Dutoprol (Metoprolol and hydrochlorothiazide) - Dose, Side effects

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:
- For the treatment of hypertension, a combination of metoprolol and hydrochlorothiazide is employed.For the treatment of hypertension, a combination of metoprolol and hydrochlorothiazide is employed.

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;

The particular agent titration.
A mix product that is swapped according to daily needs.

Note: Over 50 mg of hydrochlorothiazide per day is not advised.

Metoprolol tartrate (immediate release)/hydrochlorothiazide:
- Dosage range:
  - Metoprolol tartrate 50 to 100 mg/hydrochlorothiazide 12.5 to 25 mg twice a day is an alternative to the combination of
  - 100 to 200 mg of metoprolol tartrate and 25 to 50 mg of hydrochlorothiazide.
Concomitant therapy:
- To prevent patients from developing hypotension, a slow titration should be performed using the other antihypertensive agent's typical starting dose.

Metoprolol succinate (extended release)/ hydrochlorothiazide Dosage:

Initial dose:
- Metoprolol succinate 25 mg/hydrochlorothiazide 12.5 mg once a day, with the possibility of titrating once every two weeks up to a maximum of 200 mg/25 mg of hydrochlorothiazide.

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:
- The manufacturer's labelling does not mention dosage modifications.
- Metoprolol should not be taken by patients with increasing renal impairment or anuria.
Metoprolol succinate (extended release)/hydrochlorothiazide:
- CrCl >30 mL/minute:
  - No change in dose is necessary.
- CrCl ≤30 mL/minute:
  - The manufacturer's labelling does not mention dose adjustments (has not been studied).
  - Use is contraindicated in people with anuria; discontinue use if renal impairment worsens.

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):

Beta-blockers, other sulfonamide-derived medications, metoprolol and hydrochlorothiazide hypersensitivity, as well as any ingredient in the composition
More than a first-degree obstruction, sickly sinus condition, and sinus bradycardia (unless a permanent pacemaker has been installed).
Cardiogenic shock
Cardiac failure.
Anuria

Notification:

Although the FDA-approved product labelling warns that this medication should not be taken with other groups of drugs that contain sulfonamides, the scientific validity of this claim has been questioned.
For more information, go to "Warnings/Precautions."
Metoprolol tartrate and immediate-release hydrochlorothiazide are two more contraindications.
- Severe peripheral arterial disease

Warnings and precautions

Acute renal failure:
- In patients with significant heart failure or volume loss, hydrochlorothiazide can lead to acute renal failure.
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 utilise the medication may have Bradycardia (sinus pause, heart block and cardiac arrest).
- Patients who have first-degree atrioventricular block, malfunction of the sinus node, or conduction disorders (such as Wolff-
- Parkinson-White syndrome) may be at higher risk.
- It's crucial to keep track of heart rate and beat. Reduce the dosage or stop the medication if severe bradycardia appears.
Electrolyte disturbances:
- Hypokalemia, hypochloremic acidosis, hyponatremia, and hypomagnesemia are all side effects of hydrochlorothiazide.
  Before starting, treat electrolyte imbalances as necessary.
Hypersensitivity reactions
- Hypersensitivity responses can occur when taking hydrochlorothiazide.
- Patients with a history or allergy to bronchial asthma, bronchial asthma, or allergies are at greater risk.
Ocular effects
- Temporary myopia and acute angle-closure glaucoma, which commonly develop within hours to weeks of treatment, are potential side effects of hydrochlorothiazide.
- In patients experiencing sudden drops in visual acuity or ocular pain, stop therapy right away.
- 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")
- Wide-ranging contraindications for patients who have previously experienced an allergic reaction to sulfonamides are listed on the
- FDA-approved product labels for drugs that contain these chemical groups.
- Cross-reactivity between members of a class is conceivable (eg two antibiotic sulfonamides).
- Crossreactivity concerns have been raised for all compounds with the sulfonamide structural.
- Cross-reactivity between sulfonamides that aren't antibiotic and those that are shows that cross-reactivity between antibiotic and nonantibiotic sulfonamides is improbable.
- Sulfonamides that are not antibiotics are not likely to induce 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
- Diuretics should not be used for the first 24 hours following bariatric surgery to prevent dehydration.
- Dehydration or electrolyte problems can happen.
- If oral fluid consumption targets have been reached, diuretics may be restarted if necessary.
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.
- Metoprolol is not recommended for patients with severe sinus bradycardia or second- or third-degree AV blockade unless an artificial pacemaker has been implanted.
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 have the potential to change fluid and electrolyte balance, which could result in hepatic coma.
- Patients who have deteriorating liver disease or compromised liver function should exercise caution.
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.
- When using hydrochlorothiazide, patients with chronic kidney disease are more likely to experience acute renal failure.
- Anuric patients shouldn't 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

