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Toprol-XL (metoprolol succinate) is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins).
Toprol-XL is used to treat angina (chest pain) and hypertension (high blood pressure).
Toprol-XL is also used to lower your risk of death or needing to be hospitalized for heart failure.
Toprol-XL may also be used for indications not in this medication guide.
You should not use Toprol-XL if you have a severe heart block (greater than first degree), sick sinus syndrome without a pacemaker, severe circulation problems, severe heart failure, a history of slow heart beats that caused fainting, or if you are allergic to Toprol-XL or metoprolol.
You should not use Toprol-XL if you are allergic to metoprolol, or other beta-blockers (atenolol, carvedilol, labetalol, nadolol, nebivolol, propranolol, sotalol, and others), or if you have:
a serious heart problem such as heart block greater than first degree or sick sinus syndrome without a pacemaker;
severe circulation problems;
severe heart failure (that required you to be in the hospital); or
a history of slow heart beats that have caused you to faint.
To make sure Toprol-XL is safe for you, tell your doctor if you have:
asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing disorder;
diabetes (taking Toprol-XL may make it harder for you to tell when you have low blood sugar);
liver disease;
congestive heart failure;
problems with circulation (such as Raynaud's syndrome);
peripheral vascular disease or claudication (pain in your legs when walking);
a thyroid disorder; or
pheochromocytoma (tumor of the adrenal gland); or
if you are planning major surgery or dental work.
Do not give Toprol-XL to a child without medical advice.
Tell your doctor about all medications you are taking before using Toprol-XL, especially any calcium channel blockers (including diltiazem, verapamil, and others).
Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether metoprolol succinate will harm an unborn baby. However, having high blood pressure during pregnancy may cause complications such as diabetes or eclampsia (dangerously high blood pressure that can lead to medical problems in both mother and baby). The benefit of treating hypertension may outweigh any risks to the baby.
Ask a doctor before using Toprol-XL if you are breast-feeding. Metoprolol succinate can pass into breast milk and may cause dry skin, dry mouth, diarrhea, constipation, or slow heartbeats in your baby.
Take Toprol-XL exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.
Toprol-XL should be taken with a meal or just after a meal.
Take the medicine at the same time each day.
Swallow the extended release tablet whole and do not crush or chew the tablet.
A Toprol XL tablet can be divided in half if your doctor has told you to do so. Swallow the half-tablet whole, without chewing or crushing.
You will need frequent medical tests, and your blood pressure will need to be checked often.
If you need surgery, tell the surgeon ahead of time that you are using metoprolol.
You should not stop using Toprol-XL suddenly. Stopping suddenly may make your condition worse.
If you have high blood pressure, keep using Toprol-XL even if you feel well. High blood pressure often has no symptoms. You may need to use metoprolol for the rest of your life.
Store at room temperature away from moisture and heat.
Usual Adult Dose for Hypertension:
Metoprolol succinate extended release tablets:Usual Adult Dose for Angina Pectoris:
Initial dose:
-Metoprolol succinate extended release tablets: 100 mg orally once a day
Maintenance dose: 100 to 400 mg per day.
Metoprolol succinate extended release tablets:
25 mg orally once a day (12.5 mg orally once a day in patients with more severe heart failure); double dose every 2 weeks to highest tolerated dose or up to 200 mg orally once a day
Usual Pediatric Dose for Hypertension:
Metoprolol succinate extended release tablets:
6 Years or Older:
Initial dose: 1 mg/kg orally once a day (not to exceed 50 mg orally once a day)
Maximum dose: 2 mg/kg (or 200 mg) orally once a day
Skip the missed dose and use your next dose at the regular time. Do not use two doses at one time.
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Signs and symptoms of an overdose may include chest pain, difficulty breathing, dizziness or fainting, nausea, vomiting, or coma. Death can occur.
Avoid driving or hazardous activity until you know how metoprolol succinate will affect you. Your reactions could be impaired.
Drinking alcohol can increase certain side effects of Toprol-XL.
Get emergency medical help if you have signs of an allergic reaction to Toprol-XL: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
very slow heartbeat, excessive tiredness, or chest pain;
a light-headed feeling, like you might pass out;
shortness of breath (even with mild exertion), swelling, rapid weight gain; or
cold feeling in your hands and feet.
Common Toprol-XL side effects may include:
dizziness, tired feeling;
depression, confusion, memory problems;
nightmares, trouble sleeping;
diarrhea; or
mild itching or rash.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Tell your doctor about all your current medicines. Many drugs can interact with Toprol-XL, especially:
any other heart or blood pressure medications, especially digitalis, clonidine, diltiazem, verapamil, quinidine, propafenone, and others;
epinephrine (Epi-Pen);
an antidepressant, especially monoamine oxidase (MAO) inhibitors (including isocarboxazid, rasagiline, selegiline, phenelzine, transcypromine, and methylene blue injection) and selective serotonin reuptake inhibitors (SSRIs) including fluoxetine, paroxetine and others; or
an ergot medicine--dihydroergotamine, ergonovine, ergotamine, or methylergonovine; or
This list is not complete and many other drugs may interact with metoprolol succinate. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Toprol-XL only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Medically reviewed by USARx EDITORIAL TEAM Last updated on 1/1/2020.
Source: Drugs.com Toprol Xl (www.drugs.com/toprol.html).
