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Email a friendGeneric Name is metoprolol tartrate (ma TOE proe lol / TAR trayt) and Brand Name is Lopressor (loe PRES sor)
Generic Name for extended release is metoprolol succinate (ma TOE proe lol / SUK sin ate) and Brand Name is Toprol-XL (TOE prawl ‘X’ ‘L’)
Overview
Metoprolol is available as metoprolol tartrate (Lopressor), an immediate release tablet and metoprolol succinate (Toprol-XL), a long acting, extended release tablet. Metoprolol belongs to the group of heart/blood pressure drugs known as beta-blockers. That means they work partly by blunting the action of adrenaline, the body's natural fight-or-flight chemical. People normally respond to stressful situations with a rapid pulse, a pounding heart and an increase in blood pressure. Metoprolol (Lopressor, Toprol-XL) helps block such reactions by slowing the heart rate and relaxing the blood vessels so the heart does not have to pump as hard.
Metoprolol (Lopressor, Toprol-XL) is usually prescribed for high blood pressure, chest pain, heart attacks, and prevention of a second heart attack. The extended release metoprolol (Toprol-XL) is also used in combination with other medications to treat heart failure. Although the FDA has not specifically approved its use for other purposes, doctors sometimes prescribe metoprolol (Lopressor, Toprol-XL) to treat irregular heart rhythms or tremors, and to prevent migraine headaches.
People’s Pharmacy Perspective
Beta blockers have been around a long time and generally have low cost generics available. One word of caution, however: We have heard from a significant number of people that not all generic Toprol XL (metoprolol succinate) is created equal. Some people have seen their blood pressure skyrocket while others have developed irregular heart rhythms. See their stories.
Beta blockers such as metoprolol should probably not be considered as first-line treatments for high blood pressure (1,2). British hypertension experts reserve beta blockers almost as a last resort, when other blood pressure medicines don’t work (3). Since beta blockers have the potential to cause numerous side effects (and negatively impact blood fats), we agree that they should be used cautiously.
Beta blockers are valuable for managing chest pain and preventing another heart attack after someone has already had one. They may also be valuable when adequate blood pressure control is not achieved with other classes of drugs. You and your physician will need to decide if the benefits outweigh the risks.
Be certain to consult a physician about your health, especially with regard to any signs or symptoms that may require diagnosis or medical attention. Information provided is not a substitute for the medical advice or care of a physician or other health care professional.
Special Precautions
DO NOT stop taking metoprolol (Lopressor, Toprol-XL) suddenly without first talking to your doctor. Stopping abruptly may trigger potentially fatal heart problems.
Pregnancy/Breastfeeding: Consult your doctor if you are pregnant or planning a pregnancy, or will be breastfeeding while taking this medication.
Metoprolol (Lopressor, Toprol-XL) is not recommended for some people: People who have had an allergic reaction to beta-blockers, metoprolol (Lopressor, Toprol-XL) or its components and people with certain serious heart problems, such as heart rates less than 45 beats per minute (for heart attack patients) or abnormal heart rhythms. The medication could occasionally lead to serious cardiac complications for these individuals. Note that only metoprolol succinate (Toprol-XL), the extended release tablet, is indicated for heart failure. Metoprolol tartrate (Lopressor) is not recommended for people with heart failure.
Some people must be very carefully monitored if they take beta-blockers such as metoprolol (Lopressor, Toprol-XL). In general, people with heart failure must be extremely cautious if prescribed beta blockers because the medicine could lead to cardiac complications. Those prescribed metoprolol succinate (Toprol-XL) are no exception; other medications they are on may need to be adjusted, and most importantly, they must be closely monitored for worsening of their heart condition.
Asthmatics and patients with other respiratory problems are especially vulnerable, as these drugs can make breathing worse. Metoprolol (Lopressor, Toprol-XL) may be a little better than other beta-blockers in this regard, but monitor your breathing carefully. Diabetics should inform their physicians if being prescribed metoprolol (Lopressor, Toprol-XL) since the medication may mask the signs of low blood sugar levels.
People with a history of depression should inform their doctors to ensure both their depression and beta-blocker therapy is well managed. Metoprolol (Lopressor, Toprol-XL) is more likely to affect the nervous system than others in its class and may contribute to depression. People with a thyroid disorder should also be carefully monitored as metoprolol (Lopressor, Toprol-XL) may mask signs of an overly active thyroid. Lastly, people with liver impairments may also need to be very carefully monitored.
