Adult Dosing
Hypertension
Lopressor HCT, hydrochlorothiazide/metoprolol tartrate
- 2 tabs (25 mg/50 mg) ORALLY daily in one or divided doses, or 1 to 2 tabs (25 mg/100 mg) ORALLY daily in one or divided doses, or 1 tab (50 mg/100 mg) ORALLY per day in one or divided doses
Dutoprol
- 1 tab PO qd. Max: 200 mg/25 mg/day
- Subsequent titration may be carried out every 2 weeks
Notes:- Dosing regimens exceeding 50 mg/day of hydrochlorothiazide are not recommended
- If essential gradually add another antihypertensive agent beginning with 50% of the usual recommended starting dose to avoid an excessive fall in blood pressure
- Gradually taper dose to discontinue
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal dose adjustment
Lopressor HCT, hydrochlorothiazide/metoprolol tartrate
- Severe renal impairment: Use with caution; dose adjustments not defined
Dutoprol
Hepatic dose adjustment
Lopressor HCT, hydrochlorothiazide/metoprolol tartrate
- Hepatic impairment/progressive hepatic disease: Use with caution, dose adjustments not defined
Dutoprol
- Moderate hepatic impairment: Reduce start dose
- Severe hepatic impairment: Dose adjustments not defined
See Supplemental Patient Information
- Potential hazard for further depressing myocardial contractility and precipitating more severe failure exists. Cautiously administer this combination drug in hypertensive patients whose CHF is controlled by digitalis and diuretic
- Cardiac failure has occurred following continued depression of the myocardium with beta-blockers over a period of time. Fully digitalized patients and administer diuretic at the first sign or symptom of impending cardiac failure; closely observe response. Withdraw therapy if cardiac failure continues despite adequate digitalization and diuretic therapy
- Avoid beta-blockers in patients with bronchospastic disease. Use cautiously in patients with bronchospastic disease failing to respond or tolerate other antihypertensive treatment. Concomitantly administer a beta2-stimulating agent and use the lowest possible dose of this combination drug. In such circumstances initially administer smaller doses tid, instead of larger doses bid to avoid the higher plasma levels associated with the longer dosing interval
- Augments risks of general anesthesia and surgical procedures. Severe hypotension have occurred in patients treated with dobutamine or isoproterenol used for reversing effect of this combination drug. Difficulties in restarting and maintaining the heart beat with beta blockers exists
- Masks signs and symptoms of tachycardia occurring with hypoglycemia
- If use of this combination drug is considered in the setting of pheochromocytoma, administer it in combination with an alpha blocker, and only after the alpha blocker is initiated
- Paradoxical increase in blood pressure due to the attenuation of beta-mediated vasodilatation in skeletal muscle has occurred following administration of beta blockers alone in the setting of pheochromocytoma
- Masks certain clinical signs or hyperthyroidism. On suspecting patients for developing thyrotoxicosis carefully manage and avoid abrupt withdrawal as exacerbation of symptoms of hyperthyroidism, including thyroid storm have occurred
- Thiazide component is associated with precipitation of azotemia in patients with renal disease. Cumulative effects have developed in patients with impaired renal function
- Minor alterations of fluid and electrolyte balance is associated with precipitation of hepatic coma in patients with impaired hepatic function or progressive liver disease
- Thiazide component adds or potentiates the action of ganglionic or peripheral adrenergic blocking drugs
- Hydrochlorothiazide component is associated with hypersensitivity reactions in patients with or without a history of allergy or bronchial asthma; patients having such a history are more prone
- Exacerbation or activation of systemic lupus erythematosus is associated with thiazide component of this drug
- At appropriate intervals periodically determine serum electrolytes to detect possible electrolyte imbalance. Observe patients receiving thiazide therapy for clinical signs of fluid or electrolyte imbalance. Determine serum and urine electrolyte when the patient is vomiting excessively or receiving parenteral fluids. Hypokalemia with brisk diuresis have occurred in presence of severe cirrhosis or after long term therapy. Cardiac arrhythmia has occurred in association with hypokalemia resulting in sensitization or exaggeration of the response of the heart to the toxic effects of digitalis. Chloride replacement may be essential for treatment of metabolic alkalosis. Dilutional hyponatremia have occurred in edematous patients in hot weather; Impose water restriction rather than administration of salt except in rare occasions when the hyponatremia is fatal. In actual salt depletion provide appropriate replacement therapy. Thiazide component is associated with hyperuricemia or precipitation of frank gout in certain patients
- Manifestations of latent diabetes are associated with thiazide component
- Antihypertensive effects of the drug are enhanced in the postsympathectomy patient
- Pathological changes in the parathyroid gland with hypercalcemia and hypophosphatemia are associated with thiazides
- Thiazides are also associated with increasing the urinary excretion of magnesium
Cautions: Use cautiously in:
- Severe renal impairment
- Hepatic impairment
- Peripheral vascular disease
- Diabetes mellitus
- Arrhythmias
- Seizure disorder
- Bronchospastic disease
- Volume depletion
- Electrolyte abnormalities
- Pheochromocytoma
- Thyroid disorder
- History of gout
- History of pancreatitis
- SLE
- Post-sympathectomy
- Major surgery
- Wolff-Parkinson-White syndrome
- History of severe anaphylactic reaction
- Major surgery
- Geriatrics
Supplemental Patient Information
- Advise patients to avoid engaging in tasks requiring alertness and operating automobiles and machinery until the patients response to therapy with this combination drug is determined
- Advise patients to contact the physician on development of difficulties in breathing
- Advise patients to inform the physician or dentist before any type of surgery
Pregnancy Category:C
Breastfeeding: Hydrochlorothiazide doses of 
50 mg/day are acceptable during lactation. Intense diuresis with higher doses may decrease breastmilk production. As low levels of metoprolol are excreted in breastmilk, amounts ingested by the infant are small and are unexpected to cause any adverse effects in breastfed infants. Studies involving use of metoprolol during breastfeeding have found no adverse reactions in breastfed infants. This information is (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 23 February 2011). According to manufacturer's data if use of hydrochlorothiazide/metoprolol is deemed essential, the patient should avoid nursing.
US Trade Name(s)
US Availability
hydrochlorothiazide/metoprolol tartrate (generic)
- TABS:
- 25 mg/50 mg
- 25 mg/100 mg
- 50 mg/100 mg
Dutoprol (hydrochlorothiazide/metoprolol succinate)
- ETABS:
- 12.5 mg/25 mg
- 12.5 mg/50 mg
- 12.5 mg/100 mg
Lopressor HCT (hydrochlorothiazide/metoprolol)
Canadian Trade Name(s)
Canadian Availability
UK Trade Name(s)
UK Availability
Australian Trade Name(s)
Australian Availability
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Lopressor HCT 100-50 MG TABS [Bottle] (NOVARTIS)
30 mg = $81.99
90 mg = $224.97 - Lopressor HCT 50-25 MG TABS [Bottle] (NOVARTIS)
60 mg = $120.99
180 mg = $349.96
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.