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Increased triglyceride levels and insulin resistance, decreased high-density lipoprotein HDL levels. Exacerbation of angina and, in some cases, myocardial infarction MI may occur after abrupt discontinuance. When long-term beta blocker therapy particularly with ischemic heart disease is https://www.walgreens.com discontinued, dosage should be gradually reduced over weeks with careful monitoring. If angina worsens markedly or acute coronary insufficiency develops, beta-blocker administration should be promptly reinitiated, at least temporarily in addition to other measures appropriate for unstable angina. Patients should be warned against interruption or discontinuance of beta-blocker therapy without physician advice. Because coronary artery disease CAD is common and may be unrecognized, beta-blocker therapy must be discontinued slowly, even in patients treated only for hypertension. Use with caution in cerebrovascular insufficiency, CHF, cardiomegaly, myasthenia gravis, hyperthyroidism or thyrotoxicosis may mask signs or symptoms, liver disease, renal impairment, peripheral vascular disease, psoriasis may cause exacerbation of psoriasis. Beta blockers can cause myocardial depression and may precipitate heart failure and cardiogenic shock. Sudden discontinuance can exacerbate angina and lead to MI and ventricular arrhythmias in patients with CAD. Avoid starting high-dose regimen of extended-release metoprolol in patients undergoing noncardiac surgery; use in patients with cardiovascular risk factors is associated with bradycardia, hypotension, stroke, and death.

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