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INTRODUCTION
METOLET R 25/2.5 TABLET is a combination of Metoprolol and Ramipril which belongs to the group of medicines called Antihypertensive agents. It is used to treat hypertension (high blood pressure) and angina (chest pain). It can also be used to treat and prevent heart failure and reduces the chances of hospitalization among the heart patients.
It also protects the function of kidneys particularly in patients who have both hypertension and type II diabetes mellitus.
Before taking METOLET R 25/2.5 TABLET inform your doctor if you have any liver, kidney or heart problems apart from hypertension, angina and heart failure. You must also inform your doctor if you have asthma, COPD, diabetes, severe dehydration due to any recent sickness (such as vomiting or diarrhea), psoriasis or muscle problems before taking METOLET R 25/2.5 TABLET as a precaution.
METOLET R 25/2.5 TABLET is not recommended for use in patients with severe hypotension (low blood pressure). It is also not suitable for use in women who are pregnant or breastfeeding due to increased risk of side effects.
The most common side effects of taking METOLET R 25/2.5 TABLET are dizziness, swelling of ankles or other body parts, headache, sleepiness, tiredness, indigestion, constipation and muscle cramps. Contact your doctor if any of these side effects trouble you.
USES OF METOLET R 25/2.5 TABLET
It is used to:
- Treat hypertension and angina
- Treat and prevent heart failure
- Protect kidney functions in patients with hypertension and diabetes
HOW METOLET R 25/2.5 TABLET WORKS
METOLET R 25/2.5 TABLET contains two medicines namely metoprolol and ramipril. Metoprolol is a beta-blocker. It blocks the effects of certain chemicals in the body (such as adrenaline) that increases heart rate and blood pressure.
Ramipril is an ACE inhibitor. It blocks the effects of certain enzymes in the body (such as angiotensin converting enzyme (ACE)) that causes narrowing of blood vessels and increase in blood pressure.
Collectively, blocking the actions of adrenaline and ACE reduces the strain on the heart and relaxes the blood vessels supplying the heart and the kidneys, which improves blood flow and oxygen supply to them and reduces blood pressure and kidney damage.
DIRECTIONS FOR USE
Take METOLET R 25/2.5 TABLET as advised by your physician. Swallow the medicines with a glass of water. Do not crush or chew the medicine.
Your doctor will decide the correct dose and duration of therapy for you depending upon your age, body weight and disease condition.
Continue to take METOLET R 25/2.5 TABLET for the stipulated duration instructed by your doctor to achieve better results.
SIDE EFFECTS OF METOLET R 25/2.5 TABLET
COMMON
- headache, tiredness, dizziness
- feeling faint or dizzy while standing up
- dry cough, inflammation of sinus
- stomach pain, nausea, vomiting, diarrhea, indigestion
- skin rash
- chest pain
- muscle pains
- increased potassium levels in blood
- slow heart rate
UNCOMMON
- anxiety, depression
- insomnia (sleeplessness)
- changes in taste
- tingling sensation in limbs, loss of pain sensation
- blocked nose
- heartburn, constipation, dry mouth, loss of appetite
- increased urination
- increased sweating
- swollen arms and legs (oedema)
- flushing (skin redness and warmth)
- blurred vision
- inability to obtain an erection, enlargement of the breasts in men
- joint pain, back pain
RARE
- confusion
- red, swollen tongue
- loosening or separation of a nail from its bed
- skin rash, itching, redness
- red, itchy, swollen or watery eyes
Stop taking METOLET R 25/2.5 TABLET and contact your doctor immediately if you experience any of the following side effects:
- signs of allergic reactions (such as skin rash, swelling of the face, lips, mouth or throat which can lead to difficulty in breathing or swallowing)
- severe skin reactions (such as skin rash with itching and redness, blistering and peeling of skin, skin swelling and inflammation of mucous membrane)
- chest pain, shortness of breath (signs of heart attack)
- inflammation of pancreas (causing severe stomach pain that radiates to the back side of the body)
- signs of liver problems (such as fever, muscle pain, rashes, itching, stomach pain, diarrhea, discoloration of eyes, skin and urine)
- increased bleeding or bruising, fever, chills, red spots under the skin, tiredness, dizziness, pale skin (signs of low blood cells counts)
HOW TO MANAGE SIDE EFFECTS
Nausea:
Take METOLET R 25/2.5 TABLET with or just after a meal or a snack. Stick to simple meals. Avoid eating rich or spicy food. Consult your doctor if your nausea worsens.