Risk Factor C (Monitor therapy)
Acetylcholinesterase Inhibitors	Could make beta-blockers' bradycardic impact stronger.
Ajmaline	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Ajmaline	Sulfonamides might make ajmaline more harmful or poisonous. In particular, there may be an elevated risk for cholestasis.
Alcohol (Ethyl)	Increases the effectiveness of thiazide and thiazide-like diuretics in lowering orthostatic blood pressure.
Alfuzosin	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Allopurinol	The possibility of allergic or hypersensitive reactions to allopurinol may be increased by thiazide and thiazide-like diuretics. The serum concentration of Allopurinol may rise in response to thiazides and thiazide-like diuretics. In particular, Thiazide Diuretics may raise Oxypurinol's levels, an active metabolite of Allopurinol.
Alpha1-Blockers	Alpha1Blockers' orthostatic hypotensive action may be strengthened by beta-blockers. Ophthalmic products likely carry a lower level of risk than systemic ones.
Aminolevulinic Acid (Topical)	Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Topical).
Aminoquinolines (Antimalarial)	Beta-Blockers' metabolism might be slowed down.
Amiodarone	Could make beta-blockers' bradycardic impact stronger. It could have reached the point of cardiac arrest. Beta-Blockers' serum concentration may rise as a result of amiodarone.
Amphetamines	May lessen the effectiveness of antihypertensive agents.
Angiotensin-Converting Enzyme Inhibitors	Angiotensin-Converting Enzyme Inhibitors' hypotensive effects may be enhanced by thiazide and thiazide-like diuretics. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by thiazide and thiazide-like diuretics.
Anticholinergic Agents	May raise the levels of thiazide and thiazide-like diuretics in the blood.
Antidiabetic Agents	The therapeutic value of anti-diabetic agents may be diminished by thiazide and thiazide-like diuretics.
Antidiabetic Agents	The therapeutic benefit of anti-diabetic agents may be reduced by hyperglycemia-associated agents.
Antipsychotic Agents (Phenothiazines)	May strengthen beta-blockers' hypotensive effects. Antipsychotic Agents' metabolism may be slowed down by beta-blockers (Phenothiazines).
Antipsychotic Agents (Second Generation [Atypical])	Antipsychotic drugs' hypotensive effects may be enhanced by blood pressure-lowering medications (Second Generation [Atypical]).
Barbiturates	May lower the level of beta-blockers in the serum.
Barbiturates	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Benazepril	Benazepril's hypotensive impact may be strengthened by hydrochlorothiazide. Benazepril may have a more nephrotoxic effect when combined with hydrochlorothiazide. Benazepril may lower the level of HydroCHLOROthiazide in the blood.
Benperidol	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Beta2-Agonists	Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact.
Beta2-Agonists	The bronchodilatory impact of beta2-agonists may be lessened by beta-blockers (beta1 selective). Particular attention should be paid to nonselective beta-blockers or beta1 selective beta-blockers at larger doses.
Bradycardia-Causing Agents	May intensify other bradycardia-causing agents' bradycardic effects.
Brigatinib	May lessen the effectiveness of antihypertensive agents. Antihypertensive Agents' bradycardic action may be strengthened by brutinib.
Brimonidine (Topical)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Bupivacaine	Beta-blockers may raise the serum level of buprenorphine.
Calcium Channel Blockers (Nondihydropyridine)	May strengthen betablockers' hypotensive effects. In addition, reports of bradycardia and heart failure symptoms have been made. The serum concentration of beta-blockers may rise in response to calcium channel blockers (nondihydropyridine). Bepridil is an exception.
Calcium Salts	The excretion of calcium salts may be decreased by thiazide and thiazide-like diuretics. Metabolic alkalosis can also be brought on by continued concurrent usage.
CarBAMazepine	Thiazide and Thiazide-Like Diuretics may intensify CarBAMazepine's negative/toxic effects. Particularly, there could be a higher risk of hyponatremia.
Cardiac Glycosides	Cardiac Glycosides' bradycardic action may be strengthened by beta-blockers.
Cardiac Glycosides	Cardiac Glycosides may have an increased negative or toxic effect when used with thiazide and thiazide-Like Diuretics. Particularly, the hypokalemic and hypomagnesemic impact of thiazide diuretics may worsen cardiac glycoside toxicity.
Cholinergic Agonists	Beta-Blockers may make Cholinergic Agonists' harmful or toxic effects worse. The possibilities for bronchoconstriction and aberrant cardiac conduction are of special concern.
CloBAZam	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Cobicistat	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Corticosteroids (Orally Inhaled)	Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact.
Corticosteroids (Systemic)	Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact.
Cyclophosphamide	Thiazide and Thiazide-Like Diuretics may intensify Cyclophosphamide's harmful or hazardous effects. Particularly, granulocytopenia could be worsened.
CYP2D6 Inhibitors (Moderate)	Metoprolol serum levels can rise.
CYP2D6 Inhibitors (Strong)	Metoprolol serum levels can rise.
Darunavir	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Dexketoprofen	Sulfonamides' harmful or poisonous effects could be amplified.
Dexmethylphenidate	May lessen the effectiveness of antihypertensive agents.
Diacerein	Could make diuretics' therapeutic effects stronger. Particularly, there may be a higher chance of hypokalemia or dehydration.
Diazoxide	Thiazide and Thiazide-Like Diuretics may intensify Diazoxide's harmful or toxic effects.
Diazoxide	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Dichlorphenamide	The hypokalemic impact of dichlorphenamide may be enhanced by thiazide and thiazide-like diuretics.
Dipyridamole	Could make beta-blockers' bradycardic impact stronger.
Disopyramide	Could make beta-blockers' bradycardic impact stronger.
DULoxetine	Blood pressure lowering drugs may intensify DULoxetine's hypotensive effects.
EPINEPHrine (Nasal)	The therapeutic effects of epinephrine may be diminished by beta-blockers (Beta1 Selective) (Nasal).
EPINEPHrine (Oral Inhalation)	The therapeutic effects of epinephrine may be diminished by beta-blockers (Beta1 Selective) (Oral Inhalation).
Epinephrine (Racemic)	Epinephrine's therapeutic impact may be diminished by beta-blockers (Beta1 Selective) (Racemic).
EPINEPHrine (Systemic)	The therapeutic effects of epinephrine may be diminished by beta-blockers (Beta1 Selective) (Systemic).
Herbs (Hypertensive Properties)	May lessen the effectiveness of antihypertensive agents.
Herbs (Hypotensive Properties)	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Hypotension-Associated Agents	The hypotensive action of hypotension-associated agents may be strengthened by blood pressure lowering medications.
Imatinib	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Insulins	Beta-Blockers might improve insulin's ability to lower blood sugar.
Ipragliflozin	The toxic and harmful effects of thiazide and thiazide-like diuretics may be increased. In particular, there may be an elevated risk for intravascular volume depletion.
Ivabradine	The arrhythmogenic impact of ivabradine may be enhanced by thiazide and thiazide-like diuretics.
Ivabradine	Bradycardia-Causing Agents may intensify Ivabradine's bradycardic impact.
Lacosamide	Bradycardia-Causing Substances may intensify Lacosamide's AV-blocking effects.
Lercanidipine	May strengthen metoprolol's hypotensive effects. Lercanidipine's serum levels may drop when metoprolol is used.
Levodopa-Containing Products	Levodopa-Containing Products' hypotensive effects may be strengthened by blood pressure-lowering medications.
Licorice	Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact.
Lidocaine (Systemic)	Beta-blockers might boost the level of lidocaine in the blood (Systemic).
Lidocaine (Topical)	Beta-blockers might boost the level of lidocaine in the blood (Topical).
Lormetazepam	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Lumefantrine	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Mepivacaine	Mepivacaine's serum levels may rise after taking beta-blockers.
Methacholine	Beta-Blockers might make methacholine's harmful or toxic effects worse.
