BETA-ADRENERGIC BLOCKING AGENTS & THIAZIDE DIURETICS

Brand & Generic Names

ATENOLOL &	NADOLOL &
CHLORTHALIDONE	BENDROFLUMETHIAZIDE
BETAXOLOL &	Normozide
CHLORTHALIDONE	PINDOLOL &
Co-Betaloc	HYDROCHLOROTHIAZIDE
Corzide	PROPRANOLOL &
Inderide	HYDROCHLOROTHIAZIDE
Inderide LA	Tenoretic
LABETALOL &	Timolide
HYDROCHLOROTHIAZIDE	TIMOLOL &
Lopressor HCT	HYDROCHLOROTHIAZIDE
METOPROLOL &	Trandate HCT
HYDROCHLOROTHIAZIDE	Viskazide

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? Yes
• Drug class: Beta-adrenergic blocker, diuretic (thiazide)

Uses

• Controls, but doesn't cure, high blood pressure.
• Reduces fluid retention (edema).
• Reduces angina attacks.
• Stabilizes irregular heartbeat.
• Lowers blood pressure.
• Reduces frequency of migraine headaches. (Does not relieve headache pain.)
• Other uses prescribed by your doctor.

Dosage & Usage Information

How to take:
Extended-release capsules--Swallow with liquid. If you can't swallow whole, open capsule 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 4 hours late. If more than 4 hours, wait for next scheduled dose (don't double this dose).

What drug does:
Forces sodium and water excretion, reducing body fluid.
Relaxes muscle cells of small arteries.
Reduced body fluid and relaxed arteries lower blood pressure.
Blocks some of the actions of sympathetic nervous system.
Lowers heart's oxygen requirements.
Slows nerve impulses through heart.
Reduces blood vessel contraction in heart, scalp and other body parts.

Time lapse before drug works:
1 to 4 hours for beta-blocker effect.
May require several weeks to lower blood pressure.

Don't take with:
Any other medicines, even over-the-counter drugs such as cough/cold medicines, diet pills, nose drops, caffeine, without consulting your doctor.

Overdose

SYMPTOMS:
Irregular heartbeat (usually too slow), seizures, confusion, fainting, convulsions, 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:

Wheezing, chest pain, Seek emergency seizures, irregular treatment heartbeat. immediately.

Common:

• Dry mouth, weak pulse, vomiting, muscle cramps, increased thirst, mood changes, nausea.
• Weakness, tiredness, dizziness, mental depression, diminished sex drive, constipation, nightmares, insomnia.

Infrequent:

• Cold feet and hands, chest pain, breathing difficulty, anxiety, nervousness, headache, appetite loss, abdominal pain, numbness and tingling in fingers and toes, slow heartbeat.
• Confusion, diarrhea.

Rare:

• Hives, skin rash; joint pain; jaundice; fever, sore throat, mouth ulcers.
• Impotence, back pain.

Warnings & Precautions

Don't take if:

• You are allergic to any beta-adrenergic blocker or any thiazide diuretic drug.
• You have asthma or hay fever symptoms.
• You have taken MAO inhibitors in past two weeks.

Before you start, consult your doctor:

• If you have heart disease or poor circulation to the extremities.
• If you have hay fever, asthma, chronic bronchitis, emphysema, overactive thyroid function, impaired liver or kidney function, gout, diabetes, hypoglycemia, pancreas disorder, systemic lupus erythematosus.
• If you are allergic to any sulfa drug or tartrazine dye.
• 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:

• Weakens heart muscle contractions.
• You may need medicine to treat high blood pressure for the rest of your life.
• 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:

• May mask hypoglycemia symptoms.
• 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.
Aminophylline	Decreased effectiveness of both.
Antidepressants,	Dangerous drop in blood pressure.
tricyclic (TCA)*	Avoid combination unless under
	medical supervision.
Antidiabetics*	Increased antidiabetic effect.
Antihistamines*	Decreased antihistamine effect.
Antihypertensives*	Increased antihypertensive effect.
Barbiturates*	Increased barbiturate effect.
	Dangerous sedation.
Bumetanide	Increased diuretic effect.
Calcium channel	Increased antihypertensive
blockers*	effect. Dosages of both drugs may
	require adjustments.
Cholestyramine	Decreased hydrochlorthiazide
	effect.
Cortisone drugs*	Excessive potassium loss that
	causes dangerous heart rhythms.
Diclofenac	Decreased antihypetensive effect.
Digitalis	Excessive potassium loss that causes
preparations*	dangerous heart rhythms. Can either
	increase or decrease heart rate.
	Improves irregular heartbeat.
Diuretics, thiazide*	Increased effect of other thiazide
	diuretics.
Ethacrynic acid	Increased diuretic effect.
Furosemide	Increased diuretic effect.
Guanfacine	Increased effect of both drugs.
Hypoglycemics*,	Decreased ability to
oral	lower blood glucose.
Indapamide	Increased diuretic effect.
Insulin	Decreased ability to lower blood
	glucose.
Lisinopril	Increased antihypertensive effect.
	Dosage of each may require
	adjustment.
MAO inhibitors*	Increased hydrochlorothiazide
	effect.
Metolazone	Increased diuretic effect.
Narcotics*	Increased narcotic effect.
	Dangerous sedation.
Nicardipine	Possible irregular heartbeat and
	congestive heart failure.
Nicotine	Increased beta blocker effect.
Nitrates*	Excessive blood pressure drop.
Non-steroidal	Decreased anti-
anti-inflammatory	inflammatory effect.
Phenytoin	Increased betaadrenergic effect.
Potassium	Decreased potassium
supplements*	effect.
Probenecid	Decreased probenecid effect.
Propafenone	Increased effect of both drugs and
	increased risk of toxicity.
Quinidine	Slows heart excessively.
Reserpine	Increased reserpine effect.
	Excessive sedation and depression.
Sympathomimetics*	Decreased effectiveness of both.
Theophylline	Decreased effectiveness of both.
Tocainide	May worsen congestive heart
	failure.
Zinc supplements	Increased need for zinc.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	Dangerous blood pressure drop.
	Avoid.
Beverages:	None expected.
Cocaine:	Irregular heartbeat, decreased
	beta-blocker effect. Avoid.
Licorice.	Excessive potassium loss that
	causes dangerous heart rhythms.
Marijuana:	May increase blood pressure.
Tobacco:	May increase blood pressure and
	make heart work harder. Avoid.