$Unique_ID{BRK03313} $Pretitle{} $Title{propranolol and hydrochlorothiazide combination} $Subject{Inderide Wyeth-Ayerst LA Beta-adrenergic blocking agent diuretic propranolol hydrochlorothiazide high blood pressure water pill fluid accumulation elimination salt water kidneys beta blockers nerve impulses pathways} $Volume{} $Log{ Inderide*0331301.scf} Copyright (C) 1993 Publications International, Ltd. propranolol and hydrochlorothiazide combination ------------------------------------------------------------------------------ BRAND NAMES (Manufacturers) Inderide (Wyeth-Ayerst) Inderide LA (Wyeth-Ayerst) TYPE OF DRUG Beta-adrenergic blocking agent and diuretic INGREDIENTS propranolol and hydrochlorothiazide DOSAGE FORMS Tablets (40 mg propranolol and 25 mg hydrochlorothiazide; 80 mg propranolol and 25 mg hydrochlorothiazide) Long-acting capsules (80 mg propranolol and 50 mg hydrochlorothiazide; 120 mg propranolol and 50 mg hydrochlorothiazide; and 160 mg propranolol and 50 mg hydrochlorothiazide) STORAGE Store at room temperature in a tightly closed, light-resistant container. USES This drug is prescribed to treat high blood pressure. Hydrochlorothiazide is a diuretic (water pill), which reduces fluid accumulation in the body by increasing the elimination of salt and water through the kidneys. Propranolol belongs to a group of drugs known as beta-adrenergic blocking agents or, more commonly, beta blockers. They work by controlling nerve impulses along certain nerve pathways. TREATMENT This medication can be taken with a glass of water, with meals, immediately following meals, or on an empty stomach (depending on your doctor's instructions). Try to take the medication at the same time(s) each day. Avoid taking a dose after 6:00 p.m.; otherwise, you may have to get up during the night to urinate. If you miss a dose of this medication, take the missed dose as soon as possible, unless it is almost time for your next dose. In that case, do not take the missed dose at all; just wait until the next scheduled dose. Do not double the dose. Propranolol and hydrochlorothiazide combination does not cure high blood pressure, but it will help control the condition as long as you continue to take it. SIDE EFFECTS Minor. Anxiety, constipation, cramps, decreased sexual ability, diarrhea, difficulty in sleeping, drowsiness, dizziness, dryness of the eyes and skin, headache, heartburn, loss of appetite, nervousness, stomach discomfort, restlessness, or tiredness. These side effects should disappear as your body adjusts to the medication. Hydrochlorothiazide can cause increased sensitivity to sunlight. Avoid prolonged exposure to sunlight and sunlamps. Wear protective clothing and use sunscreen. If you become extra-sensitive to the cold, be sure to dress warmly during cold weather. To relieve constipation, increase the amount of fiber in your diet (fresh fruits and vegetables, salads, bran, and whole-grain breads) unless your doctor directs you to do otherwise. Plain, nonmedicated eye drops (artificial tears) may help to relieve eye dryness. To avoid dizziness or light-headedness when you stand, contract and relax the muscles of your legs for a few moments before rising from a sitting or reclining position. Do this by pushing one foot against the floor while raising the other foot slightly, alternating feet so that you are "pumping" your legs in a pedaling motion. Major. Tell your doctor about any side effects that are persistent or particularly bothersome. IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about blurred vision, cold hands and feet (due to decreased blood circulation to skin, fingers, and toes), confusion, depression, difficulty in breathing, dry mouth, excessive thirst, excessive weakness, fever, hair loss, hallucinations, itching, joint pain, mood changes, muscle spasms, nausea, nightmares, numbness or tingling in the fingers or toes, palpitations, rapid weight gain (three to five pounds within a week), reduced alertness, skin rash, sore throat, swelling, unusual bleeding or bruising, vomiting, or yellowing of the eyes or skin. INTERACTIONS This medicine interacts with other types of drugs: 1. Indomethacin, aspirin, and other salicylates may decrease the blood-pressure-lowering effects of beta blockers. 2. Use of propranolol and calcium channel blockers (diltiazem, nifedipine, or verapamil) or disopyramide can lead to heart failure or very low blood pressure. 3. Cimetidine or oral contraceptives (birth control pills) can increase the blood levels of propranolol, which can result in greater side effects. Side effects may also be increased when propranolol is taken with clonidine, digoxin, epinephrine, phenylephrine, phenylpropanolamine, phenothiazine tranquilizers, prazosin, reserpine, or monoamine oxidase (MAO) inhibitors. At least 14 days should separate the use of propranolol and an MAO inhibitor. 4. Barbiturates, alcohol, and rifampin can increase the breakdown of propranolol, which can lead to a decrease in its effectiveness. 5. The action of beta blockers may be increased if they are used with chlorpromazine, furosemide, or hydralazine, which may have a negative effect. 6. Propranolol can antagonize (act against) the effects of theophylline, aminophylline, albuterol, isoproterenol, metaproterenol, and terbutaline. 7. Propranolol can also interact with insulin and oral antidiabetic agents, raising or lowering blood sugar levels and masking the symptoms of low blood sugar. 8. Hydrochlorothiazide can decrease the effectiveness of oral anticoagulants (blood thinners, such as warfarin), antigout medications, and methenamine. 