Methenamine	The therapeutic effects of methenamine may be diminished by thiazide and thiazide-like diuretics.
Methoxyflurane	May strengthen beta-blockers' hypotensive effects.
Methylphenidate	May lessen the effectiveness of antihypertensive agents.
Midodrine	Bradycardia-Causing Agents' bradycardic effect might be enhanced.
Mirabegron	May lessen metoprolol's antihypertensive effects. Metoprolol serum levels may rise as a result of mirabegron.
Molsidomine	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Multivitamins/Fluoride (with ADE)	Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact.
Multivitamins/Minerals (with ADEK, Folate, Iron)	The effect of multivitamins and minerals on hypercalcemia may be enhanced by thiazide and thiazide-like diuretics (with ADEK, Folate, Iron).
Multivitamins/Minerals (with AE, No Iron)	The serum concentration of multiple vitamins and minerals may rise after taking thiazide and thiazide-like diuretics (with AE, No Iron). Particularly, thiazide diuretics may reduce calcium excretion, and long-term concurrent usage may result in metabolic alkalosis.
Naftopidil	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Neuromuscular-Blocking Agents (Nondepolarizing)	The neuromuscular-blocking action of neuromuscular-blocking agents may be enhanced by thiazide and thiazide-like diuretics (Nondepolarizing).
Nicergoline	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Nicorandil	The hypotensive effects of blood pressure-lowering medications may be strengthened.
NIFEdipine	May strengthen beta-blockers' hypotensive effects. The detrimental inotropic impact of beta-blockers may be amplified by NIFEdipine.
Nitroprusside	Nitroprusside's hypotensive impact may be strengthened by blood pressure-lowering medications.
Nonsteroidal Anti-Inflammatory Agents	BetaBlockers' ability to reduce hypertension may be diminished.
Nonsteroidal Anti-Inflammatory Agents	Nonsteroidal Anti-Inflammatory Agents' nephrotoxic effects may be intensified by thiazide and thiazide-like diuretics. Thiazide and Thiazide-Like Diuretics may have less of a therapeutic impact when used with nonsteroidal anti-inflammatory drugs.
Opioid Agonists	Could make diuretics' harmful or toxic effects worse. Opioid antagonists may reduce diuretics' therapeutic benefit.
Opioids (Anilidopiperidine)	Could make beta-blockers' bradycardic impact stronger. Beta-Blockers may have a greater hypotensive impact when combined with opioids (anilidopiperidine).
Oxcarbazepine	Thiazide and Thiazide-Like Diuretics may intensify OXcarbazepine's negative/toxic effects. Particularly, there could be a higher risk of hyponatremia.
Panobinostat	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Peginterferon Alfa-2b	May lower the serum level of CYP2D6 substrates (High risk with Inhibitors). The concentration of CYP2D6 Substrates in the serum may rise when using Peginterferon Alfa-2b (High risk with Inhibitors).
Pentoxifylline	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Perhexiline	The serum levels of perhexiline may increase when exposed to CYP2D6 Substrates (High Risk with Inhibitors). The serum concentration of CYP2D6 Substrates may rise in response to perhexiline (High risk with Inhibitors).
Pholcodine	Pholcodine's hypotensive impact may be strengthened by blood pressure lowering medications
Phosphodiesterase 5 Inhibitors	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Porfimer	The photosensitizing effect of Porfimer may be strengthened by photosensitizing agents.
Propafenone	May raise the level of beta-blockers in the serum. There is some independent beta-blocking activity in propafenone.
Prostacyclin Analogues	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Quinagolide	The hypotensive effects of blood pressure-lowering medications may be strengthened.
QuiNINE	May elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Reboxetine	Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact.
Regorafenib	Could make beta-blockers' bradycardic impact stronger.
Reserpine	May strengthen beta-blockers' hypotensive effects.
Rifamycin Derivatives	May lower the level of beta-blockers in the serum. Rifabutin is an exception.
