metoprolol succinate / Generic mfg. - LARVOL DELTA

Babesiosis masquerading as ITP in a patient with CLL (ASH 2025) - "Patient's home medications included only ramipril and metoprolol succinate...Patient was started on atovaquone and azithromycin...And patient was diagnosed with Babesiosis. This case highlights how Babesiosis can masquerade as ITP and present as severe thrombocytopenia without any symptoms suggestive of infection."

Clinical • Cardiovascular • Chronic Lymphocytic Leukemia • Coronary Artery Disease • Dyslipidemia • Hematological Disorders • Human Immunodeficiency Virus • Infectious Disease • Metabolic Disorders • Thrombocytopenia • HP

Aficamten in Obstructive Hypertrophic Cardiomyopathy: A Multidomain, Patient-Level Analysis of the MAPLE-HCM Trial. (PubMed, J Am Coll Cardiol) - P3 | "In patients with symptomatic oHCM, aficamten monotherapy led to superior and rapid treatment benefits across several clinically relevant outcome measures of disease burden compared with metoprolol. These observations support the emerging role of aficamten as monotherapy for oHCM. (Phase 3 Trial to Evaluate the Efficacy and Safety of Aficamten Compared to Metoprolol Succinate in Adults With Symptomatic oHCM [MAPLE-HCM]; NCT05767346)."

Journal • Cardiomyopathy • Cardiovascular • Hypertrophic Cardiomyopathy • Obstructive Hypertrophic Cardiomyopathy

Greenness Assessment and Stability-Indicating Hptlc Method for The Concurrent Analysis of Empagliflozin and Metoprolol Succinate in A Novel Combined Oral Formulation. (PubMed, Drug Dev Ind Pharm) - "The method demonstrated precision in both intraday (EMP-8738.68 ± 80.86 and METO- 4510.93 ± 27.61) and interday (EMP-8744.97 ± 131.91 and MET0-4492.87 ± 32.53) analyses and repeatability, with the %RSD of the peak area remaining below 2%. The stressed degradation conditions were optimized to induce degradation ranging from 5% to 20%.Conclusion- The validated HPTLC method is precise, accurate, and stability-indicating, making it suitable for routine quality control and stability testing of EMP-METO bilayer tablets."

Journal

The Proof is in the Pillbox: An Elusive Case of Cardiomyopathy (AHA 2025) - "A 63-year-old female with mixed connective tissue disease on long-term immunosuppression (prednisone, azathioprine, hydroxychloroquine (HCQ)) was referred to a tertiary care center for evaluation of progressive dyspnea and exertional chest discomfort...Catheterization revealed severe pulmonary hypertension and elevated filling pressures, without significant coronary disease.Medical treatment included empagliflozin (discontinued due to urosepsis), bumetanide, spironolactone, and metoprolol succinate...Multimodal imaging and biopsy are crucial for diagnosis. Early recognition is essential to prevent irreversible myocardial damage and improve long-term outcomes."

Clinical • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Fibrosis • Heart Failure • Immunology • Inflammation • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Rheumatology • Ventricular Tachycardia

A Polypill Strategy for Heart Failure with Reduced Ejection Fraction: The POLY-HF Trial (AHA 2025) - P2 | "Polypill strategies have been trialed for prevention of atherosclerotic conditions but not in HFrEF.Hypothesis: We hypothesized that an HFrEF polypill containing metoprolol succinate, spironolactone, and empagliflozin would improve left ventricular ejection fraction (LVEF) compared with usual care in patients. POLY-HF is a two-center, open-label RCT conducted primarily within a safety-net healthcare system in Dallas, TX (NCT04633005). POLY-HF enrolled a diverse population with high burden of adverse SDOH and poor medication adherence. Database lock is anticipated in October 2025, and complete results will be presented at the meeting. This trial will provide the first randomized evidence for polypill effectiveness on biologic and clinical outcomes in HFrEF among underrepresented populations."

