The People's Perspective on Medicine

Metoprolol Mess (Toprol XL) Reveals Serious Flaws With FDA’s Generic Process

The FDA has just announced that a maker of generic Toprol XL will have to recall 109,744 bottles of metoprolol succinate. That could represent a substantial number of pills.

Wockhardt is a large Indian drug maker and it has supplied roughly one-fourth of the metoprolol swallowed each year in the U.S. Although the FDA previously stated that all the generic metoprolol products it had tested passed initial dissolution testing, a new announcement released on May 14, 2014, reveals that Wockhardt’s metoprolol actually failed this crucial test. The implications are significant regarding FDA’s oversight of metoprolol in particular and generic drugs in general.

Let’s start at the beginning of this tale of woe and intrigue. In 2007 we started receiving messages from visitors to this website that a beta blocker heart and blood pressure medicine called Toprol XL was not working as well as expected in its generic form, metoprolol. As more and more complaints poured in, we contacted the FDA about our concerns.

On October 21, 2007, we informed Gary Buehler (the director of the Office of Generic Drugs) and other FDA executives that there was a problem with the generic formulation of this and certain other important medications.

Gary’s response: “We are investigating all aspects of this issue.”

We heard nothing from the agency that year (or in following years) about its investigation into generic metoprolol. Nevertheless, over the last seven years we have continued to receive complaints from patients who maintained that there were generic metoprolol formulations that were not working the same way the brand name Toprol XL did. Here are just a few examples:

“I had been taking Toprol XL for six years with no problems. When the generic (metoprolol succinate) came out, I was switched to that. All was well for a while but then my blood pressure shot way up. I started having dizziness & numbness on the left side of the face. I also had difficulty breathing and anxiety.

“The pharmacist told me that she has heard a ton of complaints about metoprolol succinate and that it is not the same as Toprol XL. She stated that Toprol XL is a time-release formula & metoprolol succinate is not.

“I had my cardiologist switch me back and I started feeling better right away. By the second day my BP was back to normal.” Roger, December 9, 2007

“Generic metoprolol ER is not the same as Toprol XL. My pharmacy gave me generic metoprolol in December and within two weeks I started having irregular heartbeats.” Stephanie, Feb. 12, 2007

“After taking Toprol XL with good results for three years to control cardiac arrhythmias, I was given a generic substitute three weeks ago when I switched pharmacies.

“After taking the daily dosage for five days, I began having more and more arrhythmias to the point of having to be admitted to the hospital. There were no other differences in my daily life.

“After discharge, I returned to the unused brand name drug (Toprol XL) and have had no further problems.” Nancy, March 20, 2007

“I have been taking brand name Toprol XL for quite some time without any problems. Last week, I ran out and my doctor phoned in the refill for a generic prescription. I received metoprolol ER.

“I took it for 7 days. This is absolutely NOT the same. I have a blood pressure cuff that records my last 100 readings. During about the first 12 hours after taking it, my blood pressure was way too low. During about the last 12 hours, my blood pressure was much higher than it ever was. I am on my way now to pick up a new prescription for the brand name, at an additional cost to me, of course.” Debbie, July 5, 2007

“I was recently taking Toprol XL for a heart rate problem called SVT and was doing fine. Our drug coverage changed and the mail order drug company sent me the generic metoprolol succinate ER tabs.

“About a week after starting the generic drug I was awakened at 5:00 am with a heart rate of 188. We went to emergency and they got it under control. This happened 3 times within a four week period and finally my husband and I told the doctor the only thing we could think of that had changed was the generic drug.

“She immediately wrote a new prescription for brand name Toprol XL. I never had another problem.

“I understand the generic is a immediate release and is in the system for about 6 hours and that the Toprol XL is 24 hour time release. I am 54 years old without a blood pressure problem, but someone elderly could have a real serious BP problem on this generic.” Linda, June 26, 2007

We could provide lots more stories about the problems patients have had with generic metoprolol over the last seven years, but by now you get the point.

We have continued to alert the FDA that there was a serious problem with various generic metoprolol products. For people with hypertension, irregular heart rhythms or hypertrophic cardiomyopathy, having a medication that does not work as anticipated could turn into a life-threatening situation. Nearly 40 million prescriptions of metoprolol are dispensed each year in the U.S.

NEW DEVELOPMENTS!

Fast forward to 2014. The FDA recently announced that it would begin testing generic metoprolol succinate…after seven years of our badgering. A recent report from Bloomberg News notes that the agency has received 3,425 adverse incident reports for the drug including “lack of effectiveness,” as well as “troublesome side effects.” In this Bloomberg report the FDA made it clear that in initial tests, generic forms of metoprolol succinate dissolved properly. That seemed to suggest the FDA had tested various products and found they had all passed muster. The way a pill dissolves in a test solution provides some indication how well it will dissolve in a human body.

