Metoprolol and hydrochlorothiazide (Oral route)

Pronunciation:

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

Brand Names:

Lopressor HCT

Dosage Forms:

Tablet

Classifications:

Therapeutic—

Beta-Adrenergic Blocker, Cardioselective/Thiazide Combination

Pharmacologic—

Metoprolol

Chemical—

Thiazide

Uses of This Medicine:

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.

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.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

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 this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine 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.

Children—

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.

Older adults—

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.

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.

Other 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 this medicine, 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 this medicine 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 this medicine 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.

Abiraterone Acetate
Acarbose
Aceclofenac
Acemetacin
Acetyldigoxin
Adagrasib
Albiglutide
Albuterol
Alogliptin
Amphetamine
Amtolmetin Guacil
Arsenic Trioxide
Aspirin
Benzphetamine
Bromfenac
Bromocriptine
Bufexamac
Buprenorphine
Canagliflozin
Celecoxib
Ceritinib
Chlorpropamide
Choline Salicylate
Clonidine
Clonixin
Cobicistat
Codeine
Crizotinib
Dapagliflozin
Darunavir
Deslanoside
Desmopressin
Desvenlafaxine
Dexibuprofen
Dexketoprofen
Dextroamphetamine
Diclofenac
Diflunisal
Digitalis
Digitoxin
Digoxin
Diltiazem
Dipyrone
Dronedarone
Droperidol
Droxicam
Dulaglutide
Duloxetine
Empagliflozin
Escitalopram
Etodolac
Etofenamate
Etoricoxib
Exenatide
Fedratinib
Felbinac
Fenoldopam
Fenoprofen
Fepradinol
Feprazone
Fexinidazole
Fingolimod
Flecainide
Floctafenine
Flufenamic Acid
Flurbiprofen
Formoterol
Givosiran
Glimepiride
Glipizide
Glyburide
Ibuprofen
Indacaterol
Indomethacin
Insulin
Insulin Aspart, Recombinant
Insulin Bovine
Insulin Degludec
Insulin Detemir
Insulin Glulisine
Iohexol
Ketanserin
Ketoprofen
Ketorolac
Lacosamide
Lercanidipine
Levalbuterol
Levomethadyl
Lidocaine
Linagliptin
Liraglutide
Lisdexamfetamine
Lithium
Lixisenatide
Lornoxicam
Loxoprofen
Lumiracoxib
Meclofenamate
Mefenamic Acid
Meloxicam
Methamphetamine
Methotrexate
Metildigoxin
Miglitol
Morniflumate
Nabumetone
Naproxen
Nateglinide
Nepafenac
Niflumic Acid
Nimesulide
Nimesulide Beta Cyclodextrin
Oliceridine
Olodaterol
Ouabain
Oxaprozin
Oxyphenbutazone
Panobinostat
Parecoxib
Phenylbutazone
Piketoprofen
Pioglitazone
Piroxicam
Ponesimod
Porfimer
Pramlintide
Proglumetacin
Propyphenazone
Proquazone
Proscillaridin
Repaglinide
Rifampin
Rivastigmine
Rofecoxib
Rosiglitazone
Salicylic Acid
Salmeterol
Salsalate
Saxagliptin
Sertraline
Siponimod
Sitagliptin
Sodium Salicylate
Sotalol
Sufentanil
Sulindac
Tapentadol
Tenoxicam
Terbinafine
Terbutaline
Tiaprofenic Acid
Tolazamide
Tolbutamide
Tolfenamic Acid
Tolmetin
Topiramate
Tramadol
Valdecoxib
Venlafaxine
Verapamil
Vilanterol
Vildagliptin
Vonoprazan

Using this medicine 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
Acetyldigoxin
Albiglutide
Alfuzosin
Alogliptin
Aminolevulinic Acid
Amtolmetin Guacil
Aspirin
Bepridil
Bromfenac
Bufexamac
Bunazosin
Bupropion
Canagliflozin
Carbamazepine
Celecoxib
Chlorpropamide
Cholestyramine
Choline Salicylate
Clonixin
Dapagliflozin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dipyrone
Doxazosin
Droxicam
Dulaglutide
Empagliflozin
Ertugliflozin
Etodolac
Etofenamate
Etoricoxib
Exenatide
Felbinac
Fenoprofen
Fepradinol
Feprazone
Floctafenine
Flufenamic Acid
Fluoxetine
Flurbiprofen
Ginkgo
Glimepiride
Glipizide
Glyburide
Gossypol
Ibuprofen
Indomethacin
Insulin Aspart, Recombinant
Insulin Degludec
Insulin Detemir
Insulin Glargine, Recombinant
Insulin Glulisine
Insulin Human Inhaled
Insulin Human Isophane (NPH)
Insulin Human Regular
Insulin Lispro, Recombinant
Ketoprofen
Ketorolac
Licorice
Linagliptin
Liraglutide
Lixisenatide
Lornoxicam
Loxoprofen
Lumiracoxib
Meclofenamate
Mefenamic Acid
Meloxicam
Metformin
Metildigoxin
Miglitol
Mirabegron
Morniflumate
Moxisylyte
Nabumetone
Naproxen
Nateglinide
Nepafenac
Niflumic Acid
Nimesulide
Nimesulide Beta Cyclodextrin
Oxaprozin
Oxyphenbutazone
Parecoxib
Paroxetine
Phenelzine
Phenobarbital
Phenoxybenzamine
Phentolamine
Phenylbutazone
Piketoprofen
Pioglitazone
Piroxicam
Pramlintide
Pranoprofen
Prazosin
Proglumetacin
Propafenone
Propoxyphene
Propyphenazone
Proquazone
Quinidine
Repaglinide
Rifapentine
Rofecoxib
Rosiglitazone
Salicylic Acid
Salsalate
Saxagliptin
Sitagliptin
Sodium Salicylate
St John's Wort
Sulindac
Tamsulosin
Telithromycin
Tenoxicam
Terazosin
Tiaprofenic Acid
Tolazamide
Tolbutamide
Tolfenamic Acid
Tolmetin
Trimazosin
Urapidil
Valdecoxib
Vildagliptin