Late-breaking abstract • Atherosclerosis • Cardiovascular • Congestive Heart Failure • Heart Failure

Development of a 3D printed multiple unit particle system (MUPS) containing metoprolol succinate. (PubMed, Eur J Pharm Sci) - "In vitro dissolution testing showed that 80 % of the incorporated API was released within 105 to 150 mins. The findings confirm the feasibility of producing API-3D-MUPS tablets using pharmaceutical-grade materials, while also identifying critical product defects, formulation and process parameters such as thermal instability of the API or particle agglomeration - that require further optimisation of formulation and process parameters to enable broader application in personalised drug delivery."

Journal

Daptomycin-Induced Hyperkalemia in the Absence of Creatinine Kinase Elevation: A Challenging Diagnosis in a Patient with Diabetes and Acute on Chronic CKD (KIDNEY WEEK 2025) - "Ten days prior to admission, her Cr increased from 1.5 to 1.83, and vancomycin was changed to daptomycin 600mg every 48 hours. Other pertinent home medications included cefepime 2g/d, torsemide 20mg/d, lisinopril 5mg/d, and metoprolol succinate 25mg/d...The daptomycin was changed to doxycycline on day 9, and within 48 hours, her K began to downtrend, normalizing at 72 hours while Cr was 3.08...As for this patient, it is important to consider this as her hyperkalemia was challenging to control with prolonged hospitalization prior to daptomycin discontinuation. Timely recognition of daptomycin-induced hyperkalemia should be considered in the differential to improve outcomes."

Clinical • Chronic Kidney Disease • Diabetes • Hematological Disorders • Metabolic Disorders

Apixiban-Associated Anticoagulant-Related Nephropathy in a Patient with Undiagnosed Sickle Cell Trait (KIDNEY WEEK 2025) - "His medications included metoprolol succinate 200mg daily, apixaban 5 mg twice daily, and aspirin 81 mg daily. ARN is a rare but serious complication of apixaban that can lead to irreversible kidney injury in certain patients. AKI in the absence of other obvious causes in anticoagulated patients should prompt consideration of ARN."

Clinical • Acute Kidney Injury • Atrial Fibrillation • Cardiovascular • Glomerulonephritis • Hematological Disorders • Nephrology • Renal Disease

BRASH: A Vicious Cycle (KIDNEY WEEK 2025) - "He was taking metoprolol succinate 25 mg daily, sacubitril-valsartan 24-26 mg twice daily and torsemide 40 mg daily which were held on admission. As per a systematic review, over 50% cases had non-severe hyperkalemia (less than 6.5 mg/dL). With increasing use of beta blockers, ACE/ARBs and MRAs, the incidence of this syndrome will continue to increase and requires more awareness in the community."

Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Coronary Artery Disease • Hypotension • Renal Disease

Cardiac Monitoring of Patients on Btki for Chronic Lymphocytic Leukemia (ASH 2024) - "One patient diagnosed with AF continued ibrutinib and started metoprolol succinate for rate control. Overall, patients on acalabrutinib or zanubrutinib had a lower risk of developing any arrhythmia compared to ibrutinib (OR 0.056, p=0.015 and OR 0.043, p=0.033, respectively) when corrected for age and gender. No sudden death has occurred.In conclusion, cardiac testing uncovered clinically significant arrhythmias in 11% of patients on a BTKi, providing rationale for cardiac monitoring during BTKi therapy, especially in patients receiving ibrutinib."

