Metoprolol and hydrochlorothiazide interactions

Anuria Hypersensitivity to metoprolol tartrate or hydrochlorothiazide or to other sulfonamide- derived drugs. (Metoprolol and hydrochlorothiazide label, Contraindications)

Hyperkalemia occurs commonly (about 10%) when amiloride is used without a kaliuretic diuretic. (Amiloride label, Boxed warning)

The risk of torsade de pointes is related to the extent of QTc prolongation, concomitant administration of QTc prolonging drugs, a history of torsade de pointes, pre-existing QTc interval prolongation, congestive heart failure, administration of potassium-wasting diuretics, or other conditions that result in hypokalemia or hypomagnesemia. (Arsenic trioxide label, Warnings and precautions)

Lotensin HCT is also contraindicated in patients who are hypersensitive to benazepril, to any other ACE inhibitor, to hydrochlorothiazide, or to other sulfonamide-derived drugs. (Benazepril and hydrochlorothiazide label, Contraindications)

Anuria Hypersensitivity to metoprolol tartrate or hydrochlorothiazide or to other sulfonamide- derived drugs. (Metoprolol and hydrochlorothiazide label, Contraindications)

WARNING Bumetanide is a potent diuretic which, if given in excessive amounts, can lead to a profound diuresis with water and electrolyte depletion. (Bumetanide label, Boxed warning)

Because the use of diuretics can accentuate the diminished intravascular volume, avoid diuretics except in the late phase of resolution. (Choriogonadotropin alfa label, Warnings)

Use CLOZARIL cautiously in patients with cardiovascular or cerebrovascular disease or conditions predisposing to hypotension (e.g., dehydration, use of antihypertensive medications) [see Dosage and Administration ( 2.2 , 2.6 ), Warnings and Precautions ( 5.2 )]. (Clozapine label, Boxed warning)

Potassium-Sparing Diuretics Cyclosporine should not be used with potassium-sparing diuretics because hyperkalemia can occur. (Cyclosporine label, Drug interactions)

CONTRAINDICATIONS PROGLYCEM is contraindicated in patients with: Functional hypoglycemia Hypersensitivity to diazoxide, any of the excipients in PROGLYCEM, or other thiazides (Diazoxide label, Contraindications)

Anuria Hypersensitivity to metoprolol tartrate or hydrochlorothiazide or to other sulfonamide- derived drugs. (Metoprolol and hydrochlorothiazide label, Contraindications)

The concomitant use of hydrochlorothiazide (alone or in combinations such as with triamterene) with dofetilide is contraindicated (see PRECAUTIONS, Drug-Drug Interactions ) because this has been shown to significantly increase dofetilide plasma concentrations and QT interval prolongation. (Dofetilide label, Contraindications)

Anuria Hypersensitivity to metoprolol tartrate or hydrochlorothiazide or to other sulfonamide- derived drugs. (Metoprolol and hydrochlorothiazide label, Contraindications)

Anuria Hypersensitivity to metoprolol tartrate or hydrochlorothiazide or to other sulfonamide- derived drugs. (Metoprolol and hydrochlorothiazide label, Contraindications)

Droperidol should be administered with extreme caution to patients who may be at risk for development of prolonged QT syndrome (e.g., congestive heart failure, bradycardia, use of a diuretic, cardiac hypertrophy, hypokalemia, hypomagnesemia, or administration of other drugs known to increase the QT interval). (Droperidol label, Boxed warning)

…sometimes associated with oliguria and/or progressive azotemia, and rarely with acute renal failure and/or death, include those with the following conditions or characteristics: heart failure, hyponatremia, high dose diuretic therapy, recent intensive diuresis or increase in diuretic dose, renal dialysis, or severe volume and/or salt depletion of any etiology. (Enalaprilat label, Warnings)

…• serum creatinine > 2.0 mg/dL in males or >1.8 mg/dL in females, • creatinine clearance < 50 mL/min, or • concomitant administration of potassium supplements or potassium-sparing diuretics (e.g., amiloride, spironolactone, or triamterene) [see Warnings and Precautions (5.1) , Adverse Reactions (6.2) , Drug Interactions (7) , and Clinical Pharmacology (12.3)… (Eplerenone label, Contraindications)

…of active abnormal bleeding within the previous 30 days Severe hypertension (systolic blood pressure >200 mm Hg or diastolic blood pressure >110 mm Hg) not adequately controlled on antihypertensive therapy Major surgery within the preceding 6 weeks History of stroke within 30 days or any history of hemorrhagic stroke Current or planned administration of another… (Eptifibatide label, Contraindications)

CONTRAINDICATIONS All diuretics, including ethacrynic acid, are contraindicated in anuria. (Ethacrynic acid label, Contraindications)

…concomitantly with Ferric Citrate Tablets Amlodipine Aspirin Atorvastatin Calcitriol Clopidogrel Digoxin Diltiazem Doxercalciferol Enalapril Fluvastatin Glimepiride Levofloxacin Losartan Metoprolol Pravastatin Propranolol Sitagliptin Warfarin Oral drugs that have to be separated from Ferric Citrate Tablets and meals Dosing Recommendations Doxycycline Take at least 1… (Ferric citrate label, Drug interactions)

Concomitant negative chronotropic therapy such as digoxin or beta-blockers may lower the risk of this complication. (Flecainide label, Boxed warning)

Because the use of diuretics can accentuate the diminished intravascular volume, diuretics should be avoided except in the late phase of resolution as described below. (Follitropin label, Warnings and precautions)

The concurrent use of gentamicin with potent diuretics, such as ethacrynic acid or furosemide, should be avoided, since certain diuretics by themselves may cause ototoxicity. (Gentamicin label, Boxed warning)

Avoid diuretics or laxatives in patients with diarrhea. (Irinotecan label, Warnings and precautions)

Diuretics Eplerenone Contraindicated during and 2 weeks after TOLSURA treatment. (Itraconazole label, Drug interactions)

Anuria Hypersensitivity to metoprolol tartrate or hydrochlorothiazide or to other sulfonamide- derived drugs. (Metoprolol and hydrochlorothiazide label, Contraindications)

Other Antihypertensive Drugs When metolazone tablets, USP, are used with other antihypertensive drugs, particular care must be taken to avoid excessive reduction of blood pressure, especially during initial therapy. (Metolazone label, Warnings)

In addition, life-threatening arrhythmias may occur during anesthesia and surgery, and may require treatment with a beta-blocker or lidocaine. (Metyrosine label, Warnings)

Minoxidil should be reserved for hypertensive patients who do not respond adequately to maximum therapeutic doses of a diuretic and two other antihypertensive agents. (Minoxidil label, Boxed warning)

Hypotensive Agents Do not use BYSTOLIC with other β-blockers. (Nebivolol label, Drug interactions)

The concurrent use of neomycin with potent diuretics such as ethacrynic acid or furosemide should be avoided, since certain diuretics by themselves may cause ototoxicity. (Neomycin label, Boxed warning)

The following drug interactions may occur with potassium citrate: Potassium-sparing diuretics: concomitant administration should be avoided since the simultaneous administration of these agents can produce severe hyperkalemia (7.1) (Potassium citrate label, Drug interactions)

Risk factors include high dose or overdose, rapid administration (see WARNINGS and DOSAGE AND ADMINISTRATION ), repeated doses, previous administration of protamine, and current or previous use of protamine-containing drugs (NPH insulin, protamine zinc insulin, and certain beta-blockers). (Protamine label, Boxed warning)

…sometimes associated with oliguria and/or progressive azotemia, and rarely with acute renal failure and/or death, include patients with the following conditions or characteristics: heart failure, hyponatremia, high dose diuretic therapy, recent intensive diuresis or increase in diuretic dose, renal dialysis, or severe volume and/or salt depletion of any etiology. (Quinapril label, Warnings)

