Pronunciation:

met-oh-PROE-lol

Brand Names:

• Lopressor
• Toprol XL

Dosage Forms:

• Capsule, Extended Release
• Tablet, Extended Release
• Tablet

Warnings:

Ischemic Heart DiseaseDo not abruptly discontinue metoprolol tartrate tablets USP therapy in patients with coronary artery disease. Severe exacerbation of angina, myocardial infarction and ventricular arrhythmias have been reported in patients with coronary artery disease following the abrupt discontinuation of therapy with beta-blockers. When discontinuing chronically administered metoprolol tartrate tablets USP, particularly in patients with coronary artery disease, the dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored. If angina markedly worsens or acute coronary insufficiency develops, metoprolol tartrate tablets USP 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 tablets USP therapy abruptly even in patients treated only for hypertension .

Classifications:

Therapeutic—

Cardiovascular Agent

Pharmacologic—

Beta-Adrenergic Blocker, Cardioselective

Uses of This Medicine:

Metoprolol is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks or strokes. These problems may be less likely to occur if blood pressure is controlled.

Metoprolol is also used to treat severe chest pain (angina) and lowers the risk of repeated heart attacks. It is given to people who have already had a heart attack. In addition, metoprolol is used to treat patients with heart failure.

This medicine is a beta-blocker. It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of metoprolol tablets in the pediatric population. Safety and efficacy have not been established.

Appropriate studies have not been performed on the relationship of age to the effects of metoprolol extended-release tablets and extended-release capsules in children younger than 6 years of age. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of metoprolol in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving metoprolol.

Breast-feeding—

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Abiraterone Acetate
• Adagrasib
• Albuterol
• Ceritinib
• Clonidine
• Cobicistat
• Crizotinib
• Darunavir
• Desvenlafaxine
• Diltiazem
• Dronedarone
• Duloxetine
• Escitalopram
• Fedratinib
• Fenoldopam
• Fexinidazole
• Fingolimod
• Formoterol
• Givosiran
• Indacaterol
• Iohexol
• Lacosamide
• Lercanidipine
• Levalbuterol
• Lidocaine
• Olodaterol
• Panobinostat
• Ponesimod
• Rifampin
• Rivastigmine
• Salmeterol
• Siponimod
• Terbinafine
• Terbutaline
• Tocilizumab
• Verapamil
• Vilanterol

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acarbose
• Aceclofenac
• Acemetacin
• Acetyldigoxin
• Albiglutide
• Alfuzosin
• Alogliptin
• Amtolmetin Guacil
• Aspirin
• Bromfenac
• Bufexamac
• Bunazosin
• Bupropion
• Canagliflozin
• Celecoxib
• Chlorpropamide
• Choline Salicylate
• Citalopram
• Clonixin
• Dapagliflozin
• Deslanoside
• Dexibuprofen
• Dexketoprofen
• Diclofenac
• Diflunisal
• Digitoxin
• Digoxin
• Dipyrone
• Doxazosin
• Droxicam
• Dulaglutide
• Empagliflozin
• Ertugliflozin
• Etodolac
• Etofenamate
• Etoricoxib
• Exenatide
• Felbinac
• Fenoprofen
• Fepradinol
• Feprazone
• Floctafenine
• Flufenamic Acid
• Fluoxetine
• Flurbiprofen
• Glimepiride
• Glipizide
• Glyburide
• Ibuprofen
• Indomethacin
• Insulin Aspart, Recombinant
• Insulin Degludec
• Insulin Detemir
• Insulin Glargine, Recombinant
• Insulin Glulisine
• Insulin Human Inhaled
• Insulin Human Isophane (NPH)
• Insulin Human Regular
• Insulin Lispro, Recombinant
• Ketoprofen
• Ketorolac
• Linagliptin
• Liraglutide
• Lixisenatide
• Lornoxicam
• Loxoprofen
• Lumiracoxib
• Meclofenamate
• Mefenamic Acid
• Meloxicam
• Metformin
• Metildigoxin
• Miglitol
• Mirabegron
• Morniflumate
• Moxisylyte
• Nabumetone
• Naproxen
• Nateglinide
• Nepafenac
• Niflumic Acid
• Nimesulide
• Nimesulide Beta Cyclodextrin
• Oxaprozin
• Oxyphenbutazone
• Parecoxib
• Paroxetine
• Phenelzine
• Phenobarbital
• Phenoxybenzamine
• Phentolamine
• Phenylbutazone
• Piketoprofen
• Pioglitazone
• Piroxicam
• Pramlintide
• Pranoprofen
• Prazosin
• Proglumetacin
• Propafenone
• Propoxyphene
• Propyphenazone
• Proquazone
• Quinidine
• Repaglinide
• Rifapentine
• Rofecoxib
• Rosiglitazone
• Salicylic Acid
• Salsalate
• Saxagliptin
• Sitagliptin
• Sodium Salicylate
• St John's Wort
• Sulindac
• Tamsulosin
• Telithromycin
• Tenoxicam
• Terazosin
• Tiaprofenic Acid
• Tolazamide
• Tolbutamide
• Tolfenamic Acid
• Tolmetin
• Trimazosin
• Urapidil
• Valdecoxib
• Venlafaxine
• Vildagliptin