9. Antihypertensive medications may increase the blood-pressure-lowering effects of propranolol and hydrochlorothiazide combination, which can be dangerous. 10. Cholestyramine and colestipol can decrease the absorption of hydrochlorothiazide from the gastrointestinal tract; therefore, hydrochlorothiazide should be taken one hour before or four hours after a dose of cholestyramine or colestipol if one of these medications has also been prescribed for you. 11. Hydrochlorothiazide may increase the side effects of amphotericin B, calcium, cortisone and cortisone-like steroids (such as dexamethasone, hydrocortisone, prednisone, and prednisolone), digoxin, digitoxin, lithium, quinidine, sulfonamide antibiotics, and vitamin D. TELL YOUR DOCTOR about any medications you are currently taking, especially any of those listed above. WARNINGS * Tell your doctor about unusual or allergic reactions you have had to medications, especially to propranolol or any other beta blocker (such as acebutolol, atenolol, betaxolol, carteolol, esmolol, labetalol, metoprolol, nadolol, penbutolol, pindolol, and timolol), to hydrochlorothiazide or other diuretics (such as bendroflumethiazide, benzthiazide, chlorothiazide, chlorthalidone, cyclothiazide, hydroflumethiazide methyclothiazide, metolazone, polythiazide, quinethazone, trichlormethiazide, and furosemide), or to any sulfa drug (oral antidiabetic medication and sulfonamide antibiotic). * Tell your doctor if you have ever had asthma, diabetes mellitus, heart disease, gout, kidney disease or problems with urination, liver disease, pancreatitis, systemic lupus erythematosus, thyroid disease, or poor circulation in the fingers or toes. * Hydrochlorothiazide can cause potassium loss. Signs of potassium loss include dry mouth, thirst, weakness, muscle pain or cramps, nausea, and vomiting. If you experience any of these symptoms, call your doctor. To help prevent this problem, your doctor may have blood tests performed periodically to monitor your potassium levels. To help avoid potassium loss, take this medication with a glass of fresh or frozen orange juice or cranberry juice, or eat a banana every day. The use of a salt substitute also helps to prevent potassium loss. Do not change your diet, however, until you discuss it with your doctor. Too much potassium may also be dangerous. * While you are taking this medication, limit your intake of alcohol, in order to prevent dizziness and light-headedness. * Do not take any over-the-counter medications for weight control or for allergy, asthma, cough, cold, or sinus problems unless you first check with your doctor. * To prevent severe water loss (dehydration) while taking this medication, check with your doctor if you have any illness that causes severe or continuous nausea, vomiting, or diarrhea. * This medication can raise blood sugar levels in diabetic patients. Blood sugar levels should be monitored carefully with blood or urine tests when this medication is being taken. * You may want to check your pulse while taking this medication. If your pulse is much slower than your usual rate (or if it is less than 50 beats per minute), check with your doctor. A pulse rate that is too slow may cause circulation problems. * Propranolol can affect your body's response to exercise. Make sure you ask your doctor what an appropriate amount of exercise would be for you, taking into account your medical condition. * Before having surgery or any other medical or dental treatment, tell your doctor or dentist that you are taking this medicine. Often, this medication will be discontinued 48 hours prior to any major surgery. * This medication can cause dizziness, drowsiness, light-headedness, or decreased alertness. Therefore, you must exercise caution while driving a car or operating potentially dangerous machinery. * It is important that you do not stop taking this medicine unless you first check with your doctor. Some conditions worsen when this medicine is stopped suddenly, and the danger of a heart attack is increased in some patients. Your doctor may therefore want you to gradually reduce the amount of medicine you take before stopping completely. Make sure that you have enough medicine on hand to last through vacations, holidays, and weekends. * A doctor does not usually prescribe a "fixed-dose" drug like this as the first choice in the treatment of high blood pressure. Usually, the patient first receives each ingredient singly. If there is an adequate response to the fixed dose contained in this product, it can then be substituted. The advantage of a combination product is increased convenience and (often) decreased cost. * Be sure to tell your doctor if you are pregnant. Animal studies have shown that some beta blockers can cause problems in pregnancy when used at very high doses. Adequate studies have not been conducted in humans, but there has been some association between beta blockers used during pregnancy and low birth weight, as well as breathing problems and slow heart rate in newborn infants. However, other reports have shown no such effects in newborn infants. Hydrochlorothiazide has been associated with jaundice, blood problems, and low potassium in the newborn. Also, tell your doctor if you are breast-feeding an infant. Although problems in humans have not been reported, small amounts of propranolol and hydrochlorothiazide pass into breast milk, so caution is warranted. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.