But that all changed on May 14, 2014. Without a lot of fanfare, the FDA noted that the Indian drug company Wockhardt had a problem with its metoprolol. That prompted the recall of 110,000 bottles of 50 mg metoprolol succinate. Goodness knows how patients and pharmacists will be able to determine which pill bottles need to be returned. Most pharmacies do not put a lot number on the prescription label. Even if you call your pharmacist you may not be able to discover if your metoprolol is part of this recall.

Perhaps even more worrisome is an acknowledgment by FDA spokesperson Sandy Walsh that the FDA is rethinking the criteria it has used for decades for approving generic drugs. We are gratified that the agency is rethinking its procedures, but we worry that there could be hundreds of products on pharmacy shelves that may not be working the way physicians, pharmacists and patients expect.

BOTTOM LINE:

There was a famous phrase uttered aboard the Apollo 13 moon flight on April 14, 1970: “Okay, Houston, we’ve had a problem here.”

For 25 years we were among the country’s most stalwart supporters of generic drugs. But for the last ten years we have been telling the FDA that we have a problem with some generic drugs. We suspect that there are issues with the FDA’s approval process. We also suspect that there are serious problems with manufacturing quality, particularly in countries like India and China where the FDA does not have adequate personnel to carry out inspections. Over the last few years we have heard about problems with Wockhardt, Ranbaxy and Sun Pharmaceutical, to name just a few. Given that the overwhelming majority of our generic drugs now come from abroad, Americans have a right to be indignant.

If you would like to read more about the details of our investigation into the generic drug problem in America and the FDA’s inadequate oversight, we offer our book, Top Screwups Doctors Make and How to Avoid Them. You will discover the details behind the Budeprion XL 300 debacle and learn what steps you can take to avoid generic drug disasters.

Share your own generic drug experience (positive or negative) below. We are especially interested in metoprolol stories, but please let us know about any generic drug you have taken.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I was switched to the generic metoprolol by my pharmacy. I began to have short term memory problems. My arrhythmia was off and on, but more severe when it happened. My heart seemed to be going very fast, even when I was resting. I lost 12 lbs in one year. Then my hair started to fall out and I was becoming a zombie with either no thoughts, or sad thoughts. I switched pharmacy’s and requested the brand name instead of the generic. This morning it feels like a veil has been lifted off my brain. I am happy again, and my heart has a regular slow beat. Toperol XL is working

Because of A-fib, I’ve taken generic metoprolol succinate 25 mg. twice a day for quite a while, but sometime ago I noticed that the shape of the pill had changed (I have been getting them by mail through my insurance). The shape went from round to oval. The manufacturer of the oval one is Dr. Reddy, an Indian company. I’m not sure who produced the other one I took, and I’m not sure when exactly I started taking the oval one.

Since spring, my A-fib has become chronic. I just figured it was getting worse, which I’ve read is the natural progression. In addition to the irregularity, my rate was also out of control, often being well over 100 even when I was just sitting and doing nothing.

My new cardiologist doubled my dosage to 50 mg. twice a day, and nothing changed. My heart was still out of rhythm nearly all the time and my rate was out of control. Then a relative called to ask if I was still taking that drug. She takes it for hypertension and had switched pharmacies. The generic’s manufacturer was different for the new pharmacy, and after she started taking that one, her bp got out of control. She got her doctor to write her a prescription for the brand name version, Toprol XL. I called my doc and got the same.

I started taking the brand name drug on the Tuesday before Thanksgiving, and my heart rate started dropping within the first day or so. I was still taking 50 mg. twice a day. By Friday, my heart rate seldom got out of the fifties, even when I was active, so I reduced it to 50 mg. in the morning and 25 in the evening. Today is Sunday. I did some light exercise this morning, and my rate did make it into the low sixties, but is still in the fifties most of the time, so today I’m reducing the dosage back to 25 mg. twice a day. Even with the very low rate, I feel fine.

Besides the good news that my heart rate is getting under control is that my heart rhythm is now normal most of the time. I occasionally notice a skipped beat, but for the most part, it has stabilized. Yes, I had to pay cash for the brand name because my insurance won’t cover it, but I consider it money well spent.

I’ve been taking atenolol for 10 years working perfectly to keep me BP under control. Last week I was informed that there was a shortage in the production for atenolol. They were switching all patients to metoprolol succinate ER. I started Tuesday and the very next day I felt palpitations. I knew something was off. One week later, my head felt like it was exploting and started having chest pain. I check my BP and it was the highest ever! I ended up on the hospital, they did a stress test (passed), and my BP went down to normal when they switched the medication.