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

• Ethanol

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Angina (severe chest pain)—May provoke chest pain if stopped too quickly.

• Hypotension (low blood pressure) or
• Ischemic heart disease or
• Lung disease (eg, asthma, bronchitis, emphysema) or
• Pheochromocytoma (adrenal gland tumor)—Use with caution. May make these conditions worse.

• Blood circulation problems, severe or
• Bradycardia (slow heartbeat) or
• Cardiogenic shock (shock caused by heart attack) or
• Heart block or
• Heart failure, severe or
• Peripheral vascular disorders (clogged blood vessels) or
• Sick-sinus syndrome (heart rhythm problem)—Should not be used in patients with these conditions.

• Diabetes or
• Hyperthyroidism (overactive thyroid) or
• Hypoglycemia (low blood sugar)—May cover up some of the symptoms of these diseases, such as a fast heartbeat.

• Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

• Patients who are fasting (eg, surgery, not eating regularly, vomiting)—May increase risk of hypoglycemia (low blood sugar).

• Wolff-Parkinson-White syndrome (rare heart condition)—May cause very slow heartbeat in patients with this condition.

Proper Use of This Medicine:

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Your dose may need to be changed several times in order to find out what works best for you.

In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of food you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should first check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many patients feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that this medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, strokes, or kidney disease.

Swallow the extended-release capsule or tablet whole with a glass of water. Do not crush, break, or chew it.

If you cannot swallow the extended-release capsule:

• You may open it and sprinkle the contents over a small amount (teaspoonful) of soft food (including applesauce, pudding, or yogurt). Swallow the mixture within 60 minutes. Do not store for later use.
• You may also use a nasogastric tube to give the medicine. Mix the contents of the opened capsule with water into a syringe. Gently shake the mixture for about 10 seconds, then flush it through the tube. Rinse the tube with water until all of the medicine is washed out.

Take the tablet or extended-release tablet with a meal or just after you eat. You may break the extended-release tablet into two pieces, but swallow the two pieces whole and do not crush or chew them.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For acute heart attack or heart failure:
  • For oral dosage form (extended-release capsules):
    • Adults—At first, 25 milligrams (mg) once a day for 2 weeks. Your doctor may adjust your dose as needed. However, the dose is usually not more than 200 mg per day.
    • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (extended-release tablets):
    • Adults—At first, 25 milligrams (mg) once a day for 2 weeks. In patients with severe heart failure, the starting dose is 12.5 mg once a day. Your doctor may adjust your dose as needed.
    • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (tablets):
    • Adults—At first, 50 milligrams (mg) every 6 hours for 2 days. Then, 100 mg 2 times a day. The medicine will be started in the hospital.
    • Children—Use and dose must be determined by your doctor.
• For chest pain:
  • For oral dosage form (extended-release capsules):
    • Adults—At first, 100 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 400 mg per day.
    • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (extended-release tablets):
    • Adults—At first, 100 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 400 mg per day.
    • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (tablets):
    • Adults—At first, 100 milligrams (mg) per day, given in two divided doses. Your doctor may adjust your dose as needed. However, the dose is usually not more than 400 mg per day.
    • Children—Use and dose must be determined by your doctor.
• For high blood pressure:
  • For oral dosage form (extended-release capsules):
    • Adults—At first, 25 to 100 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 400 mg per day.
    • Children 6 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 1 milligram (mg) per kilogram (kg) of body weight once a day. The first dose should not be more than 50 mg once a day. Your doctor may adjust your dose as needed.
    • Children younger than 6 years of age—Use and dose must be determined by your doctor.
  • For oral dosage form (extended-release tablets):
    • Adults—At first, 25 to 100 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 400 mg per day.
    • Children 6 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 1 milligram (mg) per kilogram (kg) of body weight per day, given as a single dose. The first dose should not be more than 50 mg per day.
    • Children younger than 6 years of age—Use and dose must be determined by your doctor.
  • For oral dosage form (tablets):
    • Adults—At first, 100 milligrams (mg) per day, given as a single dose or in divided doses. Your doctor may adjust your dose as needed. However, the dose is usually not more than 450 mg per day.
    • Children—Use and dose must be determined by your doctor. .

