Doctors' Answers to "Frequently Asked Questions" - Toprol XL

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Toprol & Pregnancy   [posted 12/09/98]
Question: I am taking Toprol XL 50mg a day for rapid heart rate. My problems began while taking Claritan-D for sinus congestion. It has continued for over a month after I have stopped taking the Claritan and I can't seem to stop the Toprol without it racing again. Do you think the Claritan could be the underlying problem with my heart rate? My other question is: if I have to stay on Toprol forever to control my heart rate, Can I still safely use it during a pregnancy?

Toprol General Information [posted 12/08/98]
Question: As of yesterday I am using Toprol XL 50mg. When my doctor prescribed this he said I should experience no side effects. I am extremely tired, but I am not sure if this is from Toprol or from being in the hospital 3 days ago with a heart rate of 210 bpm. My question is how long will I be taking this drug before it begins to slow down my heart rate?(my heart rate runs slightly high between 90 and 100 bpm). I also would like to know how common are side effects related with this drug? Also, if this medication does not work for me are there other drugs common for this problem? Thank you.

Answer: Most patients will experience fatigue with beta blockers. The pulse slowing is individual and the dosage would need to be increased until the pulse is slow enough. This may cause further fatigue. Try verapamil or other calcium blockers to avoid the fatigue.

Toprol & Zestoretic [posted 11/13/98]
Question: I had by-pass surgery 9 months ago. Since then have been taking Toprol plus Zestoretic 20/25mg. Exercising at Cardiac Wellness Center 5 days a week. No problems with blood pressure. Usually is 110 to 120 over 70 with pulse at 60 to 65. Recently cardiologist tried dropping the Zestoretic and just taking Toprol 100mg once a day. Since then BP has elevated to 170 over 95 to 100 consistently. Should I go back to the Zestoretic to see if this can get back to normal BP. Thank you.

Answer: Back to the Zestoretic. Or back to zestril without the diuretic.

Toprol XL & HDL levels [posted 10/9/98]
Question: I had a quadruple bypass last fall and as a result I am now taking the beta blocker Toprol XL. My concern lies with my decreased levels of HDL, which have dropped from 45 to 31 over the last six months. Are reductions in HDL a known side effect of Toprol XL?

Answer: Sometimes a little, but, this is excessive. Have you stopped exercising or stopped your alcohol intake? Both are known to increase HDL although exercise is preferred.

Toprol - Side Effects [posted 8/11/98]
Question: Recently my doctor sent me to a Cardiologist due to my heart racing at times. He once measured it at 200 BPM, and this was with me just sitting there. The cardiologist has me on Toprol-XL 50 mg. What are some of the side effects of this drug? I woke up one morning after taking this drug for a week on a regular basis with the room spinning. I had not taken the medicine that morning so I was wondering if that could be a side effect? I am 31 years old.

Answer: Side effects of Toprol and all beta blockers are fatigue, nausea, sleep disorder, slow pulse, low blood pressure, occasional shortness of breath.

Toprol XL [posted 8/7/98]
Question: I have just started taking this medicine as I am being treated for hypertension and my blood pressure is very high 203/148. I have been prescribed Toprol XL 100 mg and took my first dose about 2 hours ago. I became dizzy and I could feel my heart pounding. Is this right?

Answer: Toprol will generally slow your pulse, not speed it up. As to the dizziness, what was your BP on the Toprol?

Toprol XL - Long Term Effects of [posted 7/17/98]
Question: Are there any long term studies available about any effects of very low dosages of Toprol XL?

Answer: There are no obvious problems with long dosage that one doesn't see with short term dosing. There does not appear to be additional risk with extended use.

