Lopressor
Generic Name: metoprolol (Oral route)
met-oh-PROE-lol
Ischemic Heart Disease: Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. When discontinuing chronically administered metoprolol succinate, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored. If angina markedly worsens or acute coronary insufficiency develops, metoprolol succinate administration should be reinstated promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Patients should be warned against interruption or discontinuation of therapy without the physician’s advice. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue metoprolol succinate therapy abruptly even in patients treated only for hypertension .
Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. The dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored when discontinuing chronic therapy. If angina markedly worsens or acute coronary insufficiency develops, metoprolol succinate administration should be reinstated promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Patients should be warned against interruption or discontinuation of therapy without the physician's advice .
Oral routeTablet- Ischemic Heart Disease:
- Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. When discontinuing chronically administered metoprolol tartrate, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1 week to 2 weeks and the patient should be carefully monitored. If angina markedly worsens or acute coronary insufficiency develops, metoprolol tartrate administration should be reinstated promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Patients should be warned against interruption or discontinuation of therapy without the physician's advice. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue metoprolol tartrate therapy abruptly even in patients treated only for hypertension.
- Bronchospastic Diseases:
- Patients with bronchospastic diseases should, in general, not receive beta blockers, including metoprolol tartrate. Because of its relative beta(1) selectivity, however, metoprolol tartrate may be used with caution in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Since beta(1) selectivity is not absolute, a beta(2)-stimulating agent should be administered concomitantly, and the lowest possible dose of metoprolol tartrate should be used. In these circumstances it would be prudent initially to administer metoprolol tartrate in smaller doses three times daily, instead of larger doses two times daily, to avoid the higher plasma levels associated with the longer dosing interval.
- Major Surgery:
- The necessity or desirability of withdrawing beta-blocking therapy, including metoprolol tartrate, prior to major surgery is controversial; the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.
- Metoprolol tartrate, like other beta blockers, is a competitive inhibitor of beta-receptor agonists, and its effects can be reversed by administration of such agents, eg, dobutamine or isoproterenol. However, such patients may be subject to protracted severe hypotension. Difficulty in restarting and maintaining the heart beat has also been reported with beta blockers.
- Diabetes and Hypoglycemia:
- Metoprolol tartrate should be used with caution in diabetic patients if a beta-blocking agent is required. Beta blockers may mask tachycardia occurring with hypoglycemia, but other manifestations such as dizziness and sweating may not be significantly affected.
- Pheochromocytoma:
- In patients known to have, or suspected of having, a pheochromocytoma, metoprolol tartrate is contraindicated. If metoprolol tartrate is required, it should be given in combination with an alpha blocker, and only after the alpha blocker has been initiated. Administration of beta blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta-mediated vasodilatation in skeletal muscle.
- Thyrotoxicosis:
- Beta-adrenergic blockade may mask certain clinical signs (eg, tachycardia) of hyperthyroidism. Patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of beta blockade, which might precipitate a thyroid storm .
Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. The dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored when discontinuing chronic therapy. If angina markedly worsens or acute coronary insufficiency develops, metoprolol tartrate administration should be reinstated promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Patients should be warned against interruption or discontinuation of therapy without the physician's advice. Use caution when administering metoprolol tartrate to patients with bronchospastic disease, thyrotoxicosis, diabetes or hypoglycemia, or patients undergoing major surgery. Metoprolol tartrate use in patients with pheochromocytoma is contraindicated, but may be given with an alpha blocker if therapy is required .
Intravenous routeSolution- Ischemic Heart Disease:
- Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. When discontinuing chronically administered metoprolol tartrate, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1 week to 2 weeks and the patient should be carefully monitored. If angina markedly worsens or acute coronary insufficiency develops, metoprolol tartrate administration should be reinstated promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Patients should be warned against interruption or discontinuation of therapy without the physician's advice. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue metoprolol tartrate therapy abruptly even in patients treated only for hypertension.
