Usual Adult Dose for Hypertension

Immediate-release:

• Hydrochlorothiazide 25 to 50 mg-Metoprolol 100 to 200 mg orally per day in single or divided doses

• Initial dose: Hydrochlorothiazide 12.5 mg-Metoprolol 25 mg orally once a day
• Maximum dose: Hydrochlorothiazide 25 mg-Metoprolol 200 mg orally once a day

• Hydrochlorothiazide doses greater than 50 mg per day are not recommended.
• Immediate-release metoprolol (tartrate) may be administered once a day, but lower doses (100 mg) may not maintain a full effect for 24 hours; measure blood pressure near the end of the dosing interval to determine adequate control; larger or more frequent doses may be required.
• Extended-release metoprolol (succinate) may be titrated after 2 weeks.
• Beta-1 selectivity decreases as the metoprolol dose is increased.

Renal Dose Adjustments

CrCl greater than 30 mL/min: No adjustment recommended
CrCl 30 mL/min or less: Data not available

If progressive renal dysfunction develops during treatment: Withhold or discontinue treatment.

Liver Dose Adjustments

Use with caution

Precautions

US BOXED WARNING:

• CARDIAC ISCHEMIA AFTER ABRUPT DISCONTINUATION: Following abrupt discontinuation of therapy with beta adrenergic blockers, exacerbations of angina pectoris and myocardial infarction have occurred. When discontinuing chronically administered metoprolol, particularly in patients with ischemic heart disease, gradually reduce the dose over a period of 1 to 2 weeks and monitor the patient. If angina markedly worsens or acute coronary insufficiency develops, promptly resume therapy, at least temporarily, and take other measures appropriate for the management of unstable angina. Warn patients against interruption or discontinuation of therapy without the physician's advice. Because coronary artery disease is common and may be unrecognized, avoid abrupt discontinuation of metoprolol therapy even in patients treated only for hypertension

Dialysis

Data not available

Other Comments

Administration advice:

• Immediate-release: Administer with or immediately following meals.
• Extended-release: Administer with or without food.

• Monitor heart rate and rhythm.
• Monitor serum electrolytes and creatinine periodically.

• Warn patients not to interrupt therapy without their physician's advice.
• If a dose is missed, take the next scheduled dose without doubling up.
• Inform patients to contact their physician if difficulty in breathing occurs.
• Inform patients to report decreased visual acuity or ocular pain and to stop this drug and contact their healthcare provider right away if these symptoms occur.
• Advise patients to avoid operating automobiles and machinery or engaging in other tasks requiring alertness until the patient's response to therapy has been determined.