• Metoprolol

    (me toe' proe lole)

    IMPORTANT WARNING:

    Do not stop taking metoprolol without talking to your doctor. Suddenly stopping metoprolol may cause chest pain or heart attack. Your doctor will probably decrease your dose gradually.

    WHY is this medicine prescribed?

    Metoprolol is used alone or in combination with other medications to treat high blood pressure. It also is used to prevent angina (chest pain) and to improve survival after a heart attack. Extended-release (long-acting) metoprolol also is used in combination with other medications to treat heart failure. Metoprolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure

    HOW should this medicine be used?

    Metoprolol comes as a tablet and an extended-release tablet to take by mouth. The regular tablet is usually taken once or twice a day with meals or immediately after meals. The extended-release tablet is usually taken once a day. To help you remember to take metoprolol, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take metoprolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
    The long-acting tablet may be split. Swallow the whole or half tablets whole; do not chew or crush them.
    Your doctor may start you on a low dose of metoprolol and gradually increase your dose.
    Metoprolol controls high blood pressure and angina but does not cure them. Extended-release metoprolol controls heart failure but does not cure it. It may take a few weeks before you feel the full benefit of metoprolol. Continue to take metoprolol even if you feel well.

    Are there OTHER USES for this medicine?

    Metoprolol is also used sometimes to prevent migraine headaches and to treat irregular heartbeat and movement disorders caused by medications for mental illness. Talk to your doctor about the possible risks of using this medication for your condition.
    This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

    What SPECIAL PRECAUTIONS should I follow?

    Before taking metoprolol,
    • tell your doctor and pharmacist if you are allergic to metoprolol, acebutolol (Sectral), atenolol (Tenormin, in Tenoretic), betaxolol (Kerlone), bisoprolol (Zebeta, in Ziac), carvedilol (Coreg), esmolol (Brevibloc), labetalol (Trandate), nadolol (Corgard, in Corzide), pindolol, propranolol (Inderal, Inderal LA, Innopran XL, in Inderide), sotalol (Betapace, Betapace AF, Sorine), timolol (Blocadren, in Timolide), any other medications, or any of the ingredients in metoprolol tablets. Ask your pharmacist for a list of the ingredients.
    • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: bupropion (Wellbutrin), cimetidine (Tagamet), clonidine (Catapres), diphenhydramine (Benadryl), fluoxetine (Prozac, Sarafem), hydroxychloroquine, paroxetine (Paxil), propafenone (Rythmol), quinidine (Quinaglute, Quinidex), ranitidine (Zantac), reserpine (Serpalan, Serpasil, Serpatab), ritonavir (Norvir), terbinafine (Lamisil), and thioridazine (Mellaril). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
    • tell your doctor if you have a slow heart rate, heart failure, problems with blood circulation, or pheochromocytoma (a tumor that develops on a gland near the kidneys and may cause high blood pressure and fast heartbeat). Your doctor may tell you not to take metoprolol.
    • tell your doctor if you have or have ever had asthma or other lung disease; heart or liver disease; diabetes; severe allergies; or an overactive thyroid gland (hyperthyroidism).
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking metoprolol, call your doctor.
    • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking metoprolol.
    • you should know that metoprolol may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
    • remember that alcohol can add to the drowsiness caused by this medication.
    • you should know that if you have allergic reactions to different substances, your reactions may be worse while you are using metoprolol, and your allergic reactions may not respond to the usual doses of injectable epinephrine.

    What SPECIAL DIETARY instructions should I follow?

    If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.

    What should I do IF I FORGET to take a dose?

    Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Metoprolol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
    • dizziness or lightheadedness
    • tiredness
    • depression
    • nausea
    • dry mouth
    • stomach pain
    • vomiting
    • gas or bloating
    • heartburn
    • constipation
    • rash or itching
    • cold hands and feet
    • runny nose
    Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
    • shortness of breath
    • wheezing
    • swelling of the hands, feet, ankles, or lower legs
    • unusual weight gain
    • fainting
    • rapid, pounding, or irregular heartbeat
    Metoprolol may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
    Symptoms of overdose may include:
    • dizziness
    • fainting
    • difficulty breathing or swallowing
    • swelling of the hands, feet, ankles, or lower legs

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor. Your blood pressure should be checked regularly to determine your response to metoprolol. Your doctor may ask you to check your pulse (heart rate). Ask your pharmacist or doctor to teach you how to take your pulse. If your pulse is faster or slower than it should be, call your doctor.
    Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • Dutoprol® (as a combination product containing Metoprolol Succinate and Hydrochlorothiazide)
    • Lopressidone® (as a combination product containing Chlorthalidone and Metoprolol Tartrate)
    • Lopressor®
    • Lopressor® HCT (as a combination product containing Metoprolol Tartrate and Hydrochlorothiazide)
    • Toprol®
    • Toprol XL®
    • Also available generically

