About Lopressor
Lopressor is a beta-adrenergic blocker, more commonly known as
a beta-blocker. This class of anti-hypertensive medication
prevents high blood pressure by reducing the body's sensitivity
to certain chemicals produced by the sympathetic nervous system
that cause blood vessels to contract, and blood pressure to
go up. It isn't known exactly how Lopressor works to reduce
vascular headaches and tremors.
This medication is mainly prescribed for high blood pressure (hypertension),
prevention of heart attacks or to decrease the likelihood of a second
attack, reduce incidence of angina, and as a treatment for congestive
heart failure (Toprol XL only).
Other uses include the treatment of heart muscle injury, adjunct
therapy in control of panic attacks or physical anxiety responses,
reduction of migraine headache,
and reduction of eye pressure in open-angle glaucoma.
Benefits of treatment should be clear within 10-14 days. Individuals
using this therapy are advised to have regular checkups with their
doctor to monitor their progress. As high blood pressure has few
or no symptoms until the advanced stages, it can be difficult to
tell how treatment is progressing without consulting your doctor.
This medication is most effective in treating high blood
pressure when combined with a low salt diet, smoking cessation,
and weight control measures, as needed. For best results,
take Lopressor at the same time every day to maintain consistent
levels of the medication in your body.
Lopressor is only available by prescription.
Lopressor Side Effects
Common Side Effects: Cold extremities, lethargy, more frequent
bowel movements, sensitivity to cold, slower heartbeat.
Possible Mild Side Effects: These side effects are unexpected,
and should be reported to your doctor for evaluation. Allergic reaction
(drug fever with sore throat, rash, temporary hair loss), altered
blood sugar levels, constipation, diarrhea, dizziness, headache,
indigestion, insomnia, joint pain, nausea, swollen feet or ankles,
unusual dreams, vomiting, weight gain.
Possible Serious Side Effects: These side effects are very
rare and potentially dangerous. Seek medical treatment immediately
if you experience any of the following. Allergic reaction (anaphylactic
shock), behavioral difficulties (amnesia, anxiety, confusion, depression,
hallucination), blood cell disorders (low white cell or platelet
counts), bronchial asthma (in asthmatics only), carpal tunnel syndrome,
chest pain, congestive heart failure, difficulty walking, dizziness
when standing, drug induced illness (lupus, myasthenia gravis, porphyria),
hypertension, hyperthyroidism, kidney disease, peripheral neuropathy,
shortness of breath, unusual bleeding or bruising.
Overdose: Signs of overdose begin with an unusually slow
or fast and irregular heartbeat followed by severe dizziness and
possible fainting. Difficulty breathing, bluish colored palms or
fingernails, and seizures may result. Emergency medical attention
is required in theses circumstances. If you or someone in your household
takes this medication, be sure that everyone is familiar with these
signs and knows to call for emergency help.
Cautions: This medication is not for everyone, and may require
a degree of caution for use in some individuals. Be especially sure
to discuss a history of any of the following with your doctor to
ensure safe and effective treatment.
- Allergies: Inform your doctor if you have ever had an
allergic reaction to other anti-hypertensive medications, bee
stings, or airborne contaminants.
- Cardiovascular Conditons: Coronary artery spasm (Prinzmetal's);
do not use. Heart failure; do not use. Unusually slow heartbeat
(bradycardia); do not use. Serious heart block; do not use. History
of heart disease; use with caution, examine all treatment options
with your doctor. This medication may cause undesirable side effects
in the cardiovascular system is abruptly stopped, especially for
individuals with a history of heart conditions. Always follow
your medication schedule exactly, and make sure you have an adequate
supply available for vacations or holidays.
- Depression: May be worsened by beta-blockers.
- Diabetes: This medication may interact with treatments
for diabetes by lowering blood sugar too drastically, producing
hypoglycemia. It may also raise blood sugar in some individuals,
Regular blood sugar tests may be necessary to gauge a safe and
effective dose.
- Hypoglycemia: This medication may cause low blood sugar.
If you are a migraine sufferer whose headaches are triggered in
part by low blood sugar, you may want to examine your treatment
options carefully. Signs of hypoglycemia like confusion, dizziness,
irritability, or sweating won't be hidden by the effects of the
medication.