Please, what did they switch you to (from the metoprolol)? I’m in the exact same situation; Atenolol = perfect, Metoprolol = palpitations, racing heartbeats, and vastly elevated BP. IF you’ve found something that did work for you, please advise!

I was diagnosed with SVT last year, after being hospitalized twice in one week. The doctor put me on metoprolol. It seemed to work ok for a little while (with some side effects), then I started having palpitations again, so my doctor switched me to brand name Toprol. Wow! What a difference! It costs a lot more, but it works so much better. The generic is definitely NOT the same as the brand name.

My hair is falling out with metoprolol 100 mg. Will toprol close be better?

I’ve been taking Metiprollol for about two months for high BP.
It got my BP to normal. Recently got a refill and it does not control the BP at all anymore. I’ve gone on internet and found others have had this interesting issue. I am trying to find the brand in pharmacy at this time to see if this will make difference. We should not have this problem in our United States.

I have had hbp for twenty years or so controlled, but lately it has gone much higher as much 206/94, which was a scare, i was out of one prescription which was Metoprolol and ordered it again and my blood pressure is now at 153/84 which is lower but really not low enough. This Metoprolol is made by Astrazeneca. Hope it is of better quality.

my experience too & have read recently that it makes BP surge when its not working correctly & that is OFTEN!!!

Doctors seem scared to admit that hair loss can happen from the med(s) they prescribe. They plead ignorance on the subject and ascribe the side-effect to “genetics” or “nerves” or “stress” or “hormones” or “aging” –anything but their precious drug!

I took generic metoprolol succinate ER (extended release) for the past 15 years from my family practitioner for benign tachycardia (just fast heart rate with no known cause) and I was just recently sent by my mail order pharmacy the ones from Watson which I had never had before. They are very thick pills, very different from all the other generics before.

Anyways, I started having severe arrhythmias that caused dizziness, lightheadedness, and general nausea. I felt like I was going to die. It was scary. This would come and go and went on for 30 days. I kept thinking it would go away since I’m extremely healthy other than the fast heart rate.

It became hard to fall asleep because the arrhythmias would start up badly after laying down to sleep at night and would immediately wake me up once I finally got to sleep. So I began looking into seeing a cardiologist to have a holter or event monitor. But then I thought maybe the pharmacy sent me the wrong pills so I searched the tablet imprint online and found it was correct.

But the search led me to this website, and I realized these arrhythmias could very well be caused by this new generic I began a month ago. So, I count the pills, and sure enough, I took right about a month’s worth. I still have a few of the old ones (not from Watson) that I had added to this new bottle so I am only taking the old ones now as of today and in a few days I will know if these Watson pills are the culprit.

If so, I will report my side effects to the FDA. And I will have to call my doctor for a new order and pay full price from a local pharmacy. (Yet another reason I can’t stand mail order) maybe it’s the hypromellose??? I don’t know about that. I’ll have to research that for sure

I totally agree about metropol, as I have been on Toprol XL for years. For the past year and a half my blood pressure remains at 120/80 with no problems. Now my pharmacist has switch me over to metropol and my BP has risen to 140/90 and higher in the pass three months (2017). My doctor has tried to convince me they are both the same medicines, which I have totally disagreed with him and the pharmacist. I’m so glad to have come across this article. I do NOT want to take generics for anything pertaining to my heart. I also take coumadin which I need an update on that medication. Thank you!!!

I totally agree about metropol, as I have been on Toprol xl for years. For the past year ans a half my blood pressure remains at 80/120 with no problems. Now my pharmacist has switch me over to metropol and my BP has risen to 140/90 and higher in the pass three months (2017).

My doctor has tried to convince me they are both the same medicine. Which I have totally disagreed with him and the pharmacist. Im so glad to have come across this article. I do NOT want to take generics for anything pertaining to my heart. I also take coumadin which I need and update on that medication.

they are NOT the same!!

