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Inr with coumadin in all doses for the treatment of acute myocardial infarction, and to examine the effects of same medication during an open-label phase (15 days in duration). view of the lack data on this question, we used a two‐factor mixed design with 3‐way factorial (coumadin prazosin or placebo and metoprolol, respectively). In the open‐label phase there was no difference in the incidence rates of death, hospitalization nor mortality between groups. At the end of open‐label period, incidence mortality was 0 (8) in the group taking metoprolol and 0 (2) in the group given placebo. Analyses in the open‐label phase suggested a lower rate of death in the metoprolol group (0.9 per 100 patients [n = 3]) compared with the placebo group best online pharmacy for pain meds (1.8 [n = 7] in the overall analysis) (P=0.001). For hospitalization, there was a similar lower rate of hospitalization in the metoprolol group compared with placebo (0.5 per 100 patients [n = 2] compared with 1.6 [n = 20] in the overall analysis). rate of hospitalization during weeks 6 and 7 was similar (0.4 0.3 per 100 patients, respectively; P = 0.27; Figure 1 ). Discussion Our data show a significant difference in the incidence rate of mortality between metoprolol and placebo in a large trial conducted the context of acute myocardial infarction. The results showed no increase in the rate of death, hospitalization and admission during 1 year of follow up compared with that observed in the untreated groups a previous open‐label, placebo‐controlled trial (3). Moreover, there was a significant decrease in the rate of mortality on days 1–9 with the use of metoprolol. These results indicate that a single dose of metoprolol appears to have an effect on overall mortality in nonperfusing acute myocardial infarction patients. A possible mechanism of this phenomenon is the blockade of nitric oxide production in the coronary vasculature with metoprolol administration in rats (17). The lack of an effect on the incidence of hospitalization in our study is also agreement with our previous studies (18–20), demonstrating that metoprolol did not increase the hospitalization rate in acute myocardial infarction after one month. The effect of metoprolol may be attributed to a reduction of the platelet aggregation thromboxane A2 that is seen in metoprolol‐treated patients (16,21). This effect is also apparent in other noninvasively and surgically induced coronary vasculopathy. Furthermore, the lower incidence of death (2.7 and 1.8 hospitalization over one year) might also be due to better compliance with drug therapy. The higher rates of both drug efficacy and safety during the short‐term metoprolol‐treated phase is also in agreement with the results of previous studies (22,23). In contrast to these previous studies in experimental animals, which investigated only short‐Term metoprolol‐induced myocardial hypertrophy (24), our data are not in any way inconsistent with data from two large randomized control trials in nonhuman primates, which found higher drug efficacy, fewer adverse Venlaf 120 Pills 5mg $165 - $1.38 Per pill effects and no increase in incidence of death, hospitalization and/or mortality on days 3–7 in the treatment groups. These latter two controlled trials have been shown to provide evidence in favor of an effect on risk death in postmyocardial infarction patients for any given drug (21,22,23), and they provide a rationale for investigating the potential of metoprolol during extended periods follow‐up. In addition, these results provide evidence that the efficacy levels observed during short‐ term were achieved without any decrease in quality of life. In agreement with our previous analyses of the pharmacokinetics metoprolol in rabbits (17) and rats (10) the acute effect of treatment appears to be achieved at low oral doses. In the current study, acute effects of the metoprolol were similar regardless of the dose (Table 2), with no clear differences reported for dosing duration. It has to be underlined, however that there was Buspar in australia a difference in drug plasma concentrations the two experimental animal groups. apparent differences in pharmacokinetic parameters were possibly related to differences in the Montelukast cost uk dose and duration as well Diclofenac otc dose differences in the concentrations of drug and/or its conversion products observed during the course of study (15). Nevertheless, the findings of present pharmacokinetic analysis support an effect on risk of death in nonperfusing acute myocardial infarction patients. This study had several important limitations. First, in these studies of metoprolol.