Dutoprol (Metoprolol and hydrochlorothiazide), a combination of selective beta-1 receptor blocker and a thiazide diuretic, is used to treat patients with hypertension.
Dutoprol (metoprolol and hydrochlorothiazide) Uses:
-
Hypertension:
- Metoprolol and hydrochlorothiazide combination is used for the management of hypertension.
Viskazide is another Beta-blocker and hydrochlorothiazide combination that contains pindolol and hydrochlorothiazide.
Metoprolol and Hydrochlorothiazide Dose in Adults:
Dutoprol (metoprolol and hydrochlorothiazide) Dose in the treatment of Hypertension: Oral:
Dosage of metoprolol should be determined by;
- Titration of the individual agents.
- A combination product substituted based upon the daily requirements.
Note: Hydrochlorothiazide dose of >50 mg/day is not recommended.
-
Metoprolol tartrate (immediate release)/hydrochlorothiazide:
- Dosage range:
- Metoprolol tartrate 100 to 200 mg/hydrochlorothiazide 25 to 50 mg once a day or
- metoprolol tartrate 50 to 100 mg/hydrochlorothiazide 12.5 to 25 mg twice a day.
- Dosage range:
-
Concomitant therapy:
- If an additional antihypertensive agent is required, gradual titration should occur using / the usual starting dose of the other agent to avoid hypotension in patients.
Metoprolol succinate (extended release)/ hydrochlorothiazide Dosage:
- Initial dose:
- Metoprolol succinate 25 mg/hydrochlorothiazide 12.5 mg once a day, may titrate once every 2 weeks to a maximum of metoprolol succinate 200 mg/ hydrochlorothiazide 25 mg once daily.
Use in children:
Not indicated.
Pregnancy Risk Factor C
- In some studies on animal reproduction, adverse events were observed.
- Talk to individual agents.
Use of hydrochlorothiazide and metoprolol during breastfeeding
- Breast milk contains metoprolol and thiazide diuretics.
- Breastfeeding during therapy should be considered in light of the potential exposure of the infant.
- Talk to individual agents.
Dutoprol (metoprolol and hydrochlorothiazide) Dose in Kidney Disease:
-
Metoprolol tartrate (immediate release)/ hydrochlorothiazide:
- There are no dosage adjustments provided in the manufacturer’s labeling.
- Discontinue metoprolol use in progressive renal impairment;
- It is contraindicated in patients with anuria.
-
Metoprolol succinate (extended release)/hydrochlorothiazide:
- CrCl >30 mL/minute:
- No dosage adjustment needed.
- CrCl ≤30 mL/minute:
- There is no dose adjustment provided in the manufacturer’s labeling (has not been studied).
- Discontinue usage with progressive renal impairment;
- Use is contraindicated in patients with anuria.
- CrCl >30 mL/minute:
Dose in Liver disease:
Use with caution. There are no dosage adjustments provided in the manufacturer’s labeling.
Side Effects of Dutoprol (metoprolol and hydrochlorothiazide):
-
Central Nervous System:
- Drowsiness
- Headache
- Lethargy
- Vertigo
- Dizziness
- night mares
- fatigue
-
Dermatologic:
- Diaphoresis
-
Endocrine & Metabolic:
- Hypokalemia
- Gout
-
Gastrointestinal:
- Anorexia
- Constipation
- Nausea
- Diarhea
-
- Vomiting
- Xerostomia
- Pancreatitis
-
Genitourinary:
- Impotence
-
Hematologic & Oncologic:
- Purpura
-
Hepatic:
- Increased Liver Enzymes
- Increased Serum Bilirubin
-
Neuromuscular & Skeletal:
- Myalgia
-
Ophthalmic:
- Blurred Vision
-
Otic:
- Otalgia
- Tinnitus
-
Respiratory:
- Flu-Like Symptoms
- Nasopharyngitis
- Dyspnea
-
Miscellaneous:
- Decreased Exercise Tolerance
Contraindications to Dutoprol (metoprolol and hydrochlorothiazide):
- Hypersensitivity to metoprolol and hydrochlorothiazide, other drugs derived from sulfonamides, beta-blockers, and any component of the formulation
- Sinus bradycardia, sickly sinus syndrome, and more than first-degree blockage (unless a permanent pacemaker has been installed).
