TM Owner Aralez Pharmaceuticals US Inc. (current label holder; originally AstraZeneca)
Toprol-XL 100mg Tablet
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Indications & Clinical Uses
- Toprol-XL 100 mg ER (the approved spelling is TOPROL-XL) contains metoprolol succinate, a beta-1 selective beta-blocker, formulated as an extended-release tablet taken once daily.
- It is approved in adults for hypertension, to lower blood pressure and reduce cardiovascular risk; for long-term management of chronic angina pectoris; and for stable, symptomatic heart failure of NYHA Class II or III, whether from ischaemic, hypertensive or cardiomyopathic causes, usually added to standard heart-failure therapy.
- It is also approved for hypertension in children aged 6 years and above, although the paediatric study did not fully confirm a blood-pressure-lowering effect at every dose.
- TOPROL-XL was originally marketed by AstraZeneca; the current US label holder is Aralez Pharmaceuticals US Inc.
- TOPROL-XL is a self-administered oral tablet, swallowed whole and not crushed or chewed, so its extended-release coating is not broken.
Side Effects
- Toprol-XL carries a boxed warning: stopping a beta-blocker abruptly can trigger worsening angina, heart attack or dangerous rises in blood pressure, especially in people with existing heart disease, so the dose must be tapered down gradually over one to two weeks under medical supervision, never stopped suddenly.
- Common effects include tiredness, dizziness, low blood pressure, slow heart rate, cold hands and feet, and shortness of breath.
- Depression and vivid dreams have been reported.
- Serious effects that need urgent attention include a very slow or irregular pulse, fainting, worsening swelling of the legs or breathlessness, and signs of a severe allergic reaction.
- Take Toprol-XL at the same time each day, usually in the morning, and tell your healthcare provider before any planned surgery, since beta-blockers affect anaesthesia.
Precautions & Warnings
- Do not stop Toprol-XL suddenly; the dose is reduced gradually over one to two weeks, particularly in people with coronary artery disease.
- Use with caution in bronchospastic disease such as asthma or COPD, since beta-1 selectivity is not absolute; avoid in decompensated heart failure until the patient is stabilised.
- It can mask the warning signs of low blood sugar (fast heartbeat, tremor) in people with diabetes, and can mask symptoms of an overactive thyroid.
- People with a rare tumour called phaeochromocytoma need an alpha-blocker started first.
- Use a lower starting dose in liver impairment.
- Toprol-XL should be used with caution during pregnancy and breastfeeding, and only if the expected benefit outweighs the risk; discuss driving if you feel dizzy or unusually tired after starting or changing the dose.
Avoid Interactions
- Medicines that raise metoprolol levels and increase its effect include the CYP2D6 inhibitors quinidine, fluoxetine, paroxetine, bupropion, propafenone and diphenhydramine - dose adjustment of Toprol-XL may be needed.
- Combining it with verapamil, diltiazem, digoxin or clonidine increases the risk of a very slow heart rate or heart block; stopping clonidine while also taking Toprol-XL needs careful timing to avoid a rebound rise in blood pressure.
- Other beta-blockers, including eye-drop beta-blockers, add to its effects and are usually avoided together.
- Catecholamine-depleting drugs such as reserpine can cause excessive slowing of the heart and low blood pressure.
- NSAIDs may reduce its blood-pressure-lowering effect.
- Tell your healthcare provider about every prescription, over-the-counter medicine, herbal remedy and supplement you take, including cold and allergy remedies.
References
Frequently Asked Questions
Toprol-XL (metoprolol succinate) is a once-daily beta-blocker for high blood pressure, chronic angina and stable heart failure in adults. The 100 mg extended-release strength is often used once the dose has been titrated upward from a lower starting dose.
Take Toprol-XL 100 mg once daily, at the same time each day, swallowing the tablet whole - do not crush, split or chew it, since that breaks the extended-release coating. It can be taken with or without food, but stay consistent.
Toprol-XL's boxed warning is that stopping it suddenly can trigger chest pain or a heart attack, so it must be tapered gradually. Common effects include tiredness, dizziness, a slow pulse and cold hands or feet. Report fainting or a very slow heartbeat urgently.
Never stop Toprol-XL abruptly; your dose is reduced gradually over 1-2 weeks. Avoid combining it with other beta-blockers, and tell your doctor about verapamil, diltiazem, clonidine or fluoxetine, which can slow your heart rate too much when taken with Toprol-XL.
If you miss a Toprol-XL dose, take it as soon as you remember unless it is almost time for the next one - then skip it and continue your normal schedule. Never take a double dose to make up for a missed one.
Yes, Toprol-XL is taken long-term for ongoing hypertension, angina or heart failure, for as long as your doctor prescribes it. Your dose, including the 100 mg strength, may be adjusted over time based on your blood pressure and heart rate response.
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