metoprolol ER
Metoprolol succinate (Toprol XL) is used to treat hypertension and to control chronic (long-term) chest pain. It's also used to lower the risk for hospitalization and death in people with heart failure. Metoprolol succinate (Toprol XL) is the extended-release version of metoprolol tartrate (Lopressor), but keep in mind the two versions don't treat the exact same conditions. And because metoprolol succinate (Toprol XL) is longer-acting, it's taken by mouth typically taken just once daily. Some common side effects of metoprolol succinate (Toprol XL) include tiredness or dizziness.
What is Metoprolol succinate (Toprol XL)?
What is Metoprolol succinate (Toprol XL) used for?
- High blood pressure
- Chest pain (angina)
- Lower the risk of hospitalization and death in heart failure
How Metoprolol succinate (Toprol XL) works
Metoprolol succinate (Toprol XL) is a beta blocker. More specifically, it's a selective beta blocker, meaning it works mainly on your heart. It slows down your heart rate. This makes it easier for your heart to pump blood around your body and helps lower blood pressure. It also allows your heart to use less oxygen, which can help with chest pain.
Drug facts
More on Metoprolol succinate (Toprol XL) essentials
Side effects of Metoprolol succinate (Toprol XL)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Tiredness
- Dizziness
- Depression
- Diarrhea
- Trouble catching your breath
- Drop in heart rate
- Rash
Please note: The side effects above occurred in 2% or more of people taking metoprolol succinate (Toprol XL).
Less Common Side Effects
- Swelling of the hands, feet, or ankles
- Confusion
- Headache
- Nausea
- Constipation
- Dry mouth or eyes
- Itchiness
Metoprolol succinate (Toprol XL) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious drop in heart rate or other irregular heart rhythm: feeling faint or weak, dizziness, trouble breathing, chest pain, sweating
- Heart failure: trouble breathing, fast weight gain, feeling very tired, chest pain, swelling in the legs, ankles, or feet
- Bronchospasm: tightness in the chest, trouble catching your breath, difficulty breathing, wheezing, cough, dizziness, extreme tiredness
More on Metoprolol succinate (Toprol XL) side effects
The following Metoprolol succinate (Toprol XL) side effects have also been reported
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
decreased urine output
difficult or labored breathing
difficulty with speaking
dilated neck veins
disturbed color perception
double vision
extreme tiredness or weakness
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
tightness in the chest
tingling of the hands or feet
tingling or pain in the fingers or toes when exposed to cold temperatures
troubled 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
general tiredness and weakness
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
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
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
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
sensation of spinning
tiredness
trouble concentrating
trouble sleeping
Rare
Bone pain
continuing ringing or buzzing or other unexplained noise in the ears
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.
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Pros and cons of Metoprolol succinate (Toprol XL)
Pros
- A first-choice option to prevent chest pains (angina)
- A first-choice option for heart failure
- Only needs to be taken once a day
- Available as capsules (Kapspargo) that can be opened and sprinkled on soft foods, good for people who've trouble swallowing pills
Cons
- Need to take with food
- Not a first-choice treatment for high blood pressure, unless you have heart failure or heart disease
- Can hide symptoms of low blood sugar
- Stopping too suddenly can raise the risk of heart attack and stroke
Pharmacist tips for Metoprolol succinate (Toprol XL)
- You should take metoprolol succinate (Toprol XL) right after meals. This can help lower your risk of side effects, such as dizziness.
- Metoprolol succinate (Toprol XL) can cause dizziness, which could lead to falls. Make sure to sit or lie down if you feel dizzy to prevent accidental injuries.
- Check your blood pressure regularly after starting metoprolol succinate (Toprol XL). Tell your provider if it hasn't improved after a week because they might need to adjust your dose of this medication.
- Swallow the metoprolol succinate (Toprol XL) tablets or Kapspargo capsules whole. Don't chew or crush them. If your provider halves your dose, only the tablets can be split in half using a pill cutter.
- If needed, you can open the Kapspargo capsules and sprinkle the contents inside on a small amount (about a teaspoonful) of soft foods, such as applesauce, pudding, or yogurt. Swallow the mixture within an hour; don't let it sit for longer than that. If you have a nasogastric (NG) feeding tube, you or your caregiver can also mix the capsule contents with water (15 mL) in an oral syringe and slowly push the mixture into your tube. Ask your provider or pharmacist for more instructions.
- Try not to drink alcohol with metoprolol succinate (Toprol XL). Beta blockers like metoprolol succinate (Toprol XL) can make you more drowsy and dizzy, and alcohol can make this even worse. If you drink alcohol regularly and it's difficult to stop completely, talk with your provider about what's a safer amount to drink.