- Cardiogenic shock
- Cardiac failure.
- Anuria
Notification:
- Although the FDA approved product labeling states this medication is contraindicated with other sulfonamide-containing drug classes, the scientific basis of this statement has been challenged. See "Warnings/Precautions" for more detail.
- Additional contraindications include hydrochlorothiazide (immediate release) and metoprolol tartrate.
- Severe peripheral arterial disease
Warnings and precautions
-
Acute renal failure:
- Hydrochlorothiazide can cause acute renal failure in patients suffering from severe heart failure or volume loss.
-
Anaphylactic reactions
- Beta-blockers can make patients more sensitive to repeated allergen challenges. Patients who have had severe allergic reactions to allergens should be cautious.
- Patients taking beta-blockers might have anaphylaxis (eg epinephrine), which can be difficult to treat or cause side effects.
-
Bradycardia
- Patients who take the drug can develop Bradycardia (sinus pause, heart block and cardiac arrest).
- Patients with first-degree atrioventricular block, sinus node dysfunction, or conduction disorders (including Wolff-Parkinson-White) may be at increased risk.
- Monitoring heart beat and rhythm is important. If severe bradycardia develops, decrease the dosage or discontinue therapy.
-
Electrolyte disturbances:
- Hydrochlorothiazide can cause hypokalemia, hypochloremic acidkalosis, hyponatremia and hypomagnesemia.
- As appropriate, correct electrolyte disturbances before initiation
-
Hypersensitivity reactions
- Hydrochlorothiazide can cause hypersensitivity reactions.
- Patients with a history or allergy to bronchial asthma, bronchial asthma, or allergies are at greater risk.
-
Ocular effects
- Hydrochlorothiazide may cause;
- Myopia temporary and acute
- acute angle-closure glaucoma, typically occurring within hours to weeks following initiation.
- Discontinue therapy immediately in patients with acute decreases in visual acuity or ocular pain.
- If intraocular pressure is not controlled, additional treatments may be required.
- A history of penicillin allergy or sulfonamide allergy could be a risk factor.
-
Photosensitivity
- Hydrochlorothiazide may cause photosensitization.
-
Allergy to sulfonamide ("sulfa")
- FDA-approved product labels for medications that contain sulfonamide chemical groups include a wide contraindication for patients who have had an allergic reaction to sulfonamides in the past.
- Cross-reactivity is possible between members of one class (eg two antibiotic sulfonamides).
- Crossreactivity concerns have been raised for all compounds with the sulfonamide structural.
- A deeper understanding of allergic mechanisms suggests that cross-reactivity between nonantibiotic and antibiotic sulfonamides is unlikely.
- Nonantibiotic sulfonamides are not likely to cause anaphylaxis (inter-reactions due to antibody production).
- T-cell-mediated hypersensitivity reactions, such as maculopapular skin rash, are less well understood. It is impossible to exclude this possibility based on current knowledge.
- Some clinicians opt to avoid these classes in cases of severe reactions (Stevens Johnson syndrome/TEN).
-
Bariatric surgery
- Dehydration: Do not take diuretics during the first 24 hours after bariatric surgery.
- Electrolyte disturbances or dehydration can occur.
- If necessary, diuretics can be resumed if oral fluid intake goals have been met.
-
Bronchospastic Disease:
- Patients with bronchospastic diseases should not be given beta-blockers. However, metoprolol with B selectivity has been prescribed with caution and close monitoring for such patients.
- Inhaled beta-2 agonists should be immediately available for patients.
-
Conductive abnormality
- Before you start metoprolol therapy, be aware of any preexisting conditions like sick sinus syndrome.
- Patients with marked sinus bradycardia or second- or third-degree blockage of the AV are not advised to take metoprolol unless an artificial pacemaker is installed.
-
Diabetes:
- Patients with diabetes mellitus should be cautious
- Could cause hypoglycemia or mask symptoms.
-
Gout
- Hydrochlorothiazide can trigger gout in certain patients who have a history of gout or are at risk for chronic renal failure.
