WARNING: ISCHEMIC HEART DISEASE: Following abrupt cessation of therapy with beta-blocking agents, exacerbations of angina pectoris and myocardial infarction have occurred. Warn patients against interruption or discontinuation of therapy without the physician’s advice. See WARNINGS: Metoprolol Succinate; Ischemic Heart Disease in the full PI.

• TOPROL-XL is contraindicated in severe bradycardia, heart block of second or third degree, cardiogenic shock, decompensated cardiac failure, sick sinus syndrome (unless permanent pacemaker is in place), and in patients who are hypersensitive to any component of this product
• Worsening cardiac failure may occur during up-titration of TOPROL-XL
• TOPROL-XL should be used with caution in patients who have bronchospastic disease, pheochromocytoma, diabetes and hypoglycemia, hepatic impairment, thyrotoxicosis, peripheral vascular disease, those who take calcium channel blockers of verapamil and diltiazem type, or those who are undergoing major surgery
• Avoid initiation of high-dose TOPROL-XL in patients undergoing non-cardiac surgery
• Patients taking beta blockers with a history of anaphylactic reaction may be unresponsive to the usual doses of epinephrine used to treat allergic reactions
• The most common adverse reactions were tiredness, dizziness, depression, shortness of breath, bradycardia, hypotension, diarrhea, pruritus, and rash

Indication for TOPROL-XL