Be certain to inform your doctor of any other conditions you may have. This information may affect your dose, whether you should even take this medication, or require you to take special tests during treatment.
Taking the Medicine
Metoprolol (Lopressor, Toprol-XL) is best absorbed when taken with or right after meals. Food may reduce the risk of digestive tract upset and taking the drug at roughly the same time each day allows your body to maintain a constant level of the medication in your blood stream. Metoprolol (Lopressor, Toprol-XL) should be taken with a full glass of water. Avoid alcohol while on metoprolol (Lopressor, Toprol-XL) because it increases drowsiness and dizziness, and do not take calcium supplements or antacids within two hours of metoprolol because they may reduce absorption.
If surgery is scheduled, ask your surgeon and anesthesiologist to see if your beta blocker dose will need to be adjusted. Never stop taking metoprolol (Lopressor, Toprol-XL) suddenly. Your doctor must reduce your dose gradually to prevent serious heart problems.
Common Side Effects
• anxiety, nervousness
• sleep problems (insomnia)
• tired feeling
• vomiting
• decreased sex drive, impotence, or difficulty having an orgasm
• arthritis
The medicine may also have a negative effect on cholesterol and other blood fats, so a lipid test before treatment and periodically thereafter would be prudent.
Serious Side Effects
Obtain emergency medical care if you experience these signs of a potential allergic reaction:
• breathing difficulties
• swelling in your face, lips, tongue, or throat
Call your doctor promptly if you experience any of these serious side effects:
• feeling light-headed, fainting
• worsening depression, memory loss or mood swings
• wheezing, worsening asthma
• feeling short of breath, even with mild exertion
• extra-slow or uneven heartbeats
• stomach upset, low fever, lack of appetite, dark urine, pale-colored stools, jaundice (yellowing of the skin or eyes)
• swelling of your ankles or feet
• cold feeling in your hands and feet
• hives, itchiness, rash
There may be other side effects not listed here. Talk to your doctor if your condition worsens and ask about any side effect that seems unusual or is especially bothersome. Never stop taking any beta blocker medication abruptly unless you are under very close medical supervision. Angina or a heart attack could occur.
Drug Interactions
• Catapres (clonidine): If you are on both blood pressure medications, do not suddenly discontinue either medicine, as the increase in blood pressure could be life threatening.
• Prazosin (Minipress) is more likely to cause fainting problems when combined with Lopressor.
• Hydralazine (Apresoline), propafenone (Rythmol), quinidine, and calcium channel blockers ([verapamil (Calan)], [diltiazem (Cardiem)]): These are also heart/blood pressure medications, which would have increased effects if given together with metoprolol (Lopressor, Toprol-XL). Taking beta-blockers with calcium channel blockers is generally not advised since the combined effects may lead to serious heart problems. If they must be taken together, the dose of one or both medications may need to be reduced and cardiac function should be carefully monitored.
• Propylthiouracil or methimazole (Tapazole), insulins: Beta-blockers may also make treatment of diabetes and thyroid disorders more complicated. Your physician will need to monitor such conditions closely.
• Antacids containing aluminum or calcium and aspirin, ibuprofen: These can reduce absorption and interfere with the effectiveness of metoprolol (Lopressor, Toprol-XL).
• NSAID arthritis drugs such as ibuprofen, naproxen, and high dose aspirin can reduce the effectiveness of metoprolol.
• Cimetidine (Tagamet) and ranitidine (Zantac): Ulcer drugs may increase the effects of metoprolol (Lopressor, Toprol-XL).
• Barbiturates (phenobarbital) and tuberculosis antibiotics (rifampin): These drugs may reduce the effect of beta-blockers.
There may be other drug interactions not listed here. Do not start any new medications or make changes to your treatment without first consulting your prescribing physician.
References
1. Lindholm, L. H., et al. “Should Beta-Blockers Remain First Choice in the Treatment of Primary Hypertension? A Meta-Analysis.” Lancet 2005; 366:1545-1553.
2. Kaplan, N.M., and Opie, L.H. “Controversies in Hypertension.” Lancet 2006; 367:168-176.
3. Beevers, D.G. “The End of Beta-Blockers for Uncomplicated Hypertension?” Lancet 2005; 366:1510-1512.
Be certain to consult a physician about your health, especially with regard to any signs or symptoms that may require diagnosis or medical attention. Information provided is not a substitute for the medical advice or care of a physician or other health care professional.