- Doses greater than 25 mg may increase the risk.
-
Heart failure:
- Patients with compensated cardiac failure should be cautious when using metoprolol. You must closely monitor the condition for signs of worsening.
- Patients with overt or cardiogenic shock should not take metoprolol.
-
Hepatic impairment
- Thiazides can alter fluid and electrolyte equilibrium, which could lead to hepatic coma.
- Patients with impaired liver function or progressive liver disease should be cautious.
-
Hypercalcemia:
- The excretion of calcium from the kidneys may be decreased by Thiazide diuretics.
- Patients with hypercalcemia should be advised to stop using it.
-
Hypercholesterolemia:
- Patients with high or moderate cholesterol levels should be cautious; thiazides can cause increased cholesterol and triglyceride.
-
Myasthenia gravis:
- Patients with myasthenia gravis should be careful when taking metoprolol.
-
Parathyroid disease
- Thiazide diuretics reduce calcium excretion.
- Long-term use has been associated with pathologic changes in parathyroid glands that can lead to hypercalcemia or hypophosphatemia.
- You should stop using it before testing for parathyroid function.
-
Raynaud and peripheral vascular disease:
- Patients with Raynaud disease and peripheral vascular disease (PVD), such as Metoprolol, can experience symptoms of arterial insufficiency.
- Be cautious and watch for arterial obstruction.
-
Untreated Pheochromocytoma
- Before any beta-blocker can be used, it is important to have adequate alpha-blockade.
-
Psoriasis:
- Although beta-blocker usage has been linked to psoriasis exacerbation or induction, cause and effect are not clear.
- Use with caution
-
Renal impairment
- Patients with kidney impairment should be cautious; stop using if you have progressive renal impairment.
- Patients with impaired renal function may experience cumulative effects, including azotemia.
- Patients with chronic kidney disease are more at risk for acute renal failure when they use hydrochlorothiazide.
- Patients with anuria should not be used.
-
Systemic lupus, erythematosus
- Hydrochlorothiazide may cause systemic lupus activation (SLE) or exacerbation.
-
Thyroid disease:
- Hyperthyroidism symptoms (eg, tachycardia) may be mask by Metoprolol.
- Hyperthyroidism should be treated and monitored.
- Rapid withdrawal can worsen hyperthyroidism symptoms or cause a thyroid storm.
- Thyroid function tests can be altered.
Metoprolol and hydrochlorothiazide: Drug Interaction
|
Acetylcholinesterase Inhibitors |
May enhance the bradycardic effect of Beta-Blockers. |
|
Ajmaline |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
|
Ajmaline |
Sulfonamides may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased. |
|
Alcohol (Ethyl) |
May enhance the orthostatic hypotensive effect of Thiazide and Thiazide-Like Diuretics. |
|
Alfuzosin |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Allopurinol |
Thiazide and Thiazide-Like Diuretics may enhance the potential for allergic or hypersensitivity reactions to Allopurinol. Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Allopurinol. Specifically, Thiazide Diuretics may increase the concentration of Oxypurinol, an active metabolite of Allopurinol. |
|
Alpha1-Blockers |
Beta-Blockers may enhance the orthostatic hypotensive effect of Alpha1Blockers. The risk associated with ophthalmic products is probably less than systemic products. |
|
Aminolevulinic Acid (Topical) |
Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). |
|
Aminoquinolines (Antimalarial) |
May decrease the metabolism of Beta-Blockers. |
|
Amiodarone |
May enhance the bradycardic effect of Beta-Blockers. Possibly to the point of cardiac arrest. Amiodarone may increase the serum concentration of Beta-Blockers. |
|
Amphetamines |
May diminish the antihypertensive effect of Antihypertensive Agents. |
|
Angiotensin-Converting Enzyme Inhibitors |
Thiazide and Thiazide-Like Diuretics may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Anticholinergic Agents |
May increase the serum concentration of Thiazide and Thiazide-Like Diuretics. |
|
Antidiabetic Agents |
Thiazide and Thiazide-Like Diuretics may diminish the therapeutic effect of Antidiabetic Agents. |
|
Antidiabetic Agents |
Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. |
|
Antipsychotic Agents (Phenothiazines) |