Examples: beta-blockers, clonidine, guanethidine, and reserpine Clopidogrel : Avoid concomitant use; if used concomitantly initiate at 0.5 mg before each meal and limit total daily dose to 4 mg ( 7 ) (Repaglinide label, Drug interactions)

Concomitant use with metoclopramide, beta-blockers, or cholinomimetic and anticholinergic drugs is not recommended ( 7.1 , 7.2 , 7.3 ) (Rivastigmine label, Drug interactions)

Anuria Hypersensitivity to metoprolol tartrate or hydrochlorothiazide or to other sulfonamide- derived drugs. (Metoprolol and hydrochlorothiazide label, Contraindications)

Sodium bicarbonate injection is contraindicated in patients who are losing chloride by vomiting or from continuous gastrointestinal suction and in patients receiving diuretics known to produce a hypochloremic alkalosis. (Sodium bicarbonate label, Contraindications)

Anuria Hypersensitivity to metoprolol tartrate or hydrochlorothiazide or to other sulfonamide- derived drugs. (Metoprolol and hydrochlorothiazide label, Contraindications)

Anuria Hypersensitivity to metoprolol tartrate or hydrochlorothiazide or to other sulfonamide- derived drugs. (Metoprolol and hydrochlorothiazide label, Contraindications)

Anuria Hypersensitivity to metoprolol tartrate or hydrochlorothiazide or to other sulfonamide- derived drugs. (Metoprolol and hydrochlorothiazide label, Contraindications)

…coadministration of an alpha-blocker and CIALIS for the treatment of BPH has not been adequately studied, and due to the potential vasodilatory effects of combined use resulting in blood pressure lowering, the combination of CIALIS and alpha-blockers is not recommended for the treatment of BPH. [see Dosage and Administration ( 2.7 ), Drug Interactions ( 7.1 ),… (Tadalafil label, Warnings and precautions)

…Syndrome (SS) c ] Agents with blood pressure-reducing effects Use with caution d Hypotension e Non-selective H1 receptor antagonists Contraindicated a Increased anticholinergic effects Beta-adrenergic blockers (see also agents or procedures with blood pressure-reducing effects) Use with the caution d More pronounced bradycardia, postural hypotension e Blood glucose-lowering… (Tranylcypromine label, Drug interactions)

Anuria Hypersensitivity to metoprolol tartrate or hydrochlorothiazide or to other sulfonamide- derived drugs. (Metoprolol and hydrochlorothiazide label, Contraindications)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Although β-blockers should be avoided in overt cardiac failure, acebutolol can be used with caution in patients with a history of heart failure who are controlled with digitalis and/or diuretics. (Acebutolol label, Warnings)

Diuretics Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Acetaminophen and codeine label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Postural hypotension/syncope: Care should be taken in patients with symptomatic hypotension or who have had a hypotensive response to other medications or are concomitantly treated with antihypertensive medication or nitrates ( 5.1 ) (Alfuzosin label, Warnings and precautions)

Risk factors for the development of hyperkalemia include renal insufficiency, diabetes, combination use with ARBs or ACEIs [see Contraindications ( 4 ), Warnings and Precautions ( 5.2 ), and Clinical Studies ( 14.3 )] , NSAIDs, or potassium supplements or potassium sparing diuretics. (Aliskiren label, Warnings and precautions)

Hypersensitivity reactions to allopurinol tablets may be increased in patients with decreased kidney function receiving thiazide diuretics and allopurinol tablets concurrently. (Allopurinol label, Warnings and precautions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Ethacrynic Acid, Furosemide, Urea, or Mannitol Some diuretics can enhance aminoglycoside toxicity by altering aminoglycoside concentrations in serum and tissue. (Amikacin label, Drug interactions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Antihypertensive Drugs Due to its alpha-adrenergic antagonism, aripiprazole has the potential to enhance the effect of certain antihypertensive agents. (Aripiprazole label, Drug interactions)

There was also a slightly greater proportion of patients on NUVIGIL requiring new or increased use of antihypertensive medications (2.9%) compared to patients on placebo (1.8%). (Armodafinil label, Warnings and precautions)

Patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Orthostatic vital signs should be monitored in patients who are vulnerable to hypotension (elderly patients, patients with dehydration, hypovolemia, concomitant treatment with antihypertensive medications, patients with known cardiovascular disease (history of myocardial infarction or ischemic heart disease, heart failure, or conduction abnormalities), and patients… (Asenapine label, Warnings and precautions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Because of its relative beta 1 selectivity, however, TENORMIN may be used with caution in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Atenolol label, Warnings)

Because of its relative beta 1 -selectivity, however, atenolol and chlorthalidone may be used with caution in patients with bronchospastic disease who do not respond to or cannot tolerate, other antihypertensive treatment. (Atenolol and chlorthalidone label, Warnings)

Antihypertensive Drugs Prevention or Management Increase the frequency of monitoring blood pressure and adjust atomoxetine oral solution dosage as clinically appropriate. (Atomoxetine label, Drug interactions)

• Use of avanafil with alpha-blockers, other antihypertensives, or substantial amounts of alcohol (greater than 3 units) may lead to hypotension ( 2.3 , 5.6 , 5.7 ) (Avanafil label, Warnings and precautions)

Hypotension in Volume- or Salt-Depleted Patients In patients with an activated renin-angiotensin system, such as volume- and/or salt-depleted patients (e.g., those being treated with high doses of diuretics), symptomatic hypotension may occur after initiation of treatment with azilsartan medoxomil. (Azilsartan label, Warnings and precautions)

Diuretics Clinical Impact : Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Belladonna and opium label, Drug interactions)

Patients at risk of excessive hypotension include those with the following conditions or characteristics: heart failure with systolic blood pressure below 100 mm Hg, ischemic heart disease, cerebrovascular disease, hyponatremia, high dose diuretic therapy, renal dialysis, or severe volume and/or salt depletion of any etiology. (Benazepril label, Warnings and precautions)

Amphetamines may decrease the hypotensive effect of antihypertensives. (Benzphetamine label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Because of its relative beta 1 -selectivity, however, BISOPROLOL FUMARATE may be used with caution in patients with bronchospastic disease who do not respond to, or who cannot tolerate other antihypertensive treatment. (Bisoprolol label, Warnings)

Because of the relative beta 1 -selectivity of bisoprolol fumarate, bisoprolol fumarate and hydrochlorothiazide tablets may be used with caution in patients with bronchospastic disease who do not respond to, or who cannot tolerate other antihypertensive treatment. (Bisoprolol and hydrochlorothiazide label, Warnings)

Hypotension: Use caution when treating patients taking antihypertensives, with a history of syncope, or with dehydration. (Bortezomib label, Warnings and precautions)

Orthostatic vital signs should be monitored in patients who are vulnerable to hypotension (e.g., elderly patients, patients with dehydration, hypovolemia, concomitant treatment with antihypertensive medication), patients with known cardiovascular disease (history of myocardial infarction, ischemic heart disease, heart failure, or conduction abnormalities), and… (Brexpiprazole label, Warnings and precautions)

Antihypertensives/Cardiac Glycosides Because brimonidine tartrate ophthalmic solution 0.1% and 0.15% may reduce blood pressure, caution in using drugs such as antihypertensives and/or cardiac glycosides with brimonidine tartrate ophthalmic solution 0.1% and 0.15% is advised. (Brimonidine label, Drug interactions)

Antihypertensives/Cardiac Glycosides Because brimonidine tartrate/timolol maleate ophthalmic solution may reduce blood pressure, caution in using drugs such as antihypertensives and/or cardiac glycosides with brimonidine tartrate/timolol maleate ophthalmic solution is advised. (Brimonidine and timolol label, Drug interactions)

