Metoprolol + Hydrochlorothiazide Pharmacology

Metoprolol + Hydrochlorothiazide

About Metoprolol + Hydrochlorothiazide
Mechanism of Action of Metoprolol + Hydrochlorothiazide
Pharmacokinets of Metoprolol + Hydrochlorothiazide
Onset of Action for Metoprolol + Hydrochlorothiazide
Duration of Action for Metoprolol + Hydrochlorothiazide
Half Life of Metoprolol + Hydrochlorothiazide
Side Effects of Metoprolol + Hydrochlorothiazide
Contra-indications of Metoprolol + Hydrochlorothiazide
Special Precautions while taking Metoprolol + Hydrochlorothiazide
Pregnancy Related Information
Old Age Related Information
Breast Feeding Related Information
Children Related Information
Indications for Metoprolol + Hydrochlorothiazide
Interactions for Metoprolol + Hydrochlorothiazide
Typical Dosage for Metoprolol + Hydrochlorothiazide
Schedule of Metoprolol + Hydrochlorothiazide
Storage Requirements for Metoprolol + Hydrochlorothiazide
Effects of Missed Dosage of Metoprolol + Hydrochlorothiazide
Effects of Overdose of Metoprolol + Hydrochlorothiazide


About Metoprolol
A selective ?1 blocker, Anti-hypertensive.
Mechanism of Action of Metoprolol
Metoprolol is a cardio selective beta-1 adrenergic antagonist.
It have negative chronotropic and negative inotropic effects on heart. It decreases oxygen consumption; cardiac work and aortic pressure It decreases nor adrenaline and renin releases. It decreases central sympathetic out flow. In sympathetic over activity, it prolongs systole by retarding conduction. It increases oxygen supply and exercise tolerance in angina patients. The drug decreases BP in hypertensive individuals.
Antimigraine action: Metoprolol is useful in migraine due to its beta blockade action. Through beta blockade action it inhibits vasodilation and relieves migraine.
Pharmacokinets of Metoprolol
Absorption: well absorbed orally, bioavailabity is increased by administering along with food. Distribution: Widely distributed. Metabolism: Metabolized in liver by hydroxylation. Excretion: Excreted through urine.
Onset of Action for Metoprolol
Duration of Action for Metoprolol
Up to 1 to12 hours
Half Life of Metoprolol
Side Effects of Metoprolol
1.Heart failure
3.Gastrointestinal problems
6.Sinus bradycardia
Contra-indications of Metoprolol
1.Hypersensitivity to the drug
2.Second or third degree heart block
3.Congestive heart failure
4.Cardiogenic shock
6.Bronchial asthma
7.Diabetes mellitus
Special Precautions while taking Metoprolol
1.Congestive heart failure
2.Hepatic impairment
3.The drug should be gradually withdraw with caution
4.Respiratory disorders
Pregnancy Related Information
Old Age Related Information
Use with caution
Breast Feeding Related Information
Children Related Information
Indications for Metoprolol
5.Prophylaxis of myocardial infarction
Interactions for Metoprolol
Thioamines: Increased efficacy of metoprolol.
Thyroid hormones: Decreased efficacy of metoprolol.
Benzodiazepines: Increased efficacy of benzodiazepines.
Clonidine: Abrupt withdrawal of clonidine may lead to hypertensive crisis.
Ergot alkaloids: Peripheral ischaemia, possible peripheral gangrene.
Lidocaine: Increased lidocaine level may occur leading to toxicity.
Prazosin: Increased postural hypotension produced by parzosin.
Sulphonylureas: Hypoglycaemic effects may be attenuated.
Typical Dosage for Metoprolol
Adult: 50 to 450mg/day
Hypertension: Starts with 50mg to 100mg/day once daily or in divided doses and gradually increases up to 450mg/day based on patient`s response
Oral: 100mg to 150mg/day in 2 to 3 divided doses
I.V.: Dose range: 10 to 15mg. Starts with 5mg infused within 5minutes. Then repeat the therapy with the same dose at every 5minutes interval based on patient`s response
Maximum dose: 20mg
Angina: 50mg twice daily, gradually increases based on patient`s response at one week intervals
Maximum dose: 0.4gm/day
Migraine: 0.1 to 0.2gm/day in divided doses in 12th hourly to 6th hourly.
Prophylaxis of myocardial infarction: 0.1 to 0.2gm/day in divided doses
Myocardial infarction: 15mg in 3divided doses at 2minutes interval as I.V.bolus administration. Then 200mg orally in four divided doses for 2days.