My insurance insists on using generic metoprobol succinate, which does not work as well, causing higher blood pressure, etc... actually ended up in the hospital, with many tests and procedures.
Am I the only one with this problem with generics... and what do you suggest I do?
Thanks
does
Since we used Toprol and its generic made by the same company, and since it has so many cautions and side effects, couldn't it be a matter of proper dosages rather than the quality of the generics?
How do we judge the allowable risks when we use drugs that are useful and have side effects?
If you are taking Toprol and you have symptoms that are not included with the information, please consult with your Dr. IBS is just one of the problems that was a side effect for me for 7 years. Once my husband and I stopped it our problems disappeared. Thanks.
I have been taking Toprol XL in varying doses (currently 50 mg) for 10 or more years, along with a diuretic, Triam/Hctz. (I am 58 yrs. old.) Now my insurance co. is strongly suggesting that I switch to the generic, and has contacted my Dr.'s office. I am reluctant since Toprol has worked well for me. My co-pay is only $11.82 per month. I am also taking Tamoxifen and an 81mg. aspirin daily. How do I decide whether to switch to the generic? Thanks.
Have been on Toprol XL, 50 mg. for 10 years. Insurance co. has required me to switch to generic. I just do not feel as well, with acid reflux, pounding heartbeats and tiredness. I had no problem while on Toprol XL. I also had to switch from Lipitor to a generic but had to try 2 prescriptions before I found one that worked for me.
I am taking lopressor for rapid heart rate and palpitations. When the insurance insisted I take the generic, it didn't work! I have tried the generic 3 times over the past few years... doesn't work. So now I pay full price for lopressor.
Also... in response to my complaints, my cardiologist told me that in a recent study of 4 different medications, Metoprolol was the only drug that was NOT able to prevent sudden death episodes in patients! So... right from the horse's mouth!
Now I am trying Bisoprolol and having good luck!
I have taken Toprol for several years and have recently stopped. I developed very dark urine with a very strong odor and also very low heart rate. What is the cause of the dark urine? It went away within a day or two of stopping the Toprol, but I am concerned about what happened to me.
Thanks,
Brad
Last year my Pharmacy(CVS) gave me a generic (metoprolol succinate) in place of Toprol XL 50mg and my blood pressure went up to the 150 range after a few weeks. I stopped the generic and went back to the brand name Toprol-XL and my BP went down to the 120 range. I showed a clipping from your column in the Chapel Hill newspaper to the Pharmacist but she wasn't aware of the problem. Thank you for publishing it.
I am 35 years old and have high blood pressure and am overweight. I ran out of my bisoprolol on a friday and had no way of filling my prescription as of a sunday night my bp went sky high and went to the ER. My bloodwork and ekg all looked good I had mild chest pains. My doctor happened to be on call in the er and took me off my bisoprolol and told me to start taking 50mg Metoprolol so i took it and went to sleep I woke up with numb lips and left side of my face was numb off n on.
And my bp had went back up again. I called and they wanted me to double up on the dosage to 100 mg Metoprolol tablet a day but to take two of my 50 mg tablets till i could fill my other prescription. so i did this and had the worst day and night i have ever had. Anxiety got so bad i woke up shaking so severe heart racing and dizzyness.
I took my xanex to calm me down and it eased up a bit but I don't think that Metoprolol is for me with those kinds of side effects it has kept me from work for two days. I plan on going back to my bisoprolol since i have only taken 4 of these pills i don't think there is enough in my system to cause anything bad as i intend on starting my bisoprolol asap. Thank you I hope this helps.
I cant remember if I took my metoprolol xl or not tonight, and I'm not sure if i should take a dose and risk double dosing or if i should not take it and risk skipping a dose. It really sucks because I know I'm not going to get an answer tonight. I guess I am just going to skip it. It is most likely the safest bet. But could someone give me some insight if this is to happen again. Thank you.
I suggest that you buy one of those strips at Wal-Mart (or another store), with one small container for each day of the week. Insert your pill(s) and take them out of the container so you can later look back to see if you have taken it. Then you will never be worried about it again!
