Metoprolol succinate (Toprol XL) is used to treat hypertension and to control chronic (long-term) chest pain. It's also used to lower the risk for hospitalization and death in people with heart failure. Metoprolol succinate (Toprol XL) is the extended-release version of metoprolol tartrate (Lopressor), but keep in mind the two versions don't treat the exact same conditions. And because metoprolol succinate (Toprol XL) is longer-acting, it's taken by mouth typically taken just once daily. Some common side effects of metoprolol succinate (Toprol XL) include tiredness or dizziness.
High blood pressure
Chest pain (angina)
Lower the risk of hospitalization and death in heart failure
Metoprolol succinate (Toprol XL) is a beta blocker. More specifically, it's a selective beta blocker, meaning it works mainly on your heart. It slows down your heart rate. This makes it easier for your heart to pump blood around your body and helps lower blood pressure. It also allows your heart to use less oxygen, which can help with chest pain.
Source: DailyMed
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
confusion
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
slow or irregular heartbeat
sweating
unusual tiredness or weakness
Less common
Bloating or swelling of the face, arms, hands, lower legs, or feet
decreased urine output
difficult or labored breathing
difficulty with speaking
dilated neck veins
disturbed color perception
double vision
extreme tiredness or weakness
fast, pounding, or racing heartbeat or pulse
halos around lights
headache
inability to move the arms, legs, or facial muscles
inability to speak
irregular breathing
loss of vision
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 the fingertips and toes
rapid weight gain
seeing, hearing, or feeling things that are not there
short-term memory loss
slow speech
swelling of the face, fingers, feet, or lower legs
tightness in the chest
tingling of the hands or feet
tingling or pain in the fingers or toes when exposed to cold temperatures
troubled breathing
tunnel vision
unusual weight gain or loss
Rare
Bluish color of the 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 with moving
general tiredness and weakness
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 the joints
rash
sores, ulcers, or white spots on the lips or in the mouth
unpleasant breath odor
unusual bleeding or bruising
upper right abdominal or stomach pain
vomiting of blood
weakness
yellow eyes and skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Bluish color of the fingernails, lips, skin, palms, or nail beds
change in consciousness
loss of consciousness
no blood pressure or pulse
stopping of the heart
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 feeling
decreased interest in sexual intercourse
difficulty having a bowel movement
discouragement
excess air or gas in stomach or bowels
feeling of constant movement of self or surroundings
feeling of fullness
feeling of indigestion
feeling sad or empty
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 the skin
sensation of spinning
tiredness
trouble concentrating
trouble sleeping
Rare
Bone pain
continuing ringing or buzzing or other unexplained noise in the ears
hair loss or thinning of the hair
hearing loss
increased sensitivity of the skin to sunlight
pain in the penis on erection
severe sunburn
Incidence not known
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.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
A first-choice option to prevent chest pains (angina)
A first-choice option for heart failure
Only needs to be taken once a day
Available as capsules (Kapspargo) that can be opened and sprinkled on soft foods, good for people who've trouble swallowing pills
Need to take with food
Not a first-choice treatment for high blood pressure, unless you have heart failure or heart disease
Can hide symptoms of low blood sugar
Stopping too suddenly can raise the risk of heart attack and stroke
You should take metoprolol succinate (Toprol XL) right after meals. This can help lower your risk of side effects, such as dizziness.
Metoprolol succinate (Toprol XL) can cause dizziness, which could lead to falls. Make sure to sit or lie down if you feel dizzy to prevent accidental injuries.
Check your blood pressure regularly after starting metoprolol succinate (Toprol XL). Tell your provider if it hasn't improved after a week because they might need to adjust your dose of this medication.
Swallow the metoprolol succinate (Toprol XL) tablets or Kapspargo capsules whole. Don't chew or crush them. If your provider halves your dose, only the tablets can be split in half using a pill cutter.
If needed, you can open the Kapspargo capsules and sprinkle the contents inside on a small amount (about a teaspoonful) of soft foods, such as applesauce, pudding, or yogurt. Swallow the mixture within an hour; don't let it sit for longer than that. If you have a nasogastric (NG) feeding tube, you or your caregiver can also mix the capsule contents with water (15 mL) in an oral syringe and slowly push the mixture into your tube. Ask your provider or pharmacist for more instructions.
Try not to drink alcohol with metoprolol succinate (Toprol XL). Beta blockers like metoprolol succinate (Toprol XL) can make you more drowsy and dizzy, and alcohol can make this even worse. If you drink alcohol regularly and it's difficult to stop completely, talk with your provider about what's a safer amount to drink.
If you have diabetes, be careful taking metoprolol succinate (Toprol XL), since this medication can hide symptoms of low blood sugar, except for sweating and dizziness.