Use caution in patients taking antihypertensive medications. (Bromocriptine label, Warnings and precautions)

Central Nervous System (CNS) depressants Antihistamines have additive effects with alcohol and other CNS depressants (hypnotics, sedatives, tranquilizers, antianxiety agents, etc.). Antihypertensive drugs Sympathomimetic may reduce the effects of antihypertensive drugs. (Brompheniramine, pseudoephedrine, and dextromethorphan label, Drug interactions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Risk of Hypertension and Bradycardia Due to Drug Interactions Between MARCAINE WITH EPINEPHRINE and Nonselective Beta-Adrenergic Antagonists Administration of MARCAINE WITH EPINEPHRINE (containing a vasoconstrictor) in patients receiving nonselective beta-adrenergic antagonists may cause severe hypertension and bradycardia. (Bupivacaine label, Warnings and precautions)

Patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Examples: cyclobenzaprine, metaxalone Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Buprenorphine label, Drug interactions)

Examples: Cyclobenzaprine, metaxalone Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Buprenorphine and naloxone label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Examples: cyclobenzaprine, metaxalone Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Butalbital, acetaminophen, caffeine, and codeine label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Thiazides Thiazides are known to induce hypercalcemia by the reduction of calcium excretion in urine. (Calcitriol label, Drug interactions)

Drugs That Increase the Risk of Hypercalcemia Increase frequency of monitoring of calcium concentrations in patients taking concomitant Calcium Chloride Injection and other drugs that increase the risk of hypercalcemia (e.g., calcipotriene, estrogen, lithium, parathyroid hormone, teriparatide, thiazide diuretics, Vitamin A, and Vitamin D). (Calcium chloride label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Symptomatic hypotension is most likely to occur in patients who have been volume and/or salt depleted as a result of prolonged diuretic therapy, dietary salt restriction, dialysis, diarrhea, or vomiting. (Candesartan label, Warnings and precautions)

Hypotension Excessive hypotension was rarely seen in hypertensive patients but is a possible consequence of captopril use in salt/volume depleted persons (such as those treated vigorously with diuretics), patients with heart failure or those patients undergoing renal dialysis (see PRECAUTIONS : Drug Interactions ). (Captopril label, Warnings)

Elderly patients and patients treated with diuretics are at greater risk of developing hyponatremia. (Carbamazepine label, Warnings and precautions)

Symptomatic postural hypotension has occurred when carbidopa, given with levodopa or carbidopa-levodopa combination products, was added to the treatment of a patient receiving antihypertensive drugs. (Carbidopa label, Drug interactions)

Antihypertensive drugs: May cause symptomatic postural hypotension. (Carbidopa and levodopa label, Drug interactions)

Antihypertensive Agents Symptomatic postural hypotension has occurred when carbidopa/levodopa was added to the treatment of patients receiving antihypertensive drugs. (Carbidopa, levodopa, and entacapone label, Drug interactions)

Orthostatic vital signs should be monitored in patients who are vulnerable to hypotension (e.g., elderly patients, patients with dehydration, hypovolemia, and concomitant treatment with antihypertensive medications), patients with known cardiovascular disease (history of myocardial infarction, ischemic heart disease, heart failure, or conduction abnormalities), and… (Cariprazine label, Warnings and precautions)

If such symptoms occur, diuretics should be increased and the carvedilol dose should not be advanced until clinical stability resumes [see Dosage and Administration (2) ] . (Carvedilol label, Warnings and precautions)

Diuretics: Nephrotoxicity has been reported with concomitant administration of cephalosporins with potent diuretics such as furosemide. (Cefepime label, Drug interactions)

Drug Interactions Nephrotoxicity has been reported following concomitant administration of cephalosporins with aminoglycoside antibacterial drugs or potent diuretics such as furosemide. (Ceftazidime label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

DRUG INTERACTIONS Cevimeline should be administered with caution to patients taking beta adrenergic antagonists, because of the possibility of conduction disturbances. (Cevimeline label, Drug interactions)

Thiazides may add to or potentiate the action of other antihypertensive drugs. (Chlorothiazide label, Warnings)

Thiazide diuretics may accentuate the orthostatic hypotension that may occur with phenothiazines. (Chlorpromazine label, Precautions)

Effect of chlorthalidone on other drugs Chlorthalidone may add to or potentiate the action of other antihypertensive drugs. (Chlorthalidone label, Drug interactions)

Cholestyramine and colestipol: Reduced absorption of thiazides. (Metoprolol and hydrochlorothiazide label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume depleted may be at greater risk for developing hyponatremia with SSRIs [see Use in Specific Populations ( 8.5 )] . (Citalopram label, Warnings and precautions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Consider use of diuretics and/or albumin. (Clofarabine label, Warnings and precautions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Codeine label, Drug interactions)

Cholestyramine and colestipol: Reduced absorption of thiazides. (Metoprolol and hydrochlorothiazide label, Drug interactions)

…concomitant use of TONMYA with: MAO inhibitors may be life-threatening [see Contraindications (4) ] , Alcohol, barbiturates, and other CNS depressants may increase the risk of adverse reactions associated with these drugs, Tramadol may increase the seizure risk, Guanethidine or other similar acting drugs may block the antihypertensive action of these drugs. (Cyclobenzaprine label, Drug interactions)

…inhibitors: ACE inhibitors can cause leukopenia. ● Natalizumab ● Paclitaxel: Increased hematotoxicity has been reported when cyclophosphamide was administered after paclitaxel infusion. ● Thiazide diuretics ● Zidovudine Increased cardiotoxicity ● Anthracyclines ● Cytarabine ● Pentostatin ● Radiation therapy of the cardiac region ● Trastuzumab Increased pulmonary toxicity… (Cyclophosphamide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with NORPRAMIN. (Desipramine label, Warnings)

…Hyponatremia Concomitant administration of DESMODA with other drugs that may increase the risk of water intoxication with hyponatremia, (e.g., tricyclic antidepressants, selective serotonin re-uptake inhibitors, chlorpromazine, opiate analgesics, thiazide diuretics, NSAIDs, lamotrigine, sulfonylureas, particularly chlorpropamide, oxybutynin and carbamazepine). (Desmopressin label, Drug interactions)

Also, patients taking diuretics or who are otherwise volume depleted can be at greater risk [see Use in Specific Populations (8.5) and Clinical Pharmacology (12.3) ] . (Desvenlafaxine label, Warnings and precautions)

Drug Interactions with Metoprolol Catecholamine Depleting Drugs: The concomitant use of catecholamine-depleting drugs (e.g., reserpine, monoamine oxidase (MAO) inhibitors) with beta adrenergic blockers may have an additive affect and increase the risk of hypotension or bradycardia CYP2D6 Inhibitors: Drugs that are strong inhibitors of CYP2D6 such as quinidine,… (Metoprolol and hydrochlorothiazide label, Drug interactions)

For patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesemia (e.g., diuretics), health care professionals may consider monitoring magnesium levels prior to initiation of PPI treatment and periodically [see Adverse Reactions (6.2) ] . (Dexlansoprazole label, Warnings and precautions)

• Antihypertensive Drugs: Monitor blood pressure. (Dexmethylphenidate label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

The pressor effects of diethylpropion and those of other drugs may be additive when the drugs are used concomitantly; conversely, diethylpropion may interfere with antihypertensive drugs (i.e., guanethidine, a-methyldopa). (Diethylpropion label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Beta Blockers Although the results of a clinical study did not indicate a safety problem associated with the administration of Dihydroergotamine Mesylate Injection, USP to subjects already receiving propranolol, there have been reports that propranolol may potentiate the vasoconstrictive action of ergotamine by blocking the vasodilating property of epinephrine. (Dihydroergotamine label, Drug interactions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Risk may be increased when used concomitantly with high dose calcium preparations, thiazide diuretics, or vitamin D compounds. (Doxercalciferol label, Warnings and precautions)

