{
 "query": "hydrochlorothiazide / metoprolol",
 "ingredient": "hydrochlorothiazide / metoprolol",
 "slug": "hydrochlorothiazide-metoprolol",
 "rxcui": "214621",
 "brands": [
  "Lopressor HCT"
 ],
 "names": [
  "hydrochlorothiazide / metoprolol"
 ],
 "components": [
  {
   "ingredient": "hydrochlorothiazide",
   "slug": "hydrochlorothiazide",
   "grade": "B",
   "total": 85,
   "scores": {
    "safety": "A",
    "evidence": "C",
    "regulatory": "B",
    "conflict": "A",
    "options": "A"
   },
   "boxed": false,
   "controlled": false,
   "first_approval_fmt": "02/24/1959",
   "first_approval": "19590224"
  },
  {
   "ingredient": "metoprolol",
   "slug": "metoprolol",
   "grade": "B",
   "total": 80,
   "scores": {
    "safety": "C",
    "evidence": "C",
    "regulatory": "B",
    "conflict": "A",
    "options": "A"
   },
   "boxed": true,
   "controlled": false,
   "first_approval_fmt": "08/07/1978",
   "first_approval": "19780807"
  }
 ],
 "classes": [],
 "alternatives": [],
 "label": {},
 "faers": null,
 "faers_base": {
  "total": 20692304,
  "serious_share": 0.5742697381596559,
  "death_share": 0.09102355155810585
 },
 "recalls": [],
 "recall_total": 0,
 "drugsfda": {
  "first_approval": "19590224",
  "first_approval_fmt": "",
  "anda": 32,
  "nda": 0,
  "rems": false,
  "labeling_recent": 0
 },
 "trials": null,
 "pubmed": null,
 "payments": {
  "year": "2024",
  "usd": 0.0,
  "records": 0,
  "by_name": [],
  "names_checked": [
   "hydrochlorothiazide / metoprolol",
   "Lopressor HCT"
  ],
  "source": "bulk-index"
 },
 "partd": {
  "year": "2024",
  "claims": 33203,
  "beneficiaries": 8997,
  "spend": 2135231.35,
  "by_brand": [
   {
    "brand": "Metoprolol-Hydrochlorothiazide",
    "claims": 33203,
    "per_claim": 64.30838629,
    "is_generic": false
   }
  ],
  "per_claim": 64.30838629039545
 },
 "mdl": [],
 "dsc": [],
 "settlements": [],
 "prescrire": null,
 "eml": null,
 "exposure": null,
 "scores": {
  "safety": {
   "score": 70,
   "letter": "C",
   "why": [
    "Graded by its riskiest ingredient, metoprolol (70)",
    "Carries an FDA boxed warning, the strongest warning the FDA issues (-30)",
    "1,037 FDA reports naming it as the suspect drug per million Medicare fills, 0.4x the median drug on this site",
    "Death share in reports is near or below the FAERS average (1.2x)"
   ],
   "weight": 0.35
  },
  "evidence": {
   "score": 64,
   "letter": "C",
   "why": [
    "Graded by its riskiest ingredient, hydrochlorothiazide (64)",
    "822 randomized trials and 31 systematic reviews/meta-analyses indexed in PubMed",
    "On the WHO Model List of Essential Medicines (shown for context; no score effect)",
    "No Cochrane review found (-5)",
    "Only 35% of completed registered trials posted results (-15)"
   ],
   "weight": 0.25
  },
  "regulatory": {
   "score": 85,
   "letter": "B",
   "why": [
    "Graded by its riskiest ingredient, hydrochlorothiazide (85)",
    "Recalls since 2016: 1 Class I, 0 Class II, 0 Class III across 32 generic makers (-15)"
   ],
   "weight": 0.15
  },
  "conflict": {
   "score": 100,
   "letter": "A",
   "why": [
    "Graded by its riskiest ingredient, hydrochlorothiazide (100)",
    "Pharma paid doctors $0 tied to this drug last year: negligible",
    "Not named in any pending federal MDL"
   ],
   "weight": 0.15
  },
  "options": {
   "score": 100,
   "letter": "A",
   "why": [
    "Graded by its riskiest ingredient, hydrochlorothiazide (100)",
    "Generic versions approved (32 applications)",
    "8 same-class alternatives exist"
   ],
   "weight": 0.1
  }
 },
 "total": 78,
 "grade": "B",
 "questions": [
  "This is a fixed combination of hydrochlorothiazide and metoprolol. Why both together, instead of only the one I need?",
  "The most-reported problems in FDA's adverse event data are fatigue, nausea, diarrhoea. How would we recognize and handle those?",
  "Why this one over bendroflumethiazide, chlorothiazide, cyclopenthiazide? What would make you pick one of those instead?",
  "What result are we expecting, by when, and what is the plan if it does not happen?",
  "If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)",
  "This drug carries a boxed warning. Which specific risk does it cover, and does it apply to me?",
  "The most-reported problems in FDA's adverse event data are fatigue, diarrhoea, dyspnoea, nausea. How would we recognize and handle those?",
  "Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?",
  "Why this one over acebutolol, atenolol, betaxolol? What would make you pick one of those instead?"
 ]
}