I would like to see an article on taking metopol XL when on coumadin therapy. I presently take coumadin 4mgs every day and the tropol 50 mgs. morning and night. I need to know if there is any interaction with these medications. Please reply

On March 24, 2017 the Doctors opened up one partial blockage and put a stent in the completly blocked vessel. Afterward they gave me a prescription for Metoprol ER succ. After three doses I began having extreme fatigue, headache, and nightmares at night. Thank GOD my drug company sent me Toprol XI and the side effects are almost gone. I still have a little tireness but nothing like before. I was taking toprol at night but bad dreams started back, so now I take Plavix and toprol at the same with very after effects. The generic med Metoprol Er is not good. Hope this helps someone. Gene

I have been taking the Brand name Toprol XL for years and had to switch insurances. My past insurance sent me the brand name and only charged me the generic price. They said there was a problem with supply but they continued to send it for years at that price.
Since changing insurances this year I started receiving the generic. I hadn’t used them yet since I still had some of the Brand Toprol left. I accidentally grabbed the wrong bottle and filled up my 2 weekly containers with the generic. So for 2 weeks I was taking them and felt awful. No energy and the bones in my arms ached and felt like I couldn’t function until late afternoon when I started feeling better. It didn’t dawn on me that it was from those generic pills until when I wanted to start filling up my containers again. I saw where there was one left in my pill container and saw that it was generic. So I counted the pills in the generic bottle and exactly 14 pills were gone so then I knew I had taken them.
Next day I started the brand one and and feel so much better. Don’t have those symptoms anymore. I am going to call the doctor for a new prescription for the Brand but it is very expensive for me.

For over a month now I have been feeling (I know this going to sound crazy) what feels like a very faint electrical charge/current in my heart. After much thought, I began to think maybe is was valve regurgitation. I don’t have medical insurance so getting an echocardiogram is not an option, they are too costly. I have been on Metoprolol for over 3 years now and wonder if the ingredients in this medication could cause a valve problem. If anyone knows if would greatly appreciate your input.

I have just started taking Dr. Reddy’s Metoprolol Succinate ER Tab 50 MG. After taking for only four days, I have a concern. Weight gain. While this may not ring as an issue to most, having a weight problem has me hyper-vigilant. Portion sizes are minimized with food quality highly stressed. Weight loss has been between 2-3 pounds a week. Now, I am gaining 2-3 pounds a day!
I am not an obsessive stick person. Along with my CHF came a significant weight gain that I have successfully been chipping away.
Now, this generic pill has me gaining without any other cause and effect. Is this usual? Is there an ingredient that would cause this?

I have recently moved and started with all new physicians. I don’t want to blow my credibility as a sane person…. I have a real concern. Any suggestions, greatly appreciate.

I was given name brand meroprolol er 50 mg this time and have been on generic for 6 years.I’v always noticed this thin name brand metoprolol pills caused me to be very irritated and angry feeling when I took them but I also have some heart irregularity on my normal generic so maybe I will try this name brand and see what happens.I do know their is a major difference in namebrand VS generic drugs but the pharmacy will NEVER ever admit that to you.I also think they should have told me I was getting a different brand also.

Heart attack 2012, prescribed Metoprolol, taken without incident 4 yrs. Until this week when I landed in hospital with chest pain, pounding headache, dizziness & blurred vision. Tests all fine. Still had headache & spiking blood pressure, more test scheduled. Upon review the only thing different was a new bottle of metoprolol from PAR via CVS. Reverted to a leftover older bottle of pills and symptoms immediately resolve. Medical personnel quick to dismiss? I am reporting this to CVS, FDA, hospital & insurance.

I’ve been taking Metoprolol ER for 6 years (with NO problems), since my sudden cardiac arrest. Since my last refill about a month ago my average heart rate has steadily increased. It got so bad that I finally went to my cardiologist yesterday and he said that there had been problems in the past with generic manufacturers. Sure enough, I went home and looked up the “new” manufacturer – Dr. Reddy’s, based in India. There was a recall on their Metoprolol in 2014, and they currently have 3 FDA sanctions against them. WHY are we distributing life and death medications made by a company that repeatedly receives sanctions? (And by the way… Dr. Reddy’s? Really? Why not just call yourselves “Bob’s Drugs”!) I was switched to PAR today. We’ll see how that goes, but if it’s not better I’m going to brand.

For some reason my pulse got out of control [never had been] and my BP was also very high. I saw your article in April or May of 2016 and shared it with my physician. I checked and my Metoprolol was from India. My physician changed me to Toprol XL and the pulse came back to normal and my BP has dropped. I am very grateful for the information as posted by The People’s Pharmacy. I am also hoping the hair loss will stop but so grateful for the other. Thank you so much.

After taking PRINIVIL for about 25 years my nephrologist switched me to METOPROLOL succinate ER 25 mg.twice a day. It worked until my last refill at my pharmacy was manufactured by PAR PHARMA (my original pill was round with a score this one is oblong with markings A & B;i must say that my blood pressure has risen 10 %?? my cardiologist shrugged it off but I am convinced that this pill is not doing its job;am I putting myself in jeopardy???

I just looked at my bottle it says:
METOPROLOL ER SUCC 25 MG.
PHARMACEUTICAL: PAR
Is this the Pharmaceutical that every one has had an issue with?
Any issues with TOPROL XL and the Pharmaceuticals?

