Toprol-XL (metoprolol succinate)
TOPROL-XL (metoprolol succinate) – a beta-1-selective adrenoreceptor blocking agent commonly used to treat hypertension, angina, and heart failure. The mechanism of the antihypertensive effects of beta-blocking agents has not been elucidated. However, several possible mechanisms have been proposed: (1) competitive antagonism of catecholamines at peripheral (especially cardiac) adrenergic neuron sites, leading to decreased cardiac output; (2) a central effect leading to reduced sympathetic outflow to the periphery; and (3) suppression of renin activity.
Heart Failure: The precise mechanism for the beneficial effects of beta-blockers in heart failure has not been elucidated.
FDA approved uses: Toprol-XL is indicated for the treatment of –
• Hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions.
• Angina Pectoris.
• Heart Failure – for the treatment of stable, symptomatic (NYHA Class II or III) heart failure of ischemic, hypertensive, or cardiomyopathic or.
Available dosage forms: Extended-Release tablets – 25, 50, and 100 mg.
Usual dosage: Administer once daily. Dosing of TOPROL-XL should be individualized. Heart Failure: Recommended starting dose is 12.5 mg or 25 mg doubled every two weeks to the highest dose tolerated or up to 200 mg. Hypertension: Usual initial dosage is 25 to 100 mg once daily. The dosage may be increased at weekly (or longer) intervals until optimum blood pressure reduction is achieved. Dosages above 400 mg per day have not been studied. Angina Pectoris: Usual initial dosage is 100 mg once daily. Gradually increase the dosage at weekly intervals until optimum clinical response has been obtained or there is an unacceptable bradycardia. Dosages above 400 mg per day have not been studied. Switching from immediate-release metoprolol to TOPROL-XL: use the same total daily dose of TOPROL-XL.
Contraindications: Do not administer to patients with Known hypersensitivity to product components; Severe bradycardia; Heart block greater than first degree; Cardiogenic shock; Decompensated cardiac failure; Sick sinus syndrome without a pacemaker.
Special Warnings: ISCHEMIC HEART DISEASE – Following abrupt cessation of therapy with beta-blocking agents, exacerbations of angina pectoris and myocardial infarction have occurred. Warn patients against interruption or discontinuation of therapy without the physician’s advice.
Adverse reactions (side effects) of these medications: The most common side effects of Toprol-XL include tiredness, dizziness, depression, shortness of breath, bradycardia, hypotension, diarrhea, pruritus, and rash. Other adverse reactions seen in clinical trials or post-marketing surveillance include: Cold extremities, arterial insufficiency (usually of the Raynaud type), palpitations, peripheral edema, syncope, chest pain, hypotension, wheezing (bronchospasm), dyspnea, confusion, short-term memory loss, headache, somnolence, nightmares, insomnia, anxiety/nervousness, hallucinations, paresthesia, nausea, dry mouth, constipation, flatulence, heartburn, hepatitis, vomiting, pruritus, musculoskeletal pain, arthralgia, blurred vision, decreased libido, male impotence, tinnitus, reversible alopecia, agranulocytosis, dry eyes, worsening of psoriasis, Peyronie’s disease, sweating, photosensitivity, and taste disturbance.
Common drug interactions: The common following drug interactions may occur with Toprol-XL. Catecholamine depleting drugs (e.g. reserpine, MAO inhibitors) may have an additive effect when given with beta-blockers.
Special instructions for patients: Read the Medication Guide that comes with Toprol-XL and discuss any questions or concerns with your healthcare provider before starting and at regular intervals while receiving Toprol-XL. Undergo regular blood pressure monitoring, adhere to anti-hypertensive regimen and follow recommended dietary restrictions. Tell healthcare provider about other medications you are taking.
Full prescribing information may be found at the manufacturer‘s official website Toprol-xl.com