Q: My aunt aged 40 used to take following medicines: Betaloc 50 (morning and evening) and losar H 1/2 (once in the afternoon). Her CAG is normal, she has MVP Gr II Trivial MR Good systolic LV function LVEF 0.71%. Recently she had slight chest discomfort but the treating doctor advised that this could be due to her anxiety, which aggravates MVP. He suggested 1/2 Restyle 0.25. The treating doctor has now changed the medicines to: Metolar XR 100 (morning single dose) and Losar H (once afternoon) Is it ok that Metolar XR 100 be given in single dose? Is it possible to give Metolar XR 100 in equally divided dose morning and evening?

A:The patient has been given three medicines: metoprolol 100mg per day (one tablet of Metolar), losartan 50mg and hydrochlorthiazide 12.5mg (one tablet of Losar- H). Earlier the dose was metoprolol 100mg per day (Betaloc 50mg twice daily), losartan 25mg and hydrochlorthiazide 6.25mg (half tablet of Losar-H). Thus the dosage of metoprolol remains the same while the dose of losartan and hydrochlorthiazide has been doubled. We are unable to comment on the increase in dose. Your doctor is the best judge. However I do not see any reason to shift the patient from Betaloc brand to Metolar XR brand. Metoprolol 50mg twice daily is fine. Betaloc also has a 100mg tablet. If at all we wish to give 100mg once daily instead of 50mg twice daily, one can prescribe Betaloc 100mg. There is no need to have a slow/extended-release preparation for metoprolol. Nowhere in the western world can I find metoprolol extended release preparation. Due to the flood of substandard/fake drugs in the market, one should always take brands.