Iam a 54 yr. old female, was put on Metoprolol ER Succ 25mg. for Severe Migraine Prevention by my Cardiologist. Iam healthy, other than migraines, & a mild heart murmur. My cardiologist said I can’t continue to keep taking Relpax, & Imitrex 3-5 x’s a week, so he gave me Metoprolol ER Succ 25mg..
As a preventative for severe migraines. Well all was great in the beginning, 5 weeks ago. Headaches were less often. But now I’m having adverse effects such as: palpitations, very nervous, weak feeling, burning pain in back, & top of head, blood pressure goes really low 110/70, pulse 45, then at night might be 150/86, pulse 64, before my next dose.
I looked this medicine up & found out that there are others with the same side effects. I called my doctor today & asked to be switched to the brand name TOPROL XL..we shall see! I can’t continue & refuse to feel this way. It’s awful for me. Good Luck! :)

I had been taking toprol XL for years and had very few problems over those years with my irregular heartbeat. Then I was switched to a generic (metoprolol) .then I started having alot of problems with my irregular heartbeat. I made them give me the name brand back.I just started taking the name brand but it is not the same name brand pill I was taking before. The first name brand pill I was taking worked wonderfully but this name brand pill looks just like the generic one I was taking, in fact practically identical and so far it’s not working. I’ve been taking it for 3 or_4 days. It concerns me that it may not be a name brand. I just know that the original name brand pill worked so well and this one is different and it doesn’t seem to be working and that is the only change I’ve had . I can’t see anything that could be causing the problem. I feel that the problems with medications should be looked into alot more carefully. We are depending on the pharmacutical companies to do their jobs correctly. But obviously they seem to be filling to do so. My prayers are with everyone having these problems.

I have been taking the metoprolol succinate 50 mg for a cardiac arrythmia, PVCs. Before I left for my vacation, I had the 6 week follow up with my cardiologist to see how things were going. All was going well, medication was working and I felt much better. When I returned from my vacation, I received my new prescription bottle in the mail ( I had to switch pharmacies due to a new health plan) and after taking the new prescription, symptoms returned after 6 weeks of feeling great. Nothing else changed. I called the pharmacy about the manufacturer. The oblong shape from Par-pharm was very effective for me but the round pill marked M2 did not work for me at all, with symptoms of palpitations and increased anxiety (due to palpitations). The point is, pay attention to the manufacturer. …there are differences! I have to unfortunately pay out of pocket for the better manufacturer.

Also had hair loss on metoprolol I am now on lower dose. But have been suffering from anxiety on it cardiologist doesn’t think it’s from metoprolol but didn’t have it before like this

I began to have problems with Metoprolol and was becoming a zombie, along with irregular heartbeats, trips to the hospital, etc. So, I began reading on my computer. I saw that this generic drug was having problems, and they all sounded like MY problems. I inquired of my insurance company and was told that I would have to pay for my TOPROL XL – and so I did! What a difference! Now and then my blood pressure rocks and rolls, but much less frequent, and is usually due to my eating habits, etc. No way will I be convinced to try Metoprolol again. Also, if it is so evident that these generics can be dangerous – why then do our insurance companies refuse to pay for the real thing???????????

Toprol Xl does not have the inactive ingredient hypromellose. This flowery sweet name was changed in the last few years from hydroxypropylmethylcellulose. And with very little close to no fanfare at all. Very deceptive. It IS in some of the metoprolol generics. Watson brand for example is one. I can’t take hypromellose. Twice it was in a drug I took daily. The first time I ended up in a coma with heart failure, liver failure and kidney failure. I had no risk factors at all. I’m lucky to be alive. The second time worsened the heart failure from the first time. Two different drugs both with hypromellose in common. No other daily drugs I took had that in it. It could be a coincidence but I’m not willing to risk my life. Last year went on one more drug with that same inactive ingredient and saw my liver enzymes begin to soar within the first two weeks. Went off that drug immediately. It is not the same as cellulose compounds don’t know why Watson would substitute it so unnecessarily. It must be cheap because it is showing up in everything from aspirin to face wash. By the way it is also used in industrial adhesivives. Go figure!

I am on Metoprolol Succ ER and have been having PVC’s, I also have other heart issues but these PVC’s are driving me crazy, and after reading all these stories I’m beginning to think it is this generic medication. I’m going to call my Dr. and request Toprol XL, and see what happens I to will have to pay for the name brand but it will be worth it. Has there been any law suit against this manufacturer?

