Metoprolol Succinate, Extended Release, Oral

What are other names for this medicine?

Type of medicine: beta blocker

Generic and brand names: metoprolol succinate, extended release, oral; Toprol XL

What is this medicine used for?

This medicine is taken by mouth to:

• lower and control high blood pressure. It may be used alone or in combination with other medicines.
• relieve angina (chest pain)
• treat congestive heart failure
• treat other conditions as determined by your healthcare provider.

What should my healthcare provider know before I take this medicine?

Before you take this medicine, be sure to tell your healthcare provider if you have ever had:

• an allergic reaction to other medicines
• breathing problems such as shortness of breath, coughing, or wheezing. (This medicine may make these problems worse.)
• depression
• diabetes
• heart failure or any other heart problems
• liver or kidney disease
• low blood pressure
• muscle disease such as myasthenia gravis
• pheochromocytoma (a tumor of the adrenal gland)
• problems with blood circulation such as Raynaud's disease or peripheral vascular disease
• thyroid problems

Tell your healthcare provider if you are taking digoxin or diuretics (water pills).

Females of childbearing age: This medicine is not usually given to pregnant women because it can harm the baby. If you are pregnant, tell your healthcare provider. Do not become pregnant during treatment with this medicine. If you become pregnant, contact your healthcare provider right away. Do not breast-feed while you are taking this medicine.

How do I use it?

Check the label on the medicine for directions about your specific dose. Take this medicine exactly as your healthcare provider prescribes, even if you feel better. Take it at the same time each day to help you remember. Do not stop taking this medicine without your healthcare provider's approval. Stopping abruptly may cause serious side effects. You must reduce your dosage gradually.

This medicine may come in different forms. If you have extended-release capsules, do not break, crush, or chew them. Swallow them whole. If you have the liquid form, you may mix it with water or juice to make it easier to swallow. Ask your pharmacist if you have any questions.

Take this medicine with or immediately after a meal.

What if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure about what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: slow or irregular heartbeat, wheezing, shortness of breath, dizziness, weakness, fainting, seizures, tremors, sweating.

What should I watch out for?

This medicine may cover up the rapid heartbeat that may occur in people who have an overactive thyroid gland. It may also reduce or eliminate chest pain you may have when you exercise or are very active. Ask your healthcare provider about a safe exercise program.

Your healthcare provider may want you to check your pulse regularly. Report any unusual slowing or irregularity of your heart rate.

This medicine may make you drowsy or dizzy or cause blurred vision. Do not drive or operate machinery unless you are fully alert and can see clearly. You may also feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may help.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

Talk to your healthcare provider before you use any nasal decongestants or take cold medicines, including nonprescription products.

Diabetics: This medicine may affect your blood sugar and cover up the symptoms of low blood sugar. It may be harder to tell if your blood sugar level is too low or too high. Talk with your healthcare provider about this. Be sure you understand how this medicine might affect you and what to do if you have a problem.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives, itching, rash, tightness in your chest, trouble breathing, swelling of your face, throat, or tongue).

Serious (report these to your healthcare provider right away): Chest pain; cold hands or feet; swelling of the arms, feet, or legs; increased coughing or night cough; confusion; depression; slow or irregular heartbeat; fainting spells.

Other: Dizziness, drowsiness, weakness, trouble sleeping, change in sexual ability or desire, abnormal dreams, headache, constipation, diarrhea, nausea, vomiting.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• ACE inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril), and ramipril (Altace)
• antacids (take them at least 2 hours before or after this medicine)
• anti-HIV medicines such as ritonavir (Norvir) and delavirdine (Rescriptor)
• asthma medicines such as epinephrine (Adrenalin), zileuton (Zyflo), albuterol (Proventil, Ventolin), metaproterenol (Alupent), and theophylline
• barbiturates such as phenobarbital (Solfoton), butabarbital (Butisol), and pentobarbital (Nembutal)
• benzodiazepines such as alprazolam (Xanax), chlordiazepoxide (Librium), and diazepam (Valium)
• cholesterol-lowering medicines such as cholestyramine (Questran) and colestipol (Colestid)
• cimetidine (Tagamet)
• cold medicines including decongestants and antihistamines such as diphenhydramine (Benadryl), pseudoephedrine (Sudafed), and phenylephrine (Neo-synephrine)
• diuretics such as furosemide (Lasix), bumetanide (Bumex), ethacrynic acid (Edecrin), and torsemide (Demadex)
• haloperidol (Haldol)
• heart or blood pressure medicines such as amiodarone (Cordarone), digoxin (Lanoxin), prazosin (Minipress), terazosin (Hytrin), clonidine (Catapres), disopyramide (Norpace), flecainide (Tambocor), hydralazine (Apresoline), reserpine, nifedipine (Adalat, Procardia), isradipine (DynaCirc), felodipine (Plendil), verapamil (Calan, Isoptin), diltiazem (Cardizem), nicardipine (Cardene), quinidine, and propafenone (Rythmol)
• herbal remedies such as dong quai, ephedra, ma huang, hawthorn, St. John's wort, yohimbe, ginseng, and garlic
• insulin and oral diabetes medicines such as glyburide (DiaBeta, Micronase), glipizide (Glucotrol), repaglinide (Prandin), metformin (Glucophage), tolbutamide, rosiglitazone (Avandia), and pioglitazone (Actos)
• MAO inhibitor antidepressants such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• migraine medicines such as methysergide (Sansert), ergotamine (Cafergot, Ergomar), rizatriptan (Maxalt), and zolmitriptan (Zomig)
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), ketoprofen, nabumetone (Relafen), indomethacin (Indocin), ketorolac (Toradol), sulindac (Clinoril), piroxicam (Feldene), diclofenac (Voltaren, Cataflam), and oxaprozin (Daypro)
• phenothiazines such as chlorpromazine (Thorazine), prochlorperazine (Compazine), perphenazine, promazine (Sparine), thioridazine, and trifluoperazine (Stelazine)
• rifampin (Rifadin, Rimactane)
• salicylates such as aspirin
• SSRI antidepressants such as fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft)
• tricyclic antidepressants such as amitriptyline (Elavil), nortriptyline (Aventyl, Pamelor), imipramine (Tofranil), and doxepin (Sinequan)
• warfarin (Coumadin)

Do not drink alcohol while you are taking this medicine unless your healthcare provider approves.

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.