Metoprolol and Hydrochlorothiazide

treats high blood pressure. Do not stop taking this medication all of a sudden.

Metoprolol and Hydrochlorothiazide Overview

Reviewed: July 27, 2015
Updated: 

Metoprolol and hydrochlorothiazide is a prescription medication used to treat high blood pressure.

Metoprolol and hydrochlorothiazide is a single product containing 2 medications: metoprolol and hydrochlorothiazide. Metoprolol belongs to a group of drugs called beta blockers, which work by relaxing blood vessels and slowing heart rate. This improves blood flow and decreases overall blood pressure. Hydrochlorothiazide belongs to a group of drugs called thiazide diuretics, which work by stopping reabsorption of salt into your body. This prevents fluid from building up in the body.

This medication comes in tablet form and can be given once or twice daily with or immediately following meals. 

Common side effects of metoprolol and hydrochlorothiazide include slow heart rate and headache. Metoprolol and hydrochlorothiazide can also cause dizziness, drowsiness, and blurred vision. Do not drive or operate heavy machinery until you know how this medication affects you. 

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Metoprolol and Hydrochlorothiazide Cautionary Labels

precautionsprecautionsprecautionsprecautions

Uses of Metoprolol and Hydrochlorothiazide

Metoprolol and hydrochlorothiazide is a prescription medication used to treat high blood pressure.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. 

Metoprolol and Hydrochlorothiazide Brand Names

Metoprolol and Hydrochlorothiazide may be found in some form under the following brand names:

Metoprolol and Hydrochlorothiazide Drug Class

Metoprolol and Hydrochlorothiazide is part of the drug class:

Side Effects of Metoprolol and Hydrochlorothiazide

Serious side effects have been reported with metoprolol and hydrochlorothiazide. See the "Metoprolol and hydrochlorothiazide Precautions" section. 

Common side effects of metoprolol and hydrochlorothiazide include the following:

  • dizziness or feeling like your surroundings are spinning (vertigo)
  • headache
  • drowsiness (fatigue)
  • slow heart rate
  • difficulty breathing (dyspnea)
  • diarrhea or constipation
  • dry mouth
  • nausea or vomiting
  • low amount of potassium in your blood (hypokalemia)
  • retaining fluid (edema)
  • painful joint(s) (gout)
  • an eating disorder associated with low body weight (anorexia)
  • blurred vision
  • ringing in the ears (tinnitus)
  • earache
  • sweating
  • rash of purple spots on the skin (purpura)
  • cant get or keep an erection (impotence)
  • muscle pain

This is not a complete list of metoprolol and hydrochlorothiazide side effects. Ask your doctor or pharmacist for more information. 

Tell your doctor if you have any side effect that bothers you or that does not go away.

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

Metoprolol and Hydrochlorothiazide Interactions

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

  • other beta blockers such as metoprolol (Toprol XL, Lopressor), carvedilol (Coreg), bisoprolol (Zebeta), betaxolol (Kerlone), nebivolol (Bystolic), and propranolol (Inderal)
  • drugs that deplete a substance in the body called catecholamines such as reserpine (Serpalan) or guanethidine (Ismelin)
  • digoxin (Lanoxicaps, Lanoxin), digitoxin 
  • medications that block a protein in the body (CYP2D6) such as quinidine (Qualaquin), fluoxetine (Prozac, Sarafem), amitriptyline (Elavil, Amitril, Amitid), and paroxetine (Paxil)
  • cholestyramine (Questran) and colestipol (Colestid)
  • lithium (Lithobid)
  • nonsteroidal anti-inflammatory drugs (NSAIDS) such as naproxen (Aleve) and ibuprofen (Advil)
  • clonidine (Catapres)

Do not drink alcohol while taking this medication.

This is not a complete list of metoprolol and hydrochlorothiazide drug interactions. Ask your doctor or pharmacist for more information. 

Metoprolol and Hydrochlorothiazide Precautions

Serious side effects have been reported with metoprolol and hydrochlorothiazide including the following:

