinet 6 Novartis Pharmaceuticals, East Hanover, NJ. J Am Coll Cardiol 29 Available for Android and iOS devices. (1995): 212-8, Olsen SL, Gilbert EM, Renlund DG, Taylor DO, Yanowitz FD, Bristow MR "Carvedilol improves left ventricular function and symptoms in chronic heart failure: a double-blind randomized study." Am J Med Oct 17 This preferential effect is not absolute, however, and at higher plasma concentrations, Metoprolol Tartrate also inhibits beta2-adrenoreceptors, chiefly located in … Moderate Potential Hazard, High plausibility. Increases in serum VLDL and LDL cholesterol and triglycerides, as well as decreases in HDL cholesterol, have been reported with some beta-blockers. Whether differences in beta-receptor specificities affect lung or vascular function in CHF patients, particularly those with coexistent COPD, remains incompletely characterized. Since cardioselectivity is not absolute, larger doses of beta-1 selective agents may demonstrate these effects as well. "Product Information. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. The use of beta-blockers in psoriatic patients should be carefully weighed since the use of these agents may cause an aggravation in psoriasis. (1998): "Product Information. Whether differences in beta-receptor specificities affect lung or vascular function in CHF patients, particularly those with coexistent COPD, remains incompletely characterized. Merck & Co, Inc, West Point, PA. "Product Information. Major Potential Hazard, High plausibility. Eur J Heart Fail. Whether differences in beta-receptor specificities affect lung or vascular function in CHF patients, particularly those with coexistent COPD, remains incompletely characterized. "Product Information. (1983): 342-8, Cleland JGF, Swedberg K "Carvedilol for heart failure, with care." Pharmacokinetic studies have demonstrated an approximately 50% increase in systemic clearance of propranolol during long-term therapy. Chronic obstructive pulmonary disease is found among people who take Metoprolol succinate, especially for people who are female, 60+ old, have been taking the drug for < 1 month. Doctors commonly prescribe this drug to treat high blood pressure, heart failure and heart-related chest pain called angina. "Product Information. Searle, Skokie, IL. Applies to: Psoriasis. There is also increasing evidence that the addition of a beta-blocker to standard therapy can improve morbidity and mortality in patients with advanced heart failure, although it is uncertain whether effectiveness varies significantly with the different agents. JAMA 284 2015 Mar 5;10:515-23. doi: 10.2147/COPD.S79942. Blocadren (timolol)." Avoid combinations; the risk of the interaction outweighs the benefit. (1996): 2800-6, Hjalmarson A, Goldstein S, Fagerberg B, et al. Interested to know if anyone has a combination of mild COPD (no trouble breathing), AFIB and PVC’s. (1994): 1177-83, Safran AB, Simona F, Sansonetti A, Pometta D, James R "Effects of ocular carteolol and timolol on plasma high-density lipoprotein cholesterol level." Br J Clin Pract 40 Int J Clin Pharmacol Ther 32 DuPont Pharmaceuticals, Wilmington, DE. Circulation 92 Metoprolol succinate, is a beta 1-selective (cardioselective) adrenoceptor blocking agent, for oral administration, available as extended release tablets. The "ER" stands for extended release 1 8. Community. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. Tirlapur VG, Evans PJ, Jones MK "Shock syndrome after acebutolol." Please enable it to take advantage of the complete set of features! Di Lenarda A, Remme WJ, Charlesworth A, Cleland JG, Lutiger B, Metra M, Komajda M, Torp-Pedersen C, Scherhag A, Swedberg K, Poole-Wilson PA; COMET investors. (1984): 333-9, Regardh C-G, Jordo L, Ervik M, et al "Pharmacokinetics of metoprolol in patients with hepatic cirrhosis." Int J Cardiol 10 Br Heart J 74 Major Potential Hazard, High plausibility. (1990): 279-81, Choi KL, Wat MS, Ip TP, Kung AWC, Lam KSL "Phaeochromocytoma associated with myasthenia gravis precipitated by propranolol treatment." (1994): 1765-73, Doughty RN, Whalley GA, Gamble G, MacMahon S, Sharpe N "Left ventricular remodeling with carvedilol in patients with congestive heart failure due to ischemic heart disease. Kalman J, Buchholz C, Steinmetz M, Courtney M, Gass A, Lansman S, Kukin ML "Safety and efficacy of beta blockade in patients with chronic congestive heart failure awaiting transplantation." MOCHA Investigators." Moderate Potential Hazard, Moderate plausibility. 190 mg of metoprolol succinate equivalent to 25, 50, 100 and 200 mg of metoprolol tartrate, USP, respectively. Zebeta (bisoprolol)." Applies to: Pheochromocytoma. Beta-adrenergic receptor blocking agents (aka beta-blockers) in general should not be used in patients with overt congestive heart failure (CHF). Visken (pindolol)." N-terminal pro-hormone brain natriuretic peptide was significantly lower with carvedilol than with metoprolol or bisoprolol (mean: carvedilol 1,001 [95% confidence interval (CI): 633 to 1,367] ng/l; metoprolol 1,371 [95% CI: 778 to 1,964] ng/l; bisoprolol 1,349 [95% CI: 782 to 1,916] ng/l; p < 0.01), and returned to baseline level on resumption of the initial beta-blocker. Major Potential Hazard, High plausibility. (1998): 1759-65. Eur J Clin Pharmacol 24 Normodyne (labetalol)." In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may inhibit catecholamine-mediated glycogenolysis, thereby potentiating insulin-induced hypoglycemia and delaying the recovery of normal blood glucose levels. Applies to: Ischemic Heart Disease. 2005 Jun;7(4):640-9. doi: 10.1016/j.ejheart.2004.09.010. (1989): 219-24, Clucas A, Miller N "Effects of acebutolol on the serum lipid profile." However, the rate of severe or very severe exacerbations was higher with metoprolol than placebo (0.45 vs. … (1980): 25-7, Darga LL, Hakim MJ, Lucas CP, Franklin BA "Comparison of the effects of guanadrel sulfate and propranolol on blood pressure, functional capacity, serum lipoproteins and glucose in systemic hypertension." Major Potential Hazard, High plausibility. Applies to: Asthma, Chronic Obstructive Pulmonary Disease The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). "Harrison's Principles of Internal Medicine. N Engl J Med 334 Metoprolol Succinate Extended Release/Hydrochlorothiazide is a combination tablet of metoprolol succinate, a beta adrenoceptor blocking agent and hydrochlorothiazide, a diuretic. Thisstudy was designed to test the concept that beta-blockers could reduce theincidence of COPD exacerbation. Echocardiography, N-terminal pro-hormone brain natriuretic peptide, central augmented pressure from pulse waveform analysis, respiratory function testing, 6-min walk distance, and New York Heart Association (NYHA) functional class were assessed at each visit. Br Med J 298 Coreg (carvedilol)." Ann Clin Res 12 Pharmacotherapy 16(2 Pt 2) (1979): 267-70, Lepantalo M "Beta blockade and intermittent claudication." Applies to: Asthma, Chronic Obstructive Pulmonary Disease. Metoprolol is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins). (1988): 586-7, Lind L, Pollare T, Berne C, Lithell H "Long-term metabolic effects of antihypertensive drugs." Applies to: Allergies. We now know that you can take safely take beta blockers if you have COPD. Reed and Carnrick, Jersey City, NJ. Tenormin (atenolol)." "Double-blind, placebo-controlled study of the long-term efficacy of carvedilol in patients with severe chronic heart failure." NIH Applies to: Hyperlipidemia. During chronic administration, the clearance of beta-blockers that are primarily metabolized by the liver (e.g., labetalol, metoprolol, penbutolol, propranolol) may be increased in patients with hyperthyroidism due to increased liver blood flow and enhanced activity of drug-metabolizing enzymes.

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