Dizziness:
Try to rest and relax. Get enough sleep. Avoid driving or operating any tools or machines completely while you are feeling dizzy. Do not consume excessive alcohol, as it could aggravate your dizziness. Consult your doctor if your dizziness worsens.
Headache:
Rest and relax. Keep yourself hydrated by drinking plenty of fluids such as water or electrolytes. Applying a pain-relieving balm on your forehead can be beneficial. Do not consume excessive alcohol, as it could aggravate your headache. Consult your doctor if your headache worsens.
Constipation:
Eat plenty of fibre rich foods such as fresh fruits, vegetables and cereals. Drink plenty of fluids. Exercise more regularly. Consult your doctor if this side effect bothers you.
WARNING & PRECAUTIONS
PREGNANCY
METOLET R 25/2.5 TABLET is not recommended for use in pregnant women as it may cause serious harm to the growing foetus. Therefore, inform your doctor before taking this medicine if you are pregnant, think you may be pregnant or planning to have a baby. If you accidentally become pregnant while undergoing therapy with METOLET R 25/2.5 TABLET, inform your doctor immediately.
BREASTFEEDING
METOLET R 25/2.5 TABLET is not recommended for use in breast-feeding women. Therefore, consult your doctor before taking it.
DRIVING AND USING MACHINES
Do not drive or operate any heavy tools or machines if you feel dizzy after taking METOLET R 25/2.5 TABLET.
ALCOHOL
Avoid consumption of alcohol while taking METOLET R 25/2.5 TABLET as it may severely decrease your blood pressure and make you feel dizzier or faint.
KIDNEY
METOLET R 25/2.5 TABLET is not recommended for use in patients with severe kidney impairment (including dialysis or narrowing or renal arteries). It should be used with caution in patients with other kidney problems (including kidney transplantation). Therefore, consult your doctor before taking it.
LIVER
METOLET R 25/2.5 TABLET is not recommended for use in patients with liver failure. It should be used with caution in patients with other minor liver problems (such as liver cirrhosis). Therefore, consult your doctor before taking it.
ALLERGY
Do not take METOLET R 25/2.5 TABLET if you are allergic to Metoprolol, Ramipril or to any other beta-blockers (such as propranolol, atenolol) or ACE inhibitors (such as captopril, enalapril, lisinopril).
LUNGS
METOLET R 25/2.5 TABLET is not recommended for use in patients with severe lung problems (such as asthma, COPD or any form of breathing difficulties). Therefore, consult your doctor before taking it.
HEART DISEASE
METOLET R 25/2.5 TABLET is not recommended for use in patients with severe heart problems (such as slow or irregular heartbeat, severe heart failure, recent heart attack). It should be used with caution in patients with other minor heart problems. Therefore, consult your doctor before taking it.
