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Before taking metoprolol, tell your doctor if you are using:

• digoxin (digitalis, Lanoxin);

• clonidine (Catapres);

• ritonavir (Norvir);

• terbinafine (Lamisil);

• anti-malaria medications such as chloroquine (Aralen) or hydroxychloroquine (Plaquenil, Quineprox);

• medicine to treat depression or mental illness, such as bupropion (Wellbutrin, Zyban), fluoxetine (Prozac, Sarafem), paroxetine (Paxil), thioridazine (Mellaril), and others;

• an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), or selegiline (Eldepryl, Emsam);

• a diabetes medication such as insulin, glyburide (Diabeta, Micronase, Glynase), glipizide (Glucotrol), chlorpropamide (Diabinese), or metformin (Glucophage);

• a heart medication such as nifedipine (Procardia, Adalat), quinidine (Quinaglute, Quinidex), propafenone (Rythmol), reserpine (Serpasil), verapamil (Calan, Verelan, Isoptin), diltiazem (Cartia, Cardizem);

• medicine for asthma or other breathing disorders, such as albuterol (Ventolin, Proventil), bitolterol (Tornalate), metaproterenol (Alupent), pirbuterol (Maxair), terbutaline (Brethaire, Brethine, Bricanyl), and theophylline (Theo-Dur, Theolair);

• a diuretic (water pill) such as amiloride (Midamor, Moduretic), chlorthalidone (Hygroton, Thalitone), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril, Hyzaar, Lopressor, Vasoretic, Zestoretic), spironolactone (Aldactazide, Aldactone), triamterene (Dyrenium, Maxzide, Dyazide), torsemide (Demadex), and others; or

• cold medicines, stimulant medicines, or diet pills.

If you are using any of these drugs, you may not be able to take metoprolol, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect metoprolol. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

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

Call your doctor at once if you have any of these serious side effects:

• slow or uneven heartbeats;

• feeling light-headed, fainting;

• feeling short of breath, even with mild exertion;

• swelling of your ankles or feet;

• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

• depression; or

• cold feeling in your hands and feet.

Other less serious side effects are more likely to occur, such as:

• vomiting;

• decreased sex drive, impotence, or difficulty having an orgasm;

• sleep problems (insomnia);

• tired feeling; or

• anxiety, nervousness.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.