    Hydrochlorothiazide

    (hye droe klor oh thye' a zide)

    IMPORTANT WARNING:

    This MedWatch affects the following medications:
    Amturnide (aliskiren hemifumarate, amlodipine besylate, and hydrochlorothiazide)
    Tekturna (aliskiren hemifumarate)
    Tekturna HCT (aliskiren hemifumarate and hydrochlorothiazide)
    Tekamlo (aliskiren hemifumarate and amlodipine besylate)
    Valturna (aliskiren hemifumarate and valsartan). Valturna will no longer be marketed after July 2012.
    [Posted 04/20/2012] ISSUE: FDA notified healthcare professionals of possible risks when using blood pressure medicines containing aliskiren with other drugs called angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in patients with diabetes or kidney (renal) impairment. These drug combinations should not be used (are contraindicated) in patients with diabetes. In addition, avoid use of aliskiren with ARBs or ACEIs in patients with moderate to severe renal impairment (i.e., where glomerular filtration rate [GFR] < 60 mL/min). The labels for the aliskiren drugs are being updated based on preliminary data from a clinical trial, ''Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE).''
    BACKGROUND: Aliskiren is a renin inhibitor used to treat high blood pressure (hypertension) by lowering blood pressure.
    RECOMMENDATION: Concomitant use of aliskiren with ARBs or ACEIs in patients with diabetes is contraindicated because of the risk of renal impairment, hypotension, and hyperkalemia. Avoid use of aliskiren with ARBs or ACEIs in patients with renal impairment where GFR < 60 mL/min. Patients should not stop taking aliskiren without talking to your healthcare professional. Stopping aliskiren suddenly can cause problems if your high blood pressure (hypertension) is not treated.
    See the Drug Safety Communication for the Data Summary at: http://www.fda.gov/Drugs/DrugSafety/ucm300889.htm for a list of ACEI and ARB products, and additional recommendations for healthcare professionals and patients. For more information visit the FDA website at: http://www.fda.gov/Safety/MedWatch/SafetyInformation and http://www.fda.gov/Drugs/DrugSafety .

    WHY is this medicine prescribed?

    Hydrochlorothiazide, a 'water pill,' is used to treat high blood pressure and fluid retention caused by various conditions, including heart disease. It causes the kidneys to get rid of unneeded water and salt from the body into the urine.
    This medicine is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

    HOW should this medicine be used?

    Hydrochlorothiazide comes as a tablet and liquid to take by mouth. It usually is taken once or twice a day. If you are to take it once a day, take it in the morning; if you are to take it twice a day, take it in the morning and in the late afternoon to avoid going to the bathroom during the night. Take this medication with a meal or snack. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take hydrochlorothiazide exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
    Hydrochlorothiazide controls high blood pressure but does not cure it. Continue to take hydrochlorothiazide even if you feel well. Do not stop taking hydrochlorothiazide without talking to your doctor.

    Are there OTHER USES for this medicine?

    Hydrochlorothiazide may also be used to treat patients with diabetes insipidus and certain electrolyte disturbances and to prevent kidney stones in patients with high levels of calcium in their blood. Talk to your doctor about the possible risks of using this medicine for your condition.

    What SPECIAL PRECAUTIONS should I follow?

    Before taking hydrochlorothiazide,
    • tell your doctor and pharmacist if you are allergic to hydrochlorothiazide, sulfa drugs, or any other drugs.
    • tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially other medicines for high blood pressure, anti-inflammatory medications such as ibuprofen (Motrin, Nuprin) or naproxen (Aleve), corticosteroids (e.g., prednisone), lithium (Eskalith, Lithobid), medications for diabetes, probenecid (Benemid), and vitamins. If you also are taking cholestyramine or colestipol, take it at least 1 hour after hydrochlorothiazide.
    • tell your doctor if you have or have ever had diabetes, gout, or kidney, liver, thyroid, or parathyroid disease.
    • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking hydrochlorothiazide, call your doctor immediately.
    • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking hydrochlorothiazide.
    • you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you.
    • remember that alcohol can add to the drowsiness caused by this drug.
    • plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Hydrochlorothiazide may make your skin sensitive to sunlight.

    What SPECIAL DIETARY instructions should I follow?