- Lab Tests: X-Ray contrast preparations may increase the
risk of severe allergic reactions which are dangerous and potentially
life-threatening. Several types of blood tests may also be affected,
as well as certain liver tests. Inform medical personnel in advance
if you need to go in for any tests.
- Kidney or Liver Disease: Increased chance of side effects
as the medication may stay in the body longer.
- Myasthenia Gravis: This weakness in the muscles my be
exaggerated by beta-blockers.
- Overactive Thyroid: Beta-blockers can hide the racing
heartbeat symptomatic of this condition.
- Psoriasis: This skin condition can be worsened by beta-blockers.
It's not clear how many psoriasis cases are caused by allergies,
though these medications are known to make other allergic conditions
worse.
- Raynaud's phenomenon: This condition, characterized by
chronic poor circulation in the extremities leads to sensations
of cold, tingling, or numbness. Some individuals have developed
Raynaud's while taking Lopressor, or have had their condition worsened.
Cold extremities are a common side effect of treatment, though
you may want to check with your doctor if it occurs.
- Respiratory Conditions: Bronchial asthmatics should not
use this prescription treatment. If you have asthma, chronic bronchitis,
emphysema, recurrent hay fever or sensitivity to other airborne
allergens, be cautious and get regular checkups if your doctor
determines that this treatment is safe for you. Breathing trouble
and allergy sensitivity can be increased by beta-blockers.
- Surgery: Lopressor is reactive with certain drugs used
in surgery. Inform your doctor or dentist well in advance of any
procedure.
Lopressor Interactions
Some medications may interact with Lopressor (metoprolol) treatment,
and may require either careful monitoring or the selection of a
different treatment if their use is necessary. Certain over the
counter treatments may result in interactions as well. Serious circulatory
side effects could result fram drug interactions with this medicine.
Only your doctor can decide if it's safe for you to mix other medication
with prescription treatments, but be especially sure to inform them
if you use any of the following:
- Alcohol - Use of alcohol while being treated with Lopressor
may lead to low blood pressure or oversedation.
- Aldomet (methyldopa) - Risk of blood pressure increase
with increased stress.
- Allergy medication or skin test agents - metoprolol may
greatly increase the likelihood of a serious allergic reaction.
- Anesthetics like lidocaine may have their effects dangerously
increased. Inform your doctor or dentist that you take Lopressor
before having any surgery.
- Antacids may decrease metoprolol's effectiveness.
- Anti-diabetic drugs or Insulin - This combination may
result in undesirably low blood sugar, regular testing for
hypoglycemia is recommended.
- Anti-hypertensive drugs of any other type may result in
undesirably low blood pressure. Reduced dosages could be
necessary.
- Apresoline (hydralazine)
- Bronchodilators of the xanthine (thioxanthine) class (Aminophylline,
Dyphylline, Oxtriphylline, Somophyllin, Theo-Dur,
etc...) - May be less effective asthma treatments when combined
with metoprolol.
- Caffeine (excess coffee or cola, No-Doz, Vivarin) - The
effects of both caffeine and metoprolol may cancel each
other out.
- Calcium channel blockers - Medications like Bepadin (bepridil),
Calan (verapamil), Cardene
(nicardipine), Cardizem
(diltiazem), DynaCirc (isradipine), Norvasc
(amlodipine), Nimotop (nimodipine), Plendil (felodipine),
Procardia (nifedipine),
or Sibelium (flunarizine) may cause unwanted heart problems
when combined with beta-blockers like metoprolol.
- Catapres (clonidine) - Neither medication should be stopped
abruptly if used together, increased risk of sudden high
blood pressure.
- Cipro (ciprofloxacin) - Can cause metoprolol buildup.
- Colestid (colestipol) - Treatment benefits may be decreased.
- Cordarone (amiodarone) - Do not combine, abnormal hearth
rhythms or low pulse may result.
- Coumadin (warfarin)
- Increased risk of bleeding, dosage adjustment may be needed.
- Diuretics may increase metoprolol's effects, as well as
the risk of side effects.
- Eleuthro Root - May raise blood pressure, avoid if you
have hypertension.
- Epinephrine/Adrenalin - Increased blood pressure and slower
heart rate may result.
- Ephedra - This herb may be found on its own, or in herbal
diet preparations. Individuals with hypertension should
avoid it.