- Bronchospastic Diseases:
- Patients with bronchospastic diseases should, in general, not receive beta blockers, including metoprolol tartrate. Because of its relative beta(1) selectivity, however, metoprolol tartrate may be used with caution in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Since beta(1) selectivity is not absolute, a beta(2)-stimulating agent should be administered concomitantly, and the lowest possible dose of metoprolol tartrate should be used. In these circumstances it would be prudent initially to administer metoprolol tartrate in smaller doses three times daily, instead of larger doses two times daily, to avoid the higher plasma levels associated with the longer dosing interval.
- Major Surgery:
- The necessity or desirability of withdrawing beta-blocking therapy, including metoprolol tartrate, prior to major surgery is controversial; the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.
- Metoprolol tartrate, like other beta blockers, is a competitive inhibitor of beta-receptor agonists, and its effects can be reversed by administration of such agents, eg, dobutamine or isoproterenol. However, such patients may be subject to protracted severe hypotension. Difficulty in restarting and maintaining the heart beat has also been reported with beta blockers.
- Diabetes and Hypoglycemia:
- Metoprolol tartrate should be used with caution in diabetic patients if a beta-blocking agent is required. Beta blockers may mask tachycardia occurring with hypoglycemia, but other manifestations such as dizziness and sweating may not be significantly affected.
- Pheochromocytoma:
- In patients known to have, or suspected of having, a pheochromocytoma, metoprolol tartrate is contraindicated. If metoprolol tartrate is required, it should be given in combination with an alpha blocker, and only after the alpha blocker has been initiated. Administration of beta blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta-mediated vasodilatation in skeletal muscle.
- Thyrotoxicosis:
- Beta-adrenergic blockade may mask certain clinical signs (eg, tachycardia) of hyperthyroidism. Patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of beta blockade, which might precipitate a thyroid storm .
Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. The dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored when discontinuing chronic therapy. If angina markedly worsens or acute coronary insufficiency develops, metoprolol tartrate administration should be reinstated promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Patients should be warned against interruption or discontinuation of therapy without the physician's advice. Use caution when administering metoprolol tartrate to patients with bronchospastic disease, thyrotoxicosis, diabetes or hypoglycemia, or patients undergoing major surgery. Metoprolol tartrate use in patients with pheochromocytoma is contraindicated, but may be given with an alpha blocker if therapy is required .
Commonly used brand name(s):
In the U.S.
- Lopressor
- Toprol XL
Available Dosage Forms:
- Tablet, Extended Release
- Tablet
Therapeutic Class: Cardiovascular Agent
Pharmacologic Class: Beta-Adrenergic Blocker, Cardioselective
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Uses For Lopressor
Metoprolol is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk for heart attacks. These problems may be less likely to occur if blood pressure is controlled .
Metoprolol is also used to treat severe chest pain (angina) and lowers the risk of repeated heart attacks. It is given to people who have already had a heart attack. In addition, metoprolol is used to treat patients with heart failure .
This medicine is a beta-blocker. It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart .
This medicine is available only with your doctor's prescription .
Before Using Lopressor
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Pediatric
Appropriate studies have not been performed on the relationship of age to the effects of metoprolol tablets in the pediatric population. Safety and efficacy have not been established .
Appropriate studies have not been performed on the relationship of age to the effects of metoprolol extended-release tablets in children younger than 6 years of age. Safety and efficacy have not been established .
Geriatric
Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of metoprolol in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require an adjustment of dosage in patients receiving metoprolol .
