May 22, 2017
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"SYDNEY, AUSTRALIA ” A small randomized trial reports sharp blood-pressure reductions in untreated hypertensives using a single pill combining four BP-lowering drugs at one-quarter the usual dose.

Among 18 patients, mean 24-hour systol"...





Signs And Symptoms

The most frequently observed signs expected with overdosage of a beta adrenergic blocker are bradycardia and bradyarrhythmia, hypotension, heart failure, cardiac conduction disturbances and bronchospasm.

With thiazide diuretics, acute intoxication is rare. The most prominent feature of overdose is acute loss of fluid, electrolytes and magnesium. Signs and symptoms of overdose may include hypotension, dizziness, muscle cramps, renal impairment or failure, and sedation/ impairment of consciousness. Altered laboratory findings can also occur (e.g. hypokalemia, hypomagnesaemia, hyponatremia, hypochloremia, alkalosis, increased BUN).


Care should be provided at a facility that can provide appropriate supporting measures, monitoring and supervision as treatment is symptomatic and supportive and there is no specific antidote. Limited data suggest that neither metoprolol nor hydrochlorothiazide is dialyzable. If justified, gastric lavage and/or activated charcoal can be administered.

Based on the expected pharmacologic actions and recommendations for other beta adrenergic blockers and hydrochlorothiazide, the following measures should be considered when clinically warranted.

Bradycardia and conduction disturbances: Use atropine, adrenergic-stimulating drugs or pacemaker.

Hypotension, acute heart failure, and shock: Treat with suitable volume expansion, injection of glucagon (if necessary, followed by an intravenous infusion of glucagon), intravenous administration of adrenergic drugs such as dobutamine, with α1 receptor agonistic drugs added in the presence of vasodilation.

Bronchospasm: Can usually be reversed by bronchodilators.


DUTOPROL is contraindicated in patients with:

  • Cardiogenic shock or decompensated heart failure.
  • Sinus bradycardia, sick sinus syndrome, and greater than first-degree block unless a permanent pacemaker is in place.
  • Anuria
  • Hypersensitivity to metoprolol succinate or hydrochlorothiazide or to other sulfonamidederived drugs.
This monograph has been modified to include the generic and brand name in many instances.

Last reviewed on RxList: 12/6/2016


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