Metoprolol is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. A lower blood pressure can reduce the risk of strokes and heart attacks.

Metoprolol is also used to treat severe chest pain (angina) and lowers the risk of repeated heart attacks. It is given to people who have already had a heart attack. In addition, metoprolol is used to treat patients with heart failure.

This medicine is a beta-blocker. It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart.

This medicine is available only with your doctor's prescription.

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Your dose may need to be changed several times in order to find out what works best for you.

In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of food you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should first check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many patients feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that this medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, strokes, or kidney disease.

Swallow the extended-release capsule and tablet whole. Do not crush, break, or chew them.

If you cannot swallow the extended-release capsule:

     -> You may open it and sprinkle the contents over a small amount (teaspoonful) of soft food (including applesauce, pudding, or yogurt). Swallow the mixture within 60           minutes. Do not store for later use.
     -> You may also use a nasogastric tube to give the medicine. Mix the contents of the opened capsule with water into a syringe. Gently shake the mixture for about 10          seconds, then flush it through the tube. Rinse the tube with water until all of the medicine is washed out.

Take the tablet or extended-release tablet with a meal or just after you eat. You may break the extended-release tablet into two pieces, but swallow the two pieces whole and do not crush or chew them.

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

cough

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

fever

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

sore throat

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

Incidence not known

Black, tarry stools

bleeding gums

blood in the urine or stools

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

cool, sweaty skin

pinpoint red spots on the 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

dry mouth

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

runny nose

sensation of spinning

sneezing

stuffy nose

tiredness

trouble concentrating

trouble sleeping

Rare

Bone pain

continuing ringing or buzzing or other unexplained noise in the ears

dry eyes

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.

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Metoprolol may worsen the symptoms of heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort, dilated neck veins, extreme fatigue, irregular breathing or heartbeat, shortness of breath, swelling of the face, fingers, feet, or lower legs, or weight gain.

Do not suddenly stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous.

This medicine may cause changes in blood sugar levels. Also, this medicine may cover up the symptoms of low blood sugar, such as a rapid pulse rate. Check with your doctor if you notice a change in your normal symptoms or a change in the results of your blood or urine sugar tests.

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery.

This medicine may cause some people to become less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

Dizziness, lightheadedness, or even fainting may occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem. Also, lying down for a while may relieve the dizziness or lightheadedness.

Avoid drinking alcohol while you are using the extended-release capsules.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may increase your blood pressure.