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metoprolol and hydrochlorothiazide (Oral route)

met-oh-PROE-lol TAR-trate, hye-droe-klor-oh-THYE-a-zide

Oral route(Tablet)

Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have been reported. Even in the absence of overt angina pectoris, when discontinuing therapy, hydrochlorothiazide/metoprolol tartrate should not be withdrawn abruptly, and patients should be cautioned against interruption of therapy without the physician's advice .

Commonly used brand name(s)

In the U.S.

  • Lopressor HCT

Available Dosage Forms:

  • Tablet

Therapeutic Class: Beta-Adrenergic Blocker, Cardioselective/Thiazide Combination

Pharmacologic Class: Metoprolol

Chemical Class: Thiazide

Uses For metoprolol and hydrochlorothiazide

Metoprolol and hydrochlorothiazide combination is used to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.

Slideshow: HealthQuiz - Basics About Stroke Signs and Symptoms

Metoprolol is a beta-blocker. It works by affecting the response to some nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart.

Hydrochlorothiazide is a thiazide diuretic (water pill). It reduces the amount of water in the body by increasing the flow of urine, which helps lower the blood pressure.

metoprolol and hydrochlorothiazide is available only with your doctor's prescription.

Before Using metoprolol and hydrochlorothiazide

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For metoprolol and hydrochlorothiazide, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to metoprolol and hydrochlorothiazide or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of metoprolol and hydrochlorothiazide combination in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of metoprolol and hydrochlorothiazide combination in the elderly. However, elderly patients are more likely to have age-related liver, kidney or heart problems, which may require caution and an adjustment in the dose for patients receiving metoprolol and hydrochlorothiazide combination.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking metoprolol and hydrochlorothiazide, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using metoprolol and hydrochlorothiazide with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Dofetilide

Using metoprolol and hydrochlorothiazide with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acetyldigoxin
  • Albuterol
  • Amiodarone
  • Arformoterol
  • Arsenic Trioxide
  • Bambuterol
  • Clenbuterol
  • Clonidine
  • Colterol
  • Crizotinib
  • Cyclophosphamide
  • Deslanoside
  • Digitalis
  • Digitoxin
  • Digoxin
  • Diltiazem
  • Dronedarone
  • Droperidol
  • Fenoldopam
  • Fenoterol
  • Fingolimod
  • Flecainide
  • Formoterol
  • Hexoprenaline
  • Indacaterol
  • Isoetharine
  • Ketanserin
  • Levalbuterol
  • Levomethadyl
  • Lidocaine
  • Lithium
  • Metaproterenol
  • Methotrexate
  • Metildigoxin
  • Ouabain
  • Pirbuterol
  • Procaterol
  • Proscillaridin
  • Reproterol
  • Ritodrine
  • Salmeterol
  • Sotalol
  • Terbutaline
  • Tretoquinol
  • Tulobuterol
  • Verapamil
  • Vilanterol