Other interactions—

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 this medicine. 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 (eg, 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 (eg, high calcium or low chloride, magnesium, potassium, sodium in the body) or
Glaucoma, secondary angle-closure or
Gout or
Kidney disease or
Liver disease or
Myopia (changes in the eyeball causing vision problems), acute or
Pheochromocytoma (adrenal gland tumor) or
Systemic lupus erythematosus (SLE)—Use with caution. May make these conditions worse.

Lung disease (eg, asthma, bronchitis, emphysema)—Use with caution. May cause difficulty with breathing in patients with this condition.

Patients who are fasting (eg, surgery, not eating regularly, vomiting)—May increase risk of hypoglycemia (low blood sugar).

Sympathectomy—Use with caution. The effects of this medicine may be increased.

Proper Use of This Medicine:

This medicine 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 this medicine, 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 this medicine 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 the tablet with a meal or just after you eat.

Swallow the extended-release tablet whole. Do not crush, break, or chew it. You may take it with or without food.

Dosing—

The dose of this medicine 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 this medicine. 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 high blood pressure:
- For oral dosage form (extended-release tablets):
  - Adults—At first, one tablet once a day. Each tablet contains 25 milligrams (mg) metoprolol and 12.5 mg hydrochlorothiazide. Your doctor may adjust your dose as needed. However, the dose is usually not more than 200 mg metoprolol and 25 mg hydrochlorothiazide once a day.
  - Children—Use and dose must be determined by your doctor.
- For oral dosage form (tablets):
  - Adults—One or two tablets per day, given as a single dose or in divided doses. Your doctor may adjust your dose as needed.
  - Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, 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 This Medicine:

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

This medicine may worsen the symptoms of 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 uneven heartbeat, swelling of the face, fingers, feet, or lower legs, or weight gain.

This medicine may cause changes in blood sugar levels. Also, this medicine may cover up the symptoms of low blood sugar, including fast heartbeat and increase the risk for serious or prolonged hypoglycemia (low blood sugar). Check with your doctor if you notice a change in your normal symptoms or a change in the results of your blood or urine sugar tests. Call your doctor right away if you have anxiety, blurred vision, chills, cold sweats, coma, confusion, cool, pale skin, depression, dizziness, fast heartbeat, headache, increased hunger, nausea, nervousness, nightmares, seizures, shakiness, slurred speech, or unusual tiredness or weakness.

This medicine may increase your risk of getting skin cancer (eg, non-melanoma skin cancer). Avoid sun exposure. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds. Talk to your doctor if you have concerns about this risk.

Make sure any doctor or dentist who treats you knows that you are using this medicine. Do not stop taking this medicine before surgery without your doctor's approval.

This medicine 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 this medicine.

Do not interrupt or stop taking this medicine 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 this medicine. These may be symptoms of dehydration or mineral imbalance.

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).

This medicine may cause erectile dysfunction in some males. Check with your doctor right away if you have decreased interest in sexual intercourse, inability to have or keep an erection, or loss in sexual ability, drive, or performance. If you have questions about this, talk to your doctor.

Alcohol, narcotic pain relievers, or sleeping pills may cause you to feel more lightheaded, dizzy, or faint when used with this medicine. Tell your doctor if you are drinking alcohol or using pain relievers or sleeping pills.

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.

Side Effects of This Medicine:

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; 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; seizures; slow or irregular heartbeat; unusual tiredness or weakness

Less common: Ankle, knee, or great toe joint pain; chest tightness; 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

Incidence not known: Anxiety; blurred vision; chills; cold sweats; coma; confusion; cool, pale skin; depression; fast heartbeat; headache; increased hunger; nightmares; nervousness; persistent non-healing sore; pink growth; reddish patch or irritated area; shakiness; shiny bump; slurred speech; white, yellow or waxy scar-like area

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; dilated neck veins; dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position; drowsiness; fast or pounding heartbeat or pulse; frequent urination; headache; increased volume of pale, dilute urine; irregular breathing; irritability; noisy breathing; not able to pass urine; pain or aching in the lower legs; pain or weakness in the hands or feet; 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: Diarrhea; feeling of constant movement of self or surroundings; fever; general feeling of discomfort or illness; muscle aches; 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.

Last Updated: 4/24/2024

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