In November I went for a refill on my 25mg metroprolol succinate ER, which I've used for 4 years without incident. It turns out the distributor, Santos, had recalled the product, and I ended up with another generic. 4 days later the problems started: palpitations, chest tightness, higher heart rate, cold hands and feet, higher blood pressure, slightly swollen and throbbing throat, and mild depression.
My doctor said that the brand name is always better anyway, and put me on Toprol XL: but the problems remained. If the generic sucinate ER wasn't causing problems and the brand name is, what does that tell me? Toprol XL just doesn't seem to suit me, whereas the succinate ER did. Does anyone have any insights? Where can I get the succinate again? Or is there an alternative I can discuss with my doctor? It's not in my head. I'm a pretty rational person, and this is all wrong. I understand that many people are saying the brand name is better, but in my particular case, the opposite may be the case.
I was put on metoprolol because I attempted to get off Klonopin too fast which I learned the hard way. I ended up in ER with a heart rate of 149bpm. I had no idea that you had to get off benzo meds verrrrry slowly. I did not go cold turkey-but I also did not do it in a very slow fashion. I was given Metoprolol extended release- 100 mg a day to help get the high rate under control. Well, I did get down from the 149 bpm. But the problem is, I have always had episodic sinus tachycardia and this drug has been THE WORSE AT HELPING TACHYCARDIA !
I used generic Nadolol in the past- on a as needed basis in baby doses and got far better results for my episodes. Now I am weaning myself off this useless Metoprolol and am down to 50 mg and I feel like I did when I first took it- like I am on a sugar pill. It just does not work for me.
Yet Nadolol is a generic and it did help me and I did not need it on a daily basis either. My goal is to get off the Metoprolol completely, but a part of me almost feels like it is actually MAKING MY TACHYCARDIA WORSE. Not only is my rate faster than normal( but no where near 149bpm) the level of pounding to the palpitations is annoying at best- down right scary at worst.
I would not recommend this generic drug to anyone. One other thing: I was finally off anti-depressants when I got put on Metoprolol. DEFINITELY CAUSED DEPRESSION & ANXIETY. Think twice before you go with generic on any drug. I have always heard beta blockers are one line of medicine you should always try to buy in brand formula.
Metoprolol has been horrible for me and I have been on it since Oct 2008 :(
I have too been taking Metoprolol tartrate 50 mg 2 x daily for a couple of years, for rapid heart and palpatations and a slight arrthymia( sorry if its not spelled right ) At first I was only on 25 mg 2x a day but my rapid pulse still remained, so my doctor raised my dose to 50. At first it helped alot. But this is 3 years later and I'm having all kinds of problems.
My heart is racing again, sometimes over 160 bpm, I have spikes in my blood pressure from sitting (147/100) to standing (119/78). I also have unexplained diarrhea for 6 months straight. I have terribly anxiety and am having to see a doctor for that too. Can Metoprolol tartrate cause the diarrhea?
I've have every test you can think of done to me and they all come back normal. I need any and all info on this. Like I said I've been going through this for 6 months having to take Lorzepam 1 mg 3x a day which before my Metoprolol was raised I only took 1 mg of Lorazepam a day, I'm afraid to eat because it make my rapid heart rate faster and it starts when I get up every morning.
Taking it kinda calms it down but it always gets right back up there somehow. The diarrhea started first then all this other, can it cause the diarrhea? If so what is the best to take for rapid heart rate and arrhythmia? I've also been on Atenolol 25 mg with no stomach problems and less anxiety but it completely quit working for me. Any advice will be appreciated. Thank you so much. Also I am 28 years old and also overweight. Have had this problem for 8 years. Thanks again.
I have a question on metoprolol tartrate. I was put on metoprolol sussinate ER 12 1/2 mg per day Oct.2008. Just got switched over to metoprolol tartrate 12 1/2 mg per day. I am currently on lorazapam 1 mg per day. Both very low mg per day. I am in the process of weaning off the metoprolol tartrate 12 1/2 mg because of to many side effects..yucky!! My doctor has me taking 4 more days of 12 1/2 mgs and then cut that in half for about 5 days and then stop. My question is...Should I have a problem after I stop where my dose is so low? I am thinking not because I also have the lorazapam. Any helpful hints or suggestions? I am only doing this under doctors supervision.
