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Propranolol and hydrochlorothiazide (Oral route)

Pronunciation:

proe-PRAN-oh-lol hye-droe-KLOR-ide, hye-droe-klor-oh-THYE-a-zide

Brand Names:

  • Inderide

Dosage Forms:

  • Capsule, Extended Release
  • Tablet

Warnings:

Oral route(Tablet)

Following abrupt cessation of therapy with propranolol, exacerbations of angina pectoris and, in some cases, myocardial infarction have been reported. Even in the absence of overt angina pectoris, when discontinuing therapy, propranolol should not be withdrawn abruptly, and patients should be cautioned against interruption of therapy without the physician's advice .

Classifications:

Therapeutic—

Beta-Adrenergic Blocker, Nonselective/Thiazide Combination

Pharmacologic—

Propranolol

Chemical—

Thiazide

Uses of This Medicine:

Propranolol and hydrochlorothiazide combination is used to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.

Propranolol is a beta-blocker. It works by affecting the response to some nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart.

Hydrochlorothiazide is a diuretic (water pill). It reduces the amount of water in the body by increasing the flow of urine, which helps lower the blood pressure.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of propranolol and hydrochlorothiazide combination in the pediatric population. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of propranolol and hydrochlorothiazide combination in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving propranolol and hydrochlorothiazide combination.

Pregnancy—

Pregnancy CategoryExplanation
All TrimestersCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Dofetilide
  • Thioridazine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acetyldigoxin
  • Albuterol
  • Amiodarone
  • Arformoterol
  • Arsenic Trioxide
  • Bambuterol
  • Bupivacaine
  • Bupivacaine Liposome
  • Bupropion
  • Clenbuterol
  • Clonidine
  • Clozapine
  • Colterol
  • Crizotinib
  • Cyclophosphamide
  • Deslanoside
  • Diatrizoate
  • Digitalis
  • Digitoxin
  • Digoxin
  • Diltiazem
  • Dronedarone
  • Droperidol
  • Epinephrine
  • Eslicarbazepine Acetate
  • Fenoldopam
  • Fenoterol
  • Fingolimod
  • Flecainide
  • Fluoxetine
  • Formoterol
  • Haloperidol
  • Hexoprenaline
  • Indacaterol
  • Isoetharine
  • Ketanserin
  • Levalbuterol
  • Levomethadyl
  • Lidocaine
  • Lithium
  • Lomitapide
  • Mefloquine
  • Mepivacaine
  • Metaproterenol
  • Methotrexate
  • Metildigoxin
  • Nilotinib
  • Ouabain
  • Pirbuterol
  • Pixantrone
  • Prilocaine
  • Procaterol
  • Proscillaridin
  • Reproterol
  • Ritodrine
  • Salmeterol
  • Simeprevir
  • Sotalol
  • Terbutaline
  • Tocophersolan
  • Tretoquinol
  • Tulobuterol
  • Verapamil
  • Vilanterol

