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Poor cyp2d6 metabolizers can exhibit higher blood concentrations of metoprolol comparing to extensive metabolizers with normal cyp2d6, thereby decreasing metoprolol cardioselectivity.

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Asthma or other lung problemseven if you have had them in the past allergic problemsincluding hayfever diabetes very slow heart beatless than 45-50 beats/minutesevere blood vessel disorder causing poor circulation in the arms and legs liver problems kidney problems certain types of angina any other heart problems phaeochromocytomaa rare tumour of the adrenal gland hyperthyroidisman overactive thyroid gland)

Be careful driving or operating machinery until you know how TOPROL-XL affects you.

TOPROL-XLlike other beta-blocker medicinestends to decrease blood circulation in the skinfingers and toesIt may make you more sensitive to cold weatherespecially if you have circulation problems.

Individualize the dosage of TOPROL-XLThe usual initial dosage is 100 mg dailygiven in a single doseGradually increase the dosage at weekly intervals until optimum clinical response has been obtained or there is a pronounced slowing of the heart rateDosages above 400 mg per day have not been studiedIf treatment is to be discontinuedreduce the dosage gradually over a period of 12 weekssee Warnings and Precautions5

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