The NICE British National Formulary (BNF) and British National Formulary for Children (BNFc) sites are only available to users in the UK, Crown Dependencies and British Overseas Territories. If you believe you are seeing this page in error please contact us. Switching from immediate-release to extended-release: Use same total daily dose of metoprolol Switching between oral and IV dosage forms: Equivalent beta-blocking effect is achieved in 2.5:1 (oral-to-IV) ratio Dizziness (10%) Headache (10%) Tiredness (10%) Depression (5%) Diarrhea (5%) Pruritus (5%) Bradycardia (9%) Rash (5%) Dyspnea (1-3%) Cold extremities (1%) Constipation (1%) Dyspepsia (1%) Heart failure (1%) Hypotension (1%) Nausea (1%) Flatulence (1%) Heartburn (1%) Xerostomia (1%) Wheezing (1%) Bronchospasm (1%) Anxiety/nervousness Hallusinations Paresthesia Hepatitis Vomiting Arthralgia Male impotence Reversible alopecia Agranulocytosis Dry eyes Worsening of psoriasis Pyronie’s disease Sweating Photosensitivity Taste disturbance Lopressor and Toprol XL only Ischemic heart disease may be exacerbated after abrupt withdrawal Hypersensitivity to catecholamines has been observed during withdrawal Exacerbation of angina and, in some cases, myocardial infarction (MI) may occur after abrupt discontinuance When long-term beta blocker therapy (particularly with ischemic heart disease) is discontinued, dosage should be gradually reduced over 1-2 weeks with careful monitoring If angina worsens markedly or acute coronary insufficiency develops, beta-blocker administration should be promptly reinitiated, at least temporarily (in addition to other measures appropriate for unstable angina) Patients should be warned against interruption or discontinuance of beta-blocker therapy without physician advice Because coronary artery disease (CAD) is common and may be unrecognized, beta-blocker therapy must be discontinued slowly, even in patients treated only for hypertension Use with caution in cerebrovascular insufficiency, CHF, cardiomegaly, myasthenia gravis, hyperthyroidism or thyrotoxicosis (may mask signs or symptoms), liver disease, renal impairment, peripheral vascular disease, psoriasis (may cause exacerbation of psoriasis) May exacerbate bronchospastic disease; monitor closely Beta blockers can cause myocardial depression and may precipitate heart failure and cardiogenic shock Sudden discontinuance can exacerbate angina and lead to MI and ventricular arrhythmias in patients with CAD Worsening cardiac failure may occur during up-titration of metoprolol succinate; if such symptoms occur, increase diuretics and restore clinical stability before advancing the dose of metoprolol succinate; it may be necessary to lower the dose of metoprolol succinate or temporarily discontinue it Bradycardia, including sinus pause, heart block, and cardiac arrest, has been reported; patients with 1° atrioventricular block, sinus node dysfunction, or conduction disorders may be at increased risk Increased risk of stroke after surgery May potentiate hypoglycemia in patients with diabetes mellitus and may mask signs and symptoms Avoid starting high-dose regimen of extended-release metoprolol in patients undergoing noncardiac surgery; use in patients with cardiovascular risk factors is associated with bradycardia, hypotension, stroke, and death Long-term beta blockers should not be routinely withdrawn before major surgery; however, impaired ability of the heart to respond to reflex adrenergic stimuli may augment risks of general anesthesia and surgical procedures Metoprolol loses beta-receptor selectivity at high doses and in poor metabolizers If drug is administered for tachycardia secondary to pheochromocytoma, it should be given in combination with an alpha blocker (which should be started before metoprolol is started) While taking beta blockers, patients with history of severe anaphylactic reaction to variety of allergens may be more reactive to repeated challenge Extended release tablet should not be withdrawn routinely prior to major surgery Hydrochlorothiazide, can cause an idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma, which can lead to permanent vision loss if not treated; discontinue hydrochlorothiazide as rapidly as possible if symptoms occur; prompt medical or surgical treatments may need to be considered if intraocular pressure remains uncontrolled; risk factors for developing acute angle-closure glaucoma may include history of sulfonamide or penicillin allergy Caution in patients with history of psychiatric illness; may cause or exacerbate CNS depression Beta-blockers can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease There are no adequate and well-controlled studies in pregnant women Limited data on the use of metoprolol in pregnant women Risk to fetus/mother is unknown; because animal reproduction studies are not always predictive of human response, use if clearly needed Bioavailability: 40-50% (immediate-release) ; 65-77% (extended-release) relative to immediate release Onset: 20 min (IV), when infused over 10 min; onset may be immediate, depending on clinical setting; 1-2 hr (PO) Duration: 3-6 hr (PO); duration is dose-related; 24 hr (ER); 5-8 hr (IV) Peak plasma time: 1.5-2 hr (immediate-release); 3.3 hr (extended-release) Therapeutic range: 35-212 ng/m L The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. Clonidine 0.2 mg Cheap cialis nz Metoprolol can mask the early warning symptoms of low blood sugar. Metoprolol oral tablet is a prescription medication used to treat high blood pressure, chest pain, and heart stress after a heart attack. It's a drug called a. Dispensing errors have occurred between topiramate Topamax and extended-release metoprolol Toprol-XL resulting from confused drug names. Additional. Before taking metoprolol, tell your doctor if you have congestive heart failure, low blood pressure, circulation problems, pheochromocytoma, asthma or other breathing problems, diabetes, depression, liver or kidney disease, a thyroid disorder, or severe allergies. Metoprolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension. If you are being treated for high blood pressure, keep using this medication even if you feel well. You may need to use blood pressure medication for the rest of your life. Metoprolol is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins). A Toprol XL tablet can be divided in half if your doctor has told you to do so. Metoprolol is used to treat angina (chest pain) and hypertension (high blood pressure). Metoprolol may also be used for other purposes not listed in this medication guide. Do not take in larger or smaller amounts or for longer than recommended. The half tablet should be swallowed whole, without chewing or crushing. By Mike Mc Evoy Generic Name: Metoprolol (multiple manufacturers) Common Brand Name: Lopressor (Novartis Pharmaceuticals – U. S.) Popularity: 16th most commonly prescribed drug between 2002 – 2008 (U. S.) Classes: Beta-adrenergic blocker, antianginal, antiarrhythmic, antihypertensive, antimigraine. Treatment Uses — Angina pectoris, heart failure, mild to moderate high blood pressure, and to improve survival after heart attacks. Also effective in treating arrhythmias, pheochrocytoma, essential tremor and neuroleptic drug induced movement disorders, preventing migraine headaches, reducing eye pressures in glaucoma, and reducing the frequency of vasovagal syncopal episodes. May have a role in treatment of aggressive behavior, panic attacks, and reducing atherosclerosis. Widely used (off-label) by performers to reduce symptoms of stage fright. 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