I am 60 years old and was switched from a beta blocker to a channel blocked ( metoprolol) 7 years ago. It was actually my ex wife driving by that started the paul is losing his hair rumor in an excited way.

I ignored her gossip until a couple years ago when I realized I was shedding hair faster than my black lab.

It was everywhere… in my hat, intertwined in my eyebrows, (also thinning disproportionatly), stuck In my glasses, on my robe, on my shoulders in the vacuum even.

I am not a vain man but when this became more than annoying I noticed the hair falling out was really really thin and enimic looking.
I did some research and found one of the side effects of metoprolol was hair loss. But it was so far down the list ait was in the very rare catagory.
I do not believe them.

As of last week I stopped taking metoprolol 200 mg and also amlodepine cold turkey.
even though my doctor had assured me my pulse would skyrocket in 48 hours without it, my pulse and blood pressure have actually improved. 138/78 pulse of 98.

I don’t care if I drop dead today, as long as I don’t lose any more hair!!

signed… waiting for hair

We do not advocate stopping blood pressure medication suddenly, and urge those on blood pressure pills to get their doctors’ guidance for getting off.

I’ve been taking this medicine since I was 21 and now that I have read the side effects and what people was going through now I know that it wasn’t just me. I’ve been having dizzy spells been feeling light headed my anxiety is very up and I’ve been trying to switch to the brand name but my insurance don’t cover it covers the generic. so now I also have a heart veil problem also so I have eyes anyone that is taking this medicine talk to the doctor for the brand name cuz I’m 30 dealing with a heart veil problem and also with anxiety problem

There is some misinformation here. Metoprolol Succinate is NOT the same as Toprol XL. It IS the same as Toprol. Metoprolol Succinate ER is the sub for Toprol XL. ER and XL mean Extended Release. If it does NOT have the ER on the name it is not extended release and will not perform the same.

I believe most of the people having problems switched from extended release (XL) to non-extended release unknowingly, which could cause adverse side effects.

Also getting anxiety

I just got this E-mail forwarded to me from a friend, I had the same issues too! I have been on and paid for the real Toprol xl too and I am so relieved to know I am not crazy! I can tell when its real and when its generic!

So glad I read this article! I have been taking Metoprolol for several years for Hypertension. I was given the Wockhardt brand at a local drugstore and did not think much of it at first. The next day, I was covered in hives and itching all over. I could not attribute it to anything else but that. I returned it to the pharmacy and told them I wanted the previous kind ( which was Mylan ) instead. I never had anymore problems after that! I will never use anything Wockhardt makes again!

I have been taking generic metoprolol succinate ER (Par brand) for about 2 years without problems. Earlier this month I had my prescription refilled with a notice that my pharmacy had filled my script with a different brand. I have cardiomyopathy (reason for beta blocker) as well as thyroid disease & celiac disease. I knew immediately I had been glutened. The medication also is not sustained release that I can see. My normal 75 beats per minute heart rate has woken me up twice this week in the 130-140s range.

I’ve been on Metoprolol Succ 50mg for approximately 8 years. Throughout that time I’ve experienced contiuous hair shedding. According to my doc, there is only a 1% chance it’s the Metoprolol. Wondering if anyone else is experiencing the same. The medication has been helpful in other ways.

Was twice in hospital & had to have stress tests, due to new time release pain meds. Now I wonder what I was given.
Regards

Went to pick up my Metoprolol Succ 25mg – today and a notice said the pills may appear different but the content was the same. Since I have severe reactions to some meds, I questioned the change as I wanted to secure the same thing I have taken for 2 years. I checked with other pharmacies and found they have none of the metoprolol succ from Wockhardt. The pharmacist said they now only deal with Wilson as they are in the USA. I am checking with my regular druggist to see where they get the new generic, and I think I will check in the future for all meds and where they come from.
I am on Medicare and Blue Cross and they sometimes decide on their own what we should take, but with my severe allergies (I stop breathing) I try to retain what I have once I know I can tolerate it. Very grateful for this article, as it answered my questions and then some.

I am currently taking Metoprolol Succinate Extended-release Tablets 50 mg once a day. I do not feel I am having any problems; however, I am concerned about the recall and do not know if I am affected.
My medication is in the original bottle which lists the following information:
NDC 49884-405-01
Mfd. by: AstraZeneca AB
S-151 85 Sodertalje, Sweden
Mfd. for: Par Pharmaceutical Cos., Inc.
Spring Valley, NY 10977 U.S.A
Product of India
PAR R12/10
Pharmaceutical LA405-01-69-03
Can you help me determine this$

I too, had Cardiac problems after being on Metoprolol for a few years. My GP refused to believe I had problems from the medication. Eventually I was hospitalized. The Cardiologist stated that If I had not come to the hospital via 911, I would not have “awaken”. RN.,BA.

