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What is metoprolol?
Metoprolol is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins). Metoprolol is used to treat angina (chest pain) and hypertension (high blood pressure). It is also used to treat or prevent heart attack. Metoprolol may also be used for purposes other than those listed in this medication guide.

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What is the price of this medication and similar alternatives?

Pricing information provided by drugstore.com.

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What are the possible side effects of metoprolol?

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.

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How should I take metoprolol?
Take metoprolol exactly as it was prescribed for you. Do not take the medication in larger amounts or for longer than recommended by your doctor. Take this medication with a full glass of water. Take metoprolol at the same time every day. Metoprolol should be taken with food or just after a meal. A Toprol XL tablet can be divided in half if your doctor has told you to do so. The half tablet should be swallowed whole, without chewing or crushing. Chewing or crushing the pill could cause too much of the drug to be released at one time.

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What is the most important information I should know about metoprolol?
Do not stop taking metoprolol without first talking to your doctor. Stopping suddenly may make your condition worse. If you need to have any type of surgery, you may need to temporarily stop using metoprolol. Be sure the surgeon knows ahead of time that you are using metoprolol. Metoprolol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol, which could increase drowsiness and dizziness while you are taking metoprolol.

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What happens if I miss a dose?
Take the missed dose as soon as you remember. If your next dose is less than 4 hours away, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

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What other drugs will affect metoprolol?
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);

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Can I take this if I am pregnant or trying to get pregnant or if I am breastfeeding?

Metoprolol has been assigned to pregnancy category C by the FDA. Animal studies have revealed decreased embryo and neonatal survival in rats at doses up to 22 times (on a mg/m2 basis) the daily dose of 200 mg in a 60 kg patient, although there was no evidence of impaired fertility or teratogenicity. There are no controlled data in human pregnancy. Metoprolol should only be given during pregnancy when benefit outweighs risk.

Metoprolol readily crosses the placenta. The maternal to fetal serum metoprolol concentration ratio is approximately 1:1. No teratogenic effects have been reported in human pregnancy. In a large study, the incidence of perinatal mortality was 2% of 57 hypertensive women who were treated with metoprolol alone, compared to 8% of 97 patients who were treated with hydralazine alone. No signs or symptoms of beta-blockade were noted in the fetuses or neonates. A case of a pregnant woman successfully treated with metoprolol for pheochromocytoma has been reported. Again, no signs or symptoms of beta-blockade were noted in the newborn. It is recommended that newborns who are exposed in utero to metoprolol should be carefully monitored for signs and symptoms of beta-blockade (bradycardia or hypotension) for at least 48 hours after birth. Incidentally, the plasma clearance (CL/F) of metoprolol is increased during pregnancy, averaging 362 mL/min/kg, compared to 82 mL/min/kg in the same patients postpartum.

Metoprolol is excreted into human milk in very small quantities. Adverse effects on the nursing infant are unlikely. The American Academy of Pediatrics considers metoprolol to be compatible with breast-feeding.

Data from three lactating women who each were taking metoprolol up to 100 mg orally twice a day show that the mean area under the concentration versus time curve (AUC) in milk to AUC maternal serum ratio was 3.6, indicating concentration of metoprolol in human milk. Assuming ingestion of 75 mL of milk per meal, the infant's dose at the time of maximum maternal drug concentration would not exceed 0.05 mg, and would be considerably less at other times. The authors of this study recommended that, unless the nursing infant has impaired renal or hepatic function, breast-feeding need not be interrupted with ordinary doses of metoprolol. Nursing infants should be carefully observed for signs of beta-blockade, however.

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Who should NOT use this medication?

• Patients with sinus bradycardia, heart block greater than 1st degree, cardiogenic shock, overt or decompensated cardiac failure, or sick sinus syndrome (unless a permanent pacemaker is in place).
• Patients with AMI who have a heart rate <45 bpm, heart block greater than 1st degree, systolic BP <100 mm Hg, or moderate to severe cardiac failure.

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What do the pills look like?
Metoprolol is available with a prescription under the brand names Lopressor and Toprol XL. Other brand or generic formulations of this medication may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you. Lopressor 50 mg--pink, capsule-shaped, scored tablets Lopressor 100 mg--light-blue, capsule-shaped, scored tablets Toprol XL 50 mg extended-release tablets--white, round, film-coated, scored tablets Toprol XL 100 mg extended-release tablets--white, round, film-coated, scored tablets

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What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. Symptoms of a metoprolol overdose may include uneven heartbeats, shortness of breath, bluish-colored fingernails, dizziness, weakness, fainting, or seizure (convulsions).

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What should I discuss with my healthcare provider before taking metoprolol?
Do not use this medication if you are allergic to metoprolol, or if you have: a heart problem such as heart block, sick sinus syndrome, or slow heart rate; pheochromocytoma; or problems with circulation (such as Raynaud's syndrome). Before taking metoprolol, tell your doctor if you have: congestive heart failure; asthma, bronchitis, emphysema; diabetes; low blood pressure; depression; liver or kidney disease; a thyroid disorder; or myasthenia gravis. If you have any of these conditions, you may not be able to use metoprolol, or you may need a dosage adjustment or special tests during treatment.

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Can I stop taking the medication if I feel better?
Even though you may feel better you should not stop taking your high blood pressure medication without first checking with your healthcare provider.

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I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.

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Where can I get more information?
More Information

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