I have been on metoprolo for 2 years and have lost a lot of my hair and have had dizzy spells and over all weakness in arms and legs. I did notice changes in my pill sizes. I recently researched and found out about the recalls. I wish I had been informed about this recall and the problems with the dosage''s of this pill before I lost my hair and felt this way.
It also made my B/P rise! I recently went off of it and my blood pressure went back to normal, and I'm trying to get it out of my system. I have experienced insomnia and weakness in my body and heart palpitations! It has been a nightmare for me that I'm still trying to wake up from..
I'm on Nioxin for my hair now that it is gone. I do have before and after pictures that I showed the doctor, I am now trying to figure out what I can take for heart flutters from M.V.P.
To all of you! Keep on top of the recalls and what the patients are going through and pretty much you will find yourself among them and it's not just you alone. I wish the Doctors would take these complaints more seriously and the F.D A. I do feel it is time for the patients to be heard.We need a web page with our stories with our names, for legal advice for all who have been affected by this drug and hold those responsible for not informing patients of the recall and allowing us to suffer by taking this drug.
Can you tell me if it is OK to eat grapefruit while taking Metoprolol Tartrate 50 MG/ I can not find any information to tell me not to eat it but friends tell me I should not be eating it.
Thanks.
Can you tell me if it is OK to eat grapefruit while on the medication Toprol XL 100 mg?
PEOPLE'S PHARMACY RESPONSE: WE ARE NOT AWARE OF AN INTERACTION BETWEEN GRAPEFRUIT AND METOPROLOL.
I have taken Toprol XL 50 mg for more than 3 years. The pharmacy switched me to a generic. No problem until they switched suppliers. The pill was very large and after a a few days I began to feel awful and my blood sugar was testing quite high. I switched back to Toprol XL and the problem went away. No more generic Toprol for me--ever.
I have been taking 25 mg Metoprolol Tartrate (MT) daily for several years. I'm a member of an Health Maintenance Organization (HMO) and they occasionally switch pills or suppliers. I believe the original Metoprolol given to me was a white, round, and flat 50 mg pill which I had to split in half. It was later switched to a larger red 50 mg pill and then to a 25 mg small white pill. The first two pills seem to work find although I did develop some severe PVC's while using the red pill. However, the small white 25 mg pill caused me to have major breathing problems and I ended up in the emergency room. At the time I did not realize the medication was causing the problem. All sorts of tests were performed on me while I was in the emerency room but no problems were found. When I informed my doctor about this he indicated that all Metoprolol was the same and there was only one supplier. I have not taken anymore of the Metoprolol that I believed caused the breathing problems and have not had the breathing problems that sent me to the emergency room since. Luckily, I still had some of my original Metoprolol and I have resumed taking it.
After 14 years of Metoprolol Succ 10/25mg once a day the insurance company switched me to Metoprolol TAR(L) 25mg twice a day, because of the recall on the Succ. I have taken TAR for about 40 days. In the last few days I have been lethargic at best along with numerous aches (chest, leg, arm) headaches, extreme fatigue and some shortness of breath.
A visit to my doctor two days ago found nothing in an EKG or blood work. Dr. advised to cut TAR dosage in half for 4 days, then half again the next 4 and then none. After reading several post and not feeling any better after 2 days of reduced dosage, should I have concern over the Dr's suggested trial and error method?
He advised if it didn't work he would try to locate a supplier for Succ. I am to monitor blood pressure during this trial and advise him if it rises over 160/95 consistently. I am also taking amlod/benazp 10-20mg once a day and 325mg of ecotrin. Should I seek a second opinion?
since taking Metoprolol Tartrate 12.5 mgm B.I.D. for elevated B/P.. I've experienced shortness of breath, and over-all joint and muscle aches..I'm weaning off..
I have been on Metoprolol 25mg 2Xdaily for approx. 4 years now since being diagnosed with an aortic aneurysm. I have lost a lot of my hair and I am SICK about it. This was never listed as a side effect that I got from the pharmacy but after doing my research I now see it is a side effect. What is in this drug that causes the hair loss? You would think the pharmaceutical co. could figure this out?? Please can someone help me? Is there another beta that I can take that does not cause HAIR LOSS? I am so worried about this I cannot sleep.
Since my doctor switched me to Metoprolol 100mg twice a day I have rashes in my ears and nose, also my legs and feet swell so bad they feel like they are going to burst.