Metoprolol + Hydrochlorothiazide

By Medically reviewed by hellodoktor

Generic Name: Metoprolol + Hydrochlorothiazide Brand Name(s): Metoprolol + Hydrochlorothiazide.

Uses

What is Metoprolol + Hydrochlorothiazide used for?

This medication is used to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. This product contains 2 medications, metoprolol and hydrochlorothiazide. Metoprolol belongs to a class of drugs known as beta blockers. It works by keeping certain natural chemicals such as epinephrine from acting on the heart and blood vessels. This effect lowers the heart rate, blood pressure, and strain on the heart. Hydrochlorothiazide is a “water pill” (diuretic) and causes your body to get rid of extra salt and water. This effect may increase the amount of urine you make when you first start the medication. It also helps relax the blood vessels so that blood can flow more easily.

How should I take Metoprolol + Hydrochlorothiazide?

Take this medication by mouth with or right after a meal, usually 1 or 2 times daily or as directed by your doctor.

If you take this drug too close to bedtime, you may need to wake up to urinate. Therefore, it is best to take this medication at least 4 hours before your bedtime. Consult your doctor or pharmacist if you have questions about when to take this medication.

If you also take certain drugs to lower your cholesterol (bile acid-binding resins such as cholestyramine or colestipol), take this product at least 4 hours before or at least 4 to 6 hours after these medications.

The dosage is based on your medical condition and response to treatment.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

It may take several weeks before you get the full benefit of this medication. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick.

Tell your doctor if your condition does not improve or if it worsens (for example, your routine blood pressure readings remain high or increase).

How do I store Metoprolol + Hydrochlorothiazide?

Metoprolol + Hydrochlorothiazide is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Metoprolol + Hydrochlorothiazide in the bathroom or the freezer. There may be different brands of Metoprolol + Hydrochlorothiazide that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Metoprolol + Hydrochlorothiazide down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Metoprolol + Hydrochlorothiazide?

Before taking this product, tell your doctor or pharmacist if you are allergic to metoprolol or hydrochlorothiazide; or to other thiazide diuretics (such as chlorothiazide); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: certain types of heart rhythm problems (such as a slow heartbeat, second- or third-degree atrioventricular block, sick sinus syndrome), an inability to make urine (anuria).

Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood circulation problems (such as Raynaud’s disease, peripheral vascular disease), pheochromocytoma, breathing problems (such as asthma, chronic bronchitis, emphysema), overactive thyroid (hyperthyroidism), liver disease, kidney disease, lupus, serious allergic reactions including those needing treatment with epinephrine, mental/mood disorders (such as depression), gout, loss of too much body water (dehydration), untreated salt imbalance (for example, high calcium, low potassium, low magnesium), a certain muscle/nerve disease (myasthenia gravis).

Before having surgery, tell your doctor or dentist that you are taking this medication.

This drug may make you dizzy or drowsy. Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

To help prevent dizziness, drink plenty of fluids while taking this medication unless your doctor directs you otherwise. Too much sweating, diarrhea, or vomiting may cause you to feel lightheaded. Report prolonged diarrhea or vomiting to your doctor.

This medication may reduce the potassium levels in your blood. Ask your doctor about adding potassium to your diet. Your doctor may prescribe a potassium supplement.

If you have diabetes, this product may mask the fast/pounding heartbeat you would usually feel when your blood sugar falls too low (hypoglycemia). Other symptoms of low blood sugar, such as dizziness and sweating, are unaffected by this drug. This product may also make it harder to control your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of high blood sugar such as increased thirst/urination. Your doctor may need to adjust your diabetes medication, exercise program, or diet.

This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.

Older adults may be more sensitive to the side effects of this drug, including dizziness.

During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor.

Metoprolol and hydrochlorothiazide pass into breast milk, but are unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Metoprolol + Hydrochlorothiazide during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Metoprolol + Hydrochlorothiazide. Metoprolol + Hydrochlorothiazide is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Metoprolol + Hydrochlorothiazide?

Dizziness, lightheadedness, drowsiness, headache, slow heartbeat, tiredness, or diarrhea may occur. Decreased sexual ability has been reported rarely. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

To lower your risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

This product may reduce blood flow to your hands and feet, causing them to feel cold. Smoking may worsen this effect. Dress warmly and avoid tobacco use.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

The hydrochlorothiazide in this product may cause your body to lose too much water and salt (dehydration). Tell your doctor right away if you have any of these unlikely but serious symptoms of dehydration: very dry mouth, extreme thirst, muscle cramps/weakness, fast heartbeat, severe dizziness, confusion, fainting, seizures.

