These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including metoprolol. When discontinuing chronically administered TOPROL-XL, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1 - 2 weeks and the patient should be carefully monitored. TOPROL-XL is indicated for the treatment of hypertension, to lower blood pressure. Your doctor will likely examine you for signs of illness, infection or neurological problems and ask about your headache history.If the cause of your headaches remains uncertain, your doctor might order imaging tests, such as a CT scan or MRI, to look for an underlying medical condition.Treatment for an underlying condition often stops frequent headaches. An infant consuming 1 liter of breast milk daily would receive a dose of less than 1 mg of the drug. At the end of the study, the mean daily dose of TOPROL-XL was 159 mg. Seek consultation with a regional poison control center and a medical toxicologist as needed. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue TOPROL-XL therapy abruptly even in patients treated only for hypertension Adverse Reactions Occurring in the MERIT-HF Study at an Incidence ≥1% in the TOPROL-XL Group and Greater Than Placebo by More Than 0.5% Because of its relative betaIf TOPROL-XL is used in the setting of pheochromocytoma, it should be given in combination with an alpha blocker, and only after the alpha blocker has been initiated. These drugs decrease prolactin production and may shrink the tumor in most people with prolactinoma.Nausea and vomiting, nasal stuffiness, headache, and drowsiness are common side effects of these medications. These increases in plasma concentration would decrease the cardioselectivity of metoprolol.Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. Chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery, however, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.Beta-blockers may mask tachycardia occurring with hypoglycemia, but other manifestations such as dizziness and sweating may not be significantly affected.Consider initiating TOPROL-XL therapy at doses lower than those recommended for a given indication; gradually increase dosage to optimize therapy, while monitoring closely for adverse events.Beta-adrenergic blockade may mask certain clinical signs of hyperthyroidism, such as tachycardia.

Observe patients treated with TOPROL-XL plus a catecholamine depletor for evidence of hypotension or marked bradycardia, which may produce vertigo, syncope, or postural hypotension.Drugs that inhibit CYP2D6 such as quinidine, fluoxetine, paroxetine, and propafenone are likely to increase metoprolol concentration. Not all complementary or alternative therapies have been studied as headache treatments, and others need further research.Coenzyme Q10 supplements might be helpful in some individuals. The adverse reaction information from clinical trials does, however, provide a basis for identifying the adverse events that appear to be related to drug use and for approximating rates. Initial difficulty with titration should not preclude later attempts to introduce TOPROL-XL. Many patients will require more than 1 drug to achieve blood pressure goals. Women of childbearing age also will have a pregnancy test. Safety and effectiveness of TOPROL-XL have not been established in patients < 6 years of age.Clinical studies of TOPROL-XL in hypertension did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Compare Toprol-XL head-to-head with other drugs for uses, ratings, cost, side effects, interactions and more. Nevertheless, over the 24-hour dosing interval, βLong-term studies in animals have been conducted to evaluate the carcinogenic potential of metoprolol tartrate. Because coronary artery disease is common and may be unrecognized, avoid abruptly discontinuing TOPROL-XL in patients treated only for hypertension.Worsening cardiac failure may occur during up-titration of TOPROL-XL.

"Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Consequently, no reduction in metoprolol succinate dosage is usually needed in patients with chronic renal failure. For prolactinoma, some basic questions to ask include:Your doctor is likely to ask you questions, including:Mayo Clinic does not endorse companies or products. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.Take a family member or friend along, if possible, to help you remember information.For chronic headaches, some questions to ask your doctor include:Your doctor is likely to ask you questions, such as:To ease your headache pain until you see your doctor, you might:Mayo Clinic does not endorse companies or products. It was studied in patients already receiving ACE inhibitors, diuretics, and, in the majority of cases, digitalis.

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