How does that pertain to this conversation? You don’t even tell us if you were on the brand name or the generic or if there was a change.

Metoprolol tartrate (generic for Lopressor) is not the same drug as the one they are talking about above, which is metoprolol succinate (generic for Toprol XL). Both are metoprolol, but one is long-acting (Toprol XL) and one is not (Lopressor).

More bad information. Metoprolol Succinate is Toprol. Metoprolol Tartrate is NOT sold under the Toprol name at all.

Metoprolol Succinate = Toprol
Metoprolol Succinate ER = Toprol XL
Metoprolol Tartrate = Lopressor

Thank you for this article,
For a long time I have questioned the effectiveness of generics, particularly those from other countries.
I too have had similar issues with Blood pressure management suffering real lows and real highs along with dizziness at times.
Early on I started on Toprol XL then like all the others was steered into the generic Metoprolol succinate approved by cardiologist..
I cannot begin to comprehend the how and why this country has allowed the importing of the majority of its drugs from countries that do not have the same standards as we once had. Oh I do $$$ but why do we allow it to continue?
Every single day I receive FDA recalls and I am shocked at the amount of recalls on major drugs and IV solutions. These are life saving drugs not some insignificant Supplement. Scares me.
What can we do ? Who can we turn to ? How do we demand safety once again
Respectfully, Annie T

The FDA has been playing games for years with Wockhardt in India. You contacted them in 2007 re: generic metoprolol and this is 2014 ! If the readers get on their computers and read all the FDA warning letters, import bans etc etc they will be shocked. A general search on Wockhardt problems will result in many many articles regarding all the problems, and yet we continue to let their generics come into this country. Between some doctors not admitting that there are problems with some generics, and the FDA not cracking down hard enough on some of these companies, it is just a losing battle for the patient.
Everyone can look up their pills on drugs.com. There is a pill identifier that allows one to put the code, shape, and color of medications to find out exactly what it is and who manufactured it. Take the time to find out what it is in that bottle that the pharmacy gave you. People who don’t have computers can ask someone to do it for them. It’s important.

I have taken metoprolol for more than two years with no side effects.

My experience with generic metoprolol was troubling. My doctor prescribed 50 mg Toprol XL for PVCs but my insurance would only cover the generic metoprolol. At the time (2009-2010) the companies making the generic were Watson Labs and Par Pharmaceuticals. My first 3 months were with the Watson version and the PVCs were greatly reduced but I felt slightly lightheaded and seasick. After 90 days I refilled my Rx and got the generic from Par.
BIG difference! I felt much worse: dizzy, off-balance, loads of PVCs – just plain awful. I called around to different pharmacies and checked to see if they used Watson or Par for their generic metoprolol before placing my next order and picking it up. This went on for a year, until I got new insurance and they covered the brand name Toprol XL at an *almost* reasonable cost.
I happily paid the extra because while on the brand name drug I felt human again. No PVCs, much less dizziness, no seasickness. Unfortunately, the Toprol stopped working after a year and I had an ablation. All is well now and I’m drug-free but it scares me to think of all the patients who rely on this drug to control their symptoms and are forced by their insurance company to get the generic.
I know from my personal experience that the generic metoprolol (from any company) just plain doesn’t work as well as the brand name.

Here again, unless your generic had ER on the name, you were put on the non time-release version. There are TWO different metoprolols….one is time release, one is not. Toprol XL is, and you need the corresponding generic when you switch.

After having a bad reaction to a generic toprol in 2007, I began using the AstraZeneca original and then switched to the PAR extended release generic, which is the one authorized by AstraZeneca. It’s more expensive than other generics but I’ve always done well with it (50mg/day), so for me it’s well worth the money (it’s also the only med I take). To my knowledge there’s never been an issue with this generic, but I look forward to PP corroborating that.

I am so glad I read your comments. I also am having a problem with irregular palpitations (very strong) and also since I take my blood pressure every day (As per my cardiologist). I have noticed that it is much higher that it has ever been. I take metoprolol Succ ER 25 Mg at night and metoprolol Succ ER 50 mg in the morning. The 50 Mg. is made in India: company is MYLAN and the 25 mg. metoprolol is made by Par Pharmaceutical.
I had an aortic valve replaced on Oct 28, 2011 and I am 80 years old. I try to be active but the pounding of my heart quickly scares me and I rest until it goes away. Thank you, Mrs. V. Lopez

Thank God for People’s Pharmacy!!!

I continue to have problems with generic bupropion, it doesn’t seem to have the same release all the time if feel on some days like being on a roller coaster. No way will my insurance pay for name brand and I can’t afford to pay top dollar for it.