Ruxolitinib	Bradycardia-Causing Agents' bradycardic effect might be enhanced. Management: The Canadian product labelling for roxolitinib advises against using it in conjunction with medications that can cause bradycardia whenever feasible.
Selective Serotonin Reuptake Inhibitors	May raise the level of beta-blockers in the serum. Citalopram, Escitalopram, and FluvoxaMINE are exceptions.
Selective Serotonin Reuptake Inhibitors	Thiazide and Thiazide-Like Diuretics might have an enhanced hypokalemic impact.
Sulfonylureas	Beta-Blockers might make Sulfonylureas' hypoglycemia effect more potent. Beta-blockers that are cardioselective (such penbutolol, acebutolol, atenolol, and metoprolol) may be less dangerous than nonselective beta-blockers. As the initial sign of hypoglycemia, tachycardia seems to be concealed by all beta-blockers. Beta-blockers used intravenously most likely carry a lesser risk than those used systemically.
Terlipressin	Bradycardia-Causing Agents' bradycardic effect might be enhanced.
Theophylline Derivatives	Theophylline derivatives may not have the same bronchodilatory action when used with beta-blockers (Beta1 Selective). Management: Keep an eye out for decreased theophylline effectiveness when using any beta-blocker at the same time. Compared to nonselective medicines, beta-1 selective drugs are less likely to antagonise theophylline.
Tofacitinib	Bradycardia-Causing Agents' bradycardic effect might be enhanced.
Toremifene	Toremifene's hypercalcemic impact may be enhanced by thiazide and thiazide-like diuretics.
Valsartan	HydroCHLOROthiazide may increase Valsartan's ability to lower blood pressure.The serum concentration of HydroCHLOROthiazide may rise in response to Valsartan.
Verteporfin	Verteporfin's photosensitizing effect may be strengthened by photosensitizing agents.
Vitamin D Analogs	The hypercalcemic impact of vitamin D analogues may be enhanced by thiazides and thiazide-like diuretics.
Yohimbine	May lessen the effectiveness 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 elevate CYP2D6 Substrates' serum concentration (High risk with Inhibitors).
Bile Acid Sequestrants	The absorption of thiazide and thiazide-like diuretics may be reduced. Also reduced is the diuretic reaction.
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	The excretion of lithium may be reduced by thiazide and thiazide-like diuretics.
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	The nephrotoxic effects of sodium phosphates may be increased by diuretics. In particular, there may be an increased risk of acute phosphate nephropathy. Treatment: You might want to temporarily stop taking diuretics or look for an alternative to the oral sodium phosphate bowel preparation in order to prevent this combo. If the combination cannot be avoided, drink well and keep an eye on your kidney and fluid levels.
Topiramate	The hypokalemic impact of topiramate may be enhanced by thiazide and thiazide-like diuretics. The blood concentration of topiramate may rise in response to thiazide and thiazide-like diuretics. When using a thiazide diuretic, monitor for elevated topiramate levels and any negative consequences (such as hypokalemia). Serum potassium levels should be closely watched when receiving concurrent treatment. There may be a need to lower topiramate dosage.
Risk Factor X (Avoid combination)
Aminolevulinic Acid (Systemic)	Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (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	The QTc-prolonging action of dofetilide may be strengthened by hydrochlorothiazide. The serum levels of Dofetilide may rise in response to HydroCHLOROthiazide.
Fexinidazole [INT]	Fexinidazole [INTability ]'s to induce arrhythmias may be enhanced by the use of thiazide and thiazide-like diuretics.
Fexinidazole [INT	Bradycardia-Causing Agents may intensify Fexinidazole's [INT] ability to induce arrhythmias.
Floctafenine	May intensify the hazardous or harmful effects of beta-blockers.
Levosulpiride	Thiazide and Thiazide-Like Diuretics may intensify Levosulpiride's negative/toxic effects.
Mecamylamine	Sulfonamides may intensify Mecamylamine's harmful or hazardous effects.
Promazine	Promazine's ability to prolong QTc may be enhanced by thiazide and thiazide-like diuretics.
Rivastigmine	Could make beta-blockers' bradycardic impact stronger.

