GUANETHIDINE & HYDROCHLOROTHIAZIDE

Brand & Generic Names

Esimil

Ismelin-Esidrix

Basic Information

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

Uses

• Controls, but doesn't cure, high blood pressure.
• Reduces fluid retention (edema).

Dosage & Usage Information

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

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:
Forces sodium and water secretion, reducing body fluid.
Displaces norepinephrine--hormone necessary to maintain small blood vessel tone. Blood vessels relax and high blood pressure drops.

Time lapse before drug works:
Regular use for several weeks may be necessary to determine effectiveness.

Don't take with:
Non-prescription drugs containing alcohol without consulting doctor.
Any other medicine without consulting your doctor or pharmacist.

Overdose

SYMPTOMS:
Cramps, weakness, drowsiness, blurred vision, weak pulse, severe blood pressure drop, fainting, cold and sweaty skin, loss of consciousness, coma.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

Chest pain, shortness Discontinue. Seek of breath, irregular emergency treatment. heartbeat.

Common:

• Slow heartbeat, swollen feet and ankles, fatigue, weakness.
• Dizziness, stuffy nose, dry mouth, diarrhea, diminished sex drive.

Infrequent:

• Mood change, rash or hives, blurred vision, drooping eyelids, muscle pain or tremors.
• Increased nighttime urination, abdominal pain, vomiting, nausea, headache, weakness.
• Impotence, nighttime urination, hair loss.

Rare:

• Decreased white blood cells causing sore throat, fever; jaundice.
• Weight gain or loss.

Warnings & Precautions

Don't take if:

• You are allergic to any thiazide diuretic drug or guanethidine.
• You have taken MAO inhibitors within 2 weeks.

Before you start, consult your doctor:

• If you are allergic to any sulfa drug.
• If you have gout, asthma, liver, pancreas or kidney disorder, peptic ulcer or chronic acid indigestion.
• If you have had stroke or 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:
Not recommended.

Prolonged use:

• Due to drug's cumulative effect, dose will require adjustment to prevent wide fluctuations in blood pressure.
• 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 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.

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
------------------------	-----------------------
Allopurinol	Decreased allopurinol effect.
Amphetamines*	Decreased guanethidine effect.
Antidepressants,	Dangerous drop in
tricyclic (TCA)*	blood pressure. Avoid combination
	unless under medical supervision.
Antihistamines*	Decreased guanethidine effect.
Barbiturates*	Increased hydrochlorothiazide
	effect.
Beta-adrenergic	Increased antihypertensive
blockers*	effect. Dosages of both drugs may
	require adjustments.
Carteolol	Increased antihypertensive effect.
Cholestyramine	Decreased hydrochlorothiazide
	effect.
Contraceptives,	Decreased guanethidine
oral*	effect.
Cortisone drugs*	Excessive potassium loss that
	causes dangerous heart rhythms.
Digitalis	Excessive potassium
preparations*	loss that causes dangerous heart
	rhythms.
Diuretics, thiazide*	Increased thiazide and guanethidine
	effect.
Haloperidol	Decreased guanethidine effect.
Indapamide	Possible increased effects of both
	drugs. When monitored carefully,
	combination may be beneficial in
	controlling hypertension.
Insulin	Increased insulin effect.
Lithium	Increased lithium effect.
MAO inhibitors*	Increased hydrochlorothiazide
	effect.
Minoxidil	Dosage adjustments may be necessary
	to keep blood pressure at proper
	level.
Nicardipine	Blood pressure drop. Dosages may
	require adjustment.
Nimodipine	Dangerous blood pressure drop.
Nitrates*	Excessive blood pressure drop.
Oxprenolol	Increased antihypertensive effect.
	Dosages of both drugs may require
	adjustments.
Phenothiazines*	Decreased guanethidine effect.
Potassium	Decreased potassium
supplements*	effect.
Probenecid	Decreased probenecid effect.
Sotalol	Increased antihypertensive effect.
Terazosin	Decreases effectiveness of
	terazosin.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	Use caution. Decreases blood
	pressure.
Carbonated drinks.	Use sparingly. Sodium content
	increases blood pressure.
Cocaine:	Raises blood pressure. Avoid.
Spicy or	Avoid if subject to indigestion
acid foods.	or peptic ulcer.
Licorice.	Excessive potassium loss that
	causes dangerous heart rhythms.
Marijuana:	Effect on blood pressure
	unpredictable.
Tobacco:	Possible blood pressure rise.
	Avoid.