- If you have diabetes, be careful taking metoprolol succinate (Toprol XL), since this medication can hide symptoms of low blood sugar, except for sweating and dizziness.
- Don't stop taking this medication suddenly unless your provider tells you to. Stopping metoprolol succinate (Toprol XL) all of a sudden cause your blood pressure to go up, which can raise the risk of heart attack and stroke. If you want to stop this medication, your provider can lower your dose slowly over time.
Common questions about Metoprolol succinate (Toprol XL)
Metoprolol succinate (Toprol XL) can start to work within 1 hour of taking the medication. But you might not see the full effects of metoprolol succinate (Toprol XL) until about a week or so after you start. Your provider will probably ask you to check your blood pressure and heart rate regularly to see how well this medication is working. Keep in mind that your provider might need to adjust your dose over time, so it can take a few weeks before your provider and you to find a dose of metoprolol succinate (Toprol XL) that works for you.
The effects of metoprolol succinate (Toprol XL) on your blood pressure and heart rate will typically last up to 24 hours. It's important to take this medication daily as prescribed by your provider in order to experience the full benefits of this medication.
It doesn't matter when you take metoprolol succinate (Toprol XL) as long as you try to take it around the same time each day. Keep in mind that you need to take this medication with food, so it might be best to take it at a meal time. If you're just starting metoprolol succinate (Toprol XL), you might consider taking your dose at a time when you know you'll get a chance to sit or lie down, just in case it makes you feel dizzy. If you don't notice any dizziness after a few doses, you can take this medication at a different time of the day, such as the morning, if you like.
Metoprolol tartrate (Lopressor) and metoprolol succinate (Toprol XL) are two different forms of metoprolol. They work in very similar ways, but there are some differences between them. (1) One difference is how many times a day you take each medication. Metoprolol tartrate (Lopressor) is an immediate-release tablet (faster-acting) that's typically taken twice daily. On the other hand, metoprolol succinate (Toprol XL) is an extended-release tablet (longer-acting) that's typically taken just once a day. (2) Another difference is what conditions they're approved to treat. Both metoprolol tartrate (Lopressor) and metoprolol succinate (Toprol XL) are used to lower blood pressure and ease chest pain. But only metoprolol tartrate (Lopressor) can help lower the risk of death after a heart attack, while metoprolol succinate (Toprol XL) can lower the risk of death and hospitalization in people with heart failure.
It isn’t typical for someone to take both metoprolol tartrate (Lopressor) and metoprolol succinate (Toprol XL) at the same time. These medications work in very similar ways and taking them together can raise your of risk side effects, such as dizziness or very low blood pressure. Check in with your provider if you think they've prescribed you both versions of metoprolol to take at the same time. It might be possible that your provider is switching you from one form to the other, depending on your preference for taking pills once daily or twice daily. If you're not sure, it's best to confirm your most current medication with your provider first and then make sure that your pharmacy discontinues the version of metoprolol you're no longer taking.
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Risks and warnings for Metoprolol succinate (Toprol XL)
Metoprolol succinate (Toprol XL) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Heart problems after suddenly stopping the medication
- Risk factors: Coronary artery disease (CAD)
Don't stop taking metoprolol succinate (Toprol XL) suddenly. This can lead to an irregular or fast heartbeat, high blood pressure, poor blood circulation to your heart, or raise your risk of chest pain or heart attack. Work with your provider to lower your dose slowly over 1 to 2 weeks if you'd like to stop taking metoprolol succinate (Toprol XL).
Worsened symptoms of heart failure
- Risk factors: Heart failure | When the dose is raised
Though metoprolol succinate (Toprol XL) can be used for heart failure, worsening symptoms of heart failure can also occur when the dose is raised. Talk to your provider if you think your heart failure is getting worse (e.g., more swelling in your legs, trouble breathing). They will work with you to find the best dose of metoprolol succinate (Toprol XL) and your other heart failure medications for you.
Risk of difficulty breathing
- Risk factors: Chronic obstructive pulmonary disease (COPD) | Asthma
Metoprolol succinate (Toprol XL) can cause the vessels in your lung to tighten. This can make breathing difficult, especially in people with breathing problems, like asthma. This problem is very rare with metoprolol succinate (Toprol XL) because it's a selective beta blocker, meaning it targets your heart rather than your lungs. To be safe, make sure your provider knows about your full medical history before starting this medication.