Toprol XL
Question: After having a triple bypass August 18th I was proscribed Toprol 50 mg, 1 a day. The pharmacy made a mistake and gave me 100 mg. I took them as told, but my blood pressure remained elevated (190/100-110). My physician told me to take a second one each day. Remember, I was already taking double what he knew of because of the pharmacy mistake. I then reduced to what he actually prescribed, but the results were as expected - high blood pressure. I called the doctor and find out the exact dosage that he prescribed, but I could only talk to a nurse who told me what my original dosage was. Since I cannot get in touch with the doctor that insists that I should take Toprol, I have increased my dosage back to what it was with the originally mis-marked bottle, which was 100 mg, and added the second dosage that the doctor told me to when I did visit and none of us new that the bottle was mis-marked. My blood pressure now stays around 190 over 100 to 110. I have had to go back to work to pay my share of the hospital bill and I can't go to the doctor’s office every time that there is a mistake and he wants to try a new drug. Can I increase the Toprol XL beyond the 200 mg I am now taking,? Should it be taken at one time? If I can ever manage to get an appointment with the doctor, should I insist on a drug change or should we continue to increase the dosage until the Toprol works? I read virtually everything on-line concerning Toprol and did not make the changes in dosages totally blind. I am aware that in trials that it was increased to 400 mg but that after 300 mg no significant result was shown (at least that I found). There also was no data for overdose. I am 49 years old, 6 feet tall, 205 lbs, large bones, 20 lbs overweight, don't smoke (did smoke for 30 years), and the heart surgeon says I have no damage. I exercise daily, walk 3 miles, work nine hours and ride an exercise bike 30 minutes each evening. Before operation, I took Procardia XL 30 mg twice a day.

Answer: Beta blockers are used post bypass to increase long term survival. This data is really from post infarction studies, but we do it anyway - even if there is no damage. In your case, you also need it for bp control. So, an additional medication will be necessary. Procardia would certainly be an acceptable 2nd drug. I doubt that increasing the Toprol will lower your bp sufficiently. That would be my choice since you have already used it without major problem.

Toprol
Question: I have been taking toprol for about 8 months. The doctor that put me on it said my obesity is causing high blood pressure. I have not seen any change in blood pressure since I started. I would like to stop taking toprol because it slow my thinking down and my reflexes in golf. How do I get off Toprol? I told the heart doctor the same story but all he advised is to take a half a pill more of Toprol. The reason for seeing him in the first place was because my dentist said my heart was racing too much after he injected Novocain.

Answer: Do you work for the cardiologist or does the cardiologist work for you? If the drug is causing excessive side effects tell him that you need to stop it. You are paying him for God's sake. There are several other drugs which will usually lower blood pressure without major side effects. Many of the calcium channel blockers slow heart rate and are well tolerated. ACE inhibitors will not slow the heart, but will usually lower blood pressure. Occasionally, small doses of a beta blocker (a drug called Ziac) will lower blood pressure without the other beta blocker side effects.

Toprol XL - 50 mg
Question: Recently my doctor prescribed Toprol as a preventive medicine for migrains. Since I started to take Toprol, I have been tired, and have experienced numbness of the lower lip. The migrains have not stopped and my blood pressure is still elevated: 129/90. The doctor increased the dosage to 75 mg per day. Will the tiredness decrease over time? Does toprol prevent mirgraines?

Answer: Toprol-XL(metoprolol succinate-extended release) is a selective beta-blocker. This means that it primarily works on the receptors in the heart and blood vessels and less so on the receptors in the lungs. Earlier beta-blockers like Inderal(propanolol) are non-selective and can produce asthma in some patients by activating receptors in the lung. The beta blockers have multiple uses due to their ability to block the effect of adrenaline in different tissues. They were also found to have a protective-not treatable effect. That is, when used on a regular basis they prevent migraines, or decrease their severity. They have no effect when a migraine is in full steam. Beta blockers all have similar side effects, except that non-selective drugs effect the lungs. That is, fatigue, slow heart rate, nightmares, nausea, depression, and lowering blood pressure. These side effects do not tend to go away. Fatigue will last as long as you are on the medicine. Other preventive drugs include calcium channel bockers, aspirin, and tri-cyclic antidepressants.

Toprol XL
Question: My mother is taking Toprol XL, and has been for many years, to treat high blood pressure and nervousness. She is 71 years old. She has also been prescribed something called "Tranxene".

Answer: Toprol XL is the brand name for metaprolol succinate extended release tablets. Metoprolol is a relatively selective beta-blocker which is used in several areas, but is mainly used to treat angina and hypertension. This class of drug has been available for about fourteen years and tends to have most of the common side effects of beta-blockers. These include fatigue, some difficulty with sleeping or dreams, slow heart beat, and occasionally shortness of breath. Since it is a selective beta-blocker, it will have less shortness of breath than non-selective blockers like propranolol. Tranxene is the brand name for clorazepate dipotassium. This is a benzodiazepine very similar in action to more familiar drugs like valium and librium. It is used in anxiety disorders for short term relief of anxiety. Its side effects include lethargy, drowsiness, and mental confusion. It should never be stopped abruptly as a withdrawal syndrome may occur. These withdrawals have occasionally produced death.



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