Metoprolol with Hydralazine Interaction Details

Brand Names Associated with Metoprolol

Brand Names Associated with Hydralazine

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 15, 2023

Interaction Effect

Increased metoprolol concentrations

Interaction Summary

HydrALAZINE increases the oral bioavailability of metoprolol; this interaction occurs more frequently in a fasting state and does not occur with sustained-release beta-blockers. Concomitant use of hydrALAZINE and metoprolol may cause inhibition of presystemic metabolism of metoprolol by hydrALAZINE, resulting in increased metoprolol bioavailability and metoprolol levels. HydrALAZINE is also a CYP2D6 inhibitor, which may increase plasma concentrations of metoprolol, leading to decreased cardioselectivity . If concurrent therapy is required, monitor blood pressure carefully.

Severity

Moderate

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Concomitant use of hydrALAZINE and metoprolol may cause inhibition of presystemic metabolism of metoprolol by hydrALAZINE, resulting in increased metoprolol bioavailability and metoprolol levels. HydrALAZINE is also a CYP2D6 inhibitor, which may increase plasma concentrations of metoprolol, leading to decreased cardioselectivity. If concurrent therapy is required, monitor blood pressure carefully.

Mechanism Of Interaction

Inhibition of presystemic metabolism of metoprolol and inhibition of CYP2D6-mediated metabolism of metoprolol by hydrALAZINE

Literature Reports

A) Concomitant administration of oral metoprolol 50 mg twice daily and oral hydrALAZINE 25 mg twice daily resulted in significant increases (38%) in the median area under the plasma concentration-time curve (AUC) for metoprolol in 10 hypertensive pregnant women. Metoprolol Cmax levels were increased by 88%, and the Tmax was decreased from 1.5 to 1 hour. No effect on plasma levels of alpha-hydroxymetoprolol were observed, suggesting that the mechanism of this interaction is primarily related to a reduction in the hepatic first-pass elimination. No significant increases in the metoprolol serum levels occurred if the baseline levels were high during monotherapy. The hydrALAZINE effect on the metoprolol serum levels was of short duration (2 to 3 hours) in most of the patients. This interaction should not be clinically significant for this patient population .

Metoprolol Overview

• Metoprolol is used alone or in combination with other medications to treat high blood pressure. It also is used to treat chronic (long-term) angina (chest pain). Metoprolol is also used to improve survival after a heart attack. Metoprolol also is used in combination with other medications to treat heart failure. Metoprolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.

• High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Hydralazine Overview

• Hydralazine is used to treat high blood pressure. Hydralazine is in a class of medications called vasodilators. It works by relaxing the blood vessels so that blood can flow more easily through the body.

• High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Return To Our Drug Interaction Homepage

Feedback, Question Or Comment About This Information?

Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.