Metoprolol is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins).

Metoprolol is used to treat angina (chest pain) and hypertension (high blood pressure).

Metoprolol is also used to lower your risk of death or needing to be hospitalized for heart failure.

Metoprolol injection is used during the early phase of a heart attack to lower the risk of death.

You should not use metoprolol if you have a serious heart problem (heart block, sick sinus syndrome, slow heart rate), severe circulation problems, severe heart failure, or a history of slow heart beats that caused fainting.

Before taking this medicine

You should not use this medicine 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, sick sinus syndrome, or slow heart rate;

• 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 this medicine is safe for you, tell your doctor if you have:

• asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing disorder;

• diabetes (taking metoprolol 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);

• a thyroid disorder; or

• pheochromocytoma (tumor of the adrenal gland).

Do not give this medicine to a child without medical advice.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether metoprolol 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 this medicine if you are breast-feeding. Metoprolol can pass into breast milk and may cause dry skin, dry mouth, diarrhea, constipation, or slow heartbeats in your baby.

Take metoprolol 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.

Metoprolol should be taken with a meal or just after a meal.

Take the medicine at the same time each day.

Swallow the capsule whole and do not crush, chew, break, or open it.

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.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

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 this medicine.

You should not stop using this medicine suddenly. Stopping suddenly may make your condition worse.

If you have high blood pressure, keep using metoprolol even if you feel well. High blood pressure often has no symptoms. You may need to use this medicine for the rest of your life.

Store at room temperature away from moisture and heat.

Metoprolol injection is given as an infusion into a vein. A healthcare provider will give you this injection in a medical setting where your heart and blood pressure can be monitored. The injections are given for only a short time before switching you to the oral form of this medicine.

Usual Adult Dose for Hypertension:

Metoprolol Tartrate Immediate Release Tablets:
Initial dose: 100 mg orally per day in single or divided doses

Maintenance dose: 100 to 450 mg orally per day.

Metoprolol Succinate Extended Release Tablets:
Initial dose: 25 to 100 mg orally once a day

Maintenance dose: 100 to 400 mg orally once a day.

Usual Adult Dose for Angina Pectoris:

Initial dose:
-Metoprolol tartrate immediate release tablets: 50 mg orally twice a day
-Metoprolol succinate extended release tablets: 100 mg orally once a day

Maintenance dose: 100 to 400 mg per day.

Usual Adult Dose for Myocardial Infarction:

Metoprolol Tartrate :
Early Treatment:
Initial dose: 5 mg IV every 2 minutes as tolerated for 3 doses
-Patients tolerant of full IV dose (15 mg): 50 mg orally every 6 hours starting 15 minutes after the last IV dose and continued for 48 hours
-Patients intolerant of full IV dose (15 mg): 25 or 50 mg orally every 6 hours depending on the degree of intolerance starting 15 minutes after the last IV dose or as soon as their clinical condition allows

Late Treatment:
Maintenance dose: 100 mg orally twice a day.

Usual Adult Dose for Congestive Heart Failure:

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.

You should not use this medicine 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, sick sinus syndrome, or slow heart rate;

• 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 this medicine is safe for you, tell your doctor if you have:

• asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing disorder;

• diabetes (taking metoprolol 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);

• a thyroid disorder; or

• pheochromocytoma (tumor of the adrenal gland).

Do not give this medicine to a child without medical advice.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether metoprolol 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 this medicine if you are breast-feeding. Metoprolol can pass into breast milk and may cause dry skin, dry mouth, diarrhea, constipation, or slow heartbeats in your baby.

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.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Drinking alcohol can increase certain side effects of this medicine.

Get emergency medical help if you have signs of an allergic reaction to metoprolol: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Metoprolol may cause serious side effects. Call your doctor at once if you have:

• very slow heartbeats;
• 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 side effects of metoprolol may include:

• dizziness;
• tired feeling;
• depression;
• confusion;
• memory problems;
• nightmares;
• trouble sleeping;
• diarrhea;
• 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 metoprolol, especially:

• any other heart or blood pressure medications;

• epinephrine (Epi-Pen);

• an antidepressant;

• an ergot medicine--dihydroergotamine, ergonovine, ergotamine, methylergonovine; or

• an MAO inhibitor--isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, tranylcypromine.

This list is not complete and many other drugs may interact with metoprolol. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Keep all appointments with your doctor. Your blood pressure should be checked regularly to determine your response to metoprolol. Your doctor may ask you to check your pulse (heart rate). Ask your pharmacist or doctor to teach you how to take your pulse. If your pulse is faster or slower than it should be, call your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Metoprolol typically begins to work after about two hours, but it can take up to a week before the full effects are felt.

You may not feel different while using metoprolol, but that doesn’t mean it’s not working.

Continue to take metoprolol unless your doctor tells you otherwise.

Your dosage will depend on your medical condition, your age, your overall health, and other factors.

Your doctor may start you on a lower dose if you have liver problems.

Metoprolol is sometimes used “off-label” to treat other conditions, such as migraines and heart arrhythmias.

• Dutoprol® (containing Metoprolol, Hydrochlorothiazide)
• Lopressidone® (containing Chlorthalidone, Metoprolol)
• Lopressor® HCT (containing Metoprolol, Hydrochlorothiazide)