  • Ischemic Heart Disease. if you abruptly stop this medication, you may experience chest pain or, in some cases, a heart attack. Talk to your doctor about how to safely discontinue this medication. 
  • Bronchospastic Diseases. Patients with bronchospastic diseases should not take metoprolol and hydrochlorothiazide since it contains metoprolol
  • Large increase in blood pressure for patients with pheochromocytoma. your doctor may prescribe an alpha blocker to be given with metoprolol and hydrochlorothiazide.
  • Low blood sugar in patients with diabetes. Metoprolol and hydrochlorothiazide should be used with caution in diabetic patients.
  • Thyrotoxicosis. Taking metoprolol and hydrochlorothiazide can make it hard to determine conditions involving the thyroid (hyperthyroidism).
  • Renal disease. Metoprolol and hydrochlorothiazide should be used in caution in patients with renal disease. 
  • Allergic reactions. More likely with a history of allergic reactions. 
  • A condition in which close objects appear clearly, but far ones don't (myopia) or a buildup of pressure in the eye that can cause blindness (glaucoma). Tell your healthcare provider right away if you experience  visual changes or eye pain.
  • Imbalances in the levels of salts and fluids in your body (electrolyte and fluid imbalance). Tell your healthcare provider right away if you have some or all of the following symptoms:
    • dry mouth
    • thirst
    • weakness
    • drowsiness
    • restlessness
    • muscle pains or cramps
    • low blood pressure
    • low output of urine
    • fast heart rate
    • nausea
    • vomiting
  • changes in a gland next to the thyroid that secretes a substance that regulates calcium levels in a person's body (parathyroid disease)
  • a condition of excess of uric acid in the blood (hyperuricemia)
  • a painful joint (acute gout)

Metoprolol and hydrochlorothiazide can also cause dizziness, drowsiness, and blurred vision. Do not drive or operate heavy machinery until you know how this medication affects you. 

Do not take metoprolol and hydrochlorothiazide if you:

  • are allergic to metoprolol and hydrochlorothiazide or any of its ingredients and sulfonamide-derived drugs
  • have a heart block greater than first degree
  • have cardiogenic shock
  • have overt cardiac failure 
  • have a slow heart rate 
  • have a group of heart rhythm disorders (sick-sinus syndrome)
  • your kidneys fail to produce urine (anuria)
  • have problems with blood circulation

Metoprolol and Hydrochlorothiazide Food Interactions

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of metoprolol and hydrochlorothiazide, salt substitutes containing potassium should be avoided.

Inform MD

Before taking metoprolol and hydrochlorothiazide, tell your doctor about all of your medical conditions. Especially tell your doctor if:

  • are allergic to metoprolol and hydrochlorothiazide or any of its ingredients and sulfonamide-derived drugs
  • have a slow heart rate 
  • have heart failure
  • have problems with blood circulation
  • have a condition that blocks the conduction of impulses in the heart (heart block greater than first degree) 
  • have a group of heart rhythm disorders (sick-sinus syndrome)
  • your kidneys fail to produce urine (anuria)
  • have pheochromocytoma (a tumor that develops on a gland near the kidneys and may cause high blood pressure and fast heartbeat)
  • have diabetes
  • are about to have major surgery
  • have liver disease
  • you have or ever had asthma
  • have a lung disease
  • have hyperthyroidism (an overactive thyroid gland)
  • you are breastfeeding or plan to breastfeed
  • you are pregnant or plan to become pregnant
  • have a condition where your heart suddenly can't pump enough blood to meet your body's needs (cardiogenic shock)
  • have heart failure

Tell you doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. 

 

Metoprolol and Hydrochlorothiazide and Pregnancy

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Metoprolol and hydrochlorothiazide falls into category C. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child. 

Metoprolol and Hydrochlorothiazide and Lactation

Tell your doctor is you are breastfeeding or plan to breastfeed. 

Metoprolol and hydrochlorothiazide have been detected in human breast milk. Because of the possibility for adverse reactions in nursing infants from metoprolol and hydrochlorothiazide, a choice should be made whether to stop nursing or to stop use of this medication. The importance of the drug to the mother should be considered. 

Metoprolol and Hydrochlorothiazide Usage

Take metoprolol and hydrochlorothiazide exactly as prescribed. 

This medication comes in tablet form and can be given once or twice daily with or immediately following meals. 

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of metoprolol and hydrochlorothiazide at the same time.

Do not discontinue metoprolol and hydrochlorothiazide without talking to your doctor. 

Metoprolol and Hydrochlorothiazide Dosage

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully. 

The dose your doctor recommends may be based on the following:

  • your blood pressure
  • previous medications used and the doses tried
  • other medical conditions you have
  • how you respond to this medication

Common dosing schedules for metoprolol and hydrochlorothiazide for the treatment of blood pressure include:

  • 50/25 mg tablets: 2 tablets daily in a single or divided dose
  • 100/25 mg tablets: 1 to 2 tablets daily in a single or divided dose
  • 100/50 mg tablets: 1 tablet daily in a single or divided dose

Metoprolol and Hydrochlorothiazide Overdose

If you take too much metoprolol and hydrochlorothiazide, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away. 

Other Requirements

  • Store at controlled room temperature, 59-86°F (15-30°C).
  • Protect from moisture.
  • Dispense in a tight, light-resistant container. 
  • Keep this and all medicines out of the reach of children. 

Metoprolol and Hydrochlorothiazide FDA Warning

Ischemic Heart Disease: 

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, metoprolol and hydochlorothiazide should not be withdrawn abruptly, and patients should be cautioned against interruption of therapy without the physician’s advice.