May enhance the hypotensive effect of Beta-Blockers. Beta-Blockers may decrease the metabolism of Antipsychotic Agents (Phenothiazines). Antipsychotic Agents (Phenothiazines) may decrease the metabolism of Beta-Blockers. |
|
Antipsychotic Agents (Second Generation [Atypical]) |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). |
|
Barbiturates |
May decrease the serum concentration of Beta-Blockers. |
|
Barbiturates |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Benazepril |
HydroCHLOROthiazide may enhance the hypotensive effect of Benazepril. HydroCHLOROthiazide may enhance the nephrotoxic effect of Benazepril. Benazepril may decrease the serum concentration of HydroCHLOROthiazide. |
|
Benperidol |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Beta2-Agonists |
May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Beta2-Agonists |
Beta-Blockers (Beta1 Selective) may diminish the bronchodilatory effect of Beta2-Agonists. Of particular concern with nonselective beta-blockers or higher doses of the beta1 selective beta-blockers. |
|
Bradycardia-Causing Agents |
May enhance the bradycardic effect of other Bradycardia-Causing Agents. |
|
Brigatinib |
May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. |
|
Brimonidine (Topical) |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Bupivacaine |
Beta-Blockers may increase the serum concentration of Bupivacaine. |
|
Calcium Channel Blockers (Nondihydropyridine) |
May enhance the hypotensive effect of BetaBlockers. Bradycardia and signs of heart failure have also been reported. Calcium Channel Blockers (Nondihydropyridine) may increase the serum concentration of Beta-Blockers. Exceptions: Bepridil. |
|
Calcium Salts |
Thiazide and Thiazide-Like Diuretics may decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis. |
|
CarBAMazepine |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of CarBAMazepine. Specifically, there may be an increased risk for hyponatremia. |
|
Cardiac Glycosides |
Beta-Blockers may enhance the bradycardic effect of Cardiac Glycosides. |
|
Cardiac Glycosides |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of thiazide diuretics. |
|
Cholinergic Agonists |
Beta-Blockers may enhance the adverse/toxic effect of Cholinergic Agonists. Of particular concern are the potential for cardiac conduction abnormalities and bronchoconstriction. |
|
CloBAZam |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
|
Cobicistat |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
|
Corticosteroids (Orally Inhaled) |
May enhance the hypokalemic effect of Thiazide and ThiazideLike Diuretics. |
|
Corticosteroids (Systemic) |
May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Cyclophosphamide |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cyclophosphamide. Specifically, granulocytopenia may be enhanced. |
|
CYP2D6 Inhibitors (Moderate) |
May increase the serum concentration of Metoprolol. |
|
CYP2D6 Inhibitors (Strong) |
May increase the serum concentration of Metoprolol. |
|
Darunavir |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
|
Dexketoprofen |
May enhance the adverse/toxic effect of Sulfonamides. |
|
Dexmethylphenidate |
May diminish the therapeutic effect of Antihypertensive Agents. |
|
Diacerein |
May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. |
|
Diazoxide |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Diazoxide. |
|
Diazoxide |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Dichlorphenamide |
Thiazide and Thiazide-Like Diuretics may enhance the hypokalemic effect of Dichlorphenamide. |
|
Dipyridamole |
May enhance the bradycardic effect of Beta-Blockers. |
|
Disopyramide |
May enhance the bradycardic effect of Beta-Blockers. Beta-Blockers may enhance the negative inotropic effect of Disopyramide. |
|
DULoxetine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. |
|
EPINEPHrine (Nasal) |
Beta-Blockers (Beta1 Selective) may diminish the therapeutic effect of EPINEPHrine (Nasal). |
|
EPINEPHrine (Oral Inhalation) |
Beta-Blockers (Beta1 Selective) may diminish the therapeutic effect of EPINEPHrine (Oral Inhalation). |
|
Epinephrine (Racemic) |
Beta-Blockers (Beta1 Selective) may diminish the therapeutic effect of Epinephrine (Racemic). |
|
EPINEPHrine (Systemic) |
Beta-Blockers (Beta1 Selective) may diminish the therapeutic effect of EPINEPHrine (Systemic). |
|
Herbs (Hypertensive Properties) |
May diminish the antihypertensive effect of Antihypertensive Agents. |
|
Herbs (Hypotensive Properties) |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Hypotension-Associated Agents |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. |
|
Imatinib |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
|
Insulins |
Beta-Blockers may enhance the hypoglycemic effect of Insulins. |
|
Ipragliflozin |
May enhance the adverse/toxic effect of Thiazide and Thiazide-Like Diuretics. Specifically, the risk for intravascular volume depletion may be increased. |
|
Ivabradine |
Thiazide and Thiazide-Like Diuretics may enhance the arrhythmogenic effect of Ivabradine. |
|
Ivabradine |
Bradycardia-Causing Agents may enhance the bradycardic effect of Ivabradine. |
|
Lacosamide |
Bradycardia-Causing Agents may enhance the AV-blocking effect of Lacosamide. |
|
Lercanidipine |
May enhance the hypotensive effect of Metoprolol. Metoprolol may decrease the serum concentration of Lercanidipine. |
|
Levodopa-Containing Products |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. |
|
Licorice |
May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Lidocaine (Systemic) |
Beta-Blockers may increase the serum concentration of Lidocaine (Systemic). |
|
Lidocaine (Topical) |
Beta-Blockers may increase the serum concentration of Lidocaine (Topical). |
|
Lormetazepam |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Lumefantrine |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
|
Mepivacaine |
Beta-Blockers may increase the serum concentration of Mepivacaine. |
|
Methacholine |
Beta-Blockers may enhance the adverse/toxic effect of Methacholine. |
|
Methenamine |
Thiazide and Thiazide-Like Diuretics may diminish the therapeutic effect of Methenamine. |
|
Methoxyflurane |
May enhance the hypotensive effect of Beta-Blockers. |
|
Methylphenidate |
May diminish the antihypertensive effect of Antihypertensive Agents. |
|
Midodrine |
May enhance the bradycardic effect of Bradycardia-Causing Agents. |
|
Mirabegron |
May diminish the antihypertensive effect of Metoprolol. Mirabegron may increase the serum concentration of Metoprolol. |
|
Molsidomine |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Multivitamins/Fluoride (with ADE) |
May enhance the hypercalcemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Multivitamins/Minerals (with ADEK, Folate, Iron) |
Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Multivitamins/Minerals (with ADEK, Folate, Iron). |
|
Multivitamins/Minerals (with AE, No Iron) |
Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, thiazide diuretics may decrease the excretion of calcium, and continued concomitant use can also result in metabolic alkalosis. |
|
Naftopidil |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Neuromuscular-Blocking Agents (Nondepolarizing) |
Thiazide and Thiazide-Like Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). |
|
Nicergoline |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Nicorandil |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
NIFEdipine |
May enhance the hypotensive effect of Beta-Blockers. NIFEdipine may enhance the negative inotropic effect of Beta-Blockers. |
|
Nitroprusside |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. |
|
Nonsteroidal Anti-Inflammatory Agents |
May diminish the antihypertensive effect of BetaBlockers. |
|
Nonsteroidal Anti-Inflammatory Agents |
Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. |
|
Opioid Agonists |
May enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. |
|
Opioids (Anilidopiperidine) |
May enhance the bradycardic effect of Beta-Blockers. Opioids (Anilidopiperidine) may enhance the hypotensive effect of Beta-Blockers. |
|
Oxcarbazepine |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of OXcarbazepine. Specifically, there may be an increased risk for hyponatremia. |
|
Panobinostat |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
|
Peginterferon Alfa-2b |
May decrease the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Peginterferon Alfa-2b may increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
|
Pentoxifylline |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Perhexiline |
CYP2D6 Substrates (High risk with Inhibitors) may increase the serum concentration of Perhexiline. Perhexiline may increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
|
Pholcodine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. |
|
Phosphodiesterase 5 Inhibitors |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Porfimer |
Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. |
|
Propafenone |
May increase the serum concentration of Beta-Blockers. Propafenone possesses some independent beta blocking activity. |
|
Prostacyclin Analogues |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Quinagolide |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
QuiNINE |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
|
Reboxetine |
May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Regorafenib |
May enhance the bradycardic effect of Beta-Blockers. |
|
Reserpine |
May enhance the hypotensive effect of Beta-Blockers. |
|
Rifamycin Derivatives |
May decrease the serum concentration of Beta-Blockers. Exceptions: Rifabutin. |
|
Ruxolitinib |
May enhance the bradycardic effect of Bradycardia-Causing Agents. Management: Ruxolitinib Canadian product labeling recommends avoiding use with bradycardia-causing agents to the extent possible. |
|
Selective Serotonin Reuptake Inhibitors |
May increase the serum concentration of Beta-Blockers. Exceptions: Citalopram; Escitalopram; FluvoxaMINE. |
|
Selective Serotonin Reuptake Inhibitors |
May enhance the hyponatremic effect of Thiazide and Thiazide-Like Diuretics. |
|
Sulfonylureas |
Beta-Blockers may enhance the hypoglycemic effect of Sulfonylureas. Cardioselective beta-blockers (eg, acebutolol, atenolol, metoprolol, and penbutolol) may be safer than nonselective beta-blockers. All beta-blockers appear to mask tachycardia as an initial symptom of hypoglycemia. Ophthalmic beta-blockers are probably associated with lower risk than systemic agents. |
|
Terlipressin |
May enhance the bradycardic effect of Bradycardia-Causing Agents. |
|
Theophylline Derivatives |
Beta-Blockers (Beta1 Selective) may diminish the bronchodilatory effect of Theophylline Derivatives. Management: Monitor for reduced theophylline efficacy during concomitant use with any beta-blocker. Beta-1 selective agents are less likely to antagonize theophylline than nonselective agents, but selectivity may be lost at higher doses. |
|
Tofacitinib |
May enhance the bradycardic effect of Bradycardia-Causing Agents. |
|
Toremifene |
Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Toremifene. |
|
Valsartan |
HydroCHLOROthiazide may enhance the hypotensive effect of Valsartan. Valsartan may increase the serum concentration of HydroCHLOROthiazide. |
|
Verteporfin |
Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. |
|
Vitamin D Analogs |
Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Vitamin D Analogs. |
|
Yohimbine |
May diminish the antihypertensive effect of Antihypertensive Agents. |
|
Risk Factor D (Consider therapy modification) |
|
|
Abiraterone Acetate |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible. When concurrent use is not avoidable, monitor patients closely for signs/symptoms of toxicity. |
|
Alpha2-Agonists |
May enhance the AV-blocking effect of Beta-Blockers. Sinus node dysfunction may also be enhanced. Beta-Blockers may enhance the rebound hypertensive effect of Alpha2Agonists. This effect can occur when the Alpha2-Agonist is abruptly withdrawn. Management: Closely monitor heart rate during treatment with a beta blocker and clonidine. Withdraw beta blockers several days before clonidine withdrawal when possible, and monitor blood pressure closely. Recommendations for other alpha2-agonists are unavailable. Exceptions: Apraclonidine. |
|
Amifostine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. |
|
Asunaprevir |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). |
|
Bile Acid Sequestrants |
May decrease the absorption of Thiazide and Thiazide-Like Diuretics. The diuretic response is likewise decreased. |
|
Ceritinib |
Bradycardia-Causing Agents may enhance the bradycardic effect of Ceritinib. Management: If this combination cannot be avoided, monitor patients for evidence of symptomatic bradycardia, and closely monitor blood pressure and heart rate during therapy. Exceptions are discussed in separate monographs. |
|
Dacomitinib |
May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Avoid concurrent use of dacomitinib with CYP2D6 subtrates that have a narrow therapeutic index. |
|
Dronedarone |
May enhance the bradycardic effect of Beta-Blockers. Dronedarone may increase the serum concentration of Beta-Blockers. This likely applies only to those agents that are metabolized by CYP2D6. Management: Use lower initial beta-blocker doses; adequate tolerance of the combination, based on ECG findings, should be confirmed prior to any increase in betablocker dose. |
