Metoprolol Succinate + Telmisartan

Dosage Forms Available

• This combination is available as an oral tablet.
• Metoprolol succinate is generally provided in an extended-release form.
• Do not crush or chew the tablet. Divide it only if it is scored and the doctor or product instructions permit splitting.

Age and Dose Restrictions

• This combination is generally prescribed to adults.
• The dose depends on your blood pressure, heart rate, kidney and liver function, and other medicines you take.
• Take it only at the dose and for the duration prescribed by your doctor.
• The safety and appropriate dose of this combination have not been established in children. Give it to a child only if specifically prescribed by a specialist.

Contraindications

• Do not take this medicine if you are allergic to metoprolol, telmisartan or any other ingredient in the tablet.
• It must not be used during pregnancy.
• It should not be used if you have a very slow heart rate or certain serious disorders affecting the heart’s electrical signals, unless your doctor considers it appropriate.
• It should not be used in cardiogenic shock, a serious condition in which the heart cannot supply enough blood to the body.
• Do not use it during severe or rapidly worsening heart failure unless you are being closely monitored by a doctor.
• If you have diabetes and kidney impairment, do not take telmisartan with aliskiren.

Other Medicines to Avoid With This Medicine

• ACE inhibitors or aliskiren may increase the risk of low blood pressure, kidney problems and high potassium levels.
• Consult your doctor before taking potassium supplements, potassium-containing salt substitutes or potassium-sparing diuretics.
• Non-steroidal anti-inflammatory medicines, such as ibuprofen and naproxen, may reduce its blood-pressure-lowering effect and affect kidney function.
• Verapamil, diltiazem, digoxin and amiodarone may cause the heart rate to become too slow.
• Fluoxetine, paroxetine and propafenone may increase the amount of metoprolol in the body.
• Metoprolol may hide some warning signs of low blood sugar in patients taking insulin or other diabetes medicines.
• Telmisartan may increase lithium levels and the risk of lithium-related side effects.
• Tell your doctor about all prescription medicines, non-prescription medicines, herbal products, vitamins and supplements you take.

Overdose and Missed Dose

• An overdose may cause extremely low blood pressure, a very slow heart rate, dizziness, fainting, breathing difficulty or severely impaired heart function.
• Seek emergency medical help immediately after an overdose. Do not wait for symptoms to appear.
• If you miss a dose, take it when you remember. If it is nearly time for the next dose, skip the missed dose.
• Do not take 2 doses together.

Management of Side Effects

• Rise slowly from a sitting or lying position to reduce dizziness. Sit or lie down if you feel faint.
• If you experience stomach discomfort, take the medicine consistently in relation to meals, as directed by your doctor or the product instructions.
• Drink enough water if you have diarrhoea or vomiting. Contact your doctor if these symptoms continue.
• Seek immediate medical help if you develop a very slow heart rate, fainting, breathing difficulty or severe weakness.
• Swelling of the face, lips, tongue or throat, or difficulty breathing, may indicate a serious allergic reaction and requires immediate medical help.
• Do not stop this medicine suddenly. Suddenly stopping metoprolol may worsen chest pain or cause other serious heart problems.

Driving and Operating Machinery

• This medicine may cause dizziness, tiredness or weakness.
• Do not drive or operate heavy machinery until you know how it affects you.
• Avoid these activities if you experience dizziness, faintness or difficulty concentrating.

Use in Pregnancy and Breastfeeding

• This combination must not be used during pregnancy because telmisartan can seriously harm the developing baby, particularly the baby’s kidneys.
• If you become pregnant, stop taking it and contact your doctor immediately for an alternative treatment.
• If you are planning a pregnancy, consult your doctor in advance so that it can be replaced with a more suitable blood pressure medicine.
• Information about the safety of this combination during breastfeeding is limited. Your doctor will consider the need for treatment and the potential risk to the baby before recommending it.

Caution in Other Conditions

• Metoprolol may hide some warning signs of low blood sugar, particularly a rapid heart rate, in people with diabetes.
• It may worsen breathing problems in some people with asthma or another respiratory condition.
• If you have kidney disease or heart failure, your kidney function and blood potassium levels may need regular monitoring.
• Your doctor may adjust the dose if you have liver disease.
• Metoprolol may hide warning signs, such as a rapid heart rate, in people with an overactive thyroid.
• It may worsen symptoms in people with reduced blood flow to the hands or feet.
• Before surgery, tell the surgeon and anaesthesia team that you take this medicine.

Special Dietary and Lifestyle Recommendations

• Reduce your intake of salt and foods containing large amounts of sodium.
• Do not use potassium supplements or potassium-containing salt substitutes without medical advice.
• Follow a balanced diet containing fruits, vegetables, pulses and whole grains.
• Exercise regularly, such as by walking, as advised by your doctor.
• Maintain a healthy weight and regularly monitor your blood pressure and heart rate.
• Avoid or limit alcohol because it may worsen dizziness and low blood pressure.
• Stop smoking to reduce the risk of heart and blood vessel disease.