Uses

What is metoprolol/hydrochlorothiazide used for?

Metoprolol/hydrochlorothiazide is commonly used to treat high blood pressure (hypertension). Lowering blood pressure may also lower the risk of heart attack or stroke.

Metoprolol/hydrochlorothiazide may also be used for other conditions as determined by your healthcare provider.

How does metoprolol/hydrochlorothiazide work (mechanism of action)?

Metoprolol/hydrochlorothiazide blocks beta receptors in your heart. These receptors normally bind to hormones called catecholamines. When catecholamines bind to these receptors, it causes your heart to beat harder and faster. Blocking these receptors helps your heart beat more slowly. Metoprolol/hydrochlorothiazide also works by increasing how much you pee. It does this by helping the kidneys remove electrolytes such as sodium (salt), and water from the body. It also appears to relax your blood vessels to allow blood to flow more freely (less resistance to flow). Together, these effects can help lower blood pressure and may reduce your risk for heart attack and stroke.

How is metoprolol/hydrochlorothiazide supplied (dosage forms)?

Brands and other names

  • Lopressor HCT

Dosage forms and strengths

  • 50 mg/25 mg oral tablets
  • 100 mg/25 mg oral tablets
  • 100 mg/50 mg oral tablets

How should I store metoprolol/hydrochlorothiazide?

Metoprolol/hydrochlorothiazide should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a tightly closed and light-resistant container, protected from moisture, in a cool, dry place.

Side Effects

What are the most common side effects of metoprolol/hydrochlorothiazide?

The most common side effects of metoprolol/hydrochlorothiazide are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Feeling unusually weak or tired 
  • Shortness of breath
  • Slow heartbeat or bradycardia (see below)
  • Low blood pressure (see below)
  • Diarrhea
  • Itching
  • Rash
  • Electrolyte changes and increased blood sugar (see below)
  • An increase in how much you pee

There may be other side effects of metoprolol/hydrochlorothiazide that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of metoprolol/hydrochlorothiazide?

While less common, the most serious side effects of metoprolol/hydrochlorothiazide are described below, along with what to do if they happen.

Severe Allergic Reactions. Metoprolol/hydrochlorothiazide may cause allergic reactions, which can be serious. Stop taking metoprolol/hydrochlorothiazide and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

New or Worsening Heart Failure. Metoprolol/hydrochlorothiazide may worsen existing heart failure or cause fluid buildup in your body. For individuals with underlying heart disease or heart damage, metoprolol can potentially lead to heart failure over time. Tell your healthcare provider right away if you have any of the following symptoms.

  • Shortness of breath or trouble breathing, especially while lying down
  • Swelling in your feet, ankles, or legs
  • Unusually fast weight gain
  • Unusual tiredness

Heart Rate Changes. Metoprolol/hydrochlorothiazide can make your heart beat slower than normal (bradycardia). Call your healthcare provider right away if you have any of the following symptoms of bradycardia.

  • Feeling lightheaded, dizziness, or fainting
  • Confusion
  • Feeling weak or easily tired 
  • Chest pain
  • Shortness of breath

Low Blood Pressure or Low Blood Pressure Upon Standing (Orthostatic Hypotension). Metoprolol/hydrochlorothiazide may cause low blood pressure (hypotension) or a sudden drop in blood pressure when standing up from a seated or lying position. To help prevent this, be careful not to get up too quickly. If you feel dizzy, sit or lie down right away until the dizziness stops, then take your time getting up again. Tell your healthcare provider right away if you have any of the following symptoms of orthostatic hypotension.

  • Dizziness, feeling lightheaded, or fainting upon standing
  • Blurred vision
  • Confusion
  • Feeling weak

Kidney Damage. Kidney damage can happen when taking metoprolol/hydrochlorothiazide, especially if you have existing kidney problems, severe heart failure, or are dehydrated. Call your healthcare provider right away if you have any of the following symptoms of kidney damage.

  • Reduced need to pee
  • Swelling in your feet, ankles, or legs
  • Weakness or unusual tiredness
  • Difficulty catching your breath or chest pain/pressure
  • Confusion
  • Nausea
  • Seizures

Electrolyte Changes and Increased Blood Sugar. Metoprolol/hydrochlorothiazide may increase your blood sugar (glucose) levels and cause changes to the levels of certain minerals in your body, called electrolytes. For example, it may cause low potassium levels (hypokalemia), low sodium levels (hyponatremia), low magnesium levels (hypomagnesemia), high calcium levels (hypercalcemia), or low chloride levels (hypochloremia), or high glucose levels (hyperglycemia). These changes can be serious. Your healthcare provider will do bloodwork to check your glucose and electrolyte levels, especially if you take certain other medicines. Keep your appointments to have your blood checked. Call your healthcare provider if you have any of the following symptoms.