|
Ergot Derivatives |
Beta-Blockers may enhance the vasoconstricting effect of Ergot Derivatives. Exceptions: Nicergoline. |
|
Fingolimod |
Beta-Blockers may enhance the bradycardic effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and beta-blockers if possible. If coadministration is necessary, patients should have overnight continuous ECG monitoring conducted after the first dose of fingolimod. Monitor patients for bradycardia. |
|
Grass Pollen Allergen Extract (5 Grass Extract) |
Beta-Blockers may enhance the adverse/toxic effect of Grass Pollen Allergen Extract (5 Grass Extract). More specifically, Beta-Blockers may inhibit the ability to effectively treat severe allergic reactions to Grass Pollen Allergen Extract (5 Grass Extract) with epinephrine. Some other effects of epinephrine may be unaffected or even enhanced (e.g., vasoconstriction) during treatment with Beta-Blockers. |
|
Lithium |
Thiazide and Thiazide-Like Diuretics may decrease the excretion of Lithium. |
|
Obinutuzumab |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. |
|
Siponimod |
Bradycardia-Causing Agents may enhance the bradycardic effect of Siponimod. Management: Avoid coadministration of siponimod with drugs that may cause bradycardia. |
|
Sodium Phosphates |
Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with diuretics, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, hydrate adequately and monitor fluid and renal status. |
|
Topiramate |
Thiazide and Thiazide-Like Diuretics may enhance the hypokalemic effect of Topiramate. Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Topiramate. Management: Monitor for increased topiramate levels/adverse effects (e.g., hypokalemia) with initiation/dose increase of a thiazide diuretic. Closely monitor serum potassium concentrations with concomitant therapy. Topiramate dose reductions may be necessary. |
|
Risk Factor X (Avoid combination) |
|
|
Aminolevulinic Acid (Systemic) |
Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). |
|
Bromperidol |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents. |
|
Dofetilide |
HydroCHLOROthiazide may enhance the QTc-prolonging effect of Dofetilide. HydroCHLOROthiazide may increase the serum concentration of Dofetilide. |
|
Fexinidazole [INT] |
Thiazide and Thiazide-Like Diuretics may enhance the arrhythmogenic effect of Fexinidazole [INT]. |
|
Fexinidazole [INT |
Bradycardia-Causing Agents may enhance the arrhythmogenic effect of Fexinidazole [INT]. |
|
Floctafenine |
May enhance the adverse/toxic effect of Beta-Blockers. |
|
Levosulpiride |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Levosulpiride. |
|
Mecamylamine |
Sulfonamides may enhance the adverse/toxic effect of Mecamylamine. |
|
Promazine |
Thiazide and Thiazide-Like Diuretics may enhance the QTc-prolonging effect of Promazine. |
|
Rivastigmine |
May enhance the bradycardic effect of Beta-Blockers. |
Monitoring parameters:
- Blood pressure
- heart rate
- fluid and electrolyte balance
- serum glucose regularly (in patients with diabetes)
- renal function
How to administer Dutoprol (metoprolol and hydrochlorothiazide)?
- To avoid nocturia, doses of these drugs should be taken early in the day and the last dose of multiple doses should be taken no later than 6 pm.
- Metoprolol tartrate (immediate-release) and hydrochlorothiazide:
- Administer with or immediately following meals (or as directed).
- Metoprolol succinate (extended-release) and hydrochlorothiazide:
- Administer with or without food.
Mechanism of action of Dutoprol (metoprolol and hydrochlorothiazide):
Metoprolol:
- It is a selective inhibitor of beta-adrenergic receptors;
- It competitively blocks beta-1 receptors, with little or no effect on beta-2 receptors at doses less than 100 mg;
- Metoprolol does not exhibit any membrane stabilizing or intrinsic sympathomimetic activity.
Hydrochlorothiazide:
- It inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions.
See individual agents.
International Brands of Metoprolol and hydrochlorothiazide:
- Dutoprol
- Lopressor HCT
- Beloc Comp
- Beloc-Zok Comp
- Betoprolol
- Seloken Retard Comp.
- Selokomb
- Selopres Zok
- Selopress Zok
- Selozide
- ZokZid
Metoprolol and hydrochlorothiazide Brand Names in Pakistan:
No Brands Available in Pakistan.
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