CLONIDINE & CHLORTHALIDONE

Brand & Generic Names

Combipres

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? No
• Drug class: Antihypertensive

Uses

• Treatment of high blood pressure.
• Reduces fluid retention (edema) caused by conditions such as heart disorders and liver disease.

Dosage & Usage Information

How to take:
Tablet--Swallow with liquid. If you can't swallow whole, crumble tablet and take with liquid or food. Don't exceed dose.

When to take:
At the same time each day.

If you forget a dose:
Take as soon as you remember up to 2 hours late. If more than 2 hours, wait for next scheduled dose (don't double this dose).

What drug does:
Relaxes and allows expansion of blood vessel walls.
Forces sodium and water excretion, reducing body fluid.
Reduced body fluid and relaxed arteries lower blood pressure.

Time lapse before drug works:
4 to 6 hours. May require several weeks to lower blood pressure.

Don't take with:
Any medicine that will decrease mental alertness such as alcohol, antihistamines, cold/cough medicines, sedatives, tranquilizers, narcotics, prescription pain medicine, barbiturates, seizure medicine, anesthetics.

Overdose

SYMPTOMS:
Vomiting; fainting; rapid, irregular, slow heartbeat; diminished reflexes; cramps; shortness of breath; weakness; drowsiness; weak pulse; coma.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• If patient is unconscious and not breathing, give mouth-to- mouth breathing. If there is no heartbeat, use cardiac massage and mouth-to-mouth breathing (CPR). Don't try to make patient vomit. If you can't get help quickly, take patient to nearest emergency facility.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

Irregular heartbeat, Discontinue. Seek weak pulse. emergency treatment.

Common:

Dry mouth, increased thirst, muscle cramps, nausea or vomiting, mood changes, drowsiness.

Infrequent:

Vomiting, diminished sex desire and performance, insomnia, dizziness, diarrhea, constipation, appetite loss.

Rare:

• Jaundice; easy bruising or bleeding; sore throat, fever, mouth ulcers; rash or hives; joint pain; flank pain; abdominal pain.
• Cold fingers and toes, nightmares.

Warnings & Precautions

Don't take if:

• You are allergic to any thiazide diuretic drug or alpha- adrenergic blocker.
• You are under age 12.

Before you start, consult your doctor:

• If you are allergic to any sulfa drug.
• If you have gout, liver, pancreas or kidney disorder, a peripheral circulation disorder (intermittent claudication, Buerger's disease), history of depression, heart disease.
• If you will have surgery within 2 months, including dental surgery, requiring general or spinal anesthesia.

Over age 60:
Adverse reactions and side effects may be more frequent and severe than in younger persons, especially dizziness and excessive potassium loss.

Pregnancy:
Risk to unborn child outweighs drug benefits. Don't use.

Breast-feeding:
Drug passes into milk. Avoid drug or discontinue nursing until you finish medicine. Consult doctor for advice on maintaining milk supply.

Infants & children:
Use only after careful medical supervision after age 12. Avoid before age 12.

Prolonged use:

• Don't discontinue without consulting doctor. Dose may require gradual reduction if you have taken drug for a long time. Doses of other drugs may also require adjustment.
• Continued use may cause fluid retention, requiring addition of diuretic to treatment program.
• Request yearly eye examinations.
• Talk to your doctor about the need for follow-up medical examinations or laboratory studies.

Skin & sunlight:
May cause rash or intensify sunburn in areas exposed to sun or sunlamp.

Driving, piloting or hazardous work:
Don't drive or pilot aircraft until you learn how medicine affects you. Don't work around dangerous machinery. Don't climb ladders or work in high places. Danger increases if you drink alcohol or take medicine affecting alertness and reflexes, such as antihistamines, tranquilizers, sedatives, pain medicine, narcotics and mind-altering drugs.

Discontinuing:
Don't discontinue abruptly. May cause rebound high blood pressure, anxiety, chest pain, insomnia, headache, nausea, irregular heartbeat, flushed face, sweating.

Others:

• Hot weather and fever may cause dehydration and drop in blood pressure. Dose may require temporary adjustment. Weigh daily and report any unexpected weight decreases to your doctor.
• May cause rise in uric acid, leading to gout.
• May cause blood-sugar rise in diabetics.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
ACE inhibitors*:	Possible excessive
captopril, enalapril,	potassium in blood.
Allopurinol	Decreased allopurinol effect.
Antidepressants,	Dangerous drop in
tricyclic (TCA)*	blood pressure. Avoid combination
	unless under medical supervision.
Antihypertensives,	Excessive blood
other*	pressure drop.
Appetite	Decreased clonidine
suppressants*	effect.
Barbiturates*	Increased chlorthalidone effect.
Beta-adrenergic	Possible precipitous
blockers*	change in blood pressure.
Carteolol	Increased antihypertensive effect.
Cholestyramine	Decreased chlorthalidone effect.
Cortisone drugs*	Excessive potassium loss that
	causes dangerous heart rhythms.
Digitalis	Excessive potassium
preparations*	loss that causes dangerous heart
	rhythms.
Diuretics*	Excessive blood pressure drop.
Fenfluramine	Possible increased clonidine
	effect.
Guanfacine	Blood pressure control impaired.
Indapamide	Increased diuretic effect.
Lithium	Increased effect of lithium.
MAO inhibitors*	Increased chlorthalidone effect.
Nabilone	Greater depression of central
	nervous system.
Nicardipine	Blood pressure drop. Dosages may
	require adjustment.
Nitrates*	Possible excessive blood pressure
	drop.
Potassium	Decreased potassium
supplements*	effect.
Probenecid	Decreased probenecid effect.
Sedatives* or central	Increased sedative effect of
nervous system (CNS)	both drugs.
Sotalol	Decreased antihypertensive effect.
Terazosin	Decreases effectiveness of
	terazosin.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	Increased sensitivity to sedative
	effect of alcohol and very low
	blood pressure. Avoid.
Caffeine-containing	Decreased clonidine
drinks.	effect.
Cocaine	Increased risk of heart block and
	high blood pressure.
Licorice.	Excessive potassium loss that
	causes dangerous heart rhythm.
Marijuana:	Weakness on standing. May increase
	blood pressure.
Tobacco:	None expected.