Give a low dose of beta-blockers initially, and increase only after ECG verification of good tolerability [see Drug Interactions (7.3) , Clinical Pharmacology (12.3) ] . (Dronedarone label, Drug interactions)

Medications that may increase serum potassium concentration include ACE inhibitors, angiotensin-II receptor antagonists, potassium-sparing diuretics, potassium supplementation, heparin, aldosterone antagonists, and NSAIDS. (Drospirenone and ethinyl estradiol label, Warnings and precautions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Patients at risk of excessive hypotension include those with the following conditions or characteristics: heart failure with systolic blood pressure below 100 mmHg, ischemic heart disease, cerebrovascular disease, hyponatremia, high dose diuretic therapy, renal dialysis, or severe volume and/or salt depletion of any etiology. (Enalapril label, Warnings and precautions)

Patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Following initiation and titration of Epogen, approximately 25% of patients on dialysis required initiation of or increases in antihypertensive therapy; hypertensive encephalopathy and seizures have been reported in patients with CKD receiving Epogen. (Epoetin alfa label, Warnings and precautions)

Additional reductions in blood pressure may occur when VELETRI is administered with diuretics, antihypertensive agents, or other vasodilators. (Epoprostenol label, Drug interactions)

The beta-blocker Inderal (propranolol) has been reported to potentiate the vasoconstrictive action of ergotamine tartrate and caffeine tablets by blocking the vasodilating property of epinephrine. (Ergotamine and caffeine label, Drug interactions)

Also, patients taking diuretics or who are otherwise volume depleted may be at greater risk. (Escitalopram label, Warnings and precautions)

Antihypertensive agents clonidine, guanfacine, or moxonidine: Beta blockers also increase the risk of clonidine-, guanfacine-, or moxonidine-withdrawal rebound hypertension. (Esmolol label, Drug interactions)

For patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesemia (e.g., diuretics), health care professionals may consider monitoring magnesium levels prior to initiation of PPI treatment and periodically [see Adverse Reactions (6.2) ] . (Esomeprazole label, Warnings and precautions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

…treatment with Class 1 and Class III antiarrhythmics, 4) treatment with monoamine oxidase inhibitors (MAOI's), 5) concomitant treatment with other drug products known to prolong the QT interval and 6) electrolyte imbalance, in particular hypokalemia and hypomagnesemia, or concomitant treatment with drugs (e.g., diuretics) that may cause electrolyte imbalance. (Fentanyl label, Warnings and precautions)

Hydrochlorothiazide In a pharmacokinetic interaction study, coadministration of multiple-dose hydrochlorothiazide to healthy volunteers receiving fluconazole increased plasma concentrations of fluconazole by 40%. (Fluconazole label, Drug interactions)

Amphotericin B or potassium-depleting diuretics (benzothiadiazines and related drugs, ethacrynic acid and furosemide)—enhanced hypokalemia. (Fludrocortisone label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Propranolol or metoprolol : Reduce dose if coadministered and titrate more cautiously ( 7.3 ). (Fluvoxamine label, Drug interactions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

When diuretics are indicated, thiazides are recommended over loop diuretics because the latter inhibit renal tubular secretion, and may impair elimination of FOSCAVIR, potentially leading to toxicity. (Foscarnet label, Drug interactions)

In separate single or multiple dose pharmacokinetic interaction studies with chlorthalidone, nifedipine, propranolol, hydrochlorothiazide, cimetidine, metoclopramide, propantheline, digoxin, and warfarin, the bioavailability of fosinoprilat was not altered by coadministration of fosinopril with any one of these drugs. (Fosinopril label, Drug interactions)

The thiazide component of fosinopril sodium and hydrochlorothiazide may potentiate the action of other antihypertensive drugs, especially ganglionic or peripheral adrenergic-blocking drugs. (Fosinopril and hydrochlorothiazide label, Warnings)

If such symptoms occur, increase diuretics and restore clinical stability before advancing the dose of metoprolol. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Table 4: Clinically Significant Drug Interaction with GVOKE and GVOKE VialDx Beta-Blockers Clincial Impact: Patients taking beta-blockers may have a transient increase in pulse and blood pressure when given GVOKE or GVOKE VialDx. (Glucagon label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Caution is advised when haloperidol decanoate is used in combination with drugs known to cause electrolyte imbalance (e.g., diuretics or corticosteroids) because hypokalemia, hypomagnesemia, and hypocalcemia are risk factors for QT prolongation. (Haloperidol label, Drug interactions)

Example: Cyclobenzaprine, metaxalone Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Hydrocodone label, Drug interactions)

Diuretics Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Hydrocodone and acetaminophen label, Drug interactions)

Diuretics : Hydrocodone may reduce the efficacy of diuretics. (Hydrocodone and chlorpheniramine label, Drug interactions)

Diuretics : Hydrocodone may reduce the efficacy of diuretics. (Hydrocodone and homatropine label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Examples: cyclobenzaprine, metaxalone Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Hydromorphone label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Orthostatic vital signs should be monitored in patients who are vulnerable to hypotension (e.g., elderly patients, patients with dehydration, hypovolemia, and concomitant treatment with antihypertensive medications), patients with known cardiovascular disease (history of myocardial infarction, ischemic heart disease, heart failure, or conduction abnormalities), and… (Iloperidone label, Warnings and precautions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with imipramine hydrochloride tablets. (Imipramine label, Warnings)

Drug Interactions Other Antihypertensives: Indapamide may add to or potentiate the action of other antihypertensive drugs. (Indapamide label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Hypotension in Volume or Salt-Depleted Patients In patients with an activated renin-angiotensin system, such as volume or salt-depleted patients (e.g., those being treated with high doses of diuretics), symptomatic hypotension may occur after initialization of treatment with AVAPRO. (Irbesartan label, Warnings and precautions)

Concomitant Use with Beta Blockers Concomitant use of beta blockers may exaggerate the cardiovascular effects of inhalational anesthetics, including hypotension and negative inotropic effects. (Isoflurane label, Drug interactions)

Catecholamine-depleting drugs (e.g., MAO inhibitors): Hypotension, bradycardia. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

The risk of bradycardia increases with concomitant administration of drugs that slow heart rate (e.g., digoxin, amiodarone, beta-blockers). (Ivabradine label, Drug interactions)

Antivirals indinavir, maraviroc, saquinavir Beta Blockers nadolol Calcium Channel Blockers felodipine, nisoldipine other dihydropyridines, verapamil Calcium channel blockers can have a negative inotropic effect which may be additive to those of ketoconazole. (Ketoconazole label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

VIMPAT should also be used with caution in patients on concomitant medications that affect cardiac conduction, including sodium channel blockers, beta-blockers, calcium channel blockers, potassium channel blockers, and medications that prolong the PR interval [see Drug Interactions (7.2) ] . (Lacosamide label, Warnings and precautions)

Bradycardia-Inducing Drugs (e.g., beta-blockers) : Lanreotide Injection may decrease heart rate. (Lanreotide label, Drug interactions)

For patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesemia (e.g., diuretics), health care professionals may consider monitoring magnesium levels prior to initiation of PPI treatment and periodically [see Adverse Reactions (6.2) ] . (Lansoprazole label, Warnings and precautions)

Patients also taking beta blockers, or those with underlying cardiac comorbidities and/or advanced liver disease, may be at increased risk for symptomatic bradycardia with coadministration of amiodarone. (Ledipasvir and sofosbuvir label, Warnings and precautions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Also, patients taking diuretics or who are otherwise volume depleted can be at greater risk. (Levomilnacipran label, Warnings and precautions)