My previous internist had me on metoprolol and Lisinopril for high blood pressure. He retired and I asked my new doctor if I needed both since my BP was always in the low normal range. She told me to stop the metoprolol. I did and my BP has actually dropped to an average of 98/60.

What remedies do knowledgeable people suggest? I doubt there is a data gathering organization to record when people die because the drug they needed has vanished and been replace with a non-effective [Indian?] substitute.

This may help someone. Usually, the metoprolol was a small white tapered pill. My prescription was refilled with one that was white and asprin shaped. I only took a couple to experience an irregular heartbeat.
I call the pharmacist and she exchanged the round pills. The problem stopped. I told my previous doctor what had happened and she said, “That couldn’t happen.” I said, “The pharmacist said it could.” Later my drug store was out of the small white tapered shaped pill. I was sent to another drug store to get it refilled. I told the pharmacist what had happened and he said, “Of course, that happened, the round pill is not timed release.”
Comment: When this pharmacist saw my retired military ID card, he paid for the prescription with the comment, “Thanks for your service to our country, my parents were Holocaust victims.”
Another recent change that seems to be OK is the Micardis HCT has been changed to a generic: Telmisartan and Hydrochlorothiazide Tablets USP.
Thanks

I just picked up a renewal of my generic Metroprolol succinate ER 50 mg from pharmacy. It is generic made by PAR Pharm. Has this manufacturer had any issues with this drug?
thanks

I have been using metoprolol for several years and have been having ongoing problems with blood pressure spiking for no apparent reason, irregular heart beat which is why I am taking this medicine and it doesn’t seem to be doing much good.
As a result I am now also taking another blood pressure medicine called Micardis. I never really had high blood pressure and only started on medicine because of the irregular heart beat. Metoprolol slows your heart beat and really makes me very listless. Am not happy and am contacting my doctor today.

My patients and I thank you for all the great work you do at the People’s Pharmacy! I love that you stay on the FDA trying to make our medications safer. I also appreciate all the non-pharmacological remedies you suggest.
It’s wonderful to have alternatives to offer my low income and under-insured patients.

It strikes me that many of the patients who have commented on the poor therapeutic effects of generic medications were at first on a branded pharmaceuticals. With all of the cost management going on in medicine today, I have to believe most patients are started on a generic version when one is available and in that case would never know the difference between an effective and ineffective response. Scary thought.

In January of 2013 I was admitted to the hospital with a-fib. They tried all sorts of meds on me and even did a cardioversion which did not hold. I continued to have the a-fib but was able to function pretty well on Rythmal, Warfarin and Lisinopril. In an attempt to stop the a-fib my cardiologist put me on Metoprolol Tartrate. I don’t know if this is a similar drug to what you are discussing.
All I know is that within a few hours of the first dose I could not walk across my house without being short of breath and exhausted. And, the a-fib was worse. I was simply unable to function at all. It took me a couple of days to figure out that it was the Metropolol so I stopped it and went back to the original meds.
Finally I was put on Amiodarone and another cardioversion was done which held this time. I was able to drop the dose of Amiodarone from 400 a day to 200 and then to 100 a day. My pulse stays in the 60s and 70s usually and I’m able to finally get back to my normal activities which means walking several miles a week.
I have thought all along that my reaction to Metoprolol was because I’ve been unable to take any beta blocker. Now, I see this on your site and will certainly bring it to the attention of my cardiologist. Of course I am concerned about the many reported side effects of Amiodarone and my eye doctor is watching my eyes carefully for signs of amiodarone in the cornea. I did notice at once that it caused muscle aches and a phlegm producing cough, but, it allows me to function without a-fib. I’m 78 years old anyway. I figure the good outweighs the bad.

I used the generic, metoprolol Succ and had the same result as tho I’d had food poisoning.
I was switched to TOPROL XL (non-generic)with the dosage cut back 50%. It worked. This is strong stuff. I think doctor’s should start small and if needed, then work up to a stronger dosage.

Was your generic timed release or not? That’s the important piece.

How do I know if the pills I have are good/bad/recalled? My blood pressure is good but I’ve been experiencing some numbness and headaches lately?

I have supraventricular tachycardia proximal and have been taking Metoprolol Tartrate ONLY when I need it for palpitations which happen about once or twice per month. I am very concerned, although I have not had any problems with my drug other than it sometimes takes longer to work.
I was notified just this morning (e-mail) by Walgreen’s that they cannot refill my prescription. It is gratifying that they are on top of things!
I was not aware that my medication was being produced in India. Had I known, I would have requested a change.

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