Rise in blood pressure in people with pheochromocytoma
- Risk factors: History of pheochromocytoma
If you have pheochromocytoma (a hormone-producing tumor from your adrenal glands), let your provider know. In people with this condition, taking metoprolol succinate (Toprol XL) alone can actually raise your blood pressure instead of lowering it. To avoid this, your provider will likely prescribe an alpha-blocker medication first to keep your blood pressure under control.
Greater risk during surgery
- Risk factors: Major surgery requiring anesthesia | Risk of heart disease, heart attack, or stroke
If you're planning to undergo a major surgery (not heart-related) requiring anesthesia, tell your surgeon that you're taking metoprolol succinate (Toprol XL). Taking high doses of this medication around the time of surgery has been linked to low heart rate, low blood pressure, stroke, and death. So your surgeon will make sure to monitor your heart closely.
Hiding symptoms of low blood sugar
- Risk factors: Diabetes
Taking metoprolol succinate (Toprol XL) can make it difficult for you to identify symptoms of low blood sugar, such as fast heart beat or tremors. If you’re taking medications, like glipizide or insulin, to lower your blood sugar, you might not be able to rely on all the typical symptoms of low blood sugar (e.g., irritability, sight tremors, confusion, and fast heartbeat) to warn you of a dangerous drop in your sugar levels. Sweating might be the only symptom not affected by taking metoprolol succinate (Toprol XL). Speak with your healthcare provider about when and how to monitor your blood sugar if you start metoprolol succinate (Toprol XL).
Masked symptoms of overactive thyroid
- Risk factors: Hyperthyroidism
Because metoprolol succinate (Toprol XL) lowers your heart rate, it might be harder to notice heart-related symptoms caused by an overactive thyroid (hyperthyroidism). If you have hyperthyroidism, don't suddenly stop taking metoprolol succinate (Toprol XL), since this can worsen thyroid problems.
Metoprolol succinate (Toprol XL) dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 100mg | 90 tablets | $18.80 | $0.21 |
| 200mg | 90 tablets | $28.14 | $0.31 |
| 25mg | 90 tablets | $15.75 | $0.18 |
| 50mg | 90 tablets | $16.18 | $0.18 |
Typical dosage for Metoprolol succinate (Toprol XL)
High blood pressure
- Adults: The typical starting dose is 25 mg to 100 mg by mouth once daily. Your provider might adjust your dose weekly based on how your blood pressure is doing.
- Children ages 6 years and older: Your child's provider will determine your child's dose based on their body weight. The typical starting dose is 1 mg/kg of body weight (up to 50 mg of metoprolol succinate) by mouth once a day. Your child's provider might adjust their dose weekly based on how their blood pressure is doing.
Chest pain
- Adults: The typical starting dose is 100 mg by mouth once daily. Your provider might raise your dose weekly based on your heart rate.
Heart failure
- Adults: The typical starting dose ranges from 12.5 mg to 25 mg by mouth once daily. Your provider might raise your dose every 2 weeks based on your symptoms, up to a maximum of 200 mg daily.
Interactions between Metoprolol succinate (Toprol XL) and other drugs
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.
- Albuterol
- Ceritinib
- Clonidine
- Crizotinib
- Diltiazem
- Dronedarone
- Fenoldopam
- Fingolimod
- Formoterol
- Givosiran
- Indacaterol
- Iohexol
- Lacosamide
- Lercanidipine
- Levalbuterol
- Lidocaine
- Olodaterol
- Panobinostat
- Ponesimod
- Rifampin
- Rivastigmine
- Salmeterol
- Siponimod
- Terbinafine
- Terbutaline
- 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
- Arbutamine
- Aspirin
- Bromfenac
- Bufexamac
- Bunazosin
- 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
- 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
- Mibefradil
- Miglitol
- Mirabegron
- Morniflumate
- Moxisylyte
- Nabumetone
- Naproxen
- Nateglinide
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Phenelzine
- Phenobarbital
- Phenoxybenzamine
- Phentolamine
- Phenylbutazone
- Piketoprofen
- Pioglitazone
- Piroxicam
- Pramlintide
- Pranoprofen
- Prazosin
- Proglumetacin
- Propoxyphene
- Propyphenazone
- Proquazone
- 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
How much does Metoprolol succinate (Toprol XL) cost?
Metoprolol succinate (Toprol XL) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Metoprolol succinate (Toprol XL) will not be safe for you to take.
- Severely low heart rate
- Second- or third-degree heart block
- Cardic (cardiogenic) shock
- Severe heart failure
- Heart rhythm problem called sick sinus syndrome, unless you have a permanent pacemaker
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