CARSEL PLUS
METOPROLOL AND HYDROCHLOROTHIAZIDE · by UNIMARK
Composition
Tab 50/25 mg: Metoprolol tartrate 50 mg, hydrochlorothiazide 25 mg. Tab100/25 mg: Metoprolol tartrate 100 mg, hydrochlorothiazide 25 mg.
Indications & Dosage
Hypertension, angina: Adults: 1 tab 1-3 times daily. Children: Not recommended.
Contraindications
2nd or 3rd degree AV block (without pacemaker), severe bradycardia, sick sinus syndrome, un-controlled heart failure, cardiogenic shock, severe peripheral arterial disease, hypotension, metabolic acidosis, untreated pheochromocytoma, severe asthma or COPD.
Precautions
1st degree AV block, heart failure (avoid if un-controlled), peripheral arterial circulatory disorders (avoid if severe), Prinzmetals angina, myasthenia gravis, ischaemic heart disease, withdraw gradually, history of bronchospasm, diabetes, hyperthyroidism, renal or hepatic impairment, psoriasis, elderly, anaphylaxis risk due to increased sensitivity to al-lergens, withdraw gradually over period of 1-2 weeks.
Interactions
Ca+ + antagonists, antihypertensives including centrally acting agent (e.g. clonidine), antiarrhythmics, antipsychotics. TCADs, MAOIs, fluvoxamine, barbiturates, cardiac glycosides, sympathomimetics, cimetidine, hydralazine, rifampicin, insulin/oral hypoglycaemics, NSAIDs, ergot derivatives, erythromycin, anaesthetics, diuretics
Pregnancy
Avoid, risk cannot be ruled out.
Lactation
Caution advised or effect undetermined.
Side Effects
Cardiovascular effects including bradycardia, postural hypotension, increased AV block, cardiac arrhythmias, Raynauds phenomenon, cold extremities, sexual dysfunction, GI upset, sleep and CNS disturbances, skin reactions, fatigue, paraesthesia, peripheral neuropathy, arthralgia, myopathy, altered blood sugar haematology and lipid levels. Withdraw if unexplained dry eyes or rash. Rare: Heart failure, dyspnea, bronchospasm