The dose should then be doubled every two weeks metoprolol withdrawal anxiety to the highest dosage level tolerated by the patient or up to 200 mg of TOPROL-XL. In general, the maximum effect of any given dosage level will be apparent after week of therapy. While taking beta blockers, patients with history of severe anaphylactic reaction to variety of allergens may be more reactive to repeated challenge, either accidental, diagnostic, or therapeutic. In patients with severely damaged hearts, adequate ventricular function may depend on sympathetic drive. It is important that you not miss any scheduled visits to your doctor. Angina Pectoris Metoprolol tartrate tablets are indicated in the long-term treatment of angina pectoris. Such patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction.