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Toprol or Metoprolol?

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  • Toprol or Metoprolol?

    We discovered on Jan 1 that we have been switched to a new insurance. We have this insurance through Ed's former company, and he gets it as an early retiree, so we have no say in what we get, how much it costs, etc. Our share of the premiums doubled and our coverage got worse. But the question that we are puzzling over is this thing called an "open formulary." We have a three-tier system. Several of my regular meds are in the third tier and the company will only pay partially for them with prior approval, which it sounds like they rarely give. Of the ones in this group the only one that we think is a particular problem is Toprol XL.

    Currently I take 200 mg divided over twice a day. It is extremely difficult for me to take them at exactly the same time every day because my schedule changes completely from one day to the next depending on which classes I am teaching. The insurance covered metoprolol as a generic, or tier one drug, but I am a little concerned about the need to take this pretty much on exact schedule.

    Has anyone else tried switching this way? How crucial is taking it on schedule? Any advice?

    Rhoda

  • #2
    Rhoda,

    There are medications with what is called 'regulated release' whereby the medication doesn't 'peak' but is gradually released, resulting in an evenly distributed dosage even over 24 hours. I currently take Selokeen (as this medication is known in NL) which is metoprolol but with regulated release.

    Having a regulated release scheduling is pretty much a non-issue, as long as taking the medication falls within a certain timeframe - which in my experience can stretch several hours. I take 50 mg once a day (in the morning) and it'll cover me till the next morning.

    Selokeen is produced by AstraZeneca, in case you need to find it. Its english name appears to be Seloken ZOK / Toprol-XL (this is the medicine with regulated release).

    Ad
    \"Hope is disappointment postponed\"

    Dx in 2004, first symptoms 20 years ago? Obstructed, A-fib, family history!

    Combined Morrow and (left atrial) Maze procedures & PVI at St. Antonius Hospital, Netherlands, March 28, 2013.

    Meds (past) propranolol, metoprolol, disopyramide, sotalol, amiodaron, aspirin, dabigatran, acenocoumarol.

    Meds (current) sotalol, dabigatran, furosemide.

    Comment


    • #3
      Toprol XL

      Rhoda,

      First of all, extended release medications should never be broken or cut since it is the coating that times the release. Please see your doctor about getting the 100mg tablets (I take them, so I know they come in that size, at least in the US.)

      Second, about the formulary. They are designed to keep people from taking new brand medications willy-nilly. The cheapest tier is generic.

      The company will take your money for third-tier drugs, but they make it a hassle so you'll just switch instead.

      All you need for coverage is a doctor's letter. I would even try and get them to cover it at second-tier, if you can (you don't ask, you don't get). Or evaluate the cost and determine if you can afford to stay on XL--keeping your ability to take shorter acting pills into consideration.

      However, I doubt you are getting the full effect of the XL if you've been cutting them in half.

      Good luck,

      Sarah

      Comment


      • #4
        Rhoda, Just a thought on splitting your 200 mg. of Toprol XL.

        I have been on Toprol XL for almost five years, at various dosages. I have been told by the doctors that if the pill is scribed, it was okay to split. If the pill has no scribe point on it, then, yes, the effectiveness is compromised upon splitting. Hope this helps.
        Dorothy

        Diagnosed 1996, Myectomy Aug. 2000, 3 Radio-frequency ablations for a-fibs 2003-2005.

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        • #5
          Obviously, I was unclear. I currently take a 100mg tablet of Toprol XL in the morning and a different 100 mg tablet of Toprol XL at night. Actually, the instructions on the pills clearly say they can be cut along the score line, but I do not need to do this since I take the 100 mg tablets.

          My question is, will going to a non-extended release generic cause me to lose effectiveness? I like Sarah's idea of trying to get the company to cover it as a tier 2, but am skeptical of getting them to make an exception. Has anyone ever tried this?

          Rhoda

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          • #6
            My question is, will going to a non-extended release generic cause me to lose effectiveness?
            Most likely, yes. My own experience with propranolol compared to Toprol-XL is that Toprol-XL has a far more (and better) sort of diffused effect compared to propranonol which feels 'peaking' 30~60 minutes after taking the drug (with the effect slowly waning off after several hours).