Clinical • Atrial Fibrillation • Cardiovascular • Chronic Lymphocytic Leukemia • Heart Failure • Hematological Disorders • Hematological Malignancies • Leukemia • Lymphoma • Lymphoplasmacytic Lymphoma • Oncology • Ventricular Tachycardia • Waldenstrom Macroglobulinemia

Effect of Aficamten versus Metoprolol Monotherapy on Biomarkers in Obstructive Hypertrophic Cardiomyopathy: The MAPLE-HCM Trial (AHA 2025) - P3 | "MAPLE-HCM (NCT05767346) compared aficamten vs metoprolol succinate as monotherapy/first-line treatment on peak oxygen uptake (pVO2), Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS), and echocardiographic measures in symptomatic oHCM.Methods/Approach: Differences in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-cTnI) were studied in MAPLE-HCM. As monotherapy for oHCM, aficamten significantly reduced NT-proBNP and hs-cTnI compared with metoprolol as monotherapy. Reduction in NT-proBNP concentrations correlated significantly with improved exercise capacity, LVOT-G, and health status. These results provide insights regarding the mechanism of clinical benefit of aficamten compared to metoprolol in MAPLE-HCM."

Biomarker • Monotherapy • Cardiomyopathy • Cardiovascular • Hypertrophic Cardiomyopathy • Obstructive Hypertrophic Cardiomyopathy • TNNI3

Capacity to manufacture key pharmaceuticals in New Zealand after a global catastrophe. (PubMed, N Z Med J) - "This preliminary analysis suggests that none of the 10 most extensively prescribed pharmaceuticals that can be used for acute treatments could be manufactured in New Zealand after a trade-ending global catastrophe. To address this and other domains lacking in resiliency (e.g., liquid fuel supply), planning for building shared resiliency with other neighbouring nations (e.g., Australia) could be considered."

Journal

Factors Influencing Internal Medicine Resident Beta-Blocker Discontinuation in Acute Decompensated Heart Failure. (PubMed, CJC Open) - "In scenario 2, 74% of participants initiated metoprolol succinate, 25% chose carvedilol, and only 1 participant chose bisoprolol. Drivers of inpatient beta blocker discontinuation should be considered by internal medicine training programs and heart failure guideline writers when opportunities arise to enact practice changes that align with evidence."

Journal • Cardiovascular • Congestive Heart Failure • Heart Failure

One-Year Outcomes of Bisoprolol vs Metoprolol Succinate in Patients with Heart failure with reduced ejection fraction and End Stage Kidney Disease: A Propensity-Matched Study (AHA 2025) - "In this real-world, propensity-matched cohort of patients with HFrEF and ESRD, bisoprolol was associated with lower 1-year mortality compared with metoprolol succinate, but had comparable MACE and Hospitalization rates. These findings suggest bisoprolol may offer a survival benefit in this high-risk population and merit further prospective evaluation."

Clinical • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Heart Failure • Myocardial Infarction • Nephrology • Renal Disease

Surviving sudden cardiac arrest during pregnancy: strategic planning for maternal and fetal outcomes (AHA 2025) - "She was started on metoprolol succinate, hydralazine, and aspirin. This case underscores collaborative management of heart failure and arrhythmias in pregnancy. A patient-centered approach supports favorable outcomes. Cardio-obstetrics program growth will advance such care."

Anesthesia • Asthma • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Fibrosis • Genetic Disorders • Heart Failure • Immunology • Inflammation • Obesity • Obstetrics • Polycystic Ovary Syndrome • Respiratory Diseases • Sarcoidosis

Guideline-Directed Medical Therapy Prescribing Trends in Patients with Heart Failure with Preserved Ejection Fraction: A Nationwide Analysis (AHA 2025) - "Trends in prescribing of SGLT2i, MRAs, GLP-1 RAs (semaglutide and tirzepatide), ARNIs, ACEi/ARBs, and BBs (metoprolol succinate, carvedilol, bisoprolol) from 2017 to 2024 were analyzed in the overall HFpEF population and subgroups with obesity, DM, CV disease (AF/flutter, CAD, HTN), CKD, and by sex.ResultsWe identified 940,185 patients with HFpEF from 2017 to 2024 [mean age 75 ± 13 yrs, 56.3% female, 79.2% white, 4.7% Hispanic, mean BMI 34.2 ± 5.1 kg/m2]. (Figure/Table 1).ConclusionsAlthough prescription trends have improved, the use of SGLT2i, MRAs, GLP-1 RAs and ARNI (in females) remains suboptimal in patients with HFpEF, with prescribing decisions largely influenced by associated comorbidities. Further clinician awareness of the latest evidence-based management strategies for HFpEF is essential."