Pregnancy
| Pregnancy Category | Explanation | |
|---|---|---|
| All Trimesters | C | Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women. |
Breast Feeding
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with Medicines
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Albuterol
- Amiodarone
- Arformoterol
- Bambuterol
- Bitolterol
- Broxaterol
- Clenbuterol
- Clonidine
- Colterol
- Diltiazem
- Dronedarone
- Fenoldopam
- Fenoterol
- Fentanyl
- Formoterol
- Hexoprenaline
- Isoetharine
- Levalbuterol
- Lidocaine
- Metaproterenol
- Pirbuterol
- Procaterol
- Reproterol
- Rimiterol
- Ritodrine
- Salmeterol
- Terbutaline
- Tretoquinol
- Tulobuterol
- Venlafaxine
- Verapamil
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acarbose
- Acetohexamide
- Alfuzosin
- Amlodipine
- Arbutamine
- Benfluorex
- Bunazosin
- Bupropion
- Chlorpropamide
- Cimetidine
- Citalopram
- Digoxin
- Diphenhydramine
- Doxazosin
- Escitalopram
- Felodipine
- Fluoxetine
- Gliclazide
- Glimepiride
- Glipizide
- Gliquidone
- Glyburide
- Guar Gum
- Hydralazine
- Hydroxychloroquine
- Insulin
- Insulin Aspart, Recombinant
- Insulin Glulisine
- Insulin Lispro, Recombinant
- Lacidipine
- Lercanidipine
- Manidipine
- Metformin
- Mibefradil
- Miglitol
- Moxisylyte
- Nicardipine
- Nifedipine
- Nilvadipine
- Nimodipine
- Nisoldipine
- Nitrendipine
- Paroxetine
- Phenelzine
- Phenobarbital
- Phenoxybenzamine
- Phentolamine
- Pranidipine
- Prazosin
- Propafenone
- Propoxyphene
- Quinidine
- Repaglinide
- Rifampin
- Rifapentine
- Ritonavir
- St John's Wort
- Tamsulosin
- Telithromycin
- Terazosin
- Terbinafine
- Thioridazine
- Tolazamide
- Tolbutamide
- Trimazosin
- Troglitazone
- Urapidil
Interactions with Food/Tobacco/Alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Blood vessel disease or
- Bradycardia (slow heartbeat) or
- Heart block or
- Pheochromocytoma (adrenal gland tumor) or
- Sick-sinus syndrome (heart rhythm problem)—Should not use in patients with these conditions .
- Diabetes or
- Hyperthyroidism (overactive thyroid) or
- Hypoglycemia (low blood sugar)—May cover up some of the signs and symptoms of these diseases, such as a fast heartbeat .
- Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body .
- Lung disease (e.g., asthma, bronchitis, emphysema)—May cause difficulty with breathing in patients with this condition .
Proper Use of metoprolol
This section provides information on the proper use of a number of products that contain metoprolol. It may not be specific to Lopressor. Please read with care.
In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet .
Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well .
Remember that this medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease .
Do not interrupt or stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous .
Take this medicine with a meal or just after you eat. You may break the extended-release tablet into two, but swallow the two pieces whole and do not crush or chew them .
Dosing
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For acute heart attack or heart failure:
- For oral dosage form (extended-release tablets):
- Adults—At first, 25 milligrams (mg) once a day for two weeks. In patients with severe heart failure, the starting dose is 12.5 mg once a day. Your doctor may adjust your dose if needed.
- Children—Use and dose must be determined by your doctor .
- For oral dosage form (tablets):
- Adults—At first, 50 milligrams (mg) every 6 hours for two days starting fifteen minutes after the last intravenous (IV) dose. Then, 100 mg two times a day until discharged from the hospital. Some patients may be given a lower dose of 25 mg every 6 hours starting fifteen minutes after the last IV dose.
- Children—Use and dose must be determined by your doctor .
- For oral dosage form (extended-release tablets):
- For chest pain:
- For oral dosage form (extended-release tablets):
- Adults—At first, 100 milligrams (mg) once a day. Your doctor may adjust your dose if needed.
- Children—Use and dose must be determined by your doctor .
- For oral dosage form (tablets):
- Adults—At first, 100 milligrams (mg) per day, given in two divided doses. Your doctor may adjust your dose if needed.
- Children—Use and dose must be determined by your doctor .
- For oral dosage form (extended-release tablets):
- For high blood pressure:
- For oral dosage form (extended-release tablets):
- Adults—At first, 25 to 100 milligrams (mg) once a day. Your doctor may adjust your dose if needed.
- Children 6 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 1 mg per kilogram (kg) of body weight per day, and given as a single dose. The first dose should not be more than 50 mg per day.
- Children below 6 years of age—Use and dose must be determined by your doctor .
- For oral dosage form (tablets):
- Adults—At first, 100 milligrams (mg) per day, given in single or divided doses. Your doctor may adjust your dose if needed.
