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Metoprolol tartrate tablets are contraindicated in sinus bradycardia, heart block greater than first degree, cardiogenic shock, and overt cardiac failure see warnings .

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The following adverse reactions have been identified during post-approval use of TOPROL-XL or immediate-release metoprololBecause these reactions are reported voluntarily from a population of uncertain sizeit is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Shortness of breathbeing less able to exercise swelling of the anklesfeet or legs chest tightnesswheezingnoisy breathingdifficulty breathing chest painchanges in heart rate or palpitations swelling of the facelipstongue or throat which may cause difficulty in swallowing or breathingwhich may be signs of a serious allergic reaction yellowing of the skin or eyesjaundicegenerally feeling unwell.

Drowsinessdizzinesstirednessdiarrheaand slow heartbeat may occurDecreased sexual ability has been reported rarelyIf any of these effects persist or worsentell your doctor or pharmacist promptly.

Worsening cardiac failure may occur during up-titration of TOPROL-XLIf such symptoms occurincrease diuretics and restore clinical stability before advancing the dose of TOPROL-XLsee DOSAGE AND ADMINISTRATIONIt may be necessary to lower the dose of TOPROL-XL or temporarily discontinue itSuch episodes do not preclude subsequent successful titration of TOPROL-XL.

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