$Unique_ID{BRK02038}
$Pretitle{}
$Title{METOPROLOL AND HYDROCHLOROTHIAZIDE COMBINATION}
$Subject{Lopressor HCT (Geigy)}
$Volume{}
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Copyright (C) 1991 Publications International, Ltd.


METOPROLOL AND HYDROCHLOROTHIAZIDE COMBINATION
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BRAND NAME (Manufacturer):
     Lopressor HCT (Geigy)
TYPE OF DRUG:
     Beta-adrenergic blocking agent and diuretic
INGREDIENTS:
     metoprolol and hydrochlorothiazide
DOSAGE FORM:
     Tablets (50 mg metoprolol and 25 mg hydrochlorothiazide; 100 mg
       metoprolol and 25 mg hydrochlorothiazide; and 100 mg metoprolol and 50
       mg hydrochlorothiazide)
STORAGE:
     Metoprolol and hydrochlorothiazide combination tablets should be stored
       at room temperature in a tightly closed, light-resistant container.

USES

     Metoprolol and hydrochlorothiazide combination is prescribed to treat
high blood pressure.  Hydrochlorothiazide is a diuretic (water pill), which
reduces fluid accumulation in the body by increasing the elimination of sodium
and water through the kidneys.  Metoprolol belongs to a group of medications
known as beta-adrenergic blocking agents or, more commonly, beta blockers.
They work by controlling impulses along certain nerve pathways.

TREATMENT

     This medication can be taken with a glass of water, with meals,
immediately following meals, or on an empty stomach, depending on your
doctor's instructions.
     Try to take the medication at the same time(s) each day.  Avoid taking a
dose after 6:00 P.M.; otherwise, you may have to get up during the night to
urinate.
     If you miss a dose of this medication, take the missed dose as soon as
possible, unless it is almost time for your next dose.  In that case, do not
take the missed dose at all; just wait until the next scheduled dose.  Do not
double the dose.
     Metoprolol and hydrochlorothiazide combination does not cure high blood
pressure, but it will help to control the condition as long as you continue to
take it.

SIDE EFFECTS

     Minor.

     Anxiety, cold hands and feet (due to decreased blood circulation to the
skin, fingers, and toes), constipation, cramps, decreased sexual ability,
diarrhea, difficulty in sleeping, dizziness, drowsiness, dryness of the eyes
and skin, gas, headache, heartburn, loss of appetite, nervousness,
restlessness, stomach discomfort, sweating, or tiredness.  These side effects
should disappear as your body adjusts to the medication.
     Hydrochlorothiazide can cause increased sensitivity to sunlight.  It is,
therefore, important to avoid prolonged exposure to sunlight and sunlamps.
Wear protective clothing and sunglasses, and use an effective sunscreen.
     If you become extra-sensitive to the cold, be sure to dress warmly during
cold weather.
     Plain, nonmedicated eye drops (artificial tears) may help to relieve eye
dryness.
     To relieve constipation, increase the amount of fiber in your diet (fresh
fruits and vegetables, salads, bran, and whole-grain breads), and exercise
(unless your doctor directs you to do otherwise).
     To avoid dizziness or light-headedness when you stand, contract and relax
the muscles of your legs for a few moments before rising.  Do this by
alternately pushing one foot against the floor while raising the other foot
slightly, so that you are "pumping" your legs in a pedaling motion.

     Major.

     Tell your doctor about any side effects that are persistent or
particularly bothersome.  IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about
blurred vision, confusion, depression, difficulty in breathing, dry mouth,
excessive thirst, fever, hair loss, hallucinations, itching, joint pain, mood
changes, muscle pain or spasms, nausea, nightmares, numbness or tingling in
the fingers or toes, palpitations, rapid weight gain (three to five pounds
within a week), reduced alertness, ringing in the ears, skin rash, sore
throat, swelling, thirst, unusual bleeding or bruising, vomiting, weakness, or
yellowing of the eyes or skin.

INTERACTIONS

     Metoprolol and hydrochlorothiazide combination can interact with several
other types of medications:
     1. Indomethacin, aspirin, and other salicylates may decrease the
blood-pressure-lowering effects of beta blockers.
     2. Concurrent use of metoprolol and calcium channel blockers (diltiazem,
nifedipine, verapamil) or disopyramide can lead to heart failure or very low
blood pressure.
     3. Cimetidine can increase the blood levels of metoprolol, which can
result in greater side effects.  Side effects may also be increased when
metoprolol is taken with clonidine, digoxin, epinephrine, phenylephrine,
phenylpropanolamine, phenothiazine tranquilizers, prazosin, reserpine, or
monoamine oxidase (MAO) inhibitors.  At least 14 days should separate the use
of metoprolol and the use of an MAO inhibitor in order to prevent potentially
dangerous interactions.
     4. Alcohol, barbiturates, and rifampin can decrease the blood
concentrations of metoprolol, which can result in a decrease of effectiveness.
     5. Metoprolol can antagonize (act against) the effects of theophylline,
aminophylline, albuterol, isoproterenol, metaproterenol, and terbutaline.
     6. Metoprolol and hydrochlorothiazide combination can interact with
insulin and oral antidiabetic agents, raising or lowering blood sugar levels
and masking the symptoms of low blood sugar.
     7. Hydrochlorothiazide can decrease the effectiveness of oral
anticoagulants (blood thinners, such as warfarin), antigout medications, and
methenamine.
     8. Fenfluramine may increase the blood-pressure-lowering effects of this
drug, which can be dangerous.
     9. Cholestyramine and colestipol can decrease the absorption of
hydrochlorothiazide from the gastrointestinal tract.  This drug should,
therefore, be taken one hour before or four hours after a dose of
cholestyramine or colestipol (if you have also been prescribed one of these
drugs).
     10. Hydrochlorothiazide may increase the side effects of amphotericin B,
calcium, cortisone and cortisone-like steroids (such as dexamethasone,
hydrocortisone, prednisone, and prednisolone), digoxin, digitalis, lithium,
quinidine, sulfonamide antibiotics, and vitamin D.
     11. The action of beta blockers may be increased if they are used with
chlorpromazine, furosemide, hydralozine, or oral contraceptives, which may
have a negative effect.
     Before starting metoprolol and hydrochlorothiazide combination, BE SURE
TO TELL YOUR DOCTOR about all of the medications you are currently taking,
especially any of the ones listed above.

