SIDE EFFECTS: See also Warning and Precautions sections. Dizziness, lightheadedness, drowsiness, headache, slow heartbeat, tiredness, or diarrhea may occur. Decreased sexual ability has been reported rarely. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. To lower your risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. This product may reduce blood flow to your hands and feet, causing them to feel cold. Smoking may worsen this effect. Dress warmly and avoid tobacco use. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. The hydrochlorothiazide in this product may cause your body to lose too much water and salt (dehydration). Tell your doctor right away if you have any of these unlikely but serious symptoms of dehydration: very dry mouth, extreme thirst, muscle cramps/weakness, fast heartbeat, severe dizziness, confusion, fainting, seizures. Tell your doctor right away if any of these unlikely but serious side effects occur: very slow/irregular heartbeat, mental/mood changes (such as depression, mood swings), toe/joint pain. Tell your doctor right away if any of these rare but very serious side effects occur: trouble breathing, blue fingers/toes, yellowing eyes/skin, persistent nausea/vomiting, severe stomach/abdominal pain, dark urine, decrease in vision, eye pain, easy bruising/bleeding, signs of infection (such as fever, persistent sore throat), signs of kidney problems (such as change in the amount of urine). Although this medication may be used to treat heart failure, some people may rarely develop new or worsening symptoms of heart failure. Tell your doctor right away if you experience any of these unlikely but serious side effects: shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain. A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before taking this product, tell your doctor or pharmacist if you are allergic to metoprolol or hydrochlorothiazide; or to other thiazide diuretics (such as chlorothiazide); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: certain types of heart rhythm problems (such as a slow heartbeat, second- or third-degree atrioventricular block, sick sinus syndrome), an inability to make urine (anuria). Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood circulation problems (such as Raynaud's disease, peripheral vascular disease), pheochromocytoma, breathing problems (such as asthma, chronic bronchitis, emphysema), overactive thyroid (hyperthyroidism), liver disease, kidney disease, lupus, serious allergic reactions including those needing treatment with epinephrine, mental/mood disorders (such as depression), gout, loss of too much body water (dehydration), untreated salt imbalance (for example, high calcium, low potassium, low magnesium), a certain muscle/nerve disease (myasthenia gravis). Before having surgery, tell your doctor or dentist that you are taking this medication. This drug may make you dizzy or drowsy. Alcohol or marijuana can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana. To help prevent dizziness, drink plenty of fluids while taking this medication unless your doctor directs you otherwise. Too much sweating, diarrhea, or vomiting may cause you to feel lightheaded. Report prolonged diarrhea or vomiting to your doctor. This medication may reduce the potassium levels in your blood. Ask your doctor about adding potassium to your diet. Your doctor may prescribe a potassium supplement. If you have diabetes, this product may mask the fast/pounding heartbeat you would usually feel when your blood sugar falls too low (hypoglycemia). Other symptoms of low blood sugar, such as dizziness and sweating, are unaffected by this drug. This product may also make it harder to control your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of high blood sugar such as increased thirst/urination. Your doctor may need to adjust your diabetes medication, exercise program, or diet. This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness. Older adults may be more sensitive to the side effects of this drug, including dizziness. During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor. Metoprolol and hydrochlorothiazide pass into breast milk, but are unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: See also Precautions section. Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first. This drug should not be used with the following medications because very serious interactions may occur: cisapride, dofetilide. If you are currently using any of these medications, tell your doctor or pharmacist before starting this product. Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: fingolimod, lithium, mefloquine. Other medications can affect the removal of metoprolol from your body, which may affect how this product works. Examples include cimetidine, lumefantrine, quinidine, propafenone, ritonavir, SSRI antidepressants (such as fluoxetine), St. John's wort, among others. Some products have ingredients that could raise your heart rate or blood pressure or worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen). This product may interfere with certain laboratory tests (including parathyroid, protein-bound iodide, tyramine, and phentolamine tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug. This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, fainting, very slow heartbeat, trouble breathing.