            50 Mg Toprol-XL covers me better than a single dose (40 mg) of propranolol - i would need twice a dose per day of the latter to have the same effect. Sometimes supplementing Toprol-XL with propranolol is useful when the heart is a bit nervous.

            Ad
            \"Hope is disappointment postponed\"

            Dx in 2004, first symptoms 20 years ago? Obstructed, A-fib, family history!

            Combined Morrow and (left atrial) Maze procedures & PVI at St. Antonius Hospital, Netherlands, March 28, 2013.

            Meds (past) propranolol, metoprolol, disopyramide, sotalol, amiodaron, aspirin, dabigatran, acenocoumarol.

            Meds (current) sotalol, dabigatran, furosemide.

            Comment


            • #7
              Rhoda,

              Just FYI, I take Toprol XL 100 in the morning and then Metoprolol 100 at night.

              It seems to work for me, most of the time.

              Debbie

              Comment


              • #8
                Hi again Rhoda,
                Since others have responded on the various drug effects I will try to address the three tier formulary system – at least to the extent that I have run into it.

                The first tier is usually the generic drugs, and has the lowest co-pay costs. The second tier is usually the brand name drugs, and it has the next higher co-pay costs associated with it. The third tier is usually the non-formulary drugs, which carry the highest co-pay costs, and usually requires the doctor to obtain prior authorization from the insurance company, and he/she must also explain why this particular drug is required.

                Although it is possible for the timed release feature of a drug to move it from one tier to another, they usually fall into the same category – but not always. I have one drug of which I take 360 mg – timed release tablets per day. The pill is scored so it may be broken. The 240 mg tablet is generic, but the 360 mg tablet is non-formulary, so I take one and a half generic pills per day. (Obviously there is a marked difference in the cost of these tablets to the insurance company.) If you have a doctor who is familiar with the insurance companies formulary lists – and most doctors that accept their assignment are – they will help align your drug requirements to the formulary so that you get the drugs you need at the lowest cost to you.

                I know it sounds crazy, but then what would you expect. The insurance companies are busy looking at the bottom line, and if you can use one drug as well as another, they will try to get you on the cheaper drug. If you absolutely must have the higher cost drug, they will make you pay a greater portion of the costs.

                Hope this is of some help.
                Burt

                Comment


                • #9
                  toprol levels and tiers

                  Here is a link to a chart on the peak plasma levels of toprol xl vs. metoprolol: http://www.toprol-xl.com/HCP/8_pharmacologya.asp that makes it very clear the differences.

                  I highly recommend having your doctor send a letter with this chart to the insurance company requesting coverage of the drug --you don't ask you don't get.

                  Good luck,

                  S

                  Comment


                  • #10
                    Thanks, all and especially Sarah, for your help. I understood the formulary all too well, I'm afraid. That is why it discouraged me. One question that I had to ask myself was, was it worth fighting for the right to take Toprol or not since it will probably cost me more each month. Your data, Sarah, seems to clearly answer that question in the affirmative. I will take this data to my appointment next week and ask Dr. Gilligan to give it a try.

                    Thanks again,
                    Rhoda

                    Comment


                    • #11
                      Rhoda

                      Just wanted to say hi and welcome back if you are indeed back, i hope you are feeling better and that plane trip didn't zapp you too much, i could be better i think, i have a cold or the flu also a bad cough and a sore throat had a fever for a couple of days, but it is gone now, doc says who knows it could be a cold or it could be your CHF again all i know there for a couple of days there i felt pretty rough, Please Dr. Gilligan i said HI and that i hope he had a great holiday

                      Shirley
                      Diagnosed 2003
                      Myectomy 2-23-2004
                      Husband: Ken
                      Son: John diagnosed 2004
                      Daughter: Janet (free of HCM)

                      Grandchildren: Drew 15,Aaron 13,Karen 9,Connor 9

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