Metoprolol 200mg modified-release / Hydrochlorothiazide 25mg tablets

= 94%). Similarly, isradipine, lacidipine, and amlodipine improved carotid hemodynamics and cerebral perfusion, with meta-analysis favoring calcium channel blocker intervention for blood pressure management (CI: -3.25 to 7.64, P = 0.43). On the other hand, thiazide diuretics effectively reduced BP but showed limited efficacy in preventing atherosclerosis progression. In addition, angiotensin II receptor blockers (ARBs) significantly reduced 5-year stroke rates from 11% to 3.5%. Moreover, beta-blockers showed specific benefits, with metoprolol improving plaque echogenicity (57.3 ± 16.8 vs. 51.8 ± 20.0, p = 0.006) and reducing cardiovascular events (17% vs. 37% placebo, p = 0.011), while labetalol effectively managed post-endarterectomy hypertension. In conclusion, antihypertensive treatments showed varying effectiveness in cardiovascular event reduction and improvements in vessel measures.

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Acute pancreatitis is a common inflammatory disorder of the pancreas. While commonly caused by gallstones, alcohol use, and idiopathic causes, drug-induced acute pancreatitis (DIAP) is an often overlooked etiology that demands careful medication review and clinical vigilance. This case report describes a 72-year-old male patient with a history of hypertension and coronary artery disease who presented with severe epigastric pain radiating to the back, elevated lipase levels, and imaging findings consistent with acute pancreatitis. After excluding common causes such as gallstones, alcohol use, and hypertriglyceridemia, hydrochlorothiazide (HCTZ) was identified as the likely trigger. Discontinuation of hydrochlorothiazide led to clinical improvement and resolution of laboratory abnormalities. This case highlights the importance of considering drug-induced acute pancreatitis, particularly in patients with comorbidities who present with unexplained acute pancreatitis due to their pharmacological therapy.

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A novel green ultra high performance liquid chromatography (UHPLC) method was validated and estimated the measurement uncertainty for simultaneous determination of metoprolol tartrate (MET) and hydrochlorothiazide (HCT) in binary tablet. A Zorbax® SB-C18 column with isocratic elution (flow rate 0.9 mL min−1) at 25°C was used. Analytes and HCT degradation product were separated in approximately 1 min using acetonitrile:water:triethylamine (17:83:0.2, v/v) as mobile phase. Analytical curves were linear with (R2 > 0.99 for MET and HCT) with detection limits of 2.42 and 1.05 µg mL−1 for MET and HCT, respectively. Precision measurements showed RSD% from 0.39 to 1.2% and method accuracy by recovery tests was 100 ± 2%. Measurement uncertainties using Eurachem procedure were 100.1 ± 2.8% and 100.3 ± 2.4% for MET and HCT, respectively. This UHPLC method was accurate, precise, linear and selective, making it suitable for pharmaceutical quality control. It also proved eco-friendly compared to other reported methods.

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Concentrations of metoprolol in exhaled breath condensate (EBC) have not been investigated. Herein, we aim to determine the metoprolol levels in EBC, plasma, and urine samples. Biological samples were collected from 39 patients receiving metoprolol. Metoprolol was determined using liquid chromatography mass spectrometery. The obtained metoprolol levels in biological fluids were investigated for possible inter-correlations. Acceptable linearity was obtained with coefficient of determinations equal to 0.9998, 0.9941, and 0.9963 for EBC, plasma, and urine samples, respectively. The calibration curves were linear in the ranges of 0.6–500, 0.4–500, and 0.7–10,000 µg·L− 1 regarding EBC, plasma, and urine samples, respectively. The detection and quantification limits were (0.18, 0.12, and 0.21 µg·L− 1) and (0.60, 0.40, and 0.70 µg·L− 1) for EBC, plasma, and urine samples, respectively. The relative standard deviations for the intra- and inter-day replications were obtained between 5.2 and 6.1 and 3.3–4.6%, respectively. The obtained mean metoprolol levels in EBC, plasma, and urine samples of 39 patients were 5.35, 70.76, and 1943.1 µg·L− 1. There were correlations between daily dose and plasma and urinary concentrations of metoprolol in the investigated samples, whereas no significant correlation was observed for daily dose and EBC levels. The correlation among plasma-urine levels was significant, however, the non-significant correlation was obtained between plasma and EBC concentrations. Metoprolol levels varied widely due to the metabolic pattern of the Azeri population, different dosages received by the patients, formulation effects, age, sex, and interactions with the co-administered drugs. A poor correlation of EBC-plasma concentrations and a significant correlation of plasma-urine concentrations were observed. Further investigations are required to provide the updated services to personalized medicine departments.

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Capillary electrophoresis (CE) methods have unique potential for applications in quality control of pharmaceutical formulations. Here, we show that a single and ultra-fast CE method can be used for the determination of hydrochlorothiazide (HCT) in combination with nine other active ingredients in a single run in different pharmaceutical samples: atenolol (ATE), metoprolol (MET), propranolol (PRO), benazepril (BEN), captopril (CAP), enalapril (ENA), lisinopril (LIS), ramipril (RAM), and valsartan (VAL). This goal was achieved using a single and simple background electrolyte (BGE) composed of 10 mmol L-1 of boric acid with pH adjusted to 9.0 with sodium hydroxide. All samples can be analyzed in less than 1 min with the attainment of good analytical performance, such as high-resolution separation (r > 1.3), low sample and reagents consumption (environmentally friendly method), low relative standard deviation (RSD) values for peak area (< 4.0%) and migration times (< 1.7%), and linear relationships with good correlation coefficients (> 0.995). Furthermore, recovery tests showed good results (100 ± 5%) for all evaluated compounds.