OTHERS
METOLET R 25/2.5 TABLET is not recommended for use if you:
- have diabetes with impaired kidney functions
- are in shock
- have untreated phaeochromocytoma (a tumor of adrenal gland)
- have metabolic acidosis (increased acidity in blood)
- have problems in blood circulation (such as Raynaud’s disease)
- have block in blood vessels
- have a type of angina called Prinzmetal’s angina
- have severe low blood pressure
- suffer from frequent episodes of low blood sugar levels
Before taking METOLET R 25/2.5 TABLET, inform your doctor if you:
- have a history of allergic reaction to insects
- have diabetes
- have psoriasis (an auto-immune skin disorder)
- have dry eyes
- have myasthenia gravis (severe muscle weakness)
- are scheduled for any upcoming surgery
- are severely dehydrated due to any recent sickness such as vomiting or diarrhea
- have any autoimmune disease that affects the skin or collagen (Ex. lupus erythematosus, rheumatoid arthritis or scleroderma)
- have any desensitization treatment (used to reduce the effect of an allergy to bee or wasp stings)
- have high blood potassium levels
Use in Paediatrics:
METOLET R 25/2.5 TABLET is not recommended for use in children and adolescents (aged below 18 years). Therefore, consult your doctor before consumption.
Use in Geriatrics:
METOLET R 25/2.5 TABLET should be used with caution in elderly patients. Therefore, consult your doctor before taking it.
INTERACTIONS
A. Drug-Drug interactions:
Before taking METOLET R 25/2.5 TABLET inform your doctor, if you are taking any of the following medicines such as:
- medicines used to treat stomach ulcers (such as cimetidine)
- medicines used to treat high blood pressure (such as hydralazine, clonidine, prazosin, aliskiren, sacubitril/valsartan, verapamil or diltiazem)
- medicines used to treat irregular heart rhythm (such as amiodarone, procainamide, digoxin and propafenone)
- medicines used to treat depression (such as moclobemide, paroxetine, fluoxetine isocarboxazid, phenelzine, selegiline, tranylcypromine, lithium)
- medicines used to treat epilepsy (such as phenobarbital, phenytoin)
- anaesthetics (used to causes numbness of body parts or loss of consciousness) such as lidocaine, cyclopropane or trichloroethylene
- medicines used to treat some cancers (such as aldesleukin)
- medicines used to treat erectile dysfunction (such as alprostadil)
- medicines used to reduce anxiety and to induce sleep (such as temazepam, nitrazepam, diazepam)
- non-steroidal anti-inflammatory drugs (used for pain relief) Ex. indomethacin, ibuprofen, aspirin
- rifampicin (a medicine used to treat tuberculosis infection)
- terbinafine (a medicine used to treat fungal infections)
- contraceptive pills (birth control pills) such as ethinyl Estradiol
- hormone replacement therapy (used to treat menstrual problems) such as estrogens
- corticosteroids (used to treat pain and inflammation) such as hydrocortisone, prednisolone
- anti-diabetic medicines and insulin (used to lower the blood glucose level) Ex. vildagliptin, metformin
- timolol eye drops (used to treat glaucoma)
- sympathomimetic drugs (used to treat low blood pressure, asthma, allergies or heart failure) such as ephedrine, noradrenaline or adrenaline
- moxisylyte (a medicine used in Raynaud’s syndrome)
- medicines used to treat asthma (such as aminophylline or theophylline)
- medicines to treat migraines (such as ergotamine)
- medicines used to treat rheumatoid arthritis (such as hydroxychloroquine)
- diphenydramine (an allergic medicine)
- medicines used to prevent graft rejection (Ex. ciclosporin, sirolimus, everolimus)
- medicines that supplement potassium to the body (Ex. spironolactone, triamterene or amiloride)
- trimethoprim, co-trimoxazole (used to treat bacterial infections)
- heparin (a medicine used to treat blood clots)
- allopurinol (a medicine used to treat gout)
- racecadotril (a medicine used to treat diarrhea)
Overdosage:
If you or anyone else accidentally took more METOLET R 25/2.5 TABLET, consult your doctor immediately. Symptoms of overdose might include low blood pressure, tiredness, dizziness, slow pulse, shortness of breath, nausea, vomiting, blue colouring of the skin, low blood sugar levels and high levels of potassium in the blood.