Using metoprolol and hydrochlorothiazide with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acarbose
  • Aceclofenac
  • Acemetacin
  • Acetohexamide
  • Acetyldigoxin
  • Alacepril
  • Alfuzosin
  • Amlodipine
  • Amtolmetin Guacil
  • Arbutamine
  • Aspirin
  • Benazepril
  • Benfluorex
  • Bepridil
  • Bromfenac
  • Bufexamac
  • Bunazosin
  • Captopril
  • Carbamazepine
  • Celecoxib
  • Chlorpropamide
  • Cholestyramine
  • Choline Salicylate
  • Cilazapril
  • Citalopram
  • Clonixin
  • Delapril
  • Deslanoside
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Digitoxin
  • Digoxin
  • Dipyrone
  • Doxazosin
  • Enalaprilat
  • Enalapril Maleate
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Felodipine
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Flurbiprofen
  • Fosinopril
  • Ginkgo
  • Gliclazide
  • Glimepiride
  • Glipizide
  • Gliquidone
  • Glyburide
  • Gossypol
  • Guar Gum
  • Ibuprofen
  • Ibuprofen Lysine
  • Imidapril
  • Indomethacin
  • Insulin
  • Insulin Aspart, Recombinant
  • Insulin Glulisine
  • Insulin Lispro, Recombinant
  • Ketoprofen
  • Ketorolac
  • Lacidipine
  • Lercanidipine
  • Licorice
  • Lisinopril
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Manidipine
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Metformin
  • Metildigoxin
  • Mibefradil
  • Miglitol
  • Mirabegron
  • Moexipril
  • Morniflumate
  • Moxisylyte
  • Nabumetone
  • Naproxen
  • Nepafenac
  • Nicardipine
  • Nifedipine
  • Niflumic Acid
  • Nilvadipine
  • Nimesulide
  • Nimodipine
  • Nisoldipine
  • Nitrendipine
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Pentopril
  • Perindopril
  • Phenelzine
  • Phenobarbital
  • Phenoxybenzamine
  • Phentolamine
  • Phenylbutazone
  • Piketoprofen
  • Piroxicam
  • Pranidipine
  • Pranoprofen
  • Prazosin
  • Proglumetacin
  • Propoxyphene
  • Propyphenazone
  • Proquazone
  • Quinapril
  • Ramipril
  • Repaglinide
  • Rifampin
  • Rifapentine
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sodium Salicylate
  • Spirapril
  • St John's Wort
  • Sulindac
  • Tamsulosin
  • Telithromycin
  • Temocapril
  • Tenoxicam
  • Terazosin
  • Tiaprofenic Acid
  • Tolazamide
  • Tolbutamide
  • Tolfenamic Acid
  • Tolmetin
  • Topiramate
  • Trandolapril
  • Trimazosin
  • Troglitazone
  • Urapidil
  • Valdecoxib
  • Venlafaxine
  • Zofenopril

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Problems

The presence of other medical problems may affect the use of metoprolol and hydrochlorothiazide. Make sure you tell your doctor if you have any other medical problems, especially:

  • Angina (severe chest pain)—May provoke chest pain if stopped too quickly.
  • Anuria (not able to form urine) or
  • Blood vessel disease (circulation problems), severe or
  • Bradycardia (slow heartbeat) or
  • Cardiogenic shock (shock caused by heart attack) or
  • Heart block or
  • Heart failure or
  • Sick-sinus syndrome (type of abnormal heart rhythm) or
  • Sulfa drug allergy (e.g., sulfamethoxazole, Bactrim®, Septra®)—Should not be used in patients with these conditions.
  • Asthma, history of—May increase likelihood of having an allergic reaction.
  • Diabetes or
  • Hyperthyroidism (overactive thyroid) or
  • Hypoglycemia (low blood sugar)—May cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
  • Electrolyte imbalance (e.g., hypercalcemia, hypokalemia, hyponatremia, hypomagnesemia) or
  • Gout or
  • Hyperuricemia (high uric acid in the blood) or
  • Kidney disease or
  • Liver disease or
  • Pheochromocytoma (adrenal gland tumor) or
  • Systemic lupus erythematosus (SLE)—Use with caution. May make these conditions worse.
  • Lung disease (e.g., asthma, bronchitis, emphysema)—Use with caution. May cause difficulty with breathing in patients with this condition.
  • Sympathectomy—Use with caution. The effects of metoprolol and hydrochlorothiazide may be increased.

Proper Use of metoprolol and hydrochlorothiazide

metoprolol and hydrochlorothiazide should not be the first medicine you use to treat your condition. It is meant to be used only after you have tried other medicines that have not worked or have caused unwanted side effects.

In addition to the use of metoprolol and hydrochlorothiazide, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that metoprolol and hydrochlorothiazide will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

Take metoprolol and hydrochlorothiazide with a meal or just after you eat.

