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Metoprolol/ hydrochlorothiazide

Generic Name: metoprolol/hydrochlorothiazide (MET-oh-PROE-lol/HYE-droe-KLOR-oh-THYE-a-zide)
Brand Name: Lopressor HCT

Do not suddenly stop taking metoprolol/hydrochlorothiazide. Sharp chest pain, irregular heartbeat, and sometimes heart attack may occur if you suddenly stop taking metoprolol/hydrochlorothiazide. The risk may be greater if you have certain types of heart disease. Your doctor should slowly lower your dose over several weeks if you need to stop taking it. This should be done even if you only take metoprolol/hydrochlorothiazide for high blood pressure. Heart disease is common and you may not know you have it. Limit physical activity while you are lowering your dose. If new or worsened chest pain or other heart problems occur, contact your doctor right away. You may need to start taking metoprolol/hydrochlorothiazide again.


Metoprolol/ hydrochlorothiazide is used for:

Treating high blood pressure.

Metoprolol/hydrochlorothiazide is a beta-adrenergic blocking agent (beta-blocker) and diuretic combination. The beta-blocker works by slowing down the heartbeat, helping the heart beat more regularly, and reducing the amount of work the heart has to do. The diuretic increases the elimination of excess fluid, which helps to decrease blood pressure.

Do NOT use metoprolol/ hydrochlorothiazide if:

  • you are allergic to any ingredient in metoprolol/hydrochlorothiazide, to another beta-blocker (eg, propranolol), or to a sulfonamide medicine (eg, sulfamethoxazole, probenecid, glyburide)
  • you have a very slow heartbeat, certain types of irregular heartbeat (eg, second- or third-degree heart block, sick sinus syndrome), uncontrolled heart failure, shock caused by serious heart problems, or severe blood circulation problems
  • you are unable to urinate
  • you are taking another beta-blocker (eg, propranolol), dofetilide, ketanserin, or mibefradil

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

Slideshow: 2014 Update - First Time Brand-to-Generic Switches

Before using metoprolol/ hydrochlorothiazide:

Some medical conditions may interact with metoprolol/hydrochlorothiazide. 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 asthma, bronchitis, or other lung or breathing problems (eg, chronic obstructive pulmonary disease [COPD]), diabetes, glaucoma or increased pressure in the eye, gout, an overactive thyroid, low blood sugar, an adrenal gland tumor (pheochromocytoma), lupus, liver problems, high blood cholesterol or triglycerides, or kidney problems
  • if you have high or low blood electrolyte levels (eg, sodium, potassium, magnesium, calcium)
  • if you will be having surgery or receiving anesthesia
  • 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; or blood vessel or circulation problems
  • if you have recently had a certain type of nerve surgery (sympathectomy)
  • if you have never taken another medicine for high blood pressure

Some MEDICINES MAY INTERACT with metoprolol/hydrochlorothiazide. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Antiarrhythmics (eg, amiodarone, quinidine, propafenone), bupropion, certain calcium channel blockers (eg, diltiazem, verapamil), digoxin, diphenhydramine, hydroxychloroquine, ketanserin, monoamine oxidase inhibitors (MAOIs) (eg, phenelzine), phenothiazines (eg, thioridazine), certain protease inhibitors (eg, ritonavir), quinine, reserpine, certain selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine, paroxetine), or other medicines for blood pressure because side effects, such as slow or irregular heartbeat, unusual tiredness or weakness, low blood pressure, fainting, severe dizziness, or light-headedness when standing, may occur
  • Abiraterone, adrenocorticotropic hormone (ACTH), other beta-blockers (eg, propranolol), cimetidine, corticosteroids (eg, prednisone), guanethidine, or terbinafine because they may increase the risk of metoprolol/hydrochlorothiazide's side effects
  • Cholestyramine, colestipol, nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen), or rifamycins (eg, rifampin) because they may decrease metoprolol/hydrochlorothiazide's effectiveness
  • Alfuzosin, allopurinol, amantadine, dofetilide, fingolimod, hydralazine, insulin or other medicines for diabetes (eg, glyburide), lithium, prazosin, or thioamines (eg, propylthiouracil) because their actions and the risk of their side effects may be increased by metoprolol/hydrochlorothiazide
  • Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), barbiturates (eg, phenobarbital), diazoxide, mefloquine, mibefradil, or narcotics (eg, codeine) because the risk of their side effects may be increased by metoprolol/hydrochlorothiazide, and they may increase the risk of metoprolol/hydrochlorothiazide's side effects
  • Clonidine because stopping it or metoprolol/hydrochlorothiazide suddenly can lead to a rapid increase in blood pressure

This may not be a complete list of all interactions that may occur. Ask your health care provider if metoprolol/hydrochlorothiazide 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.

How to use metoprolol/ hydrochlorothiazide:

Use metoprolol/hydrochlorothiazide as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Take metoprolol/hydrochlorothiazide by mouth with or without food.
  • If you also take cholestyramine or colestipol, ask your doctor or pharmacist how to take it with metoprolol/hydrochlorothiazide.
  • Metoprolol/hydrochlorothiazide may increase the amount of urine or cause you to urinate more often when you first start taking it. To keep this from disturbing your sleep, try to take your dose before 6 pm.
  • Take metoprolol/hydrochlorothiazide on a regular schedule to get the most benefit from it.
  • Continue to take metoprolol/hydrochlorothiazide even if you feel well. Do not miss any doses.
  • If you miss a dose of metoprolol/hydrochlorothiazide, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use metoprolol/hydrochlorothiazide.

