Metoprolol Tartrate And Hydrochlorothiazide

Beta-blocker withdrawal several days before clonidine withdrawal required to avoid exacerbating rebound hypertension; concomitant use also increases risk of bradycardia.

Concomitant use with metoprolol can increase risk of bradycardia due to slowed atrioventricular conduction and decreased heart rate.

Calcium channel blocker that slows atrioventricular conduction; concomitant use with metoprolol can increase risk of bradycardia.

Patients taking metoprolol with history of severe anaphylactic reactions may be unresponsive to usual doses of epinephrine used to treat allergic reactions.

Strong CYP2D6 inhibitor that doubles metoprolol concentrations, decreasing cardioselectivity.

Hydrochlorothiazide reduces renal clearance of lithium and increases risk of lithium toxicity. Monitor serum lithium concentrations.

Catecholamine-depleting drugs that may have additive effect with metoprolol, increasing risk of hypotension or bradycardia.

Strong CYP2D6 inhibitor that doubles metoprolol concentrations, decreasing cardioselectivity.

Strong CYP2D6 inhibitor that doubles metoprolol concentrations, decreasing cardioselectivity.

Strong CYP2D6 inhibitor that doubles metoprolol concentrations, decreasing cardioselectivity.

Catecholamine-depleting drug that may have additive effect with metoprolol, increasing risk of hypotension or bradycardia.

Some inhalation anesthetics may enhance the cardiodepressant effect of metoprolol.

Calcium channel blocker that slows atrioventricular conduction; concomitant use with metoprolol can increase risk of bradycardia.

Dosage adjustment of antidiabetic drug may be required due to hydrochlorothiazide interaction.

Potent CYP2D6 inhibitor may increase plasma concentration of metoprolol; caution should be exercised.

Ion exchange resin that reduces hydrochlorothiazide absorption by up to 85%. Stagger dosing with at least 4 hours separation.

Potent CYP2D6 inhibitor may increase plasma concentration of metoprolol; caution should be exercised.

Ion exchange resin that reduces hydrochlorothiazide absorption by 43%. Stagger dosing with 4-6 hours separation.

Potent CYP2D6 inhibitor may increase plasma concentration of metoprolol; caution should be exercised.

Potent CYP2D6 inhibitor may increase plasma concentration of metoprolol; caution should be exercised.

Hydrochlorothiazide may increase, decrease, or have no effect on insulin requirements in diabetic patients; monitoring recommended.

( 7.1 ) CYP2D6 inhibitors: Increased metoprolol concentration. ( 7.2 ) 7.1 Drug Interactions with Metoprolol Catecholamine Depleting Drugs: The concomitant use of catecholamine-depleting drugs (e.g., reserpine, monoamine oxidase (MAO) inhibitors) with beta adrenergic blockers may have an additive affect and increase the risk of hypotension or bradycardia CYP2D6 Inhibitors: Drugs that are strong inhibitors of CYP2D6 such as quinidine, fluoxetine, paroxetine, and propafenone were shown to double metoprolol concentrations. While there is no information about moderate or weak inhibitors, these too are likely to increase metoprolol concentration.

NSAIDs may reduce the diuretic, natriuretic, and antihypertensive effects of hydrochlorothiazide.

Thiazides may decrease arterial responsiveness to norepinephrine, but not enough to preclude its therapeutic effectiveness as a pressor agent.

Concomitant use of ACTH with hydrochlorothiazide may cause hypokalemia, which can sensitize the heart to toxic effects of digitalis.

Potent CYP2D6 inhibitor may increase plasma concentration of metoprolol; caution should be exercised.

Potent CYP2D6 inhibitor may increase plasma concentration of metoprolol; caution should be exercised.

Potent CYP2D6 inhibitor may increase plasma concentration of metoprolol; caution should be exercised.

Concomitant use of steroids with hydrochlorothiazide may cause hypokalemia, which can sensitize the heart to toxic effects of digitalis.

Thiazides may increase the responsiveness to tubocurarine.

7.2 Drug Interactions with Hydrochlorothiazide Antidiabetic Drugs (oral agents and insulin) Dosage adjustment of the antidiabetic drug may be required. Ion Exchange Resins Absorption of hydrochlorothiazide is impaired in the presence of anionic exchange resins. Single doses of either cholestyramine or colestipol resins bind the hydrochlorothiazide and reduce its absorption from the gastrointestinal tract by up to 85% and 43%, respectively.

Rare reports in literature of hemolytic anemia occurring with concomitant use of hydrochlorothiazide and methyldopa.