Metoprolol/hydrochlorothiazide is a combination medication that's used to lower blood pressure in adults. It contains a beta blocker (metoprolol tartrate) that slows down the heart and a thiazide diuretic (hydrochlorothiazide) that removes extra fluids through your kidneys. Metoprolol/hydrochlorothiazide is taken by mouth, typically once or twice daily with food. Some of the more common side effects of this medication include dizziness and tiredness. The brand name, Lopressor HCT, is no longer available.
Metoprolol/hydrochlorothiazide is a combination medication:
Metoprolol tartrate is a selective beta blocker. It slows down your heartbeat, which means there's less pressure on the blood vessels.
Hydrochlorothiazide is a thiazide diuretic (water pill). It works in the kidneys to remove extra water and certain electrolytes, like sodium and potassium, to lower blood pressure.
Source: DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Chest pain or discomfort
decreased urine
increased thirst
lightheadedness, dizziness, or fainting
loss of appetite
mood changes
muscle pain or cramps
nausea or vomiting
numbness or tingling in the hands, feet, or lips
seizures
slow or irregular heartbeat
unusual tiredness or weakness
Less common
Ankle, knee, or great toe joint pain
decreased ability to exercise
difficult or labored breathing
joint stiffness or swelling
lower back or side pain
swelling of the face, fingers, feet, or lower legs
tightness in the chest
Incidence not known
Persistent non-healing sore
pink growth
reddish patch or irritated area
shiny bump
white, yellow or waxy scar-like area
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Blurred vision
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
chemical imbalance in the blood
cold, clammy skin
coma
confusion
dilated neck veins
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
drowsiness
fast or pounding heartbeat or pulse
headache
increased volume of pale, dilute urine
irregular breathing
irritability
noisy breathing
not able to pass urine
pain or aching in the lower legs
pain or weakness in the hands or feet
seizures
sweating
trembling
unconsciousness
very drowsy or sleepy
weak pulse
weakness and heaviness of the legs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Chills
feeling of constant movement of self or surroundings
general feeling of discomfort or illness
muscle aches
nightmares
sensation of spinning
shivering
sleepiness
trouble sleeping
unusual drowsiness, dullness, or feeling of sluggishness
Less common
Continuing ringing or buzzing or other unexplained noise in the ears
decreased interest in sexual intercourse
difficulty having a bowel movement (stool)
hearing loss
inability to have or keep an erection
loss in sexual ability, desire, drive, or performance
pinpoint red or purple spots on the skin
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Taken by mouth just once or twice daily
Lowers risk of heart attack and stroke
Combines 2 medications into 1 pill for convenience
Can make you urinate more often
Stopping suddenly can raise risk of chest pain and heart attack
Fixed dosing, so not as easy to adjust the dose (compared to taking each medication separately)
It's best to take metoprolol/hydrochlorothiazide with food because food helps your body better absorb this medication.
If you're taking metoprolol/hydrochlorothiazide for the first time, it might take some time for you to experience the most benefit from this medication. Your provider will ask you to check and record your blood pressure often to get an idea of how this medication is working for you. They might need to adjust your dose of metoprolol/hydrochlorothiazide based on your blood pressure numbers.
Don't stop taking metoprolol/hydrochlorothiazide suddenly since it can trigger heart problems, such as chest pain or heart attack. If you want to stop taking this medication, let your provider know. They can help you stop safely by lowering your dose slowly over time.
If you miss a dose of metoprolol/hydrochlorothiazide, just skip the missed dose. Then, take your next dose at the next scheduled time. Don't take 2 doses to make up the missed dose.
Metoprolol/hydrochlorothiazide can make you urinate more often, so don't take it too close to bedtime. If you're taking this medication once daily, consider taking it in the morning. And if you're taking metoprolol/hydrochlorothiazide twice daily, you can take it in the morning and afternoon.
Taking metoprolol/hydrochlorothiazide can make you feel dizzy, especially when you first start this medication and any time your provider raises your dose. But this side effect should get better as your body gets used to metoprolol/hydrochlorothiazide.
To prevent dizziness and falls while taking metoprolol/hydrochlorothiazide, get up slowly if you've been sitting or lying down. Hold on to something stable as you pull yourself up.
Because metoprolol/hydrochlorothiazide lowers your heart rate, it can make it harder for you to identify symptoms of low blood sugar, such as fast heart beats. This is especially important for people with diabetes since you might not be able to rely on all the typical symptoms of low blood sugar to warn you of a dangerous drop in your sugar levels. Sweating might be the only symptom not affected.
If you have peripheral vascular disease, let your provider know because they might need to monitor your condition more closely. Taking metoprolol/hydrochlorothiazide might worsen certain symptoms of poor blood flow, such as cramping or tiredness.
Metoprolol/hydrochlorothiazide can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
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.
The typical dose is to take 1 tablet of metoprolol/hydrochlorothiazide by mouth once or twice daily, as directed.
Usually, the total daily dose of hydrochlorothiazide ranges from 25 mg to 50 mg. The total daily dose of metoprolol tartrate ranges from 100 mg to 200 mg.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Worsening heart failure with symptoms not under control
Heart block, heart rate slower than 60 beats per minute, heart rhythm problem (sick sinus syndrome)
Not making urine
Sulfa allergy
High blood pressure
High blood pressure in adults
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Alembic Pharmaceuticals Inc. (2024). Metoprolol tartrate- metoprolol tablet [package insert]. DailyMed.
National Heart, Lung, and Blood Institute. (2022). What is cardiogenic shock?
Sun Pharmaceutical Industries, Inc. (2024). Metoprolol tartrate and hydrochlorothiazide tablet [package insert]. DailyMed.
Vue, M. H., et al. (2011). Drug-induced glucose alterations part 1: Drug-induced hypoglycemia. Diabetes Spectrum.
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