Some pre-specified secondary endpoints demonstrated effectiveness including:The mean placebo corrected reductions in SBP ranged from 3 to 6 mmHg, and DBP from 1 to 5 mmHg. When discontinuing chronically administered TOPROL-XL, particularly in patients with ischemic heart disease, gradually reduce the dosage over a period of 1 - 2 weeks and monitor the patient. At the end of the study, the mean daily dose of TOPROL-XL was 159 mg. Using an EAlthough beta-adrenergic receptor blockade is useful in the treatment of angina, hypertension, and heart failure there are situations in which sympathetic stimulation is vital. Find information about once-a-day TOPROL-XL® (metoprolol succinate) Extended-Release Tablets and learn more about high blood pressure. resulted in two- to five-fold increases in the steady-state concentration of metoprolol. Can hide symptoms of low blood sugar, so be careful taking this if you have diabetes. 200 mg tablets: White, oval, biconvex, film-coated scored tablet engraved with “A/my”. 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.The table below lists adverse reactions in the MERIT-HF study that occurred at an incidence of ≥ 1% in the Toprol-XL group and greater than placebo by more than 0.5%, regardless of the assessment of causality.The following adverse reactions have been identified during post-approval use of Toprol-XL or immediate-release metoprolol. At randomization, 41% of patients were NYHA Class II; 55% NYHA Class III; 65% of patients had heart failure attributed to ischemic heart disease; 44% had a history of hypertension; 25% had diabetes mellitus; 48% had a history of myocardial infarction. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including metoprolol. Inactive ingredients: silicon dioxide, cellulose compounds, sodium stearyl fumarate, polyethylene glycol, titanium dioxide, paraffin.Clinical pharmacology studies have confirmed the beta-blocking activity of metoprolol in man, as shown by (1) reduction in heart rate and cardiac output at rest and upon exercise, (2) reduction of systolic blood pressure upon exercise, (3) inhibition of isoproterenol-induced tachycardia, and (4) reduction of reflex orthostatic tachycardia.The relationship between plasma metoprolol levels and reduction in exercise heart rate is independent of the pharmaceutical formulation. Because TOPROL-XL is metabolized by the liver, metoprolol blood levels are likely to increase substantially with poor hepatic function. Seek consultation with a regional poison control center and a medical toxicologist as needed. Patients should not interrupt or discontinue TOPROL-XL without consulting the physician.Advise patients (1) to avoid operating automobiles and machinery or engaging in other tasks requiring alertness until the patient’s response to therapy with TOPROL-XL has been determined; (2) to contact the physician if any difficulty in breathing occurs; (3) to inform the physician or dentist before any type of surgery that he or she is taking TOPROL-XL.Heart failure patients should be advised to consult their physician if they experience signs or symptoms of worsening heart failure such as weight gain or increasing shortness of breath.TOPROL-XL and PLENDIL are trademarks of the AstraZeneca group of companies.Store between 20°-25°C (68°-77°F). The table below lists adverse reactions in the MERIT-HF study that occurred at an incidence of ≥ 1% in the TOPROL-XL group and greater than placebo by more than 0.5%, regardless of the assessment of causality.The following adverse reactions have been identified during post-approval use of TOPROL-XL or immediate-release metoprolol.