Note: This document contains side effect information about metoprolol. Some of the dosage forms listed on this page may not apply to the brand name Toprol-XL.
Common side effects of Toprol-XL include: hypotension. Other side effects include: bradycardia. See below for a comprehensive list of adverse effects.
Applies to metoprolol: oral capsule extended release, oral tablet, oral tablet extended release
Other dosage forms:
Oral route (Tablet, Extended Release)
Exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred after abrupt cessation of therapy with certain beta-blocking agents. When discontinuing chronic therapy, gradually reduce the dose over a period of 1 to 2 weeks and monitor the patient carefully. If angina markedly worsens or acute coronary insufficiency develops, reinstate administration promptly, at least temporarily, and take other measures appropriate for the management of unstable angina. Warn patients not to interrupt or discontinue therapy without physician advice.
Oral route (Tablet)
Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. The dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored when discontinuing chronic therapy. If angina markedly worsens or acute coronary insufficiency develops, metoprolol tartrate administration should be reinstated promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Patients should be warned against interruption or discontinuation of therapy without the physician's advice. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue metoprolol tartrate therapy abruptly even in patients treated only for hypertension.
Along with its needed effects, metoprolol (the active ingredient contained in Toprol-XL) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking metoprolol:
More common
Less common
Rare
Incidence not known
Get emergency help immediately if any of the following symptoms of overdose occur while taking metoprolol:
Symptoms of overdose
Some side effects of metoprolol may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Rare
Incidence not known
Applies to metoprolol: compounding powder, injectable solution, oral capsule extended release, oral solution, oral tablet, oral tablet extended release
The most common adverse reactions were tiredness, dizziness, depression, shortness of breath, bradycardia, hypotension, diarrhea, pruritus, and rash.
Very common (10% or more): Heart failure (up to 27.5%), hypotension (systolic blood pressure less than 90 mmHg) (up to 27.4%), bradycardia (heart rate less than 40 beats per minute) (up to 15.9%),
Common (1% to 10%): Cold extremities, arterial insufficiency, palpitation, first degree heart block (P-R interval 0.26 seconds or greater), second or third degree heart block, postural disorders
Uncommon (0.1% to 1%): Cardiogenic shock in patients with acute myocardial infarction
Rare (0.01% to 0.1%): Disturbances of cardiac conduction, cardiac arrhythmia
Very rare (less than 0.01%): Intermittent claudication increased
Frequency not reported: Claudication
Common (1% to 10%): Diarrhea, nausea, dry mouth, gastric pain, constipation, flatulence, heartburn, abdominal pain, vomiting
Frequency not reported: Retroperitoneal fibrosis
Common (1% to 10%): Tiredness, peripheral edema, accident and/or injury, death, fatigue
Uncommon (0.1% to 1%): Edema, precordial pain
Frequency not reported: Lactic dehydrogenase elevated
Postmarketing reports: Chest pain
Common (1% to 10%): Dizziness, vertigo, stroke, headache
Uncommon (0.1% to 1%): Paresthesia, somnolence, impaired concentration
Rare (0.01% to 0.1%): Alertness decreased
Very rare (less than 0.01%): Amnesia/memory impairment, tinnitus, taste disturbance
Frequency not reported: Short-term memory loss
Postmarketing reports: Syncope
Common (1% to 10%): Shortness of breath, wheezing, dyspnea
Rare (less than 0.1%): Rhinitis
Common (1% to 10%): Pruritus, rash
Uncommon (0.1% to 1%): Sweating increased
Rare (0.01% to 0.1%): Loss of hair
Very rare (less than 0.01%): Photosensitivity reactions, psoriasis aggravated, gangrene in patients with preexisting severe peripheral circulatory disorders, hyperhidrosis, alopecia
Common (1% to 10%): Depression
Uncommon (0.1% to 1%): Insomnia, nightmare
Rare (0.01% to 0.1%): Nervousness, anxiety
Very rare (less than 0.01%): Confusion, hallucination, personality disorder, disturbances of libido
Frequency not reported: Sleep disturbance
Uncommon (0.1% to 1%): Muscle cramps
Very rare (less than 0.01%): Arthralgia, arthritis
Frequency not reported: Musculoskeletal pain
Uncommon (0.1% to 1%): Weight gain
Frequency not reported: Unstable diabetes
Postmarketing reports: Blood triglycerides increased, high density lipoprotein (HDL) decreased
Rare (less than 0.1%): Visual disturbance, dry and/or irritated eyes, conjunctivitis
Frequency not reported: Blurred vision
Rare (0.01% to 0.1%): Liver function test abnormalities
Very rare (less than 0.01%): Hepatitis
Frequency not reported: Transaminase elevated, alkaline phosphatase elevated
Postmarketing reports: Jaundice, non-specific hepatic dysfunction
Rare (0.01% to 0.1%): Impotence/sexual dysfunction
Very rare (less than 0.01%): Peyronie's disease
Rare (less than 0.1%): Positive antinuclear antibodies
Very rare (less than 0.01%): Thrombocytopenia
Frequency not reported: Agranulocytosis
Medically reviewed by USARx EDITORIAL TEAM Last updated on 1/1/2020.
Source: Drugs.com Toprol Xl (www.drugs.com/toprol.html).
March 2, 2020
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