  • Weakness
  • Unusual tiredness
  • Muscle cramps or twitching
  • Constipation
  • Nausea, vomiting, or loss of appetite
  • Dizziness
  • Restlessness or irritability
  • Difficulty breathing
  • Confusion or decreased alertness
  • Abnormal heart rhythm
  • Seizures

Peripheral Vascular Disease. Metoprolol/hydrochlorothiazide can cause the heart to pump less blood to the rest of the body. This can make blood flow problems to the arms, legs, and intestines worse. 

Breathing Problems. Metoprolol/hydrochlorothiazide may cause the muscles around the airways to tighten (bronchospasm) instead of relaxing, which can be serious. Stop taking metoprolol/hydrochlorothiazide and contact your healthcare provider right away if you have trouble breathing.

Decreased Symptoms of Low Blood Sugar (Hypoglycemia). Metoprolol/hydrochlorothiazide can decrease early signs of low blood sugar, such as fast heartbeat, and make it more likely for the low blood sugar to be serious, especially for people with diabetes. Contact your healthcare provider right away if you have trouble detecting any of the following symptoms of low blood sugar.

  • Headache
  • Crankiness or anxiety 
  • Hunger
  • Dizziness or confusion
  • Blurry vision
  • Slurred speech
  • Sweating
  • Feeling jittery or shakiness
  • Fast heartbeat
  • Seizures

Short-Sightedness and Glaucoma. Metoprolol/hydrochlorothiazide may make it harder to see faraway objects (short-sightedness). It also may increase pressure inside the eye and cause or worsen narrow-angle glaucoma, which can lead to blindness. These issues may be more likely with taking metoprolol/hydrochlorothiazide if you have a sulfa or penicillin allergy. Tell your healthcare provider right away if you have any of the following symptoms.

  • Trouble seeing faraway objects
  • Loss of vision
  • Eye pain or redness
  • Severe headache or vomiting
  • Seeing bright, colorful circles around lights (vision halos)

Inflammation of the Pancreas (Pancreatitis). Metoprolol/hydrochlorothiazide may cause inflammation of the pancreas, which is called pancreatitis. Stop taking metoprolol/hydrochlorothiazide and call your healthcare provider right away if you have symptoms of pancreatitis, including vomiting or severe pain in the upper part of your belly that travels to your back.

Liver Damage. Liver damage, also called hepatotoxicity, can happen when taking metoprolol/hydrochlorothiazide. Call your healthcare provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine

Severe Skin Reactions. Metoprolol/hydrochlorothiazide can cause severe skin reactions called Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) that can lead to death if not treated. If you develop a rash, stop metoprolol/hydrochlorothiazide, and call your healthcare provider right away. Get emergency help right away if you have any of the following symptoms of SJS or TEN.

  • Painful red or purple skin that looks burned and peels off
  • Flat red rash or blisters on your skin, mouth, nose, and genitals
  • Red, painful, watery eyes

Warnings & Precautions

Who should not use metoprolol/hydrochlorothiazide?

Allergies to Ingredients. People who are allergic to any of the following should not take metoprolol/hydrochlorothiazide.

  • Lopressor HCT
  • Dutoprol
  • Metoprolol
  • Lopressor
  • Hydrochlorothiazide
  • Any other medicine known as a sulfonamide (sulfa drug)
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific metoprolol/hydrochlorothiazide products they stock.

Bradycardia. Metoprolol/hydrochlorothiazide should not be used if your heart is beating too slow (bradycardia).

Heart Block. Metoprolol/hydrochlorothiazide should not be used if the electrical signals in your heart move too slow (heart block) unless you have a pacemaker.

Sick Sinus Syndrome. Metoprolol/hydrochlorothiazide should not be used if your body’s natural pacemaker is not able to stimulate a normal heartbeat pattern. 

Severe or Worsening Heart Failure. Metoprolol/hydrochlorothiazide should not be used if your heart failure is severe or getting worse, causing you to feel very tired, have trouble breathing, or swelling in your legs.

No Urine Production. Do not take metoprolol/hydrochlorothiazide if you are making very little to no pee. This condition is also called anuria.

Very Low Electrolytes. If you have low electrolytes, including low sodium or potassium, metoprolol/hydrochlorothiazide may not be safe to use. Your healthcare provider may measure your electrolytes before starting metoprolol/hydrochlorothiazide. Low electrolytes are not usually something you can feel, so it is important to make it to your scheduled blood work appointments. 

Cardiogenic Shock. Metoprolol/hydrochlorothiazide should not be used if you have a life-threatening condition called cardiogenic shock where your heart cannot pump enough blood to the rest of your body.

What should I know about metoprolol/hydrochlorothiazide before using it?

Do not take metoprolol/hydrochlorothiazide unless it has been prescribed to you by a healthcare provider. Take it as prescribed.

Do not share metoprolol/hydrochlorothiazide with other people, even if they have the same condition as you. It may harm them.

Keep metoprolol/hydrochlorothiazide out of the reach of children.

Metoprolol/hydrochlorothiazide should be taken with food or right after food.

Metoprolol/hydrochlorothiazide can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how metoprolol affects you.

People who are 65 or older can be at greater risk for some side effects from metoprolol/hydrochlorothiazide. Talk to your healthcare provider about your risks if you are in this age group.

