Generic Name and Formulations:
Metoprolol succinate ext-rel, hydrochlorothiazide; 25/12.5mg, 50/12.5mg, 100/12.5mg; tabs.
Individualize. Take once daily. Replacement therapy: may be substituted for individual components. Titrate, if necessary, every 2 weeks up to max 200/25mg. Severe renal impairment: not recommended. Moderate hepatic impairment: consider initiating with lower HCTZ component.
Cardiogenic shock. Overt heart failure. Sinus bradycardia. Sick sinus syndrome. 2nd- or 3rd-degree AV block unless paced. Anuria. Sulfonamide allergy.
Ischemic heart disease. Worsening cardiac failure (reduce or interrupt dose if necessary). Bronchospastic disease. Monitor HR and rhythm; reduce dose or discontinue if severe bradycardia occurs. Pheochromocytoma. Major surgery. Renal or hepatic impairment. Volume depletion. Diabetes and hypoglycemia. Thyrotoxicosis (hyperthyroidism). Peripheral vascular disease. Acute myopia. Secondary angle-closure glaucoma. SLE. Gout. Post-sympathectomy. Avoid abrupt cessation (reduce dose over 1–2 weeks and monitor). Monitor electrolytes. Pregnancy (Cat.C). Nursing mothers.
Additive effects with catecholamine-depleting drugs (eg, reserpine, MAOIs). Potentiated by CYP2D6 inhibitors (eg, quinidine, fluoxetine, paroxetine, propafenone). Risk of bradycardia with digitalis, clonidine, diltiazem, verapamil. Potentiated by alcohol, barbituates, narcotics, other antihypertensives. Hypokalemia with corticosteroids, ACTH. May increase lithium toxicity. Antagonized by NSAIDs (monitor). Adjust antidiabetic drugs. Decreased absorption with cholestyramine and colestipol resins. Antagonizes epinephrine. Possible increased response to muscle relaxants (eg, tubocurarine). Beta-blockers may mask signs of hypoglycemia. May interfere with parathyroid tests.
Cardioselective beta-blocker + diuretic.
Nasopharyngitis, fatigue, dizziness, back pain, nausea; bronchospasm, bradycardia, CHF, heart block, vision disorders.
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