WARNINGS

     * Tell your doctor about unusual or allergic reactions you have had to
any medications, especially to metoprolol or any other beta blocker
(acebutolol, atenolol, carteolol, esmolol, labetalol, nadolol, penbutolol,
pindolol, propranolol, or timolol), to hydrochlorothiazide or other diuretics
(such as bendroflumethiazide, benzthiazide, chlorothiazide, chlorthalidone,
cyclothiazide, hydroflumethiazide, methyclothiazide, metolazone, polythiazide,
quinethazone, trichlormethiazide, and furosemide), or to any sulfa drug (oral
antidiabetic medication or sulfonamide antibiotics).
     * Tell your doctor if you now have or if you have ever had asthma,
diabetes mellitus, heart disease, gout, kidney disease or problems with
urination, liver disease, lung disease, pancreatitis, poor circulation in the
fingers or toes, systemic lupus erythematosus, or thyroid disease.
     * Hydrochlorothiazide can cause potassium loss.  Signs of potassium loss
include dry mouth, muscle pain or cramps, nausea, thirst, vomiting, and
weakness.  If you experience any of these symptoms, call your doctor.  To help
prevent this problem, your doctor may have blood tests performed periodically
to monitor your potassium levels.  To help avoid potassium loss, take this
medication with a glass of fresh or frozen orange juice or cranberry juice, or
eat a banana every day.  The use of a salt substitute also helps to prevent
potassium loss.  Do not change your diet, however, until you discuss it with
your doctor.  Too much potassium may also be dangerous.
     * While taking this medication, limit your intake of alcohol in order to
prevent dizziness and light-headedness.
     * Do not take any over-the-counter (nonprescription) medication for
weight control or for allergy, asthma, cough, cold or sinus problems unless
you first check with your doctor.
     * To prevent severe water loss (dehydration) while taking this
medication, check with your doctor if you have any illness that causes severe
or continuous nausea, vomiting, or diarrhea.
     * This medication can raise blood sugar levels in diabetic patients.
Blood sugar levels should be monitored carefully with blood or urine tests
when this medication is being taken.
     * You may want to check your pulse while taking this medication.  If your
pulse is much slower than your usual rate (or if it is less than 50 beats per
minute), discuss the situation with your doctor.  A pulse rate that is too
slow may cause circulation problems.
     * Metoprolol can affect your body's response to exercise.  Make sure you
ask your doctor what an appropriate amount of exercise would be for you,
taking into account your medical condition.
     * Before having surgery or any other medical or dental treatment, tell
your doctor or dentist that you are taking this medicine.  Often, this
medication will be discontinued 48 hours prior to any major surgery.
     * This medication can cause dizziness, drowsiness, light-headedness, or
decreased alertness.  Therefore, exercise caution while driving a car or
operating potentially dangerous machinery.
     * A doctor does not usually prescribe a "fixed-dose" drug like this as
the first choice in the treatment of high blood pressure.  Usually, the
patient first receives each ingredient singly.  If there is an adequate
response to the fixed dose contained in this product, it can then be
substituted.  The advantage of a combination product is increased convenience
and (often) decreased cost.
     * It is important that you do not stop taking this medicine unless you
first check with your doctor.  Some conditions worsen when this medicine is
stopped suddenly, and the danger of a heart attack is increased in some
patients.  Your doctor may, therefore, want you to gradually reduce the amount
of medicine you take before stopping completely.  Make sure that you have
enough medicine on hand to last through vacations, holidays, and weekends.
     * Be sure to tell your doctor if you are pregnant.  Animal studies have
shown that some beta blockers can cause problems in pregnancy when used at
very high doses.  Adequate studies have not been conducted in humans, but
there has been some association between beta blockers used during pregnancy
and low birth weight, as well as breathing problems and slow heart rate in
newborn infants.  However, other reports have shown no effects on newborn
infants.  Also, tell your doctor if you are breast-feeding an infant.
Although problems in humans have not yet been reported, small amounts of
metoprolol and hydrochlorothiazide pass into breast milk, so caution is
warranted.

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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