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Metoprolol may worsen the symptoms of heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort, dilated neck veins, extreme fatigue, irregular breathing or heartbeat, swelling of the face, fingers, feet, or lower legs, trouble breathing, or weight gain.

Some men who use this medicine may cause erectile dysfunction. Check with your doctor right away if you have decreased interest in sexual intercourse, inability to have or keep an erection, or loss in sexual ability, drive, or performance. If you have questions about this, talk to your doctor.

Do not suddenly stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous.

This medicine may cause changes in blood sugar levels. Also, this medicine may cover up the symptoms of low blood sugar (including fast heartbeat) and increase the risk for serious or prolonged hypoglycemia (low blood sugar). Check with your doctor if you notice a change in your normal symptoms or a change in the results of your blood or urine sugar tests. Call your doctor right away if you have anxiety, blurred vision, chills, cold sweats, coma, confusion, cool, pale skin, depression, dizziness, fast heartbeat, headache, increased hunger, nausea, nervousness, nightmares, seizures, shakiness, slurred speech, or unusual tiredness or weakness.

Make sure any doctor or dentist who treats you knows that you are using this medicine. Do not stop taking this medicine before surgery without your doctor's approval.

This medicine may cause some people to become less alert than they are normally. If this side effect occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert while taking metoprolol.

Dizziness, lightheadedness, or even fainting may occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem. Also, lying down for a while may relieve the dizziness or lightheadedness.

Avoid drinking alcohol while you are using the extended-release capsules.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may increase your blood pressure.

Side Effects of This Medicine:

Along with its needed effects, a medicine 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:

More common

Blurred vision

chest pain or discomfort

confusion

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

slow or irregular heartbeat

sweating

unusual tiredness or weakness

Less common

Bloating or swelling of the face, arms, hands, lower legs, or feet

chest tightness

cough

decreased urine output

difficult or labored breathing

difficulty with speaking

dilated neck veins

disturbed color perception

double vision

fast, pounding, or racing heartbeat or pulse

halos around lights

headache

inability to move the arms, legs, or facial muscles

inability to speak

irregular breathing

loss of vision

night blindness

noisy breathing

overbright appearance of lights

pain, tension, and weakness upon walking that subsides during periods of rest

paleness or cold feeling in the fingertips and toes

rapid weight gain

seeing, hearing, or feeling things that are not there

short-term memory loss

slow speech

swelling of the face, fingers, feet, or lower legs

tingling of the hands or feet

tingling or pain in the fingers or toes when exposed to cold temperatures

trouble breathing

tunnel vision

unusual weight gain or loss

Rare

Bluish color of the skin of the fingers or toes

chills

clay-colored stools

continuing loss of appetite

continuing or severe abdominal or stomach pain

continuing or severe nausea and vomiting

dark urine

difficulty with moving

fever

hoarseness

increased frequency of urination

itching skin

light-colored stools

lower back or side pain

muscle pain or stiffness

numbness of the fingers or toes

pain, swelling, or redness in the joints

rash

sore throat

sores, ulcers, or white spots on the lips or in the mouth

unpleasant breath odor

unusual bleeding or bruising

upper right abdominal or stomach pain

vomiting of blood

weakness

yellow eyes and skin

Incidence not known

Black, tarry stools

bleeding gums

blood in the urine or stools

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

cool, sweaty skin

pinpoint red spots on the skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Bluish color of the fingernails, lips, skin, palms, or nail beds

change in consciousness

loss of consciousness

no blood pressure or pulse

stopping of the heart

very drowsy or sleepy

Some side effects 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

Belching

bloated feeling

decreased interest in sexual intercourse

difficulty having a bowel movement

discouragement

dry mouth

excess air or gas in stomach or bowels

feeling of constant movement of self or surroundings

feeling of fullness

feeling of indigestion

feeling sad or empty

inability to have or keep an erection

irritability

loss in sexual ability, desire, drive, or performance

loss of interest or pleasure

nightmares

pain in the chest below the breastbone

passing gas

redness or other discoloration of the skin

runny or stuffy nose

sensation of spinning

sneezing

tiredness

trouble concentrating

trouble sleeping

Rare

Bone pain

continuing ringing or buzzing or other unexplained noise in the ears

dry eyes

hair loss or thinning of the hair

hearing loss

increased sensitivity of the skin to sunlight

pain in the penis on erection

severe sunburn

Incidence not known

Change in taste or bad, unusual, or unpleasant (after) taste

fear or nervousness

hives or welts

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.