Diuretics Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Levorphanol label, Drug interactions)

Drug or Drug Class Effect Beta-adrenergic antagonists e.g., Propranolol > 160 mg/day) In patients treated with large doses of propranolol (> 160 mg/day), T 3 and T 4 levels change slightly, TSH levels remain normal, and patients are clinically euthyroid. (Levothyroxine label, Drug interactions)

Patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Catecholamine-depleting drugs (e.g., MAO inhibitors): Hypotension, bradycardia. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Drug or Drug Class Effect Beta-adrenergic antagonists (e.g., Propranolol >160 mg/day) In patients treated with large doses of propranolol (>160 mg/day), T3 and T4 levels change, TSH levels remain normal, and patients are clinically euthyroid. (Liothyronine label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Patients at risk of excessive hypotension include those with the following conditions or characteristics: heart failure with systolic blood pressure below 100 mmHg, ischemic heart disease, cerebrovascular disease, hyponatremia, high dose diuretic therapy, renal dialysis, or severe volume and/or salt depletion of any etiology. (Lisinopril label, Warnings and precautions)

When a diuretic is added to the therapy of a patient receiving lisinopril, an additional antihypertensive effect is usually observed (see DOSAGE AND ADMINISTRATION ). (Lisinopril and hydrochlorothiazide label, Drug interactions)

Lithium: Risk of lithium toxicity. (Metoprolol and hydrochlorothiazide label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Hypotension in Volume- or Salt-Depleted Patients In patients with an activated renin-angiotensin system, such as volume- or salt-depleted patients (e.g., those being treated with high doses of diuretics), symptomatic hypotension may occur after initiation of treatment with COZAAR. (Losartan label, Warnings and precautions)

Orthostatic vital signs should be monitored in patients who are vulnerable to hypotension (e.g., elderly patients, patients with dehydration, hypovolemia, and concomitant treatment with antihypertensive drugs), patients with known cardiovascular disease (history of myocardial infarction, ischemic heart disease, heart failure, or conduction abnormalities), and patients… (Lumateperone label, Warnings and precautions)

Patients at increased risk of these adverse reactions or at increased risk of developing complications from hypotension include those with dehydration, hypovolemia, treatment with antihypertensive medication, history of cardiovascular disease (e.g., heart failure, myocardial infarction, ischemia, or conduction abnormalities), history of cerebrovascular disease,… (Lurasidone label, Warnings and precautions)

The action of Mecamylamine HCl may be potentiated by anesthesia, other antihypertensive drugs and alcohol. (Mecamylamine label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

There is one report of cardiopulmonary arrest, with full recovery, in a patient who was taking a beta blocker (propranolol) (see PRECAUTIONS, Cardiac Effects ). (Mefloquine label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Examples: Cyclobenzaprine, metaxalone Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Meperidine label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Closely monitor patients with risk factors for development of prolonged QT interval (e.g., cardiac hypertrophy, concomitant diuretic use, hypokalemia, hypomagnesemia), a history of cardiac conduction abnormalities, and those taking medications affecting cardiac conduction. (Methadone label, Warnings and precautions)

…(oral): Due to potential inhibition of vitamin K activity by methimazole, the activity of oral anticoagulants (e.g., warfarin) may be increased; additional monitoring of PT/INR should be considered, especially before surgical procedures. β-adrenergic blocking agents: Hyperthyroidism may cause an increased clearance of beta blockers with a high extraction ratio. (Methimazole label, Drug interactions)

Catecholamine-depleting drugs (e.g., MAO inhibitors): Hypotension, bradycardia. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Beta-blockers Caution should be exercised when methylergonovine maleate is used concurrently with beta-blockers. (Methylergonovine label, Drug interactions)

Antihypertensive Drugs: Monitor blood pressure. (Methylphenidate label, Drug interactions)

If such symptoms occur, increase diuretics and restore clinical stability before advancing the dose of Metoprolol Tartrate Tablets [see Dosage and Administration (2) ]. (Metoprolol label, Warnings and precautions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Also, patients taking diuretics or who are otherwise volume-depleted may be at greater risk [see Geriatric Use ( 8.5 )] . (Milnacipran label, Warnings and precautions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia [see Use in Specific Populations (8.5) ] . (Mirtazapine label, Warnings and precautions)

However, a retrospective analysis of the use of antihypertensive medication in these studies showed that a greater proportion of patients on PROVIGIL required new or increased use of antihypertensive medications (2.4%) compared to patients on placebo (0.7%). (Modafinil label, Warnings and precautions)

Symptomatic hypotension is most likely to occur in patients who have been salt- and volume- depleted as a result of prolonged diuretic therapy, dietary salt restriction, dialysis, diarrhea, or vomiting. (Moexipril label, Warnings)

Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Morphine label, Drug interactions)

Patients receiving concomitant negative chronotropic drugs (e.g., beta blockers) may be more at risk for hypotension in case of hypersensitivity reaction. (Motixafortide label, Warnings and precautions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Although beta-blockers should be avoided in overt congestive heart failure, if necessary, they can be used with caution in patients with a history of failure who are well-compensated, usually with digitalis and diuretics. (Nadolol label, Warnings)

Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Diuretics Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Nalbuphine label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antihypertensive Therapy Niacin may potentiate the effects of ganglionic blocking agents and vasoactive drugs resulting in postural hypotension. (Niacin label, Drug interactions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antihypertensives: Possible additive hypotensive effects. (Nitroglycerin label, Drug interactions)

Dosage adjustments of concomitantly used drugs that have bradycardia effects (i.e. beta-blockers) may be necessary [see Drug Interactions (‎7.2) ]. (Octreotide label, Warnings and precautions)

…of myocardial infarction or ischemia, heart failure, or conduction abnormalities), cerebrovascular disease, and conditions which would predispose patients to hypotension (dehydration, hypovolemia, and treatment with antihypertensive medications) where the occurrence of syncope, or hypotension and/or bradycardia might put the patient at increased medical risk. (Olanzapine label, Warnings and precautions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Examples: cyclobenzaprine, metaxalone Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Oliceridine label, Drug interactions)

Hypotension in Volume- or Salt-Depleted Patients In patients with an activated renin-angiotensin-aldosterone system, such as volume- and/or salt-depleted patients (e.g., those being treated with high doses of diuretics), symptomatic hypotension may be anticipated after initiation of treatment with Benicar. (Olmesartan label, Warnings and precautions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

For patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesemia (e.g., diuretics), health care professionals may consider monitoring magnesium levels prior to initiation of PPI treatment and periodically [see Adverse Reactions ( 6.2 )] . (Omeprazole label, Warnings and precautions)

For patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesemia (e.g., diuretics), health care professionals may consider monitoring magnesium levels prior to initiation of PPI treatment and periodically [see Adverse Reactions ( 6.2 )] . (Omeprazole and sodium bicarbonate label, Warnings and precautions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Examples: cyclobenzaprine, metaxalone Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Oxycodone label, Drug interactions)

Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Oxycodone and acetaminophen label, Drug interactions)

Caution in using drugs such as beta-blockers, anti-hypertensives, and/or cardiac glycosides is advised. (Oxymetazoline label, Drug interactions)

Examples: butorphanol, nalbuphine, pentazocine, buprenorphine Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Oxymorphone label, Drug interactions)

Use ERZOFRI with caution in patients with known cardiovascular disease (e.g., heart failure, history of myocardial infarction or ischemia, conduction abnormalities), cerebrovascular disease, or conditions that predispose the patient to hypotension (e.g., dehydration, hypovolemia, and treatment with antihypertensive medications). (Paliperidone label, Warnings and precautions)

For patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesemia (e.g., diuretics), health care professionals may consider monitoring magnesium levels prior to initiation of PPI treatment and periodically [see Adverse Reactions (6.2) ]. (Pantoprazole label, Warnings and precautions)

The risk may be increased when Paricalcitol Injection is used concomitantly with high dose calcium preparations, thiazide diuretics, or vitamin D compounds. (Paricalcitol label, Warnings and precautions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Adjustments in the dose of drugs known to slow the heart rate (e.g., beta-blockers, calcium channel blockers) and correction of electrolyte disturbances may be necessary when initiating or during the course of SIGNIFOR LAR treatment. (Pasireotide label, Warnings and precautions)

Monitor blood pressure as clinically indicated and initiate and adjust antihypertensive therapy as appropriate. (Pazopanib label, Warnings and precautions)

Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Diuretics Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Pentazocine and naloxone label, Drug interactions)

Small decreases in blood pressure have been observed in some patients treated with pentoxifylline extended-release tablets; periodic systemic blood pressure monitoring is recommended for patients receiving concomitant antihypertensive therapy. (Pentoxifylline label, Drug interactions)

Symptomatic hypotension is most likely to occur in patients who have been volume or salt-depleted as a result of prolonged diuretic therapy, dietary salt restriction, dialysis, diarrhea or vomiting [see Dosage and Administration (2.1) ] . (Perindopril label, Warnings and precautions)

Catecholamine-depleting drugs (e.g., MAO inhibitors): Hypotension, bradycardia. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Concomitant administration of hydrochlorothiazide alone with topiramate alone has been shown to increase the C max and AUC of topiramate by 27% and 29%, respectively. (Phentermine and topiramate label, Drug interactions)

Drug Interactions Pilocarpine should be administered with caution to patients taking beta-adrenergic antagonists because of the possibility of conduction disturbances. (Pilocarpine label, Drug interactions)

Although beta-blockers should be avoided in overt congestive heart failure, if necessary, pindolol tablets can be used with caution in patients with a history of failure who are well-compensated, usually with digitalis and diuretics. (Pindolol label, Warnings)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Experience with PONVORY is limited in patients receiving concurrent therapy with drugs that decrease heart rate (e.g., beta-blockers, non-dihydropyridine calcium channel blockers - diltiazem and verapamil, and other drugs that may decrease heart rate such as digoxin). (Ponesimod label, Warnings and precautions)

Concurrent use with potassium-containing medications, potassium-sparing diuretics and angiotensin-converting enzyme inhibitors (ACE inhibitors) may result in hyperkalemia and cardiac arrhythmias or cardiac arrest. (Potassium iodide label, Drug interactions)

Syncopal episodes have usually occurred within 30 to 90 minutes of the initial dose of the drug; occasionally, they have been reported in association with rapid dosage increases or the introduction of another antihypertensive drug into the regimen of a patient taking high doses of prazosin hydrochloride capsules. (Prazosin label, Warnings)

Patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Thiazide diuretics may accentuate the orthostatic hypotension that may occur with phenothiazines. (Prochlorperazine label, Precautions)

Diuretics : Codeine may reduce the efficacy of diuretics. (Promethazine and codeine label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Beta-adrenergic blocking agents: Hyperthyroidism may cause an increased clearance of beta blockers with a high extraction ratio. (Propylthiouracil label, Drug interactions)

Use with caution in persons with increased risk of anticholinergic reactions, such as persons with bronchial asthma, chronic obstructive pulmonary disease, bradycardia, cardiac arrhythmias, beta blocker treatment (increased risk of anticholinergic reactions). (Pyridostigmine label, Warnings and precautions)

Quetiapine should be used with particular caution in patients with known cardiovascular disease (history of myocardial infarction or ischemic heart disease, heart failure, or conduction abnormalities), cerebrovascular disease, or conditions which would predispose patients to hypotension (dehydration, hypovolemia, and treatment with antihypertensive medications). (Quetiapine label, Warnings and precautions)

The thiazide component of quinapril and hydrochlorothiazide tablets may potentiate the action of other antihypertensive drugs, especially ganglionic or peripheral adrenergic- blocking drugs. (Quinapril and hydrochlorothiazide label, Warnings)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Although clinical drug interaction studies have not been performed, antimalarial doses (greater than or equal to 600 mg) of quinine may inhibit the metabolism of other drugs that are CYP2D6 substrates (e.g., flecainide, debrisoquine, dextromethorphan, metoprolol, paroxetine ). (Quinine label, Drug interactions)

For patients expected to be on prolonged treatment or who take PPIs with medications such as digoxin or drugs that may cause hypomagnesemia (e.g., diuretics), health care professionals may consider monitoring magnesium levels prior to initiation of PPI treatment and periodically [see Adverse Reactions (6.2) ]. (Rabeprazole label, Warnings and precautions)

Experience with another ACE inhibitor suggests that these increases would be reversible upon discontinuation of ramipril and/or diuretic therapy. (Ramipril label, Warnings and precautions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Catecholamine-depleting drugs (e.g., MAO inhibitors): Hypotension, bradycardia. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Decrease exposure Beta-blockers Metoprolol Decrease exposure Propranolol Decrease exposure Benzodiazepines Diazepam , Administered with rifampin 1200 mg daily Decrease exposure Benzodiazepine-related drugs Zopiclone Decrease AUC by 82% Zolpidem Decrease AUC by 73% Calcium Channel Blockers Diltiazem Decrease exposure Nifedipine Rifampin 1200 mg administered as… (Rifampin label, Drug interactions)

…Anticonvulsants Phenytoin Antimalarials Quinine Azole Antifungals Fluconazole, itraconazole, ketoconazole Antipsychotics Haloperidol Barbiturates Phenobarbital Benzodiazepines Diazepam Beta-Blockers Propranolol Calcium Channel Blockers Diltiazem, nifedipine, verapamil Cardiac Glycoside Preparations Digoxin Corticosteroids Prednisone Fibrates Clofibrate Oral Hypoglycemics… (Rifapentine label, Drug interactions)

Consider the potential for symptomatic hypotension or ischemia in patients with hypovolemia, severe left ventricular outflow obstruction, resting hypotension, autonomic dysfunction, or concomitant treatment with antihypertensives or strong CYP and P-gp/BCRP inhibitors [see Drug Interactions (7.2) and Clinical Pharmacology (12.3) ] . (Riociguat label, Warnings and precautions)

Clinically significant hypotension has been observed with concomitant use of oral RISPERDAL and antihypertensive medication. (Risperidone label, Warnings and precautions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Nadolol/Metoprolol : In a drug interactions study, effects of multiple doses of nadolol 80 mg or metoprolol 100 mg every 12 hours on the pharmacokinetics of a single dose of 10 mg rizatriptan were evaluated in healthy subjects (n=12). (Rizatriptan label, Drug interactions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Patients on beta-blockers may not manifest changes in heart rate, but blood pressure monitoring can detect a rise in systolic blood pressure. (Ropivacaine label, Warnings and precautions)

Patients with an activated renin-angiotensin system, such as volume- and/or salt-depleted patients (e.g., those being treated with high doses of diuretics), are at greater risk. (Sacubitril and valsartan label, Warnings and precautions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Catecholamine-depleting drugs (e.g., MAO inhibitors): Hypotension, bradycardia. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SSRIs [see Use in Specific Populations ( 8.5 )] . (Sertraline label, Warnings and precautions)

Caution is advised when SILDENAFIL ORAL FILM is co-administered with alpha-blockers or antihypertensives. (Sildenafil label, Warnings and precautions)

However, patients in the Phase 3 clinical studies taking concomitant antihypertensive medications with silodosin capsules did not experience a significant increase in the incidence of syncope, dizziness, or orthostasis. (Silodosin label, Warnings and precautions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Increase the dose of diuretics as needed [see Adverse Reactions (6) ] . (Sodium zirconium cyclosilicate label, Warnings and precautions)

