metoprolol / HCTZ

• Risk factors: Suddenly stopping metoprolol/hydrochlorothiazide

Don't suddenly stop taking metoprolol/hydrochlorothiazide without first speaking to your provider. Doing so can cause or worsen chest pain or heart attack. If you've been taking this medication for a while and want to stop, your provider will lower your dose slowly over the course of 1-2 weeks.

• Risk factors: Heart failure

People with heart failure shouldn't take metoprolol/hydrochlorothiazide if their heart failure symptoms aren’t well-managed. That’s because this medication can make your condition worse, especially if your provider raises your dose. But you might be able to take metoprolol/hydrochlorothiazide if your healthcare provider thinks your symptoms are under control. Let your healthcare provider know right away if you experience symptoms of heart failure, such as fluid build-up in different areas of the body including the ankles, legs, and lungs, and difficulty breathing.

• Risk factors: Chronic obstructive pulmonary disease (COPD) | Asthma

Metoprolol/hydrochlorothiazide can cause the vessels in your lung to tighten. This can make breathing difficult, especially in people with breathing problems, like asthma or COPD. Metoprolol/hydrochlorothiazide might also cause certain medications taken to ease these conditions to not work as well. Let your doctor know if you have any breathing problems before starting metoprolol/hydrochlorothiazide.

• Risk factors: Taking other medications that slow heart rate | Heart rhythm problems

People who've taken metoprolol/hydrochlorothiazide have experienced their heart rate dropping too low. If you have heart problems, such as heart block, let your provider know. They might ask you to check your heart rate regularly after starting this medication. If your heart rate drops below 60 beats per minute or if you feel symptoms such as dizziness, chest pain, or trouble catching your breath, let your provider know. They might taper you off of metoprolol/hydrochlorothiazide slowly and prescribe a different medication for your blood pressure.

• Risk factors: Major surgery requiring anesthesia

Both beta-blockers, like metoprolol, and medications used for anesthesia can lower your heart rate. So, if you’re planning to undergo a major surgery that requires anesthesia, tell your surgeon that you’re on metoprolol/hydrochlorothiazide so that they can monitor your heart closely.

• Risk factors: Diabetes

Taking metoprolol/hydrochlorothiazide can make it difficult for you to identify symptoms of low blood sugar, such as fast heart beat or tremors. If you’re taking medications, like glipizide or insulin, to lower your blood sugar, you might not be able to rely on all the typical symptoms of low blood sugar (e.g., irritability, sight tremors, confusion, and fast heartbeat) to warn you of a dangerous drop in your sugar levels. Sweating might be the only symptom not affected by taking metoprolol/hydrochlorothiazide. Speak with your healthcare provider about when and how to monitor your blood sugar if you start metoprolol/hydrochlorothiazide.

• Risk factors: Hyperthyroidism

If you have hyperthyroidism (overactive thyroid), talk to your healthcare provider before stopping metoprolol/hydrochlorothiazide. Because metoprolol/hydrochlorothiazide lowers your heart rate, it may be harder to notice heart-related symptoms that are caused by hyperthyroidism. In some people, stopping this medication suddenly may lead to a condition called a "thyroid storm,” which may include symptoms such as a high temperature, rapid heartbeat, and fainting.

• Risk factors: Kidney problems | Not enough fluid in your body | Taking other medications that can cause kidney damage

Taking metoprolol/hydrochlorothiazide can cause your fluids and electrolyte levels to be out of balance. This can put you at risk for conditions such as low potassium and low sodium levels. Your provider might order blood work to check your electrolyte level periodically during treatment. Let your provider know if you experience symptoms such as dizziness or tiredness.

In addition, taking metoprolol/hydrochlorothiazide can cause serious kidney problems for people who've already have kidney problems, heart failure, or are dehydrated. If you develop kidney problems, or if your kidney problems worsen while taking metoprolol/hydrochlorothiazide, your provider might recommend that you stop taking this medication. Let your provider know if you're urinating less often than usual, as this could be a sign that your kidneys aren't working as well.

• Risk factors: Sulfonamide or penicillin allergy Though rare, hydrochlorothiazide can cause eye problems, such as vision loss, eye pain, or angle-closure glaucoma. If it happens, symptoms can start within hours or weeks of starting metoprolol/hydrochlorothiazide. If you experience any vision changes, let your provider know because they might ask you to stop this medication. If left untreated, certain conditions (like glaucoma) can lead to permanent vision loss.

In some rare cases, metoprolol/hydrochlorothiazide can cause worsening of or new lupus. Let your provider know if you notice a rash across your cheeks and nose or feel very tired.

• Risk factors: History of sulfa allergies There is a small risk that people with allergies to sulfa medications can experience similar reactions with metoprolol/hydrochlorothiazide. Get medical attention right away if you develop signs of a serious allergic reaction such as swelling in the throat or difficulty breathing.