What is this medication?
Metoprolol, Lopressor/Toprol XL
Antihypertensive/antianginal Agent, Blocks Beta 1 adrenergic receptors with little effect on Beta 2
Metoprolol, Lopressor/Toprol XL is officially indicated for hypertension, angina, heart failure with reduced ejection fraction, and myocardial infarction (early treatment and future prevention). It is also commonly prescribed off-label for atrial fibrillation/flutter, migraine prophylaxis, supraventricular tachycardia, thyrotoxicosis, and ventricular arrhythmia.
“ALERT: US Boxed Warning
Ischemic heart disease:
Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction (MI) have occurred. When discontinuing chronically administered metoprolol, particularly in patients with ischemic heart disease, gradually reduce the dosage over a period of 1 to 2 weeks and carefully monitor the patient. If angina markedly worsens or acute coronary insufficiency develops, reinstate metoprolol administration promptly, at least temporarily, and take other measures appropriate for the management of unstable angina. Warn patients against interruption or discontinuation of therapy without their health care provider’s advice. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue metoprolol therapy abruptly, even in patients treated only for hypertension.”
How does this medication work?
Beta 1 receptor is activated by adrenaline and is involved with cardiac output by increasing the volume of each pump as well as increasing the heart rate. Metoprolol/Lopressor works by blocking this receptor having the reverse effect thereby reducing heart rate and stroke volume.
How should I take this medication?
Extended release (metoprolol succinate): Oral: Initial: 100 mg once daily; may increase dose at weekly intervals to desired effect. Maximum dose: 400 mg/day
Atrial fibrillation/flutter (off-label use):
Extended release (metoprolol succinate): Oral: 50 to 400 mg once daily
Heart failure with reduced ejection fraction:
Extended release (metoprolol succinate): Oral: Initial: 12.5 to 25 mg once daily; up-titrate gradually to a target dose of 200 mg once daily while monitoring for signs and symptoms of heart failure
Extended release (metoprolol succinate): Oral: Initial: 25 to 100 mg once daily; titrate at weekly (or longer) intervals as needed based on patient response. Maximum dose: 400 mg/day; usual dosage range: 50 to 200 mg once daily
Myocardial infarction, early treatment and secondary prevention:
Extended release (metoprolol succinate): Initial: 25 to 50 mg once daily; titrate dose based on heart rate and blood pressure as tolerated up to 200 mg once daily
Extended release (metoprolol succinate): Oral: Initial: 50 mg once daily; maximum dose: 400 mg/day
Ventricular arrhythmias (off-label use):
Extended release (metoprolol succinate): Oral: 25 to 100 mg 1 to 2 times daily
How to Take: Follow instructions provided by physician/pharmacy label, swallow whole (extended release), take consistently at same times each day unless otherwise directed, take instant release tablets with food, extended can be with or without, store at room temperature
You Need to Avoid: Careful standing up too quickly as you may get dizzy
Do not stop this medication abruptly to avoid rebound tachycardia, hypertension and in severe cases angina, heart attack, or arrhythmia
What should I watch for while using this medication?
Before starting Metoprolol, Lopressor/Toprol XL make sure your physician is aware of any allergies or medications you currently take, if you have a low resting heart rate, asthma or other bronchospastic disease, cardiac conduction abnormalities, diabetes, liver disease, myasthenia gravis, peripheral vascular disease, hyperthyroidism, or if pregnant/breastfeeding
What if I miss a dose?
If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.
How should I store this medication?
Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.
What are the possible side effects of using this medication?
Hypotension, dizziness, fatigue, bradycardia (low heart rate)
Note this is not a complete list of side effects, only common ones.
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