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)?

The last dose of several doses of these medications should be taken no later than 6 pm in order to prevent nocturia.
Metoprolol tartrate (immediate-release) and hydrochlorothiazide:
- Administer during or right after meals (or as directed).
Metoprolol succinate (extended-release) and hydrochlorothiazide:
- Both with and without food, administer.

Mechanism of action of Dutoprol (metoprolol and hydrochlorothiazide):

Metoprolol:

At doses below 100 mg, it has little to no effect on beta-2 receptors and is a selective inhibitor of beta-adrenergic receptors. Metoprolol also doesn't show any inherent sympathomimetic or membrane-stabilizing properties.

Hydrochlorothiazide:

It increases the excretion of sodium, water, potassium, and hydrogen ions by inhibiting sodium reabsorption in the distal tubules.

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.

Dutoprol (Metoprolol and hydrochlorothiazide) - Dose, Side effects

Dutoprol (metoprolol and hydrochlorothiazide) Uses:

Hypertension:

Metoprolol and Hydrochlorothiazide Dose in Adults:

Dutoprol (metoprolol and hydrochlorothiazide) Dose in the treatment of Hypertension: Oral:

Metoprolol tartrate (immediate release)/hydrochlorothiazide:

Concomitant therapy:

Metoprolol succinate (extended release)/ hydrochlorothiazide Dosage:

Use in children:

Pregnancy Risk Factor C

Use of hydrochlorothiazide and metoprolol during breastfeeding

Dutoprol (metoprolol and hydrochlorothiazide) Dose in Kidney Disease:

Metoprolol tartrate (immediate release)/ hydrochlorothiazide:

Metoprolol succinate (extended release)/hydrochlorothiazide:

Dose in Liver disease:

Side Effects of Dutoprol (metoprolol and hydrochlorothiazide):

Central Nervous System:

Dermatologic:

Endocrine & Metabolic:

Gastrointestinal:

Genitourinary:

Hematologic & Oncologic:

Hepatic:

Neuromuscular & Skeletal:

Ophthalmic:

Otic:

Respiratory:

Miscellaneous:

Contraindications to Dutoprol (metoprolol and hydrochlorothiazide):

Warnings and precautions

Acute renal failure:

Anaphylactic reactions

Bradycardia

Electrolyte disturbances:

Hypersensitivity reactions

Ocular effects

Photosensitivity

Allergy to sulfonamide ("sulfa")

Bariatric surgery

Bronchospastic Disease:

Conductive abnormality

Diabetes:

Gout

Heart failure:

Hepatic impairment

Hypercalcemia:

Hypercholesterolemia:

Myasthenia gravis:

Parathyroid disease

Raynaud and peripheral vascular disease:

Untreated Pheochromocytoma

Psoriasis:

Renal impairment

Systemic lupus, erythematosus

Thyroid disease:

Monitoring parameters:

How to administer Dutoprol (metoprolol and hydrochlorothiazide)?

Mechanism of action of Dutoprol (metoprolol and hydrochlorothiazide):

International Brands of Metoprolol and hydrochlorothiazide:

Metoprolol and hydrochlorothiazide Brand Names in Pakistan:

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