Summary

Commonly reported side effects of hydrochlorothiazide/metoprolol include: drowsiness, lethargy, thrombocytopenia, and vomiting. Continue reading for a comprehensive list of adverse effects.

Applies to hydrochlorothiazide / metoprolol: oral tablet.

Serious side effects

Along with its needed effects, hydrochlorothiazide/metoprolol 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 while taking hydrochlorothiazide / metoprolol:

More common

• Chest pain or discomfort
• decreased urine
• dry mouth
• 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
• chest tightness
• 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

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 while taking hydrochlorothiazide / metoprolol:

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
• cough
• dilated neck veins
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• drowsiness
• fast or pounding heartbeat or pulse
• frequent urination
• 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
• sweating
• trembling
• unconsciousness
• very drowsy or sleepy
• weak pulse
• weakness and heaviness of the legs
• weight gain

Other side effects

Some side effects of hydrochlorothiazide / metoprolol 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
• diarrhea
• feeling of constant movement of self or surroundings
• fever
• general feeling of discomfort or illness
• muscle aches
• nightmares
• runny nose
• sensation of spinning
• shivering
• sleepiness
• sore throat
• 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)
• earache
• 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
• weight loss

For Healthcare Professionals

Applies to hydrochlorothiazide / metoprolol: oral tablet, oral tablet extended release.

General

The most common side effects were fatigue, lethargy, flu syndrome, dizziness, vertigo, drowsiness, somnolence, and headache.^[Ref]

Gastrointestinal

Common (1% to 10%): Diarrhea, digestive disorder, dry mouth, nausea, vomiting, constipation

Hydrochlorothiazide:

Frequency not reported: Sialadenitis, vomiting, diarrhea, cramping, nausea, gastric irritation, constipation

Metoprolol:

Common (1% to 10%): Diarrhea, nausea, gastric pain, constipation, flatulence, heartburn

Frequency not reported: Vomiting, retroperitoneal fibrosis

Postmarketing reports: Dry mouth^[Ref]

Nervous system

Common (1% to 10%): Lethargy, dizziness, drowsiness, somnolence, headache, tinnitus

Hydrochlorothiazide:

Frequency not reported: Dizziness, headache, paresthesia

Metoprolol:

Common (1% to 10%): Tiredness, dizziness

Frequency not reported: Short-term memory loss, headache

Postmarketing reports: Somnolence, paresthesia, syncope, taste disturbance^[Ref]

Other

Common (1% to 10%): Fatigue, vertigo, exercise tolerance decreased, edema, earache

Hydrochlorothiazide:

Frequency not reported: Vertigo, weakness

Postmarketing reports: Fever

Metoprolol:

Frequency not reported: Fatigue

Postmarketing reports: Lactic dehydrogenase elevation, alkaline phosphatase elevation, blood triglycerides increased, high-density lipoprotein decreased, tinnitus^[Ref]

Metabolic

Common (1% to 10%): Hypokalemia, gout, anorexia

Hydrochlorothiazide:

Frequency not reported: Anorexia, hyperglycemia, hyperuricemia, hypokalemia

Metoprolol:

Frequency not reported: Weight gain^[Ref]

Dermatologic

Common (1% to 10%): Sweating, purpura

Hydrochlorothiazide:

Frequency not reported: Stevens-Johnson syndrome, purpura, urticaria, rash, photosensitivity

Postmarketing reports: Erythema multiforme, exfoliative dermatitis, toxic epidermal necrolysis

Metoprolol:

Uncommon (0.1% to 1%): Pruritus

Frequency not reported: Gangrene, rash, photosensitivity, worsening of psoriasis, alopecia

Postmarketing reports: Sweating^[Ref]

Gangrene has been reported very rarely in patients with preexisting severe peripheral circulatory disorders who were taking metoprolol.^[Ref]

Respiratory

Common (1% to 10%): Dyspnea, nasopharyngitis

Hydrochlorothiazide:

Frequency not reported: Respiratory distress, pneumonitis, pulmonary edema

Metoprolol:

Common (1% to 10%): Shortness of breath

Uncommon (0.1% to 1%): Wheezing

Frequency not reported: Rhinitis

Postmarketing reports: Dyspnea^[Ref]

Cardiovascular

Common (1% to 10%): Bradycardia

Hydrochlorothiazide:

Frequency not reported: Orthostatic hypotension, necrotizing angiitis

Metoprolol:

Common (1% to 10%): Bradycardia

Frequency not reported: Cold extremities, arterial insufficiency, palpitations, congestive heart failure

Postmarketing reports: Peripheral edema, chest pain^[Ref]

Ocular

Common (1% to 10%): Blurred vision

Hydrochlorothiazide:

Frequency not reported: Transient blurred vision, xanthopsia

Metoprolol:

Postmarketing reports: Blurred vision, dry eyes^[Ref]

Psychiatric

Common (1% to 10%): Nightmare

Hydrochlorothiazide:

Frequency not reported: Restlessness

Metoprolol:

Common (1% to 10%): Depression

Frequency not reported: Mental confusion, nightmare, insomnia

Postmarketing reports: Confusional state, anxiety/nervousness, hallucination, libido decreased^[Ref]

Genitourinary

Common (1% to 10%): Impotence

Hydrochlorothiazide:

Frequency not reported: Glycosuria

Metoprolol:

Very rare (less than 0.01%): Peyronie's disease

Postmarketing reports: Male impotence^[Ref]

Musculoskeletal

Common (1% to 10%): Muscle pain

Hydrochlorothiazide:

Frequency not reported: Muscle spasm

Metoprolol:

Frequency not reported: Arthritis

Postmarketing reports: Musculoskeletal pain, arthralgia^[Ref]

Immunologic

Common (1% to 10%): Flu syndrome

Hydrochlorothiazide:

Postmarketing reports: Anaphylactic reactions^[Ref]

Hepatic

Frequency not reported: Liver enzymes increased, serum bilirubin increased

Hydrochlorothiazide:

Frequency not reported: Pancreatitis, intrahepatic cholestatic jaundice

Metoprolol:

Postmarketing reports: Hepatitis, jaundice, non-specific hepatic dysfunction, transaminase elevation^[Ref]

Hematologic

Hydrochlorothiazide:

Frequency not reported: Aplastic anemia, agranulocytosis, leukopenia, thrombocytopenia, hemolytic anemia^[Ref]

Renal

Hydrochlorothiazide:

Postmarketing reports: Interstitial nephritis^[Ref]