Important safety information:

  • Metoprolol/hydrochlorothiazide may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use metoprolol/hydrochlorothiazide with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
  • Metoprolol/hydrochlorothiazide may cause dizziness, light-headedness, 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.
  • Drink plenty of fluids while taking metoprolol/hydrochlorothiazide and avoid engaging in activities that cause excessive sweating. Dehydration, excessive sweating, vomiting, or diarrhea may lead to a fall in blood pressure. Contact your health care provider at once if any of these occur.
  • Metoprolol/hydrochlorothiazide may decrease the amount of potassium in your body. If your doctor has also prescribed a potassium supplement for you, follow the dosing directions carefully. Check with your doctor before taking additional potassium on your own or including foods high in potassium (eg, bananas, orange juice) in your diet.
  • 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.
  • Metoprolol/hydrochlorothiazide may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to metoprolol/hydrochlorothiazide. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.
  • Tell your doctor or dentist that you take metoprolol/hydrochlorothiazide before you receive any medical or dental care, emergency care, or surgery.
  • Do not suddenly stop taking metoprolol/hydrochlorothiazide without first consulting your doctor. If your doctor decides you should no longer take metoprolol/hydrochlorothiazide, you will need to stop metoprolol/hydrochlorothiazide 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.
  • Metoprolol/hydrochlorothiazide contains a sulfonamide called hydrochlorothiazide, which can cause certain eye problems (myopia, angle-closure glaucoma). Your risk may be increased if you are allergic to sulfonamide medicines (eg, sulfamethoxazole) or to penicillin antibiotics (eg, amoxicillin). Untreated angle-closure glaucoma can lead to permanent vision loss. If these eye problems occur, symptoms usually occur within hours to weeks of starting metoprolol/hydrochlorothiazide. Contact your doctor immediately if you experience symptoms such as vision changes (eg, decreased vision clearness) or eye pain.
  • If you have high blood pressure, do not use nonprescription products that contain stimulants. These products may include diet pills or cold medicines. Contact your doctor if you have any questions or concerns.
  • Diabetes patients - Metoprolol/hydrochlorothiazide may affect your blood sugar. It may also hide signs of low blood sugar, such as a rapid heartbeat. Be sure to watch for other signs of 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.
  • If you have a history of any severe allergic reaction, talk with your doctor. You may be at risk of 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 taking metoprolol/hydrochlorothiazide.
  • Metoprolol/hydrochlorothiazide may interfere with certain lab tests, including parathyroid function. Be sure your doctor and lab personnel know you are taking metoprolol/hydrochlorothiazide.
  • Lab tests, including blood pressure, heart rate, and blood or urine electrolytes, may be performed while you use metoprolol/hydrochlorothiazide. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
  • Use metoprolol/hydrochlorothiazide with caution in the ELDERLY; they may be more sensitive to its effects.
  • Metoprolol/hydrochlorothiazide 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 taking metoprolol/hydrochlorothiazide while you are pregnant. Metoprolol/hydrochlorothiazide is found in breast milk. Do not breast-feed while taking metoprolol/hydrochlorothiazide.

Possible side effects of metoprolol/ hydrochlorothiazide:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Diarrhea; dizziness; drowsiness; headache; light-headedness; mild flu symptoms (eg, chills, fever, sore throat); tiredness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); burning, numbness, or tingling; chest pain; chills, fever, or sore throat; cold hands and feet; decreased urination; dry mouth or eyes; eye pain; fainting; fast, slow, or irregular heartbeat; hallucinations; mood or mental changes (eg, depression); muscle pain, cramps, or weakness; nausea; red, swollen, blistered, or peeling skin; restlessness; severe or persistent dizziness, drowsiness, or light-headedness; severe or persistent stomach pain; shortness of breath; sudden, unexplained weight gain; swelling of the hands, ankles, legs, or feet; symptoms of low blood sodium levels (eg, confusion, seizures, sluggishness); unusual bruising or bleeding; unusual thirst, weakness, or fatigue; vision changes (eg, decreased vision clearness); vomiting; wheezing; yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include fainting; loss of consciousness; severe dizziness or light-headedness; slow heartbeat; symptoms of blood electrolyte problems (eg, burning, numbness, or tingling; confusion; irregular heartbeat; mental or mood changes; muscle pain, weakness, or cramping; seizures; sluggishness); symptoms of dehydration (eg, decreased urination; drowsiness; dry mouth or eyes; fast heartbeat; nausea or vomiting; unusual thirst, weakness, or fatigue); symptoms of heart failure (eg, shortness or breath; sudden, unexplained weight gain; swelling of the hands, ankles, legs, or feet); trouble breathing.

Proper storage of metoprolol/hydrochlorothiazide:

Store metoprolol/hydrochlorothiazide at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep metoprolol/hydrochlorothiazide out of the reach of children and away from pets.

General information:

  • If you have any questions about metoprolol/hydrochlorothiazide, please talk with your doctor, pharmacist, or other health care provider.
  • Metoprolol/hydrochlorothiazide is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.
  • Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take metoprolol/hydrochlorothiazide or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about metoprolol/hydrochlorothiazide. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to metoprolol/hydrochlorothiazide. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using metoprolol/hydrochlorothiazide.

Issue Date: December 3, 2014
Database Edition 14.4.1.003
Copyright © 2014 Wolters Kluwer Health, Inc.

Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.

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