- Children—Use and dose must be determined by your doctor .
- For oral dosage form (extended-release tablets):
Missed Dose
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions While Using Lopressor
It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and to check for unwanted effects .
Metoprolol may worsen the symptoms of heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort; dilated neck veins; extreme fatigue; irregular breathing; an irregular heartbeat; shortness of breath; swelling of the face, fingers, feet, or lower legs; weight gain; or wheezing .
This medicine may cause changes in your blood sugar levels. Also, this medicine may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests .
Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery .
This medicine may cause some people to become less alert than they are normally. If this side effect occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert while taking metoprolol .
Lopressor Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common- Blurred vision
- chest pain or discomfort
- dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
- shortness of breath
- slow or irregular heartbeat
- sweating
- unusual tiredness or weakness
- Bloating or swelling of face, arms, hands, lower legs, or feet
- cough
- decreased urine output
- difficult or labored breathing
- dilated neck veins
- disturbed color perception
- double vision
- extreme fatigue
- fast, pounding, or racing heartbeat or pulse
- halos around lights
- irregular breathing
- loss of vision
- mental confusion
- mood or mental changes
- night blindness
- noisy breathing
- overbright appearance of lights
- pain, tension, and weakness upon walking that subsides during periods of rest
- paleness or cold feeling in fingertips and toes
- rapid weight gain
- seeing, hearing, or feeling things that are not there
- short-term memory loss
- swelling of face, fingers, feet, or lower legs
- tightness in chest
- tingling of hands or feet
- tingling or pain in fingers or toes when exposed to cold
- troubled breathing
- tunnel vision
- unusual weight gain or loss
- wheezing
- Bluish color skin of the fingers or toes
- chills
- clay-colored stools
- continuing loss of appetite
- continuing or severe abdominal or stomach pain
- continuing or severe nausea and vomiting
- dark urine
- difficulty in moving
- fever
- general tiredness and weakness
- headache
- hoarseness
- increased frequency of urination
- itching skin
- light-colored stools
- lower back or side pain
- muscle pain or stiffness
- numbness of the fingers or toes
- pain, swelling, or redness in joints
- painful or difficult urination
- rash
- sore throat
- sores, ulcers, or white spots on lips or in mouth
- unpleasant breath odor
- unusual bleeding or bruising
- upper right abdominal pain
- vomiting of blood
- weakness
- yellow eyes and skin
- Black, tarry stools
- bleeding gums
- blood in urine or stools
- burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
- cool, sweaty skin
- pinpoint red spots on skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose- Bluish color of fingernails, lips, skin, palms, or nail beds
- change in consciousness
- loss of consciousness
- no blood pressure or pulse
- stopping of heart
- unconsciousness
- very drowsy or sleepy
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common- Belching
- bloated
- decreased interest in sexual intercourse
- difficulty having a bowel movement (stool)
- discouragement
- dry mouth
- excess air or gas in stomach or intestines
- feeling of constant movement of self or surroundings
- feeling of indigestion
- feeling sad or empty
- full feeling
- inability to have or keep an erection
- irritability
- loss in sexual ability, desire, drive, or performance
- loss of interest or pleasure
- nightmares
- pain in the chest below the breastbone
- passing gas
- redness or other discoloration of skin
- runny nose
- sensation of spinning
- sleeplessness
- sneezing
- stuffy nose
- tiredness
- trouble concentrating
- trouble sleeping
- unable to sleep
- Bone pain
- continuing ringing or buzzing or other unexplained noise in ears
- dry eyes
- hair loss, thinning of hair
- hearing loss
- increased sensitivity of skin to sunlight
- pain of penis on erection
- severe sunburn
- Change in taste or bad, unusual, or unpleasant (after) taste
- fear or nervousness
- hives or welts
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
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More Lopressor resources
Compare Lopressor with other medications for the treatment of:
Angina, Heart Attack, High Blood Pressure, Atrial Fibrillation, Supraventricular Tachycardia, Mitral Valve Prolapse, Left Ventricular Dysfunction, Benign Essential Tremor, Angina Pectoris Prophylaxis
