• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet (see section 4).

1. What Metoprolol Tartrate 25 mg tablets are and what they are used for
2. What you need to know before you take Metoprolol Tartrate 25mg tablets
3. How to take Metoprolol Tartrate 25mg tablets
4. Possible side effects
5. How to store Metoprolol Tartrate 25mg tablets
6. Contents of the pack and other information

• you are allergic to metoprolol, any other beta-blocker drugs or any of the other ingredients of this medicine (listed in section 6). If you think you may be allergic, talk to your doctor before taking this medicine.
• you are allergic to any other beta-blocker drugs,
• you have severe asthma or severe attacks of wheezing,
• you have certain serious heart or blood vessel disorders which shouldn’t be treated with beta-blockers (your doctor should be aware of these),
• you have low blood pressure,
• you have been told that you have high blood pressure due to a tumour near your kidney (phaeochromocytoma),
• you have been told that your blood is more acidic than normal (a condition called metabolic acidosis).

If any of the above applies to you, do not take Metoprolol Tartrate 25mg tablets and talk to your doctor.

Talk to your doctor or pharmacist before taking Metoprolol Tartrate 25mg tablets if you:

• suffer from asthma, bronchitis or any similar lung disorder
• have problems with your heart (such as slow heart rate) or circulation (taking this medicine may make these worse)
• have diabetes
• suffer from any serious liver disease
• have had a severe allergic reaction to anything
• suffer from a rare form of angina called Prinzmetal's angina
• will be having an operation which requires a general anaesthetic
• have psoriasis

If any of these apply to you, discuss your treatment with your doctor or pharmacist because this medicine might not be the right medicine for you.

If you are going to have a general anaesthetic, tell the doctor or dentist in charge that you are taking Metoprolol Tartrate 25mg tablets.

If you are diabetic, take particular care with your blood sugar control since Metoprolol Tartrate 25mg tablets may make you less aware of low blood sugar levels.

The doctor will want to keep an eye on your heart and thyroid function while you are taking this medicine. You might also need regular eye examinations.

Metoprolol Tartrate 25mg tablets are not recommended for the treatment of children or adolescents.

Tell your doctor or pharmacist if you are taking, have taken or might take any other medicines. This includes medicines you can buy without prescription, including herbal medicines. This is because metoprolol can affect the way some medicines work. Also some medicines can affect the way metoprolol works.

In particular, tell your doctor or pharmacist if you are taking any of the following:

• Medicines for high blood pressure (including prazosin, clonidine and drugs called calcium channel blockers such as verapamil or diltiazem)
• Other beta-blockers (including those used in the form of eye drops)
• Drugs which affect the peripheral circulation (fingers and toes) such as ergotamine which can be used to treat migraine
• Medicines to treat depression
• Medicines to treat other mental illnesses
• Antiretroviral drugs used to treat AIDS and some other conditions
• Antihistamines (including medicines that you can buy without a prescription for hay fever and other allergies, colds and other conditions)
• Drugs to prevent malaria
• Medicines to treat fungal infections
• Medicines which affect liver enzymes, such as cimetidine used to treat stomach ulcers and rifampicin used to treat tuberculosis
• Medicines for heart problems including angina, such as amiodarone, digoxin, nitrates and anti-arrhythmic drugs
• Insulin and other drugs to treat diabetes
• Drugs called NSAIDs used to treat pain and inflammation
• A local anaesthetic called lidocaine.

Be careful when drinking alcohol - it may affect you more than usual.

Metoprolol is not recommended during pregnancy or breast-feeding. If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

If you feel dizzy or sleepy, or if you have problems with your eyes when you start to take these tablets, do not drive or use machinery until these effects have worn off.

This medicine contains lactose monohydrate which is a type of sugar. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially “sodium-free”.

If you accidentally take too many tablets, tell your doctor at once or contact your nearest hospital casualty department. Take your medicine with you so that people can see what you have taken.

If you forget to take a dose, take it when you remember and then take your next dose at the usual time. Do not take a double dose to make up for a forgotten tablet.

Do not stop taking your tablets suddenly as this may cause your condition to get worse.

Ask your doctor first. When discontinuing the treatment, the dose should be withdrawn gradually over a period of 10 days, the doses diminishing to 25 mg for the last 6 days.

Common: may affect up to 1 in 10 people

• Headache, dizziness, or unusual tiredness.
• Slow heartbeat.
• Low blood pressure which might make you faint or dizzy.
• Feeling short of breath when exercising.
• Feeling or being sick, stomach ache.

Rare: may affect up to 1 in 1,000 people

• Sleep disorders such as sleepiness, sleeplessness or nightmares.
• Feeling less alert.
• Coldness, numbness or tingling in your hands and feet.
• Depression.
• Muscle cramps
• Heart failure or irregular heartbeat.
• Water retention (oedema).
• Breathlessness or wheeziness (bronchospasm).
• Diarrhoea or constipation.
• Skin rash and/or itching.

Very rare: may affect up to 1 in 10,000 people

• Weight gain.
• Hallucinations or personality disorders.
• Dry or sore eyes or problems with vision.
• Tinnitus or hearing problems.
• Gangrene.
• Runny nose, dry mouth.
• Changes in the results of liver function tests.
• Bruising or increased sensitivity of the skin to sunlight, worsening of psoriasis.
• Increased sweating, loss of hair.
• Impotence or loss of libido.
• Painful joints.
• Chest pain.

The following have also been reported:

• Confusion
• Abnormal levels of certain types of fats such as cholesterol or triglycerides in the blood.
• Abnormal curvature of the penis with painful erections (known as Peyronie’s disease)
• Retroperitoneal fibrosis where abnormal scar tissue occurs behind the membrane that lines the cavity of the abdomen.
  This may present with pain in the back, groin or the lower abdomen.
• Hepatitis.

Do not be alarmed by this list - most people take metoprolol without any problems.

If any of the symptoms become troublesome, or if you notice anything else not mentioned here, please go and see your doctor as they may want to give you a different medicine.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

Each tablet contains 25mg of the active ingredient metoprolol tartrate.

The other ingredients are: cellulose, microcrystalline; maize starch; lactose monohydrate; silica, colloidal anhydrous; sodium starch glycolate; calcium stearate; silica, hydrophobic colloidal; povidone.

Metoprolol Tartrate 25mg tablets are white to off white lentil shaped tablets with a diameter of 7 mm.

The tablets come in blister packs containing 28 or 56 tablets.

Not all pack sizes may be marketed.

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