Schedule of Metoprolol
Storage Requirements for Metoprolol
Store at controlled room temperature between 20 to 25 degree C in a well closed container

Effects of Missed Dosage of Metoprolol
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Metoprolol
Treatment is supportive and symptomatic. After ingestion empty the stomach by induced emesis or gastric lavage. Administer activated charcoal. Treat Bradycardia with atropine 0.5 to 1mg.If required administer isoproterinol with caution. Treat hypotension with glucagons and vasopressors like epinephrine. Treat cardiac failure with diuretics and cardiac glycosides. Treat bronchospasm with isoproterinol and aminophylline


About Hydrochlorothiazide
Thiazide derivatibve, Diuretic.
Mechanism of Action of Hydrochlorothiazide
It is thiazide diuretic which exerts its action by acting at site-3(central dilating segment of early distal tubule). It binds to Na+Cl- symporter and inhibits Na+Cl- symport at the luminal membrane. It has additional carbonic anhydrase inhibitory actions in proximal tubules. It increases natriuresis, kaliuresis and diuresis. It decreases Ca2+ excretion and increases Mg2+excretion. It also has minor carbonic anhydrase inhibitory action. It also causes direct arteriolar vasodilatation and decreases total peripheral resistance. The antihypertensive actions of the drug may be attributable to depletion of sodium and subsequent reduction in plasma volume and a decrease in peripheral resistance. Decrease in peripheral resistance is due to either the loss of sodium from the arteriolar wall or a direct action on the vascular bed. It is an effective drug in edema associated with congestive heart failure.
Vertigo: Diuretics are used in vertigo in assumption that vertigo is due to endolymphatic hydrops. They reduce labyrinthine fluid pressure

Pharmacokinets of Hydrochlorothiazide
Absorption: It is absorbed after oral administration.
Metabolism: It is not metabolized in the body.
Excretion: Excreted unchanged in urine.

Onset of Action for Hydrochlorothiazide
1 to 3 hours
Duration of Action for Hydrochlorothiazide
12 to 16 hours
Half Life of Hydrochlorothiazide
5 to 15 hours
Side Effects of Hydrochlorothiazide
1. Dizziness
2. Blurred vision
3. Confusion
4. Tingling fingers
5. Dry mouth
6. Nausea
7. Diarrhoea
8. Constipation
9. Vomiting
10. Weakness
11. Hypokalaemia
12. Hyponatraemia
13. Hyperuricaemia
14. Elevated levels of glucose, calcium and lipids
15. Gastro intestinal disturbances
16. Polyuria
17. Electrolyte imbalance
18. Jaundice
19. Rashes
20. Photosensitivity
21. Fever
22. Itching
23. Myalgia
24. Muscle cramps
25. Arthralgia
26. Blood dyscrasias
27. Ototoxicity

Contra-indications of Hydrochlorothiazide
1. Hyper uricaemia
2. Hyper calcaemia
3. Renal impairment
4. Hepatic impairment
5. Anuria
6. Hypersensitivity to the drug
7. Hyper sensitivity to sulfonamides
8. Fluid and electrolyte imbalance

Special Precautions while taking Hydrochlorothiazide
1. Gout
2. Diabetes mellitus
3. Renal impairment
4. Hepatic impairment
5. Monitor and correct Fluid and electrolyte imbalance
6. Hyper parathyroidism
7. Cirrhosis

Pregnancy Related Information
Old Age Related Information
Use with caution
Breast Feeding Related Information
Children Related Information
May be used
Indications for Hydrochlorothiazide
1. Hypertension
2. Oedema associated with heart failure
3. Oedema due to renal and hepatic diseases
4. Diabetes insipidus
5. Idiopathic hypercalciurea.
6. Vertigo
Interactions for Hydrochlorothiazide
Cholestyramine & Colestipol: decrease absorption of hydrochlorothiazide.
Diazoxide: Additive action - may cause hyperglycemia, hyperuricaemia and hypotension.
Digitalis: Diuretics induced hypokalaemia may precipitate digitalis toxicity.
Lithium: Hydrochlorothiazide potentiates therapeutic and toxic effects by increasing its renal excretion.
Frusemide: Synergy leading to profound diuresis and greater than predicted electrolyte loss.
Non-depolarizing muscle relaxants: Diuretics induced hypokalaemia enhances efficacy.
Sulfonylureas: Efficacy decreased due to hydrochlorothiazide induced glucose intolerance.
Chlorpropamide: Hypokalaemia.
Propantheline: Bioavailability of hydrochlorothiazide increased.
Metoclopramide: Bioavailability of hydrochlorothiazide decreased.
NSAIDs: Natriuretic effect of hydrochlorothiazide decreased.
Typical Dosage for Hydrochlorothiazide
Hypertension: 25mg once daily or in divided doses. Increased to 50mg if required; depending up on the patient`s response.
Children: 1mg/kg single daily dose.
Starts with 25 to 50mg. Increased the dose until desired response is obtained.
Maximum dose: 200mg/day
Maintenance dosage: 25 to 100mg daily or on alternate days.
Children: 1mg/kg single daily dose or 1 to 3mg/kg/day in two divided doses

Schedule of Hydrochlorothiazide
Storage Requirements for Hydrochlorothiazide
Store at room temperature in a well closed container and protected from light.
Effects of Missed Dosage of Hydrochlorothiazide
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose.Continue the regular schedule.Do not double the dose.
Effects of Overdose of Hydrochlorothiazide
Treatment is supportive and symptomatic. Remove drug from the body by induced emesis and gastric lavage. Monitor and assist respiratory, cardiovascular, and renal function as indicated. Monitor and support fluid and electrolyte balance.

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