Metoprolol and hydrochlorothiazide (Oral)

Metoprolol and hydrochlorothiazide combination is used to treat high blood pressure (hypertension). High blood pressure increases the strain on the heart and arteries. If it lasts for a long time, the heart and arteries may not work properly. This can harm the blood vessels in the brain, heart, and kidneys, leading to a stroke, heart failure, or kidney failure. High blood pressure may also raise the risk of heart attacks. Controlling blood pressure may help reduce the chances of these problems.

Metoprolol is a beta-blocker. It works by changing how some nerve signals affect certain areas of the body, including the heart. As a result, the heart beats more slowly and lowers blood pressure. When blood pressure is reduced, more blood and oxygen reach the heart.

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

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

It is very important for your doctor to check your progress during regular visits to ensure this medicine is working properly and to look for unwanted effects. You may need blood and urine tests to check for unwanted effects.

This medicine may make heart failure symptoms worse in some patients. Contact your doctor right away if you experience 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 affect your blood sugar levels. It can also hide the symptoms of low blood sugar, such as a rapid pulse rate. Check with your doctor if you notice a change in your usual symptoms or in your blood or urine sugar test results. Call your doctor immediately if you experience 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 raise your risk of skin cancer (e.g., non-melanoma skin cancer). Avoid sun exposure and use sunscreen when outdoors. Stay away from sunlamps and tanning beds. Discuss any concerns about this risk with your doctor.

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

This medicine may make some people less alert than usual. If this happens, do not drive, operate machines, or do anything that could be dangerous while you are not alert.

Do not stop or interrupt this medicine without first checking with your doctor. Your doctor may want you to gradually decrease your dose before stopping it completely. Stopping suddenly can worsen some conditions and may be dangerous.

Contact your doctor right away if you experience 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 taking this medicine. These could be signs of dehydration or a mineral imbalance.

Check with your doctor immediately if you notice blurred vision, difficulty reading, eye pain, or any other changes in vision during or after treatment. This may indicate a serious eye issue. Your doctor will likely want you to see an ophthalmologist (eye doctor).

Some men using this medicine may experience erectile dysfunction. Contact your doctor right away if you have a decreased interest in sexual intercourse, trouble having or maintaining an erection, or a 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 increase feelings of lightheadedness, dizziness, or faintness when taken with this medicine. Inform your doctor if you are consuming alcohol or using pain relievers or sleeping pills.

Do not take other medicines unless you have discussed them with your doctor. This includes both prescription and nonprescription (over-the-counter) medicines for appetite control, asthma, colds, cough, hay fever, or sinus issues, as they may raise your blood pressure.

In deciding to use a drug, the risks of taking the medicine must be weighed against the beneficial it will do. This is a decision you and your physician will make. For this medication, the following should be considered:

Allergies

Inform your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Additionally 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 issues 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 chance when using this medicine during breastfeeding. Weigh the potential benefits against the potential risks before taking this medicine while breastfeeding.

Interactions with Drugs

Although certain medicines should not be used together at all, in other cases two different medications may be used together even if an interaction might occur. In these cases, your clinician may want to change the dose, or other precautions may be necessary. When you are using this medication, it is especially essential that your healthcare professional know if you are using 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 medications is not advised. Your physician may decide not to treat you with this medication or change some of the other drugs you take.

• Dofetilide

Using this medication with any of the following medicines is normally not recommended, but may be required in some cases. If both medications are prescribed together, your doctor may change the dose or how frequently 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
• 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
• Sulindac
• Tapentadol
• Tenoxicam
• Terbinafine
• Terbutaline
• Tiaprofenic Acid
• Tocilizumab
• Tolazamide
• Tolbutamide
• Tolfenamic Acid
• Tolmetin
• Topiramate
• Valdecoxib
• Verapamil
• Vilanterol
• Vildagliptin

Using this drug with any of the following medicines may cause an increased risk of certain adverse 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 drugs.

• 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
• Venlafaxine
• Vildagliptin

Interactions with Food/Tobacco/Alcohol

Certain medications 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 medications may as well 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 issues may affect the use of this medication. Make sure you inform your doctor if you have any other medical problems, especially:

• Angina (serious chest pain)—May provoke chest pain if stopped too quickly.

• Anuria (not able to form urine) or
• Blood vessel disease (circulation issues), serious 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 raise 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.

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

Along with its needed effects, this medicine may cause some unwanted effects. Not all of these side effects may happen, but if they do, you 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

• Persistent non-healing sore
• Pink growth
• Reddish patch or irritated area
• Shiny bump
• 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. Your health care professional may also 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.

In the U.S.

• Lopressor HCT

Available Dosage Forms:

• Tablet

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

Pharmacologic Class: Metoprolol

Chemical Class: Thiazide

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.