Dosing

The dose of metoprolol and hydrochlorothiazide will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of metoprolol and hydrochlorothiazide. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For high blood pressure:
      • Adults—One or two tablets per day, given as a single dose or in divided doses. Your doctor may adjust your dose if needed.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of metoprolol and hydrochlorothiazide, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using metoprolol and hydrochlorothiazide

It is very important that your doctor check your progress at regular visits to make sure metoprolol and hydrochlorothiazide is working properly and to check for unwanted effects. Blood and urine tests may be needed to check for unwanted effects.

metoprolol and hydrochlorothiazide may cause heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort; dilated neck veins; extreme fatigue; irregular breathing; an irregular heartbeat; shortness of breath; swelling of the face, fingers, feet, or lower legs; weight gain; or wheezing.

metoprolol and hydrochlorothiazide may cause changes in your blood sugar levels. Also, metoprolol and hydrochlorothiazide may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests.

Make sure any doctor or dentist who treats you knows that you are using metoprolol and hydrochlorothiazide. You may need to stop using metoprolol and hydrochlorothiazide several days before having surgery or medical tests.

metoprolol and hydrochlorothiazide may cause some people to become less alert than they are normally. If this side effect occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert while taking metoprolol and hydrochlorothiazide.

Do not interrupt or stop taking metoprolol and hydrochlorothiazide without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous.

Check with your doctor right away if you start having dry mouth, increased thirst, muscle cramps, nausea or vomiting, unusual tiredness or weakness, severe drowsiness or dizziness, seizures, a decrease in urine, or a fast heartbeat while you are using metoprolol and hydrochlorothiazide. These may be symptoms of dehydration or mineral imbalance.

Stop using metoprolol and hydrochlorothiazide and check with your doctor immediately if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment. This could be a sign of a serious eye problem. Your doctor will want you to have your eyes checked by an ophthalmologist (eye doctor).

Do not take other medicines unless they have been discussed with your doctor. This especially includes prescription or nonprescription (over-the-counter) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may increase your blood pressure.

metoprolol and hydrochlorothiazide Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Chest pain or discomfort
  • convulsions
  • decreased urine
  • dry mouth
  • increased thirst
  • lightheadedness, dizziness, or fainting
  • loss of appetite
  • mood changes
  • muscle pain or cramps
  • nausea or vomiting
  • numbness or tingling in the hands, feet, or lips
  • shortness of breath
  • slow or irregular heartbeat
  • unusual tiredness or weakness
Less common
  • Ankle, knee, or great toe joint pain
  • decreased ability to exercise
  • difficult or labored breathing
  • joint stiffness or swelling
  • lower back or side pain
  • swelling of the face, fingers, feet, or lower legs
  • tightness in the chest
  • wheezing

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
  • Blurred vision
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chemical imbalance in the blood
  • cold, clammy skin
  • coma
  • confusion
  • cough
  • difficulty with breathing
  • dilated neck veins
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • drowsiness
  • extreme fatigue
  • fast or pounding heartbeat or pulse
  • frequent urination
  • headache
  • increased volume of pale, dilute urine
  • irregular breathing
  • irritability
  • mood changes
  • noisy breathing
  • not able to pass urine
  • pain or aching in the lower legs
  • pain or weakness in the hands or feet
  • seizures
  • sweating
  • trembling
  • unconsciousness
  • very drowsy or sleepy
  • weak pulse
  • weakness and heaviness of the legs
  • weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Chills
  • diarrhea
  • feeling of constant movement of self or surroundings
  • fever
  • general feeling of discomfort or illness
  • muscle aches
  • nightmares
  • runny nose
  • sensation of spinning
  • shivering
  • sleepiness
  • sore throat
  • trouble sleeping
  • unusual drowsiness, dullness, or feeling of sluggishness
Less common
  • Continuing ringing or buzzing or other unexplained noise in the ears
  • decreased interest in sexual intercourse
  • difficulty having a bowel movement (stool)
  • earache
  • hearing loss
  • inability to have or keep an erection
  • loss in sexual ability, desire, drive, or performance
  • pinpoint red or purple spots on the skin
  • weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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