Tell your doctor right away if any of these unlikely but serious side effects occur: very slow/irregular heartbeat, mental/mood changes (such as depression, mood swings), toe/joint pain.

Tell your doctor right away if any of these rare but very serious side effects occur: trouble breathing, blue fingers/toes, yellowing eyes/skin, persistent nausea/vomiting, severe stomach/abdominal pain, dark urine, decrease in vision, eye pain, easy bruising/bleeding, signs of infection (such as fever, persistent sore throat), signs of kidney problems (such as change in the amount of urine).

Although this medication may be used to treat heart failure, some people may rarely develop new or worsening symptoms of heart failure. Tell your doctor right away if you experience any of these unlikely but serious side effects: shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Metoprolol + Hydrochlorothiazide?

This drug should not be used with the following medications because very serious interactions may occur: cisapride, dofetilide.

If you are currently using any of these medications, tell your doctor or pharmacist before starting this product.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: fingolimod, lithium, mefloquine.

Other medications can affect the removal of metoprolol from your body, which may affect how this product works. Examples include cimetidine, lumefantrine, quinidine, propafenone, ritonavir, SSRI antidepressants (such as fluoxetine), St. John’s wort, among others.

Some products have ingredients that could raise your heart rate or blood pressure or worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).

This product may interfere with certain laboratory tests (including parathyroid, protein-bound iodide, tyramine, and phentolamine tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

Metoprolol + Hydrochlorothiazide may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Metoprolol + Hydrochlorothiazide?

Metoprolol + Hydrochlorothiazide may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Metoprolol + Hydrochlorothiazide?

Metoprolol + Hydrochlorothiazide may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Metoprolol + Hydrochlorothiazide.

What is the dose of Metoprolol + Hydrochlorothiazide for an adult?

Usual Adult Dose for Hypertension

Immediate-release:

-Hydrochlorothiazide 25 to 50 mg-Metoprolol 100 to 200 mg orally per day in single or divided doses

Extended-release:

-Initial dose: Hydrochlorothiazide 12.5 mg-Metoprolol 25 mg orally once a day

-Maximum dose: Hydrochlorothiazide 25 mg-Metoprolol 200 mg orally once a day

Comments:

-Hydrochlorothiazide doses greater than 50 mg per day are not recommended.

-Immediate-release metoprolol (tartrate) may be administered once a day, but lower doses (100 mg) may not maintain a full effect for 24 hours; measure blood pressure near the end of the dosing interval to determine adequate control; larger or more frequent doses may be required.

-Extended-release metoprolol (succinate) may be titrated after 2 weeks.

-Beta-1 selectivity decreases as the metoprolol dose is increased.

Renal Dose Adjustments

CrCl greater than 30 mL/min: No adjustment recommended

CrCl 30 mL/min or less: Data not available

If progressive renal dysfunction develops during treatment: Withhold or discontinue treatment.

Liver Dose Adjustments

Use with caution

Other Comments

Administration advice:

-Immediate-release: Administer with or immediately following meals.

-Extended-release: Administer with or without food.

Monitoring:

-Monitor heart rate and rhythm.

-Monitor serum electrolytes and creatinine periodically.

Patient advice:

-Warn patients not to interrupt therapy without their physician’s advice.

-If a dose is missed, take the next scheduled dose without doubling up.

-Inform patients to contact their physician if difficulty in breathing occurs.

-Inform patients to report decreased visual acuity or ocular pain and to stop this drug and contact their healthcare provider right away if these symptoms occur.

-Advise patients to avoid operating automobiles and machinery or engaging in other tasks requiring alertness until the patient’s response to therapy has been determined.

What is the dose of Metoprolol + Hydrochlorothiazide for a child?

The dosage has not been established in pediatric patients. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Metoprolol + Hydrochlorothiazide available?

Metoprolol + Hydrochlorothiazide is available in the following dosage forms and strengths:

  • Oral tablet,
  • Oral tablet, extended release

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Metoprolol + Hydrochlorothiazide, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: March 29, 2018 | Last Modified: September 12, 2019

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