    Follow your doctor's directions. They may include following a daily exercise program or a low-salt or low-sodium diet, potassium supplements, and increased amounts of potassium-rich foods (e.g., bananas, prunes, raisins, and orange juice) in your diet.

    What should I do IF I FORGET to take a dose?

    Take the missed dose as soon as you remember it. However, if it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

    What SIDE EFFECTS can this medicine cause?

    Frequent urination should go away after you take hydrochlorothiazide for a few weeks. Tell your doctor if any of these symptoms are severe or do not go away:
    • muscle weakness
    • dizziness
    • cramps
    • thirst
    • stomach pain
    • nausea
    • vomiting
    • diarrhea
    • loss of appetite
    • headache
    • hair loss
    If you experience any of the following symptoms, call your doctor immediately:
    • sore throat with fever
    • unusual bleeding or bruising
    • severe skin rash with peeling skin
    • difficulty breathing or swallowing
    If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088].

    What should I know about STORAGE and DISPOSAL of this medication?

    Keep this medicine in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not allow the liquid to freeze. Throw away any medicine that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medicine.

    What should I do in case of OVERDOSE?

    In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

    What OTHER INFORMATION should I know?

    Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly, and blood tests should be done occasionally.
    Do not let anyone else take your medicine. Ask your pharmacist any questions you have about refilling your prescription.
    It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

    Brand Names

    • HydroDIURIL®
    • Microzide®
    • Amturnide® (as a combination product containing Aliskiren, Amlodipine, Hydrochlorothiazide)
    • Apresazide® (as a combination product containing Hydralazine, Hydrochlorothiazide)
    • Accuretic® (as a combination product containing Quinapril, Hydrochlorothiazide)
    • Benicar® HCT (as a combination product containing Olmesartan, Hydrochlorothiazide)
    • Diovan® HCT (as a combination product containing Valsartan, Hydrochlorothiazide)
    • Dutoprol® (as a combination product containing Metoprolol, Hydrochlorothiazide)
    • Exforge® HCT (as a combination product containing Amlodipine, Hydrochlorothiazide, Valsartan)
    • Hydrap-ES® (as a combination product containing Hydralazine, Hydrochlorothiazide, Reserpine)
    • Hydro-Reserp® (as a combination product containing Hydrochlorothiazide, Reserpine)
    • Hydropres® (as a combination product containing Hydrochlorothiazide, Reserpine)
    • Hydroserp® (as a combination product containing Hydrochlorothiazide, Reserpine)
    • Hydroserpine® (as a combination product containing Hydrochlorothiazide, Reserpine)
    • Hydra-Zide® (as a combination product containing Hydralazine, Hydrochlorothiazide)
    • Inderide® (as a combination product containing Hydrochlorothiazide, Propranolol)
    • Inderide® LA (as a combination product containing Hydrochlorothiazide, Propranolol)
    • Lopressor® HCT (as a combination product containing Metoprolol, Hydrochlorothiazide)
    • Mallopress® (as a combination product containing Hydrochlorothiazide, Reserpine)
    • Marpres® (as a combination product containing Hydralazine, Hydrochlorothiazide, Reserpine)
    • Monopril® HCT (as a combination product containing Fosinopril, Hydrochlorothiazide)
    • Quinaretic® (as a combination product containing Quinapril, Hydrochlorothiazide)
    • Ser-Ap-Es® (as a combination product containing Hydralazine, Hydrochlorothiazide, Reserpine)
    • Serathide® (as a combination product containing Hydralazine, Hydrochlorothiazide, Reserpine)
    • Serpazide® (as a combination product containing Hydralazine, Hydrochlorothiazide, Reserpine)
    • Serpex® (as a combination product containing Hydralazine, Hydrochlorothiazide, Reserpine)
    • Tekturna® HCT (as a combination product containing Aliskiren, Hydrochlorothiazide)
    • Teveten® HCT (as a combination product containing Eprosartan, Hydrochlorothiazide)
    • Timolide® (as a combination product containing Timolol, Hydrochlorothiazide)
    • Tri-Hydroserpine® (as a combination product containing Hydralazine, Hydrochlorothiazide, Reserpine)
    • Tribenzor® (as a combination product containing Amlodipine, Hydrochlorothiazide, Olmesartan)
    • Uni Serp® (as a combination product containing Hydralazine, Hydrochlorothiazide, Reserpine)
    • Unipres® (as a combination product containing Hydralazine, Hydrochlorothiazide, Reserpine)
    • Uniretic® (as a combination product containing Moexipril, Hydrochlorothiazide)
    • Ziac® (as a combination product containing Bisoprolol, Hydrochlorothiazide)
    • Also available generically
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