- Ergotamine based migraine treatments such as DHE 45 injections,
Cafergot, Ergostat, Migranal nasal spray, or Sansert, can
cause blood vessel constriction or decreased blood flow
to the extremities in combination with some beta blockers.
- Ginseng - May increase blood pressure.
- Goldenseal - May increase blood pressure.
- Hawthorn - May increase blood pressure.
- Indian Snakeroot - This herb is approved in Germany as
an anti-hypertensive treatment. Consult your doctor if you
wish to combine therapies, as there may be some risk of
undesirably low blood pressure when two anti-hypertensive
treatments are used together.
- Kava kava - May cause drowsiness.
- Lanoxin (digoxin) -
May result in undesirably slow heartbeat.
- Licorice - May increase blood pressure unless deglycyrrhizinated.
Glycyrrhizin is a compound in licorice which seems to produce
higher blood pressure. The majority of licorice flavored
candies do not contain enough of the herb to make a difference,
but herbal teas containing it should be avoided.
- Ma Huang - May increase blood pressure.
- MAO inhibitors - Lopressor must never be mixed with MAO
(monoamine oxidase) inhibitors, a class of antidepressants
and antisenility drugs, such as Eldepryl (selegiline), Furoxone
(furazolidone), Nardil (phenelzine), Marplan (isocarboxazid),
or Parnate (tranylcypromine). Never use Lopressor within
2 weeks of starting or stopping an MAO inhibitor. Patients
over 65 should allow a longer wait period between using
Lopressor and an MAO, as MAOs may stay in their system longer
than in other patients. Dangerously high blood pressure
could result from this combination.
- Migraine medications of the triptan class such as Amerge
(naratriptan), Imitrex
(sumatriptan), Maxalt
(rizatriptan), or Zomig (zolmitriptan) may interact
with some beta blockers. Speak to your doctor about the
risks involved in your specific case, as some individuals
have used them together safely.
- Minipress (prazosin)
- Nasal decongestants - These may raise your blood
pressure. Speak to your doctor before using any over the
counter cold medicine or nose drops.
- Nicotine can decrease the effectiveness of Lopressor directly
by speeding its elimination from the body, and indirectly
by promoting high blood pressure and other cardiovascular
problems. No current treatment for cardiovascular conditions
can entirely cancel the negative effects of nicotine use
on the circulatory system.
- Nipolept (zotepine) - These two treatments increase each
other's potential toxicity.
- Non-steroidal anti-inflammatories (NSAIDs) like Ibuprofen,
Indocin (indomethacin), Naprosyn (naproxen), and others,
as well as combination pain killers which contain NSAIDs,
may reduce the medication's effectiveness in reducing high
blood pressure.
- Norpace (disopyramide) - Undesirable metoprolol buildup
may occur.
- Oral Contraceptives - You should use a different
beta blocker, your doctor will advise you.
- Phenothiazines like Mellaril (thioridazine), Thorazine
(chlorpromazine), Trilafon (perphenazein), and others, may
increas metoprolol's effects, or build up toxic levels of
the pentothiazine.
- Propacil (propylthiouracil) - May increase metoprolol's
effects.
- Propoxyphene (Darvocet) - Can lead to medication buildup.
- Protease inhibitors such as Agenerase (amprenavir), Norvir
(ritonavir), and perhaps others, may lead to higher levels
of metoprolol in the body.
- Proventil (albuterol) - May be less effective when combined
with metoprolol.
- Quinaglute (quinidine) - Increases risk of heart failure,
low blood pressure, or slow heart rate. If medications are
to be used together, careful monitoring is advised. May
increase the risk of adverse Lopressor side effects.
- Reserpine - This combination may cause central nervous
system or cardiovascular depression.
- Rifampin (Rifadin, Rimactane) - May decrease usefulness
of metoprolol.
- Rythmol (propafenone) - These combined treatments may
cause drug build up in the body, esp. with Rythmol doses
higher than 150 mg daily.
- Saw Palmetto - May increase blood pressure.
- Sedatives like Fioricet
(butalbital, acetaminophen, and caffeine), Fiorinal,
Phenobarbitol, Seconal, or other barbiturates may decrease
the effectiveness of your treatment.