Patients also taking beta blockers, or those with underlying cardiac comorbidities and/or advanced liver disease may be at increased risk for symptomatic bradycardia with coadministration of amiodarone. (Sofosbuvir and velpatasvir label, Warnings and precautions)

Consider temporary or permanent discontinuation for severe or persistent hypertension despite antihypertensive therapy. (Sorafenib label, Warnings and precautions)

Special attention should be given to electrolyte and acid-base balance in patients experiencing severe or prolonged diarrhea or patients receiving concomitant diuretic drugs. (Sotalol label, Warnings and precautions)

If such symptoms occur, increase diuretics and restore clinical stability before advancing the dose of metoprolol. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

If such symptoms occur, increase diuretics and restore clinical stability before advancing the dose of metoprolol. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Prolonged Neuromuscular Block in Patients with Hypokalemia or Hypocalcemia Neuromuscular blockade may be prolonged in patients with hypokalemia (e.g., after severe vomiting, diarrhea, digitalisation and diuretic therapy) or hypocalcemia (e.g., after massive transfusions). (Succinylcholine label, Warnings and precautions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Initiate and/or adjust antihypertensive therapy as appropriate. (Sunitinib label, Warnings and precautions)

• Hypertension: May require antihypertensive therapy; monitor relevant drug interactions. (Tacrolimus label, Warnings and precautions)

…use of skeletal muscle relaxants and opioids, consider prescribing naloxone for the emergency treatment of opioid overdose [see Dosage and Administration (2.2) , Warnings and Precautions (5.2 , 5.3) ] Examples: cyclobenzaprine, metaxalone Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tapentadol label, Drug interactions)

Beta-adrenergic Receptor Antagonists (e.g., acebutolol, metoprolol) Beta-adrenergic receptor antagonists have been shown to reduce the production of melatonin via specific inhibition of beta-1 adrenergic receptors. (Tasimelteon label, Drug interactions)

Hypotension In patients with an activated renin-angiotensin system, such as volume- or salt-depleted patients (e.g., those being treated with high doses of diuretics), symptomatic hypotension may occur after initiation of therapy with telmisartan tablets. (Telmisartan label, Warnings and precautions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Risk of Hypotension with Concomitant Use of Other Antihypertensive Agents and Phospodiesterase Type 5 Inhibitors (PDE5-I): Concomitant administration of TEZRULY with antihypertensives or phosphodiesterase-5 (PDE-5) inhibitors can result in additive blood pressure lowering effects and symptomatic hypotension (5.3). (Terazosin label, Warnings and precautions)

CYP2D6 inhibitors: Increased metoprolol concentration. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

In patients with hypertension on antihypertensive therapy, TLANDO increased the mean systolic/diastolic BP by 4.8/1.6 mm Hg from baseline. [see Adverse Reactions ( 6.1 )] . (Testosterone label, Warnings and precautions)

Drug Interactions with Metoprolol Catecholamine Depleting Drugs: The concomitant use of catecholamine-depleting drugs (e.g., reserpine, monoamine oxidase (MAO) inhibitors) with beta adrenergic blockers may have an additive affect and increase the risk of hypotension or bradycardia CYP2D6 Inhibitors: Drugs that are strong inhibitors of CYP2D6 such as quinidine,… (Metoprolol and hydrochlorothiazide label, Drug interactions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Antidiabetic drugs: Dosage adjustment may be required. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Some diuretics can enhance aminoglycoside toxicity by altering antibiotic concentrations in serum and tissue. (Tobramycin label, Drug interactions)

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduced diuretic, natriuretic, and antihypertensive effects of diuretics. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Co-administration of diuretics also increases the risk of too rapid correction of serum sodium and such patients should undergo close monitoring of serum sodium. (Tolvaptan label, Warnings and precautions)

Hydrochlorothiazide (HCTZ) Topiramate C max and AUC increased when HCTZ was added to immediate-release topiramate. (Topiramate label, Drug interactions)

Drugs that decrease renal calcium excretion, e.g., thiazide diuretics, may increase the risk of hypercalcemia in patients receiving FARESTON. (Toremifene label, Drug interactions)

If such symptoms occur, increase diuretics and restore clinical stability before advancing the dose of metoprolol. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol label, Drug interactions)

Diuretics Clinical Impact: Opioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. (Tramadol and acetaminophen label, Drug interactions)

Symptomatic hypotension is most likely to occur in patients who have been salt- or volume-depleted as a result of prolonged treatment with diuretics, dietary salt restriction, dialysis, diarrhea, or vomiting. (Trandolapril label, Warnings)

Concomitant use with an antihypertensive may require a reduction in the dose of the antihypertensive drug. (Trazodone label, Warnings and precautions)

If such symptoms occur, increase diuretics and restore clinical stability before advancing the dose of metoprolol. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

If such symptoms occur, increase diuretics and restore clinical stability before advancing the dose of metoprolol. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Thiazide diuretics may accentuate the orthostatic hypotension that may occur with phenothiazines. (Trifluoperazine label, Precautions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Drug Interactions with Metoprolol Catecholamine Depleting Drugs: The concomitant use of catecholamine-depleting drugs (e.g., reserpine, monoamine oxidase (MAO) inhibitors) with beta adrenergic blockers may have an additive affect and increase the risk of hypotension or bradycardia CYP2D6 Inhibitors: Drugs that are strong inhibitors of CYP2D6 such as quinidine,… (Metoprolol and hydrochlorothiazide label, Drug interactions)

In patients with an activated renin-angiotensin system, such as volume- and/or salt-depleted patients receiving high doses of diuretics, symptomatic hypotension may occur. (Valsartan label, Warnings and precautions)

Vardenafil hydrochloride tablets can potentiate the hypotensive effects of nitrates, alpha- blockers, and antihypertensives. (Vardenafil label, Drug interactions)

Caution should be exercised with co-administration of venlafaxine and metoprolol. (Venlafaxine label, Drug interactions)

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. (Metoprolol and hydrochlorothiazide label, Drug interactions)

Because beta1-selectivity is not absolute, use the lowest possible dose of metoprolol tartrate and have bronchodilators (e.g., beta 2 -agonists) readily available or administered concomitantly . (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SSRIs and SNRIs [see Use in Specific Populations ( 8.5 )] . (Vilazodone label, Warnings and precautions)

Thiazide diuretics reduce calcium excretion; combined with vitamin D and calcium supplements this can lead to hypercalcemia, especially in older adults. (NIH Office of Dietary Supplements, Vitamin D)

Also, patients taking diuretics or who are otherwise volume-depleted can be at greater risk. (Vortioxetine label, Warnings and precautions)

Zileuton increases propranolol levels and beta-blocker activity. (Zileuton label, Drug interactions)

Hypokalemia may result from diuretic therapy, diarrhea, and other causes. (Ziprasidone label, Warnings and precautions)

Elderly patients and those receiving diuretic therapy are at increased risk of acute renal failure. (Zoledronic acid label, Warnings and precautions)

Effects of Adenosine on Other Drugs Adenosine injection has been given with other cardioactive drugs (such as beta adrenergic blocking agents, cardiac glycosides, and calcium channel blockers) without apparent adverse interactions, but its effectiveness with these agents has not been systematically evaluated. (Adenosine label, Drug interactions)

Coadministration of 1 Dyazide (triamterene/hydrochlorothiazide) resulted in a higher plasma amantadine hydrochloride concentration in a 61-year old man receiving amantadine hydrochloride 100 mg TID for Parkinson's disease. (Amantadine label, Drug interactions)