SYNOPSIS
| Drug | : | Metoprolol, Ramipril |
| Pharmacological Category | : | Beta blockers, ACE inhibitors |
| Therapeutic Indication | : | Hypertension, Angina, Heart failure, Kidney disease |
| Dosage Forms | : | Tablet, Capsule |
MORE INFORMATION
- Keep METOLET R 25/2.5 TABLET out of the sight and reach of children
- Store METOLET R 25/2.5 TABLET at room temperature
FAQs ABOUT METOLET R 25/2.5 TABLET
What are the uses of METOLET R 25/2.5 TABLET?
METOLET R 25/2.5 TABLET is used to treat hypertension (high blood pressure) and angina (chest pain). It can also be used to prevent heart failure and reduce the chances of hospitalization among the heart patients. It also protects the function of kidneys particularly in patients who have both hypertension and type II diabetes mellitus.
How METOLET R 25/2.5 TABLET works?
METOLET R 25/2.5 TABLET relaxes the blood vessels supplying the heart and the kidneys. This reduces the strain on the heart and improves blood flow and oxygen supply to them which reduces blood pressure and kidney damage.
What happens when I stop taking METOLET R 25/2.5 TABLET?
Do not stop taking METOLET R 25/2.5 TABLET without consulting your doctor as your symptoms may re-appear once again. Make sure to take METOLET R 25/2.5 TABLET for the stipulated duration recommended by your doctor to achieve maximum results.
What is the best time to take METOLET R 25/2.5 TABLET?
METOLET R 25/2.5 TABLET can be taken with or without meals. Your doctor will decide the best time for you to take METOLET R 25/2.5 TABLET based on your age, body weight and disease condition.
What to do if I forgot to take a dose of METOLET R 25/2.5 TABLET?
If you have missed a dose of METOLET R 25/2.5 TABLET, take it as soon as you remember. However, if it is time for the next dose of METOLET R 25/2.5 TABLET, skip the missed dose and take the next one regularly. Do not take a double dose of METOLET R 25/2.5 TABLET to compensate the missed ones.
Can I consume alcohol while taking METOLET R 25/2.5 TABLET?
Avoid consumption of alcohol while taking METOLET R 25/2.5 TABLET as it might make you feel dizzier and drowsier.
What happens if I accidentally take more METOLET R 25/2.5 TABLET?
If you or anyone else accidentally took more METOLET R 25/2.5 TABLET, consult your doctor immediately. Symptoms of overdose might include low blood pressure, tiredness, dizziness, slow pulse, shortness of breath, nausea, vomiting, blue colouring of the skin, low blood sugar levels and high levels of potassium in the blood.
Can I take METOLET R 25/2.5 TABLET daily?
Take METOLET R 25/2.5 TABLET as advised by your physician. Your doctor will evaluate your health condition and suggests whether can you take METOLET R 25/2.5 TABLET every day or not.
Can METOLET R 25/2.5 TABLET cause ankle swelling?
METOLET R 25/2.5 TABLET may cause edema or swelling of ankles in few patients. If you experience ankle swelling, keep your legs on a table or slightly elevated from the ground level. If this symptom bothers you, contact your doctor.
What are the side effects of METOLET R 25/2.5 TABLET?
The most common side effects of taking METOLET R 25/2.5 TABLET are dizziness, swelling of ankles or other body parts, headache, sleepiness, tiredness, indigestion, constipation and muscle cramps. Contact your doctor if any of these side effects trouble you.
Can I stop taking METOLET R 25/2.5 TABLET once my symptoms subside?
No. Do not stop taking METOLET R 25/2.5 TABLET without consulting your doctor. As hypertension is a chronic condition, long term treatment may be necessary to control its symptoms. Therefore, take METOLET R 25/2.5 TABLET as advised by your doctor for the stipulated duration. Sudden withdrawal of the therapy may increase your blood pressure once again.
Can the use of METOLET R 25/2.5 TABLET affect the liver?
Yes. METOLET R 25/2.5 TABLET may affect the way your liver work. Therefore, it should be used with caution in patients with liver problems. Consult your doctor before taking it.
