Metoprolol and Hydrochlorothiazide

Betablocking Agent · Beta-blocker/Thiazide diuretic

Indications

Angina pectoris. Hypertension.

Dosage

Angina/Hypertension: Adults: 1 tab 1-3 times daily. Children: Not recommended.

Adverse Effects

Metoprolol: Cardiovascular effects including bradycardia, postural hypotension. Rarely, heart failure, increased AV block, cardiac arrhythmias. Raynaud's phenomenon cold extremities, sexual dysfunction. GI, sleep and CNS disturbances. Dyspnoea rarely, bronchospasm. Skin reactions, withdraw if unexplained dry eyes or rash. Fatigue, paraesthesia, peripheral neuropathy, arthralgia, myopathy, altered blood sugar, haematology and lipid levels. Hydrochlorothiazide: Anorexia, epigastric distress.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Caution advised or effect undetermined. Contraindications: Metoprolol: 2nd or 3rd degree AV block (without pacemaker), severe bradycardia, sick sinus syndrome, uncontrolled heart failure, cardiogenic shock, severe peripheral arterial disease, hypotension, metabolic acidosis, untreated pheochromocytoma, severe asthma or COPD, patients at risk of hypoglycaemia, Prinzmetal's angina, history of bronchospasm. Hydrochlorothiazide: Anuria, renal decompensation. Precautions: Metoprolol: 1st degree AV block. Heart failure (avoid if uncontrolled). Peripheral arterial circulatory disorders (avoid if severe), Myasthaenia gravis. Ischaemic heart disease, withdraw gradually. History of bronchospasm. Diabetes, hyperthyroidism, renal or hepatic impairment, psoriasis. Elderly. Consider withdrawal before elective surgery. Anaphylaxis risk due to increased…

Interactions

Metoprolol: Ca++ antagonists. Antihypertensives including centrally acting agents (e.g. clonidine), antiarrhythmics, antipsychotics. TCADs, MAOIs, fluvoxamine, barbiturates, cardiac glycosides, sympathomimetics, cimetidine, hydralazine, rifampicin, NSAIDs, ergot derivatives, erythromycin, anaesthetics, diuretics, digoxin, xanthines, insulin/oral hypoglycaemics, antimalarials, moxisylyte, iodinated contrast media, baclofen, levothyroxine, alcohol, corticosteroids, rizatriptan, muscle relaxants, contraceptives, parasympathomimetics, fingolimod, ampicillin. Hydrochlorothiazide: Beta-blockers, ACE inhibitors, neuromuscular blocking agents, oral hypoglycaemics, NSAIDs.

Pharmacokinetics

METOPROLOL: Onset of action: Oral: Immediate release tab: Within 1 hr. Peak effect: Oral: 1-2 hrs. IV: 20 min. Duration: Oral: Immediate release: Variable (dose related). Extended release: Approx. 24 hrs. Absorption: Rapid and complete. Metabolism: Extensively hepatic; significant first-pass effect. Bioavailability: Oral: Immediate release: Approx. 40%-50%. Extended release: 77% relative to immediate release. Half-life elimination: Neonates: 5-10 hrs. Adults: 3-4 hrs. Excretion: Urine (95%). HYDROCHLOROTHIAZIDE: Onset of action: Diuresis: Infants: 2-6 hrs. Adults: Approx. 2 hrs. Peak effect: 4-6 hrs. Duration: Infants: 8 hrs. Adults: 6-12 hrs. Absorption: Well absorbed, absorption is decreased in patients with CHF. Metabolism: Not metabolized. Bioavailability: 65%-75%. Half-life elimination: Approx. 6-15 hrs. Time to peak: Approx. 1-5 hrs. Excretion: Urine.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.