Patients required intervention with a diuretic, fluid management, or, in some cases, hospitalization for decompensating heart failure. (Ambrisentan label, Warnings and precautions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Patients required intervention with a diuretic, fluid management, or hospitalization for decompensating heart failure. (Bosentan label, Warnings and precautions)

In such cases, butorphanol should be discontinued and the hypertension treated with antihypertensive drugs. (Butorphanol label, Warnings)

Thiazide diuretics reduce calcium excretion, so high calcium intake can raise blood calcium. (NIH Office of Dietary Supplements, Calcium)

Drugs that may cause hypercalcemia: Vitamin D, vitamin A, thiazide diuretics, estrogen, calcipotriene and teriparatide administration may cause hypercalcemia. (Calcium gluconate label, Drug interactions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Acthar Gel may accentuate the electrolyte loss associated with diuretic therapy. (Corticotropin label, Drug interactions)

Fluid retention events were typically managed by supportive care measures that may include diuretics or short courses of steroids. (Dasatinib label, Warnings and precautions)

If other contraceptive methods are not suitable, hormonal contraceptive therapy may continue combined with antihypertensive therapy. (Desogestrel and ethinyl estradiol label, Warnings)

Examples of alkalinizing agents include gastrointestinal alkalinizing agents (e.g., sodium bicarbonate) and urinary alkalinizing agents (e.g. acetazolamide, some thiazides). (Dextroamphetamine label, Drug interactions)

Patients developing peripheral edema may be treated with standard measures, e.g., salt restriction, oral diuretic(s). (Docetaxel label, Warnings and precautions)

Pheochromocytoma: First initiate therapy with an alpha blocker. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Pheochromocytoma: First initiate therapy with an alpha blocker. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Examples: α-adrenergic antagonists, β-adrenergic receptor antagonists, reserpine, quinidine, mephentermine Other Drug Interactions G u anethidine C linical Impact: Ephedrine may inhibit the neuron blockage produced by guanethidine, resulting in loss of antihypertensive effectiveness. (Ephedrine label, Drug interactions)

In addition to discontinuation of the drug, diuretic therapy may be required. (Esterified estrogens and methyltestosterone label, Warnings)

In Vivo Drug Interaction Studies Based on drug interaction studies in healthy patients, ULORIC does not have clinically significant interactions with colchicine, naproxen, indomethacin, hydrochlorothiazide, warfarin or desipramine [see Clinical Pharmacology (12.3) ]. (Febuxostat label, Drug interactions)

…PROSCAR was concomitantly used in clinical studies with acetaminophen, acetylsalicylic acid, α-blockers, angiotensin-converting enzyme (ACE) inhibitors, analgesics, anti-convulsants, beta-adrenergic blocking agents, diuretics, calcium channel blockers, cardiac nitrates, HMG-CoA reductase inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines,… (Finasteride label, Drug interactions)

Drugs That Slow Heart Rate or Atrioventricular Conduction (e.g., beta blockers or diltiazem) Experience with GILENYA in patients receiving concurrent therapy with drugs that slow the heart rate or AV conduction (e.g., beta blockers, digoxin, or heart rate-slowing calcium channel blockers, such as diltiazem or verapamil) is limited. (Fingolimod label, Drug interactions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

ACE Inhibitors FIRAZYR is a bradykinin B2 receptor antagonist and thereby has the potential to have a pharmacodynamic interaction with ACE inhibitors where FIRAZYR may attenuate the antihypertensive effect of ACE inhibitors. (Icatibant label, Drug interactions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Pheochromocytoma: First initiate therapy with an alpha blocker. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Abrupt withdrawal in thyrotoxicosis might precipitate a thyroid storm. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Postmarketing cases of edema and fluid retention occurring within weeks of starting OPSUMIT, some requiring intervention with a diuretic or hospitalization for decompensated heart failure, have been reported [see Adverse Reactions (6.2) ] . (Macitentan label, Warnings and precautions)

Long-term use of loop and thiazide diuretics increases magnesium loss in urine. (NIH Office of Dietary Supplements, Magnesium)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Amphotericin B injection and potassium-depleting agents : When corticosteroids are administered concomitantly with potassium-depleting agents (e.g., amphotericin B, diuretics), patients should be observed closely for development of hypokalemia. (Methylprednisolone label, Drug interactions)

In addition to discontinuation of the drug, diuretic therapy may be required. (Methyltestosterone label, Warnings)

In a large compassionate use program mexiletine has been used concurrently with commonly employed antianginal, antihypertensive, and anticoagulant drugs without observed interactions. (Mexiletine label, Drug interactions)

…been observed in limited experience with patients in whom milrinone was used concurrently with the following drugs: digitalis glycosides; lidocaine, quinidine; hydralazine, prazosin; isosorbide dinitrate, nitroglycerin; chlorthalidone, furosemide, hydrochlorothiazide, spironolactone; captopril; heparin, warfarin, diazepam, insulin; and potassium supplements. (Milrinone label, Drug interactions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

The antihypertensive action of guanethidine and similar agents may be blocked. (Nortriptyline label, Warnings)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Drug Interactions Metabolism of a number of medications, including antipsychotics, antidepressants, β-blockers, and antiarrhythmics, occurs through the cytochrome P450 2D6 isoenzyme (debrisoquine hydroxylase). (Perphenazine label, Drug interactions)

Pheochromocytoma: First initiate therapy with an alpha blocker. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Pheochromocytoma: First initiate therapy with an alpha blocker. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Loop and thiazide diuretics increase potassium loss; supplementation is sometimes prescribed alongside them. (NIH Office of Dietary Supplements, Potassium)

Potassium-depleting agents (e.g., diuretics, Amphotericin B): When corticosteroids are administered concomitantly with potassium-depleting agents, patients should be observed closely for development of hypokalemia. (Prednisolone label, Drug interactions)

Potassium-Depleting Agents (e.g., Diuretics, Amphotericin B) When corticosteroids are administered concomitantly with potassium-depleting agents, patients should be observed closely for development of hypokalemia. (Prednisone label, Drug interactions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Protriptyline may block the antihypertensive effect of guanethidine or similarly acting compounds. (Protriptyline label, Warnings)

Pheochromocytoma: First initiate therapy with an alpha blocker. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Abrupt withdrawal in thyrotoxicosis might precipitate a thyroid storm. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Amphotericin B injection and potassium-depleting agents: When corticosteroids are administered concomitantly with potassium-depleting agents ( i.e., amphotericin B, diuretics), patients should be observed closely for development of hypokalemia. (Triamcinolone label, Drug interactions)

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. (Metoprolol and hydrochlorothiazide label, Warnings and precautions)

Thiazide diuretics increase zinc loss in urine with long-term use. (NIH Office of Dietary Supplements, Zinc)

Beta-adrenergic blocking agents: Coadministration of beta-adrenergic blocking agents did not have any effect on either the safety or efficacy of ibutilide in the clinical trials. (Ibutilide label, Drug interactions)

Loop Diuretics Concomitant administration of a loop diuretic had no effect on the calcium-lowering action of pamidronate disodium. (Pamidronate label, Drug interactions)

Commonly Administered Drugs: Population analysis showed that commonly administered drugs (e.g., selegiline, amantadine, tricyclic antidepressants, benzodiazepines, ibuprofen, thiazides, antihistamines, anticholinergics) did not affect the clearance of ropinirole. (Ropinirole label, Drug interactions)

Table 5: Sevelamer Drug Interactions Oral drugs for which sevelamer did not alter the pharmacokinetics when administered concomitantly Digoxin Enalapril Iron Metoprolol Warfarin Oral drugs that have demonstrated interaction with sevelamer and are to be dosed separately from sevelamer carbonate Dosing Recommendations Ciprofloxacin Take at least 2 hours before… (Sevelamer label, Drug interactions)