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Introduction: Metoprolol is therapeutically formulated as a racemate with stereoselective pharmacokinetics influenced by CYP2D6 polymorphism. Understanding enantioselective disposition is critical for optimizing therapy in hypertensive patients, particularly during long-term treatment, where metabolic and excretory pathways may interact unpredictably. Methods: This study analyzed plasma samples from 18 hypertensive patients on long-term metoprolol therapy using a validated chiral capillary electrophoresis method. Enantiomer concentrations were quantified, and S/R ratios were evaluated alongside patient demographics, dosing regimens, and co-administered drugs. The study design focused on identifying deviations from expected enantiomeric patterns observed in single-dose or short-term multi-dose administration in healthy individuals studies. Results: While most patients (70%) exhibited the anticipated S/R ratio≥1, 30% demonstrated inverted plasma S/R ratios (<1), suggesting altered renal excretion or CYP2D6 saturation. Conclusion: Long-term metoprolol therapy reveals complex enantioselective disposition influenced by metabolic phenotype, renal excretion and drug interactions. The unexpected S/R inversion underscores the need for personalized dosing, particularly in patients with renal impairment or polypharmacy. Enantiomer monitoring may complement pharmacogenomic strategies to optimize therapeutic outcomes.

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Background: The pharmaceutical subsystem is a complex interrelationship among different stakeholders that ensure access to safe, effective, and quality pharmaceutical products in the market. Understanding the availability and affordability as key areas for access to medicines is essential to appreciate the strategies needed to strengthen the pharmaceutical subsystem. Objectives: class municipality. Further, the study determined the price comparisons of these essential antihypertensive medicines with international reference prices. Methods: This is a quantitative, cross-sectional study design which employed a modified WHO/HAI methodology to quantify antihypertensive medicines' availability and affordability in public and private primary care drug facilities. Selection of medicines was based on a criteria applicable for the primary care setting. Availability was measured through visual inspection of the selected medicines in the facility, affordability was estimated through the selling price of medicines in the public and private facilities, respectively, and was divided by the local minimum wage of the municipality. Median price ratio was computed using the local median prices over the MSH 2015 international reference prices adjusted for inflation. Results: Availability of essential antihypertensive medicines was found to be 12.96% in public facilities and 60.32% in private facilities (p = 0.0002). Only amlodipine is observed to be available in both public (83.33%) and private (85.71%) facilities, while only metoprolol 50 mg tab (33.33%) and amlodipine 5 mg tab (83.33%) were available in public facilities. All medicines are below 1 MPR, but carvedilol 6.25 mg (1 tab BID: 1.32; 2 tabs BID: 2.65), 25 mg (BID: 2.65), and enalapril 5 mg (BID: 1.14; TID: 1.70) treatment regimens are unaffordable compared to a worker's day wage. Conclusion: Availability of essential antihypertensive medicines is diverse comparing public and private facilities. There is a need to increase the availability of antihypertensive medicines in public facilities as this is an important quality measure of primary care services. Public facilities can leverage on the availability of medicines in private pharmacies by forming Primary Care Provider Networks. While most medicines were deemed affordable in the private setting, there are still drugs such as carvedilol and enalapril, that need to be regulated. There is a need to strengthen the local pharmaceutical subsystem because it is essential to ensure safe, effective, and quality medicines in the local health system through adequate mobilization of resources.

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BACKGROUND: This study aimed to explore the clinical application of renal denervation (RDN) in patients with refractory hypertension complicated by acute aortic syndrome. CASE SUMMARY: We present a case of a 54-year-old woman with refractory hypertension treated with quadruple antihypertensive therapy, including nifedipine, metoprolol, hydrochlorothiazide, and sacubitril-valsartan. Five months ago, she underwent emergent thoracic aortic endovascular stent-graft repair for acute aortic type B dissection. Successful bilateral RDN (Netrod system) was performed without complications. Postprocedure 24-hour average blood pressure decreased to 119/73 mm Hg at 3-month follow-up from 136/82 mm Hg preoperatively, with hydrochlorothiazide discontinued and the rest medications halved. DISCUSSION: This case suggests that RDN may offer an effective approach for blood pressure control in acute aortic syndrome. Careful preprocedure evaluation and multidisciplinary decision-making are crucial. TAKE-HOME MESSAGE: This case shows that RDN combined with definitive thoracic aortic endovascular stent-graft repair potentially becomes a new treatment modality for acute aortic syndrome.

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Introduction: Despite strong evidence supporting guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF), a significant gap persists in the consistent application of these therapies. This shortfall has prompted organizations like the American College of Cardiology to recommend leveraging electronic health records (EHR) to optimize GDMT. This paper discusses the development of SmartHF, a clinical decision support system designed to enhance therapy adherence by effectively linking Fast Healthcare Interoperability Resources (FHIR)-based medication data with clinical algorithms tailored for the management of HFrEF. Methods: The SmartHF system integrates FHIR-based medication data with clinical algorithms through a multi-step approach. Central to this process is data from CodeRx, a platform that utilizes streamlined data pipelines to map medication products to their ingredients using RxNorm. The methodology addresses the challenge of interpreting both structured and unstructured medication instructions, ensuring a precise linkage of product identifiers to algorithm-relevant ingredients and their corresponding strengths. Specific attention is given to the data granularity needed for distinguishing precise ingredients within complex formulations, such as sacubitril/valsartan and metoprolol salt form variants. Results: The deployment of SmartHF involved rigorous testing using actual and synthetic patient datasets to validate its functionality. Results demonstrated the system's ability to process FHIR MedicationRequest data resources accurately, convert free-text dosing instructions into usable formats, and handle edge cases, including non-standard products and missing dose information. Conclusions: This article describes the potential of FHIR-based medication data integration for enhancing clinical decision support tools and improving care quality. It highlights the challenges and solutions for this integration.

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