Toprol-XL 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.

Before taking this medicine

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:
Initial dose: 25 to 100 mg orally once a day

Maintenance dose: 100 to 400 mg orally once a day

Comments:
-May increase dose at weekly, or longer, intervals.
-Doses above 400 mg per day have not been studied.

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.

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 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.

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.