Clinical • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Genetic Disorders • Heart Failure • Obesity

Comparative 2 Year Outcomes of Carvedilol Versus Metoprolol Succinate initiation in Heart failure with reduced ejection fraction Patients with End-Stage Renal Disease on Dialysis: A Propensity- Matched analysis (AHA 2025) - "In patients with HFrEF and ESRD on dialysis, initiation of carvedilol was associated with a significant reduction in 2-year mortality and MACE compared with metoprolol succinate. However, there were higher rates of hyperkalemia. Hospitalization rates and ventricular arrhythmia were similar between groups."

Clinical • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Heart Failure • Myocardial Infarction • Nephrology • Renal Disease

Rationale, Design, and Baseline Characteristics of the Polypill for Heart Failure with Reduced Ejection Fraction (POLY-HF) Trial. (PubMed, J Card Fail) - P2 | "POLY-HF enrolled a diverse population with low socioeconomic status and suboptimal medication adherence. This trial will provide the first randomized evidence for polypill effectiveness on biologic and clinical outcomes in HFrEF among underrepresented populations (Take Home Figure)."

Journal • Atherosclerosis • Cardiovascular • Congestive Heart Failure • Heart Failure

A Case Report (ACG 2025) - "Twelve hours later, liver function tests (LFTs) showed severe elevations in ALT, AST, and bilirubin levels in hepatocellular pattern despite prior normal levels as trends shown in Table 1 Amiodarone was immediately discontinued and metoprolol succinate was used for rate control. Additionally, recovery achieved through discontinuing amiodarone further reinforced the suspicion of drug-induced injury. Figure: Table 1"

Case report • Clinical • Atrial Fibrillation • Autoimmune Hepatitis • Cardiovascular • Coronary Artery Disease • Dyslipidemia • Hepatology • Hypotension • Immunology • Infectious Disease • Inflammation • Liver Failure • Metabolic Disorders

LAUGHING ALL THE WAY TO RECOVERY: FUNNY CHANNELS REVERSE CARDIOMYOPATHY IN SINUS TACHYCARDIA (CHEST 2025) - "The patient was initially started on metoprolol succinate 50mg daily and Entresto 24/26 twice a day and a wearable cardioverter-defibrillator was implemented. The patient trialed on increased metoprolol succinate 75mg daily with addition of Jardiance 10mg daily, but unfortunately did not tolerate due to hypotension... Chronic, asymptomatic sinus tachycardia has the potential to cause severe TIC. Ivabradine, with its unique funny channel blockade, offers a promising treatment, especially for patients intolerant to up-titration of beta blockade."

Cardiomyopathy • Cardiovascular • Hypotension

WHAT'S RIGHT IS WRONG: A CASE OF RCA TORTUOSITY FROM AN ANOMALOUS ORIGIN (CHEST 2025) - "His heart failure was optimized with GDMT as tolerated including metoprolol succinate 25mg daily and sacubitril-valsartan 24-26 An anomalous coronary artery is a rare congenital condition in which the origin of the coronary artery is found in an abnormal portion of the sinus of valsalva. Anomalous RCA with a left sinus of Valsalva origin in a patient with concomitant CAD requiring CABG. Despite bypass grafting, patients are still at risk of ischemia of the RCA from high cardiac output states and should be educated on the importance of avoiding high intensity activities."

Clinical • Anemia • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Dyslipidemia • Heart Failure • Hematological Disorders • Hypertension • Myocardial Ischemia • Pulmonary Disease

Influencing factors analysis of clinical effect of heart failure patients treated with ivabradine and metoprolol succinate and construction and validation of nomogram prediction model. (PubMed, Front Cardiovasc Med) - "LVEF, LVEDD, 6 MWT, heart rate and BNP level affect the clinical effect of Ivab combined with Met-S in patients with HF. The nomogram prediction model established has high accuracy and clinical application value."

