When This Medicine Should Not Be Used:
You should not receive this medicine if you have had an allergic reaction to metoprolol or similar medicines (such as atenolol, propranolol, Bystolic®, Tenormin®). Make sure your doctor knows about any heart or blood circulation problems that you have, because you should not receive this medicine if you have certain problems.

How to Use This Medicine:
Injectable

• Your doctor will prescribe your dose and schedule. This medicine is given through a needle placed in a vein.
• A nurse or other health provider will give you this medicine.
• You might be switched to an oral form of this medicine when your condition allows. Ask your doctor if you have questions about this.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are also using digoxin (Digitek®, Lanoxin®), dipyridamole (Persantine®), medicine to treat depression (such as bupropion, clomipramine, desipramine, fluoxetine, fluvoxamine, paroxetine, sertraline, Paxil®, Wellbutrin®), medicine to treat mental illness (such as chlorpromazine, fluphenazine, haloperidol, thioridazine, Mellaril®), medicine for heart rhythm problems (such as propafenone, Rythmol®), medicine to treat HIV or AIDS (such as ritonavir, Norvir®), diphenhydramine (Benadryl®), quinidine (Quinidex®), hydroxychloroquine (Plaquenil®), or medicine to treat a fungus infection (such as terbinafine, Lamisil®).
• Make sure your doctor knows if you are also using another blood pressure medicine (such as clonidine (Catapres®), prazosin (Minipress®), reserpine, guanethidine (Ismelin®), hydralazine (Apresoline®), methyldopa, amlodipine, diltiazem, verapamil, Caduet®, Lotrel®), or an ergot medicine (such as ergotamine, Cafergot®, Ergomar®, Wigraine®).

Warnings While Using This Medicine:

• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, blood vessel or circulation problems, diabetes, low blood pressure, lung disease (such as asthma), an overactive thyroid, or an adrenal gland tumor (pheochromocytoma). Tell your doctor if you have a history of allergies.
• This medicine may worsen the symptoms of heart failure in some patients. Tell your doctor right away if you have more chest pain, trouble breathing, uneven heartbeat, rapid weight gain, or swelling of the face, fingers, feet, or lower legs.
• Tell any doctor or dentist who treats you that you are using this medicine. You may need to stop using this medicine several days before you have surgery or medical tests.
• This medicine may raise or lower your blood sugar level. If you have diabetes, report any changes in your blood sugar levels to your doctor.
• This medicine may make you dizzy or drowsy. Avoid driving, using machines, or doing anything else that could be dangerous until you know how this medicine affects you.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Fever, chills, cough, sore throat, and body aches
• Lightheadedness, dizziness, or fainting
• Rapid weight gain, swelling in your hands, ankles, or feet
• Slow, fast, pounding, or uneven heartbeat
• Trouble breathing, cold sweats, and bluish-colored skin
• Unusual bleeding or bruising
• Worsening chest pain

If you notice these less serious side effects, talk with your doctor:

• Pain, itching, burning, swelling, or a lump under your skin where the needle is placed

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088