Do NOT use Toprol XL if:

• you are allergic to any ingredient in Toprol XL or to another beta-blocker
• you have a very slow heart rate (eg, bradycardia), certain types of irregular heartbeat (eg, atrioventricular [AV] block, sick sinus syndrome), moderate to severe heart failure, very low systolic blood pressure (less than 100 mm Hg), or severe blood circulation problems.

Contact your doctor or health care provider right away if any of these apply to you.

Some medical conditions may interact with Toprol XL. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances
• if you have an adrenal gland tumor (pheochromocytoma), have an overactive thyroid, or are scheduled to have surgery
• if you have low blood pressure or a history of heart attack, slow or irregular heartbeat, heart failure, or other heart problems; chest pain or angina; blood circulation problems; or liver problems
• if you have diabetes mellitus, chronic obstructive pulmonary disease (COPD), bronchitis, breathing problems, or a history of asthma.

Some medicines may interact with Toprol XL. Tell your health care provider if you are taking any other medicines, especially any of the following:

• digoxin (digitalis, Lanoxin);
• clonidine (Catapres);
• ritonavir (Norvir);
• terbinafine (Lamisil);
• a diuretic (water pill);
• cold medicines, stimulant medicines, or diet pills;
• anti-malaria medications such as chloroquine (Aralen) or hydroxychloroquine (Plaquenil, Quineprox);
• medicine to treat depression or mental illness, such as bupropion (Wellbutrin, Zyban), fluoxetine (Prozac, Sarafem), paroxetine (Paxil), thioridazine (Mellaril), and others;
• an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), or selegiline (Eldepryl, Emsam);
• a diabetes medication such as insulin, glyburide (Diabeta, Micronase, Glynase), glipizide (Glucotrol), chlorpropamide (Diabinese), or metformin (Glucophage);
• a heart medication such as nifedipine (Procardia, Adalat), quinidine (Quinaglute, Quinidex), propafenone (Rythmol), reserpine (Serpasil), verapamil (Calan, Verelan, Isoptin), diltiazem (Cartia, Cardizem); or
• medicine for asthma or other breathing disorders, such as albuterol (Ventolin, Proventil), bitolterol (Tornalate), metaproterenol (Alupent), pirbuterol (Maxair), terbutaline (Brethaire, Brethine, Bricanyl), and theophylline (Theo-Dur, Theolair).

This may not be a complete list of all interactions that may occur. Ask your health care provider if Toprol XL may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

Important safety information:

• Toprol XL may cause drowsiness, dizziness, or lightheadedness. These effects may be worse if you take it with alcohol or certain medicines. Use Toprol XL with caution. Do not drive or perform other possible unsafe tasks until you know how you react to it.
• Toprol XL may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.
• Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel "normal." Tell your doctor if you develop any new symptoms.
• Do not suddenly stop using Toprol XL without first talking your doctor. If your doctor decides you should no longer use Toprol XL, you will need to stop Toprol XL gradually according to your doctor's instructions.
• If your doctor has instructed you to check your blood pressure and heart rate regularly, be sure to do so.
• Do not take any medicines used to treat colds or congestion without first consulting with your doctor or pharmacist.
• Diabetes patients - Toprol XL may hide signs of low blood sugar, such as rapid heartbeat. Be sure to watch for other signs or low blood sugar. Low blood sugar may make you anxious, sweaty, weak, dizzy, drowsy, or faint. It may also make your vision change; give you a headache, chills, or tremors; or make you more hungry. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.
• Tell your doctor or dentist that you take Toprol XL before you receive any medical or dental care, emergency care, or surgery.
• If you have a history of any severe allergic reaction, talk with your doctor. You may be at risk for an even more severe allergic reaction if you come into contact with the substance that caused your allergy. Some medicines used to treat severe allergies may also not work as well while you are using Toprol XL.
• Lab tests, including liver and kidney function, blood pressure, and complete blood cell counts, may be performed while you use Toprol XL. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
• Toprol XL should be used with extreme caution in children; safety and effectiveness in children have not been confirmed.
• Pregnancy and breast-feeding: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Toprol XL while you are pregnant. Toprol XL is found in breast milk. If you are or will be breast-feeding while you use Toprol XL, check with your doctor. Discuss any possible risks to your baby.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• chest pain, pounding heartbeats or fluttering in your chest;
• feeling light-headed, fainting;
• feeling short of breath, even with mild exertion;
• swelling of your hands or feet;
• nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
• easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;
• wheezing, trouble breathing;
• depression, confusion, memory problems, hallucinations; or
• cold feeling in your hands and feet.

Less serious side effects may include:

• dry mouth, constipation, heartburn, vomiting, diarrhea;
• decreased sex drive, impotence, or difficulty having an orgasm;
• headache, drowsiness, tired feeling;
• sleep problems (insomnia); or
• anxiety, nervousness.

This is not a complete list of side effects and others may occur.