- Selective serotonin reuptake inhibitors (SSRIs) like Celexa
(citalopram), Paxil
(paroxetine), Prozac
(fluoxetine), Luvox (fluvoxamine), or Zoloft
(sertraline) may cause side effects like slow heartbeat,
sedation, chest pain, a toxic buildup of metoprolol, or
a toxic buildup of the SSRI.
- Street Drugs - Cocaine may lead to a heart attack if taken
with this medication. Individuals taking prescription treatments
are strongly advised to avoid all street drugs, as the possible
interactions could be dangerous or life threatening.
- Tagamet (cimetidine)
- May cause drug buildup in the body.
- Tapazole (methimazole)
- Tonocard (tocainide) - May reduce the heart's ability
to contract.
- Valerian - May cause drowsiness.
- Wytensin (guanabenz) - Neither medication should be stopped
abruptly if used together, there's increased risk of sudden
high blood pressure.
- Yohimbe - May increase blood pressure.
- Zantac (ranitidine)
- Zyflo (zileuton) and Accolat (zafirlukast) may require
that metoprolol doages be decreased.
Lopressor Dosages
The following starting and maximum dosages are generic prescription
guidelines for adults. Dosages for the long-acting form may differ.
If the instructions you receive from your doctor are different than
the ones here, always follow your doctor's recommendations. Seniors
and children between 12 and 17 will need to have their doses individually
determined.
- Angina: 100-450 mg daily, either in one dose, or divided according
to your prescription.
- Heart Attack: 100-450 mg daily, either in one dose, or divided
according to your prescription.
- Heart Failure: After symptoms are stable, starting doses of
12.5 mg daily may be used, with gradual increases up to 200 mg
daily as needed or tolerated.
- Hypertension: 50 mg once or twice a day, up to 450 mg.
- Migraine Headache: 50 - 200 mg daily, take as directed.
Lopressor Directions
If you miss a dose of Lopressor, take it as soon as you remember,
unless you are within 4 hours of your next dose (or 8 hours for
the extended release forms). In that case, skip the missed dose
and go back to your schedule. Taking double doses of Lopressor is
not recommended, as it may lead to dangerously low blood pressure.
Lopressor should be taken an hour before food for best absorption.
While the immediate release tablets may be crushed into a small
amount of soft food, the extended release forms must be swallowed
whole.
While you are taking Lopressor, avoid all known allergens.This
medication can increase allergic response significantly, possibly
dangerously, especially in individuals with respiratory disorders.
Stopping this medication abruptly may lead to complications, in
some cases heart attack or stroke. No matter what condition you
are taking this medication for, decrease your dose gradually according
to the advice of your doctor if you must stop treatment for any
reason.
Store Lopressor away from direct light and heat. Store in a dry
location; avoid storing it in the bathroom, near sinks, or other
areas where it may become damp. Do not use after the expiration
date.
Keep Lopressor away from children; both when storing it, and when
discarding any unused medication.
Lopressor and Pregnancy
Adequate studies to confirm safety of this medication during pregnancy
have not been completed. This medication is not presently thought
to increase the risk of birth defects. Speak to your doctor if you
are, or plan to become pregnant.
If adverse effects are noticed in the infant during nursing, either
breastfeeding or treatment should be discontinued.
Lopressor and Children
Safety and effectiveness have not been studied for children under 12. For children 13 and older, watch carefully for signs of low blood sugar (hypoglycemia), including fatigue, headache, irritability, and confusion.
Lopressor and Seniors
Careful monitoring is required to ensure that blood pressure is
not reduced too greatly. Lower starting doses and frequent monitoring
may be required to determine the correct dose. Watch for confusion,
depression, dizziness, falls, hallucination, lack of balance or
coordination, or change in the frequency of urination.
Lopressor and Lopressor HCT are trademarks of Novartis
Generic Metoprolol is manufactured by Geneva, Mylan, and Watson
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This document is provided for information only. It is not a substitute for consultation with a physician, either to diagnose symptoms or prescribe treatment. Any dosages mentioned are general guidelines only, please follow the directions of your doctor or pharmacist exactly when taking medication. We have made every effort to ensure that this information is accurate, but only your doctor can say if a medication, or drug combination, is safe for you. Information intended for US residents only.
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