Journal • Cardiovascular • Congestive Heart Failure • Heart Failure

VENO-VENOUS EXTRACORPOREAL MEMBRANE OXYGENATION (VV-ECMO) AS A LIFE-SAVING MEASURE OF BETA-BLOCKER TOXICITY (CHEST 2025) - "We report a life-threatening case metoprolol succinate overdose leading to persistent hemodynamic instability unresponsive to vasopressors and its successful management with Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO)...The patient transferred to the cardiac intensive care unit (CICU) and commenced on multiple vasopressors for hemodynamic support including norepinephrine, epinephrine and dobutamine, in addition to IV glucagon and high dose IV insulin... This case highlights the potential severity of beta-blocker overdose and the utility of advanced supportive strategies such as VV-ECMO, in cases of refractory hemodynamic instability. Additionally, addressing the psychiatric aspect intentional overdose is crucial to preventing recurrence. Early multidisciplinary collaboration between cardiology, critical nephrology, and psychiatry played a vital role in this patient's recovery."

Acute Kidney Injury • Cardiovascular • Chronic Kidney Disease • CNS Disorders • Coronary Artery Disease • Depression • Diabetes • Diabetic Nephropathy • Hypertension • Hypotension • Metabolic Disorders • Nephrology • Psychiatry • Renal Disease • Respiratory Diseases

HEMORRHAGIC CARDIAC TAMPONADE IN AN END-STAGE RENAL DISEASE PATIENT ON APIXABAN (CHEST 2025) - "CASE PRESENTATION: A 56-year-old male with multiple comorbidities, including ESRD on hemodialysis, chronic obstructive pulmonary disease (COPD) requiring 2 L of supplemental oxygen at home, and Afib managed with metoprolol succinate ER 50 mg once daily and apixaban 5 mg twice daily, was transferred from a dialysis center to the emergency department (ED) due to generalized abdominal discomfort and a blood pressure (BP) of 87/52 mmHg. Emergency and critical care physicians should maintain high clinical suspicion for cardiac tamponade in ESRD patients on apixaban presenting with shock-like symptoms. Utilizing POCUS can facilitate quick assessment and reduce the time from presentation to intervention, potentially improving patient outcomes."

Clinical • Anemia • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Chronic Obstructive Pulmonary Disease • Hematological Disorders • Hypotension • Immunology • Metabolic Disorders • Nephrology • Pulmonary Disease • Renal Disease • Respiratory Diseases • Venous Thromboembolism

A RARE CASE OF CARDIOGENIC SHOCK SECONDARY TO METHAMPHETAMINE USE COMPLICATED BY ADRENAL INSUFFICIENCY (CHEST 2025) - "He was hypotensive, requiring Norepinephrine and Dobutamine for blood pressure and ionotropic support...He was started IV Hydrocortisone...He underwent pulmonary artery catheter guided diuresis and afterload reduction with sodium nitroprusside. He was weaned off vasopressor support, extubated and was initiated on Metoprolol Succinate, Valsartan and Dapagliflozin and discharged with a LifeVest... Cardiogenic shock due to dilated cardiomyopathy can be a result of methamphetamine use. Adrenal insufficiency can be a later sequalae. According to a meta-analysis in 2021, there is a moderate prevalence of adrenal insufficiency in cardiogenic shock, however further studies are needed to quantify the correlation.(2)It is important to identify risk factors for the development of cardiogenic shock in otherwise healthy patients, such as methamphetamine use."

Clinical • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Coronary Artery Disease • Cough • Endocrine Disorders • Heart Failure • Hypoglycemia • Metabolic Disorders • Myocardial Infarction • Nephrology • Renal Disease • Respiratory Diseases