metoprolol/hydrochlorothiazide (Rx)

Brand and Other Names:Lopressor HCT, Dutoprol
  • Print

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

metoprolol/hydrochlorothiazide

tablet (Lopressor HCT)

  • 50mg/25mg
  • 100mg/25mg
  • 100mg/50mg

tablet (Dutoprol)

  • 25mg/12.5mg
  • 50mg/12.5mg
  • 100mg/12.5mg
more...

Hypertension

Not indicated for initial therapy; if fixed combination represents dose titrated to patient’s needs, therapy with combination may be more convenient than with separate components

Lopressor HCT: metoprolol tartrate 50-100 mg and hydrochlorothiazide 25-50 mg PO daily in single or divided doses

Dutoprol: metoprolol succinate 25-100mg and hydrochlorothiazide 12.5 mg PO qDay as a single dose

When necessary, another antihypertensive agent may be added, beginning with 50% of usual recommended starting dose to avoid excessive fall in blood pressure

To minimize dose-independent side effects, begin combination therapy only after patient fails to achieve desired effect with monotherapy

Renal Impairment

Use caution in dosing/titrating patients with renal dysfunction

Cumulative effects of thiazides may develop with impaired renal function

Other Information

Combination may be substituted for titrated individual components

Withdraw gradually over a period of about 2 weeks

Geriatric: Start at low end of dosing range and titrate slowly

<18 years: Safety/efficacy not established

Hypertension

Not indicated for initial therapy; if fixed combination represents dose titrated to patient’s needs, therapy with combination may be more convenient than with separate components

Lopressor HCT: metoprolol tartrate 50-100 mg and hydrochlorothiazide 25-50 mg PO daily in single or divided doses

Dutoprol: metoprolol succinate 25-100mg amd hydrochlorothiazide 12.5 mg PO qDay as a single dose

When necessary, another antihypertensive agent may be added, beginning with 50% of usual recommended starting dose to avoid excessive fall in blood pressure

To minimize dose-independent side effects, begin combination therapy only after patient  fails to achieve desired effect with monotherapy    

Next:

Interactions

Interaction Checker

and metoprolol/hydrochlorothiazide

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            No adverse effects specific to combination have been observed; adverse effects limited to those previously reported with metoprolol tartrate and hydrochlorothiazide

            1-10%

            Metoprolol tartrate

            • Bradycardia (3%), cold extremities(1%), constipation (1%), depression (5%), diarrhea (5%), dizziness (10%), dyspepsia (1%), dyspnea (3%), fatigue (10%), headache (10%), heart failure (1%), hypokalemiahypotension (1%), influenza-like symptomsnausea (1%), pruritus (5%), wheezing (1%)

            Hydrochlorothiazide

            • Anorexia, epigastric distress, hypokalemia, hypotension, phototoxicity

            Frequency Not Defined

            Metoprolol tartrate

            • Bronchospasm, mask symptoms of hypoglycemia

            Hydrochlorothiazide

            • Anaphylaxis, anemia, confusion, erythema multiforme skin reactions including Stevens-Johnson syndrome, exfoliative dermatitis including toxic epidermal necrolysis, hypomagnesemia, hyponatremia, hypochloremia, dizziness, fatigue, headache, hypercalcemia, hyperuricemia, hyperglycemia, hyperlipidemia, hypercholesterolemia, muscle weakness or cramps, nausea, purpura, rash, vertigo, vomiting
            Previous
            Next:

            Warnings

            Black Box Warnings

            May exacerbate ischemic heart disease following abrupt withdrawal

            Hypersensitivity to catecholamines has been observed during withdrawal

            Exacerbation of angina and, in some cases, myocardial infarction occurrence after abrupt discontinuation

            When discontinuing chronically administered beta-blockers (particularly with ischemic heart disease) gradually reduce dose over 1-2 weeks and carefully monitor

            If angina markedly worsens or acute coronary insufficiency develops, reinstate beta-blocker administration promptly, at least temporarily (in addition to other measures appropriate for unstable angina)

            Warn patients against interruption or discontinuation of beta-blocker without physician advice

            Because coronary artery disease is common and may be unrecognized, slowly discontinue beta-blocker therapy, even in patients treated only for hypertension

            Contraindications

            Anuria

            Cardiogenic shock

            CHF

            Heart block 2°/3°

            Hypersensitivity to either component or sulfonamides

            Overt cardiac failure

            Sick sinus syndrome (unless permanent pacemaker in place)

            Severe peripheral vascular disease

            Sinus bradycardia

            Cautions

            Anesthesia/surgery (myocardial depression); chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery, however the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures

            Avoid abrupt withdrawal

            Acute transient myopia and acute angle-closure glaucoma has been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide)

            Bronchospastic disease

            Cerebrovascular insufficiency

            Cardiomegaly

            DM, fluid or electrolyte imbalance, hyperuricemia or gout, SLE

            Hyperthyroidism or thyrotoxicosis, liver disease

            May aggravate digitalis toxicity

            Peripheral vascular disease

            Pheochromocytoma

            Renal impairment

            Risk of male sexual dysfunction

            Sensitivity reactions may occur with or without history of allergy or asthma

            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: excreted in breast milk, use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Metoprolol/hydrochlorothiazide is a fixed-combination tablet that combines a beta adrenergic receptor blocker, metoprolol tartrate (Lopressor HCT) or metoprolol succinate (Dutoprol) and a thiazide diuretic, hydrochlorothiazide

            Metoprolol is a beta-1-selective (cardioselective) adrenergic blocking agent at low doses; at higher doses, it also inhibits beta-2 adrenoreceptors in the bronchial and vascular smooth muscles

            While the mechanism of the antihypertensive effects of beta-blocking agents has not been elucidated, it may involve competitive antagonism of catecholamines at peripheral (especially cardiac) adrenergic neuron sites, leading to decreased cardiac output; a central effect leading to reduced sympathetic outflow to the periphery; and suppression of renin activity

            Hydrochlorothiazide is a thiazide diuretic that inhibits Na reabsorption in distal renal tubules resulting in increased excretion of Na+ and water, also K+ and H+ ions

            Pharmacokinetics

            In comparison to immediate-release metoprolol (tartrate), the plasma metoprolol levels following administration of metoprolol succinate (long-acting) are characterized by lower peaks, longer time to peak and significantly lower peak to trough variation

            Bioavailability: 50% (metoprolol); (70%) hydrochlorothiazide

            Peak plasma concentration: 10-12 hr (metoprolol succinate); 2 hr (hydrochlorothiazide)

            Peak plasma time: 1.5-2 hr (metoprolol tartrate); 1.5-2.5 hr (hydrochlorothiazide)

            Onset: Initial diuresis from hydrochlorothiaizde (2 hr); antihypertensive effect: 3-4 days

            Duration: 3-6 hr (metoprolol tartrate); 6-12 hr (hydrochlorothiazide)

            Half-Life: 9-12 hr (metoprolol); 6-15 hr (hydrochlorothiazide)

            Clearance: hydrochlorothiazide 335 mL/min (hydrochlorothiazide)

            Excretion: Urine 95% (metoprolol) and 50-70% (hydrochlorothiazide)

            Dialyzable: No (hydrochlorothiazide)

            Distribution

            • Protein Bound: 12% (metoprolol); 40% (hydrochlorothiazide)
            • Vd: 5.6 L/kg (metoprolol); 3-4 L/kg (hydrochlorothiazide)

            Metabolism

            • Metoprolol: hepatic CYP2D6
            • Hydrochlorothiazide minimally metabolized
            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous