metoprolol succinate and hydrochlorothiazide

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Overview

What is metoprolol succinate and hydrochlorothiazide?

Metoprolol Succinate Extended Release/Hydrochlorothiazide combines a beta adrenoceptor blocker and a thiazide diuretic.

Metoprolol succinate is chemically described as (±)1-(isopropylamino)-3-[p-(2-methoxyethyl) phenoxy]-2-propanol succinate (2:1) (salt). Its structural formula is:

Metoprolol succinate is a white crystalline powder with a molecular weight of 652.8. It is freely soluble in water, soluble in methanol, sparingly soluble in ethanol, slightly soluble in dichloromethane and 2-propanol, and practically insoluble in ethyl-acetate, acetone, diethylether and heptane.

Hydrochlorothiazide is 6-chloro-3,4-dihydro-2H-1,2,4-benzothiadiazine-7-sulfonamide 1,1-dioxide. Its empirical formula is CHClNOS and its structural formula is:

Hydrochlorothiazide is a white, or practically white, crystalline powder with a molecular weight of 297.74, which is slightly soluble in water, but freely soluble in sodium hydroxide solution.

Metoprolol Succinate Extended Release/Hydrochlorothiazide is for oral administration supplied in 3 tablet strengths of metoprolol succinate extended release and hydrochlorothiazide.

Metoprolol Succinate Extended Release/Hydrochlorothiazide 25/12.5 contains 23.75 mg of metoprolol succinate extended release, equivalent to 25 mg of metoprolol tartrate and 12.5 mg of hydrochlorothiazide. Metoprolol Succinate Extended Release/Hydrochlorothiazide 50/12.5 contains 47.5 mg of metoprolol succinate extended release, equivalent to 50 mg of metoprolol tartrate, and 12.5 mg of hydrochlorothiazide. Metoprolol Succinate Extended Release/Hydrochlorothiazide 100/12.5 contains 95 mg of metoprolol succinate extended release, equivalent to 100 mg of metoprolol tartrate, and 12.5 mg of hydrochlorothiazide. The inactive ingredients of the tablets are silicon dioxide, ethylcellulose, hydroxypropyl cellulose, cornstarch, microcrystalline cellulose, polyvinyl pyrrolidone, sodium stearyl fumarate, hydroxypropyl methylcellulose, polyethylene glycol 6000, titanium dioxide, iron oxide (yellow), iron oxide (red) and paraffin.

What does metoprolol succinate and hydrochlorothiazide look like?

What are the available doses of metoprolol succinate and hydrochlorothiazide?

Tablets (metoprolol succinate/HCTZ mg): 25/12.5 mg, 50/12.5 mg, 100/12.5 mg. ()

What should I talk to my health care provider before I take metoprolol succinate and hydrochlorothiazide?

How should I use metoprolol succinate and hydrochlorothiazide?

Metoprolol Succinate Extended Release/Hydrochlorothiazide is a combination tablet of metoprolol succinate, a beta adrenoceptor blocking agent and hydrochlorothiazide, a diuretic. Metoprolol Succinate Extended Release/Hydrochlorothiazide is indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure lowers the risk of fatal and non-fatal cardiovascular (CV) events, primarily strokes and myocardial infarction. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including metoprolol and hydrochlorothiazide.

Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than 1 drug to achieve blood pressure goals. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC).

Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly.

Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension (for example, patients with diabetes or hyperlipidemia), and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal.

Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (e.g., on angina, heart failure, or diabetic kidney disease). These considerations may guide selection of therapy.

Metoprolol Succinate Extended Release/Hydrochlorothiazide may be administered with other antihypertensive agents.

The recommended starting dose of Metoprolol Succinate Extended Release/Hydrochlorothiazide is 25 mg/12.5 mg taken orally once daily with or without food. Depending on the blood pressure response, the dose may be titrated at intervals of 2 weeks to a maximum recommended dose of 200 mg/25 mg (two Metoprolol Succinate Extended Release/Hydrochlorothiazide 100 mg/12.5 mg tablets) once daily .

For specific advice on blood pressure goals, see published guidelines, such as those of the National High Blood Pressure Education Program’s Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC).

What interacts with metoprolol succinate and hydrochlorothiazide?

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What are the warnings of metoprolol succinate and hydrochlorothiazide?

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What are the precautions of metoprolol succinate and hydrochlorothiazide?

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What are the side effects of metoprolol succinate and hydrochlorothiazide?

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What should I look out for while using metoprolol succinate and hydrochlorothiazide?

Metoprolol Succinate Extended Release/Hydrochlorothiazide is contraindicated in patients with:

What might happen if I take too much metoprolol succinate and hydrochlorothiazide?

How should I store and handle metoprolol succinate and hydrochlorothiazide?

Store at 25°C (77°F); excursions permitted between 15°C to 30°C (59°F to 86°F) Metoprolol Succinate Extended Release/Hydrochlorothiazide is supplied as circular, biconvex, film-coated tablets engraved on one side.Store at 25°C (77°F). Excursions permitted to 15-30°C (59‑86°F). (See USP Controlled Room Temperature.)Metoprolol Succinate Extended Release/Hydrochlorothiazide is supplied as circular, biconvex, film-coated tablets engraved on one side.Store at 25°C (77°F). Excursions permitted to 15-30°C (59‑86°F). (See USP Controlled Room Temperature.)

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Clinical Information

Chemical Structure

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Clinical Pharmacology

The mechanism of the antihypertensive effects of beta adrenergic blockers has not been elucidated. However, several possible mechanisms have been proposed: (1) competitive antagonism of catecholamines at peripheral (especially cardiac) adrenergic neuron sites, leading to decreased cardiac output; (2) a central effect leading to reduced sympathetic outflow to the periphery; and (3) suppression of renin activity.

The mechanism of the antihypertensive effect of thiazide diuretics is unknown.

Non-Clinical Toxicology

Metoprolol Succinate Extended Release/Hydrochlorothiazide is contraindicated in patients with:

Following abrupt cessation of therapy with beta adrenergic blockers, exacerbations of angina pectoris and myocardial infarction may occur. When discontinuing chronically administered Metoprolol Succinate Extended Release/Hydrochlorothiazide, particularly in patients with ischemic heart disease, gradually reduce the dosage over a period of 1–2 weeks and monitor the patient. If angina markedly worsens or acute coronary ischemia develops, promptly resume therapy and take measures appropriate for the management of unstable angina. Warn patients not to interrupt therapy without their physician’s advice. Because coronary artery disease is common and may be unrecognized, avoid abrupt discontinuation of Metoprolol Succinate Extended Release/Hydrochlorothiazide in patients treated only for hypertension.

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Reference

This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"

While we update our database periodically, we cannot guarantee it is always updated to the latest version.

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Professional

Clonazepam Description Each single-scored tablet, for oral administration, contains 0.5 mg, 1 mg, or 2 mg Clonazepam, USP, a benzodiazepine. Each tablet also contains corn starch, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and povidone. Clonazepam tablets USP 0.5 mg contain Yellow D&C No. 10 Aluminum Lake. Clonazepam tablets USP 1 mg contain Yellow D&C No. 10 Aluminum Lake, as well as FD&C Blue No. 1 Aluminum Lake. Chemically, Clonazepam, USP is 5-(o-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one. It is a light yellow crystalline powder. It has the following structural formula: C15H10ClN3O3 M.W. 315.72

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Interactions

A total of 440 drugs (1549 brand and generic names) are known to interact with Imbruvica (ibrutinib). 228 major drug interactions (854 brand and generic names) 210 moderate drug interactions (691 brand and generic names) 2 minor drug interactions (4 brand and generic names) Show all medications in the database that may interact with Imbruvica (ibrutinib).

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