Can METOLET R 25/2.5 TABLET cause erectile dysfunction?
METOLET R 25/2.5 TABLET may cause problems in erection in few individuals. Consult your doctor if it bothers you.
Is METOLET R 25/2.5 TABLET safe to use in diabetic patients?
METOLET R 25/2.5 TABLET may alter the blood sugar levels in your body. It can also hide the symptoms of low blood sugar. Therefore, it is necessary to inform your doctor if you have diabetes before taking METOLET R 25/2.5 TABLET as a precaution. Your doctor will closely monitor your blood sugar levels to avoid the risk of side effects. Also, inform your doctor if you experience any unusual tiredness, hunger or thirst while undergoing therapy with METOLET R 25/2.5 TABLET.
Can METOLET R 25/2.5 TABLET be used during pregnancy?
METOLET R 25/2.5 TABLET is not recommended for use in pregnant women as it may cause serious harm to the growing foetus. Therefore, inform your doctor before taking METOLET R 25/2.5 TABLET if you are pregnant, think you may be pregnant or planning to have a baby.
What kind of foods should be avoided while taking METOLET R 25/2.5 TABLET?
METOLET R 25/2.5 TABLET has the capacity to increase blood potassium level which can lead to irregular heartbeat. To prevent any such occurrence, it is advisable to avoid potassium rich foods such as bananas, oranges, green leafy vegetables and potassium containing supplements while taking METOLET R 25/2.5 TABLET.
REFERENCES
1. KD. Tripathi. Anti-adrenergic drugs and Drugs for Glaucoma. Drugs affecting Renin-angiotensin system. Essentials of Medical Pharmacology. Seventh Edition. 2013. Page – 148 & 503.
2. Martin H. Strauss, Alistair S. Hall & Krzysztof Narkiewicz. The Combination of Beta-Blockers and ACE Inhibitors Across the Spectrum of Cardiovascular Diseases. Cardiovascular Drugs and Therapy. SpringerLink. September 2021. [Accessed on 9th December 2022]. https://link.springer.com/article/10.1007/s10557-021-07248-1
3. Zentiva k.s. Electronic Medicines Compendium (EMC). [Revised in April 2021] [Accessed on 9th December 2022]. https://www.medicines.org.uk/emc/files/pil.12971.pdf
4. Accord Healthcare Limited. Electronic Medicines Compendium (EMC). [Revised in March 2019] [Accessed on 9th December 2022]. https://www.medicines.org.uk/emc/files/pil.5345.pdf
5. Mylan Pharmaceuticals Inc. Metoprolol succinate tablet, film coated, extended release. Dailymed.com. [Revised in August 2022] [Accessed on 9th December 2022]. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c50e8e36-42df-406b-8e63-eb8bf3f07e89
6. Accord. Electronic Medicines Compendium (EMC). [Revised in May 2022] [Accessed on 9th December 2022]. https://www.medicines.org.uk/emc/files/pil.5890.pdf
7. Leeford Healthcare Ltd. Vesrapril-M. [Accessed on 9th December 2022]. https://www.leeford.in/product/1523/vesrapril-m
8. Sanofi Ltd. Cardace Meto. Ramipril & Metoprolol Succinate Extended-Release Tablets. [Revised in October 2021] [Accessed on 9th December 2022]. https://www.sanofi.in/dam/jcr:dc1286a7-0e3d-4b7d-942d-14f37c6c3b70/CARDACE%20Meto-%20PI.pdf
9. Centrals Drugs Standard Control Organization. Metoprolol (As succinate) ER 25mg/50mg + Ramipril 2.5mg/5mg tablets. February 2007. [Accessed on 9th December 2022]. https://cdsco.gov.in/opencms/resources/UploadCDSCOWeb/2018/UploadApprovalNewDrugs/dciApprovedfdc.pdf
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- Kidney Function Test
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