Toprol-XL (Metoprolol Succinate) for Heart Conditions

What Members Say Top Tips Side Effects FAQs

Toprol-XL (metoprolol succinate) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat angina and heart failure in adults and high blood pressure in adults and children ages 6 and older.

What Members Say

MHT logo These insights are based on 230 comments about Toprol-XL from MyHeartDiseaseTeam members. These are the experiences of a small number of people and are not meant to be medical advice.

Benefits:

Toprol-XL helps lower heart rate during atrial fibrillation, palpitations, and other fast rhythms.
Extended-release dosing once daily can feel simpler than taking short-acting metoprolol.
Toprol-XL may improve heart failure measures over time, including ejection fraction.

Considerations:

Tiredness and low energy are common concerns during treatment.
Heart rate or blood pressure can drop too low and require monitoring.
Shortness of breath can occur and requires medical attention.

How Toprol-XL Works and How It’s Taken

Toprol-XL is a type of medication called a beta-blocker. It blocks some stress signals that affect the heart. This slows the heart rate and reduces how hard the heart works.

In people with angina, Toprol-XL lowers the heart’s need for oxygen during activity.

Doctors prescribe Toprol-XL when adults need long-term treatment for angina or heart failure, or when adults or children ages 6 and older need treatment for high blood pressure. For angina, Toprol-XL can reduce attacks and improve exercise tolerance. For heart failure, it can reduce the risk of death from heart or blood vessel problems and heart failure-related hospital stays.

Lowering high blood pressure can reduce the risk of serious heart and blood vessel problems, mainly stroke and heart attack.

Toprol-XL is a tablet taken by mouth once daily. Take it regularly and exactly as directed, preferably with or immediately after a meal. The tablet may be split, but it should not be crushed or chewed.

Typical Dosing for Angina

The usual starting dose for angina is 100 milligrams once daily.

The doctor may raise the dose at weekly intervals until the best response is reached or the heart rate slows too much. Doses above 400 milligrams per day have not been studied.

If treatment must be stopped, the dose should be lowered gradually over one to two weeks. Do not stop taking Toprol-XL without medical guidance.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Typical Dosing for Heart Failure

Before starting Toprol-XL for heart failure, the doses of other heart failure medicines should be stable.

For people with mild heart failure symptoms during normal daily activity, the recommended starting dose is 25 milligrams once daily for two weeks. For people with more severe heart failure, the recommended starting dose is 12.5 milligrams once daily.

The doctor may double the dose every two weeks. The dose may be increased to the highest dose the person can tolerate, up to 200 milligrams once daily.

If the heart rate becomes too slow, the doctor may lower the dose. If heart failure symptoms temporarily worsen, the doctor may adjust other medicines, lower the dose, or pause Toprol-XL until the symptoms are stable.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Typical Dosing for High Blood Pressure

For adults with high blood pressure, the usual starting dose is 25 to 100 milligrams once daily. The doctor may adjust the dose at weekly or longer intervals until the best blood pressure response is reached. Doses above 400 milligrams per day have not been studied.

For children ages 6 and older with high blood pressure, the recommended starting dose is 1 milligram per kilogram of body weight once daily. The first dose should not be more than 50 milligrams. Doses above 2 milligrams per kilogram or above 200 milligrams once daily have not been studied in children.

Toprol-XL has not been studied in children younger than 6.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Top Advice From Members on Toprol-XL

MHT logo These insights are based on 230 comments about Toprol-XL from MyHeartDiseaseTeam members.

Members who use Toprol-XL often say it helps with heart rate control during atrial fibrillation, but they also describe the importance of paying attention to how they feel while taking it. Across the community, members most often encourage others to track side effects, bring low heart rate or blood pressure concerns to a doctor, clarify exactly which form and dose they should take, and work with a cardiologist if the medication does not seem to be a good fit.

1

Talk to your doctor about low heart rate or low blood pressure.
“I do monitor my BP more often because I found that with Entresto 49 milligrams and metoprolol, my BP was dropping too low, like 79/43.”
2

Double-check the exact form and dose you are prescribed.
“My discharge papers say metoprolol tartrate, but my pharmacy bottle says metoprolol succinate.”
3

Do not stop taking it suddenly without your doctor’s guidance.
“I was on metoprolol, and because of side effects, I was instructed to switch to a different medication. My cardiologist said I had to stop it slowly.”

Connect with others who understand life with heart disease. Join MyHeartDiseaseTeam for free.