Stopping metoprolol/hydrochlorothiazide suddenly may lead to chest pain or heart attack in people with heart disease. Do not stop taking this medication without talking to your healthcare provider first.

Metoprolol/hydrochlorothiazide can make your skin more sensitive to light from the sun, sunlamps, and tanning beds. This is called photosensitivity. Exposure to this light can cause severe sunburns, blisters, and swelling. If you need to be in sunlight, wear sunscreen, a hat, and clothing that covers your skin.

What should I tell my healthcare provider before using metoprolol/hydrochlorothiazide?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if metoprolol/hydrochlorothiazide is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

  • Heart or circulation problems, including heart failure and peripheral vascular disease
  • Breathing problems
  • Kidney or liver problems
  • Pheochromocytoma
  • Thyroid problems
  • Gout
  • Prostate problems
  • A reduced need to pee
  • Abnormal heart rhythm (arrhythmias)
  • Persistent or severe diarrhea or vomiting, which can lead to dehydration
  • Low electrolytes, including potassium and sodium
  • Pheochromocytoma

Use Epinephrine to Treat Allergic Reactions. Metoprolol/hydrochlorothiazide may lower your response to typical doses of epinephrine when treating an allergic reaction.

Diabetes. Metoprolol/hydrochlorothiazide can decrease early signs of low blood sugar, such as fast heartbeat, and make it more likely for the low blood sugar to be serious, especially for people with diabetes.

Systemic Lupus Erythematosus. Metoprolol/hydrochlorothiazide may activate or worsen systemic lupus erythematosus. Tell your healthcare provider if you develop or have a worsening rash, joint pain, fever, or unusual tiredness.

Sulfa Allergy. Some people who have a sulfa allergy may also be allergic to metoprolol/hydrochlorothiazide. A sulfa allergy is a rash or more serious reaction to sulfa, or sulfonamide, medicines. Sulfa medicines include sulfamethoxazole, sulfadiazine silver, or sulfasalazine. Tell your healthcare provider if you have any allergies to medicines.

Other Medicines and Supplements. Metoprolol/hydrochlorothiazide may interact with other medicines and supplements. Before using hydrochlorothiazide, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. It is not known if or how metoprolol/hydrochlorothiazide could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant. Your healthcare provider will advise you if you should take metoprolol/hydrochlorothiazide while you are pregnant or trying to get pregnant.

Breastfeeding. It is not known if metoprolol/hydrochlorothiazide passes into breast milk, but the individual components do. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take metoprolol/hydrochlorothiazide while breastfeeding.

Interactions

Does metoprolol/hydrochlorothiazide interact with foods or drinks?

There are no known interactions between metoprolol/hydrochlorothiazide and foods or drinks. However, since hydrochlorothiazide (one of the active ingredients in metoprolol/hydrochlorothiazide) affects electrolytes, it is important to discuss your intake of electrolytes, including sodium and potassium, with your healthcare provider.

Drinking alcohol may increase your risk of experiencing orthostatic hypotension if you are taking metoprolol/hydrochlorothiazide. The risk of dizziness may also be increased if you drink alcohol while taking metoprolol/hydrochlorothiazide. It is best to limit the amount of alcohol you drink.

Does metoprolol/hydrochlorothiazide interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking metoprolol/hydrochlorothiazide.

  • A barbiturate, such as phenobarbital, butalbital, or primidone, which is a medicine that may be used to treat insomnia, migraines, or seizures
  • An opioid, such as oxycodone, morphine, codeine, or fentanyl, which is a medicine used for certain types of pain
  • Any medicine for diabetes
  • Cholestyramine or colestipol, which are sometimes used to lower cholesterol
  • Lithium, which is a medicine commonly used for certain mental health conditions
  • A nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, naproxen, and others, which are contained in many prescription and OTC products for pain, swelling, and fever
  • Clonidine, which is a medicine used to treat high blood pressure and attention deficit hyperactivity disorder (ADHD)
  • Diltiazem and verapamil, which are medicines used to treat chest pain and high blood pressure
  • Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
  • A monoamine oxidase inhibitor (MAOI) [within the past 2 weeks], which is a medicine usually used for depression or Parkinson’s disease
  • Other beta-blockers, such as bisoprolol (Zebeta), atenolol (Tenormin), or propranolol (Inderal LA, Innopran XL), which are medicines used for certain heart conditions or to reduce blood pressure 

Some other medicines may alter the blood levels of metoprolol/hydrochlorothiazide. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with metoprolol/hydrochlorothiazide. Always check with your healthcare provider.

Does Metoprolol/Hydrochlorothiazide interact with other drugs you are taking?
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Overdose/Missed Dose

What should I do if I accidentally use too much metoprolol/hydrochlorothiazide?

If you or someone else has used too much metoprolol/hydrochlorothiazide, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of metoprolol/hydrochlorothiazide?

If you miss a dose, take your next dose at the normal time. Do not take double or extra doses.

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