Metoprolol Tartrate / Hydrochlorothiazide
Pronunciation: MET-oh-PROE-lol TAR-trate/HYE-droe-KLOR-oh-THYE-a-zide
Class: Antihypertensive combination
- Tablets 50 mg metoprolol tartrate/25 mg hydrochlorothiazide
- Tablets 100 mg metoprolol tartrate/25 mg hydrochlorothiazide
- Tablets 100 mg metoprolol tartrate/50 mg hydrochlorothiazide
Indications and Usage
Management of hypertension.
Sinus bradycardia; heart block greater than first degree; cardiogenic shock; overt cardiac failure; sick-sinus syndrome; severe peripheral arterial circulatory disorder; pheochromocytoma; anuria; hypersensitivity to any component of the product, beta-blockers, or sulfonamide-derivatives.
Dosage and Administration
Determine dosage by individual titration.Adults
PO Hydrochlorothiazide is usually given at a dose of 12.5 to 50 mg/day. Metoprolol is effective in the dose range of 100 to 450 mg/day. In general, once-daily dosing is effective and can maintain a reduction in BP throughout the day; however, lower doses of metoprolol, especially 100 mg, may not maintain full effect at end of 24-h period and larger or more frequent doses may be required.
Store at 59° to 86°F. Protect from moisture.
Metoprolol bioavailability may be decreased.Bile acid sequestrants (eg, cholestyramine)
May reduce hydrochlorothiazide absorption; give at least 2 h before the sequestrant.Catecholamine-depleting drugs (eg, reserpine)
May have additive effect when given with metoprolol.Clonidine
May enhance or reverse antihypertensive effect. Potentially life-threatening situations may occur, especially on abrupt withdrawal of clonidine.Diazoxide
May increase the risk of hyperglycemia.Digitalis glycosides
Diuretic-induced hypokalemia and hypomagnesemia may precipitate digitalis-induced arrhythmias.General anesthetics
Metoprolol cardiodepressant effects may be increased.Hydralazine
Serum levels of hydralazine and metoprolol may increase.Insulin, sulfonylureas
Hypoglycemic effect may be decreased. May need higher doses of sulfonylurea or insulin.Lidocaine
Lidocaine levels may increase, leading to toxicity.Lithium
Renal excretion of lithium may be decreased.Loop diuretics
Synergistic effects may result in profound diuresis and serious electrolyte abnormalities.NSAIDs
Some agents may impair antihypertensive effect.Potent inhibitors of CYP2D6 (eg, antiarrhythmic agents [eg, propafenone, quinidine], antifungal agents [eg, terbinafine], antihistamines [eg, diphenhydramine], antimalarial agents [eg, hydroxychloroquine], antipsychotic agents [eg, thioridazine], antiulcer agents [eg, cimetidine], antiviral agents [eg, ritonavir], bupropion, fluoxetine, paroxetine)
May elevate metoprolol plasma levels, increasing the risk of adverse reactions.Prazosin
Orthostatic hypotension may be increased.Rifampin
Effects of metoprolol may be decreased.Verapamil
Effects of verapamil or metoprolol may be increased.
Laboratory Test Interactions
Antinuclear antibodies may develop but are usually reversible on discontinuation. Serum protein-bound iodine levels may be reduced without signs of thyroid disturbance. May cause diagnostic interference of serum electrolyte levels, blood and urine glucose levels, serum bilirubin levels, and serum uric acid levels.
Bradycardia (about 6%); shortness of breath (3%); decreased exercise tolerance (about 1%); CHF, intensification of AV block.
Dizziness, drowsiness, fatigue, headache, lethargy, somnolence, tiredness, vertigo (about 10%); depression (5%); nightmares (about 1%).
Purpura, sweating (1%); Stevens-Johnson syndrome.
Blurred vision, earache, tinnitus (1%).
Diarrhea (5%); constipation, digestive disorder, dry mouth, flatulence, gastric pain, heartburn, nausea, vomiting (about 1%).
Agranulocytosis, aplastic anemia, leukopenia, nonthrombocytopenic purpura, thrombocytopenia, thrombocytopenic purpura.
Elevated alkaline phosphatase, elevated LDH and transaminase, hepatic function impairment, hepatitis, jaundice (postmarketing).
Hypokalemia (less than 10%); anorexia, edema, gout (1%).
Muscle pain (1%).
Dyspnea (about 1%).
Flu syndrome (about 10%); gangrene, hypersensitivity including fever with aching and sore throat, laryngospasm and respiratory distress, necrotizing angiitis.
Category C .
Hydrochlorothiazide and metoprolol are excreted in breast milk.
Safety and efficacy not established.
Use with caution, usually starting at low end of dosage range because of greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant diseases or other drug therapy.
May occur in patients with or without history of allergy or bronchial asthma; cross-sensitivity with sulfonamides may occur.
Use with caution in patients with severe renal disease; hydrochlorothiazide may precipitate azotemia.
Use with caution.
Use with caution; administer in smaller divided doses.
Use with caution in patients controlled by digitalis.
Metoprolol may mask tachycardia associated with hypoglycemia. Latent diabetes may become manifest with hydrochlorothiazide therapy.
Hyperuricemia or frank gout may be precipitated.
Ischemic heart disease
May occur following abrupt discontinuation of metoprolol.
Exacerbation or activation may occur.
Hydrochlorothiazide may enhance antihypertensive effects.
Metoprolol may mask clinical signs of developing or continuing hyperthyroidism. Abrupt withdrawal of metoprolol may exacerbate symptoms of hyperthyroidism, including thyroid storm.
Alkalosis, anuria, bradycardia, bronchospasm, cardiac failure, confusion, cramps of the calf muscles, dizziness, fatigue, hypochloremia, hypokalemia, hyponatremia, hypotension, impairment of consciousness, increased BUN, nausea, oliguria, paresthesia, polyuria, shock, tachycardia, thirst, vomiting, weakness.
- Instruct patients that if a dose is missed, to take only the next scheduled dose without doubling the dose.
- Advise patient to take this medication regularly and continuously, as directed.
- Advise patient to avoid operating machinery and driving, or engaging in other tasks requiring alertness until the response to therapy has been determined.
- Advise patients to contact health care provider if any difficulty breathing occurs.
- Instruct patients to inform health care provider before any type of surgery that metoprolol is being taken.
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