Don't stop taking this medication suddenly unless your provider tells you to. Stopping metoprolol succinate (Toprol XL) all of a sudden cause your blood pressure to go up, which can raise the risk of heart attack and stroke. If you want to stop this medication, your provider can lower your dose slowly over time.
Metoprolol succinate (Toprol XL) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Coronary artery disease (CAD)
Don't stop taking metoprolol succinate (Toprol XL) suddenly. This can lead to an irregular or fast heartbeat, high blood pressure, poor blood circulation to your heart, or raise your risk of chest pain or heart attack. Work with your provider to lower your dose slowly over 1 to 2 weeks if you'd like to stop taking metoprolol succinate (Toprol XL).
Risk factors: Heart failure | When the dose is raised
Though metoprolol succinate (Toprol XL) can be used for heart failure, worsening symptoms of heart failure can also occur when the dose is raised. Talk to your provider if you think your heart failure is getting worse (e.g., more swelling in your legs, trouble breathing). They will work with you to find the best dose of metoprolol succinate (Toprol XL) and your other heart failure medications for you.
Risk factors: Chronic obstructive pulmonary disease (COPD) | Asthma
Metoprolol succinate (Toprol XL) can cause the vessels in your lung to tighten. This can make breathing difficult, especially in people with breathing problems, like asthma. This problem is very rare with metoprolol succinate (Toprol XL) because it's a selective beta blocker, meaning it targets your heart rather than your lungs. To be safe, make sure your provider knows about your full medical history before starting this medication.
Risk factors: History of pheochromocytoma
If you have pheochromocytoma (a hormone-producing tumor from your adrenal glands), let your provider know. In people with this condition, taking metoprolol succinate (Toprol XL) alone can actually raise your blood pressure instead of lowering it. To avoid this, your provider will likely prescribe an alpha-blocker medication first to keep your blood pressure under control.
Risk factors: Major surgery requiring anesthesia | Risk of heart disease, heart attack, or stroke
If you're planning to undergo a major surgery (not heart-related) requiring anesthesia, tell your surgeon that you're taking metoprolol succinate (Toprol XL). Taking high doses of this medication around the time of surgery has been linked to low heart rate, low blood pressure, stroke, and death. So your surgeon will make sure to monitor your heart closely.
Risk factors: Diabetes
Taking metoprolol succinate (Toprol XL) can make it difficult for you to identify symptoms of low blood sugar, such as fast heart beat or tremors. If you’re taking medications, like glipizide or insulin, to lower your blood sugar, you might not be able to rely on all the typical symptoms of low blood sugar (e.g., irritability, sight tremors, confusion, and fast heartbeat) to warn you of a dangerous drop in your sugar levels. Sweating might be the only symptom not affected by taking metoprolol succinate (Toprol XL). Speak with your healthcare provider about when and how to monitor your blood sugar if you start metoprolol succinate (Toprol XL).
Risk factors: Hyperthyroidism
Because metoprolol succinate (Toprol XL) lowers your heart rate, it might be harder to notice heart-related symptoms caused by an overactive thyroid (hyperthyroidism). If you have hyperthyroidism, don't suddenly stop taking metoprolol succinate (Toprol XL), since this can worsen thyroid problems.
High blood pressure
Adults: The typical starting dose is 25 mg to 100 mg by mouth once daily. Your provider might adjust your dose weekly based on how your blood pressure is doing.
Children ages 6 years and older: Your child's provider will determine your child's dose based on their body weight. The typical starting dose is 1 mg/kg of body weight (up to 50 mg of metoprolol succinate) by mouth once a day. Your child's provider might adjust their dose weekly based on how their blood pressure is doing.
Chest pain
Adults: The typical starting dose is 100 mg by mouth once daily. Your provider might raise your dose weekly based on your heart rate.
Heart failure
Adults: The typical starting dose ranges from 12.5 mg to 25 mg by mouth once daily. Your provider might raise your dose every 2 weeks based on your symptoms, up to a maximum of 200 mg daily.
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.
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.
Severely low heart rate
Second- or third-degree heart block
Severe heart failure
Heart rhythm problem called sick sinus syndrome, unless you have a permanent pacemaker
High blood pressure
Chest pain (angina)
Lower the risk of hospitalization and death in heart failure
Chest pain (angina)
Lower risk of death after heart attack
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National Organization of Rare Diseases. (2021). Pheochromocytoma/paraganglioma.
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Sun Pharmaceutical Industries, Inc. (2023). KAPSPARGO- metoprolol succinate capsule, extended release [package insert]. DailyMed.
Vue, M. H., et al. (2011). Drug-induced glucose alterations part 1: Drug-induced hypoglycemia. Diabetes Spectrum.
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