Toprol-XL Side Effects

In clinical studies of Toprol-XL, the most common side effects differed depending on the condition being treated. These included:

Dizziness or vertigo (feeling lightheaded or like the room is spinning)
Bradycardia (slow heart rate)
Hypotension (low blood pressure)
Pruritus (itchy skin)
Rash
Tiredness
Depression
Shortness of breath
Diarrhea

Serious Side Effects and Warnings

Toprol-XL can cause serious side effects that may require immediate medical attention. These include:

Worsening heart failure — Symptoms can worsen when the dose is increased.
Bronchospasm — The airways can tighten and cause wheezing or trouble breathing.
Severe bradycardia and heart rhythm problems — A very slow heart rate, heart block, sinus pause, or cardiac arrest can occur.
Hypoglycemia (low blood sugar) — Severe or prolonged low blood sugar can occur, especially in people with diabetes or those who are fasting or vomiting. Toprol-XL may mask warning signs such as a fast heartbeat.
Thyrotoxicosis complications — Toprol-XL may mask signs of hyperthyroidism, and stopping it suddenly may trigger thyroid storm.
Worsening peripheral vascular disease — Reduced blood flow to the arms or legs can worsen.
Severe allergic reactions — Anaphylaxis can occur, and standard doses of epinephrine may be less effective while taking a beta-blocker.
Worsening angina or heart attack after stopping suddenly — Chest pain can worsen, and a heart attack can occur if Toprol-XL is stopped abruptly.

Get medical help right away if you think you are having a serious reaction.

What To Know Before Taking Toprol-XL

Tell your doctor if you have any allergies to metoprolol or any ingredients in Toprol-XL.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.

Before starting Toprol-XL, tell your doctor if you:

Have diabetes
Are fasting, not eating regularly, or vomiting
Have asthma or another breathing problem
Have a slow heart rate or a heart rhythm problem
Have worsening heart failure
Have poor blood flow in your arms or legs
Have an overactive thyroid
Have a tumor called pheochromocytoma
Have had a serious allergic reaction

Tell your doctor or dentist that you take Toprol-XL before any surgery.

Do not take Toprol-XL if you have:

A severely slow heart rate
Second- or third-degree heart block
Cardiogenic shock, a serious condition in which the heart cannot pump enough blood
Decompensated heart failure, meaning heart failure that has suddenly become much worse
Sick sinus syndrome, unless you have a permanent pacemaker
An allergy to metoprolol or any ingredient in Toprol-XL

Take Toprol-XL regularly and exactly as directed. Do not stop taking it without talking with your doctor.

If you miss a dose, take only your next scheduled dose. Do not take two doses at the same time.

Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. Metoprolol crosses the placenta. A newborn exposed during pregnancy may need monitoring after birth for low blood pressure, low blood sugar, a slow heart rate, or breathing problems.

Metoprolol also passes into breast milk. A breastfed baby may need monitoring for a slow heart rate or other signs of beta-blocker effects, such as unusual tiredness or low blood sugar.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Toprol-XL for angina and heart failure?

For heart failure, Toprol-XL was studied in 3,991 people with moderate to severe heart failure and an ejection fraction of 0.40 or less. Ejection fraction is a measure of how well the heart pumps blood. Compared with placebo (an inactive treatment), Toprol-XL reduced the risk of death from any cause by 34 percent.

It also reduced the combined risk of death or hospitalization from any cause by 19 percent. The combined risk of death or hospitalization related to heart failure was reduced by 31 percent, and the risk of sudden death was reduced by 41 percent. Hospital stays caused by worsening heart failure were also lower.

For angina, metoprolol has been shown to reduce the number of angina attacks and improve exercise tolerance. The prescribing information does not give a specific percentage improvement for angina.

How long does Toprol-XL take to work for angina and heart failure?

The prescribing information does not say exactly how soon Toprol-XL starts improving angina or heart failure symptoms. For angina, doctors may raise the dose at weekly intervals until the best response is reached or the heart rate becomes too slow.

For heart failure, the starting dose is usually continued for two weeks. The dose may then be doubled every two weeks if the person is doing well and can tolerate it. For high blood pressure, the full effect of a given dose is generally seen after one week.

This timing for high blood pressure does not necessarily apply to angina or heart failure.

Can Toprol-XL be used with other medicines for angina and heart failure?

Yes. Toprol-XL can be used with other medicines, but some combinations need careful monitoring.

For heart failure, the doses of other heart failure medicines should be stable before Toprol-XL is started. In the main heart failure study, many people also took diuretics, angiotensin-converting enzyme (ACE) inhibitors, digitalis, nitrates, blood thinners, or cholesterol-lowering medicines.

Some medicines can raise the risk of a very slow heart rate or low blood pressure when taken with Toprol-XL. These include:

Digoxin or other digitalis glycosides
Clonidine
Diltiazem
Verapamil
Reserpine
Monoamine oxidase (MAO) inhibitors

Some medicines can also raise metoprolol levels in the blood, including fluoxetine, paroxetine, quinidine, and propafenone. Tell your doctor about all medicines you take before starting Toprol-XL.