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acarbose
  • Aceclofenac
  • Acemetacin
  • Acetohexamide
  • Acetyldigoxin
  • Alacepril
  • Alfuzosin
  • Aluminum Carbonate, Basic
  • Aluminum Hydroxide
  • Aluminum Phosphate
  • Amlodipine
  • Amtolmetin Guacil
  • Arbutamine
  • Aspirin
  • Benazepril
  • Benfluorex
  • Bepridil
  • Bromfenac
  • Bufexamac
  • Bunazosin
  • Calcium Carbonate
  • Captopril
  • Carbamazepine
  • Celecoxib
  • Chlorpromazine
  • Chlorpropamide
  • Cholestyramine
  • Choline Salicylate
  • Cilazapril
  • Cimetidine
  • Clonixin
  • Delapril
  • Deslanoside
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Digitoxin
  • Digoxin
  • Dihydroergotamine
  • Dihydroxyaluminum Aminoacetate
  • Dihydroxyaluminum Sodium Carbonate
  • Dipyrone
  • Disopyramide
  • Doxazosin
  • Enalaprilat
  • Enalapril Maleate
  • Ergotamine
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Felodipine
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Flecainide
  • Floctafenine
  • Flufenamic Acid
  • Flurbiprofen
  • Fluvoxamine
  • Fosinopril
  • Ginkgo
  • Gliclazide
  • Glimepiride
  • Glipizide
  • Gliquidone
  • Glyburide
  • Gossypol
  • Guar Gum
  • Guggul
  • Ibuprofen
  • Ibuprofen Lysine
  • Imidapril
  • Indomethacin
  • Insulin
  • Insulin Aspart, Recombinant
  • Insulin Glulisine
  • Insulin Lispro, Recombinant
  • Ketoprofen
  • Ketorolac
  • Lacidipine
  • Lercanidipine
  • Licorice
  • Lisinopril
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Magaldrate
  • Manidipine
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Metformin
  • Metildigoxin
  • Mibefradil
  • Miglitol
  • Moexipril
  • Morniflumate
  • Moxisylyte
  • Nabumetone
  • Naproxen
  • Nepafenac
  • Nicardipine
  • Nifedipine
  • Niflumic Acid
  • Nilvadipine
  • Nimesulide
  • Nimodipine
  • Nisoldipine
  • Nitrendipine
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Pentopril
  • Perindopril
  • Phenoxybenzamine
  • Phentolamine
  • Phenylbutazone
  • Phenylephrine
  • Piketoprofen
  • Piperine
  • Piroxicam
  • Pranidipine
  • Pranoprofen
  • Prazosin
  • Proglumetacin
  • Propoxyphene
  • Propyphenazone
  • Proquazone
  • Quinapril
  • Quinidine
  • Ramipril
  • Repaglinide
  • Rifapentine
  • Rizatriptan
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sertraline
  • Sodium Salicylate
  • Spirapril
  • St John's Wort
  • Sulindac
  • Tamsulosin
  • Temocapril
  • Tenoxicam
  • Terazosin
  • Tiaprofenic Acid
  • Tolazamide
  • Tolbutamide
  • Tolfenamic Acid
  • Tolmetin
  • Topiramate
  • Trandolapril
  • Trimazosin
  • Troglitazone
  • Tubocurarine
  • Urapidil
  • Valdecoxib
  • Zileuton
  • Zofenopril

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

  • Tobacco

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Angina (severe chest pain)—May provoke chest pain if stopped too quickly.
  • Anuria (not able to form urine) or
  • Asthma or
  • Bradycardia (slow heartbeat) or
  • Cardiogenic shock (shock caused by heart attack) or
  • Congestive heart failure or
  • Heart block or
  • Sulfa drug allergy (e.g., sulfamethoxazole, Bactrim®, Septra®)—Should not be used in patients with these conditions.
  • Diabetes or
  • Hyperthyroidism (overactive thyroid) or
  • Hypoglycemia (low blood sugar)—May cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
  • Electrolyte imbalance (e.g., hypercalcemia, hypokalemia, hypomagnesemia, hyponatremia) or
  • Gout or
  • Hyperuricemia (high uric acid in the blood) or
  • Liver disease or
  • Systemic lupus erythematosus (SLE)—Use with caution. May make these conditions worse.
  • Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
  • Lung disease (e.g., bronchitis, emphysema)—May cause difficulty with breathing in patients with this condition.
  • Sympathectomy—Use with caution. The effects of this medicine may be increased.
  • Wolff-Parkinson-White syndrome (rare heart condition)—May cause very slow heartbeat in patients with this condition.

Proper Use of This Medicine:

In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that this medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For high blood pressure:
      • Adults—One tablet two times a day. Your doctor may adjust your dose if needed.
      • Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

This medicine may cause serious allergic reactions including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your hands, face, lips, tongue, or throat while you are using this medicine.

This medicine may cause heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort; dilated neck veins; extreme fatigue; irregular breathing; an irregular heartbeat; shortness of breath; swelling of the face, fingers, feet, or lower legs; weight gain; or wheezing.

Do not interrupt or stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous.

This medicine may cause changes in your blood sugar levels. Also, this medicine may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests.

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests.

Serious skin reactions can occur during treatment with this medicine. Check with your doctor right away if you start having skin itching, swelling, rash, or redness; blistering, peeling, or loosening of the skin; or any other unusual effects that may be caused by this medicine.

Check with your doctor right away if you start having dry mouth, increased thirst, muscle cramps, nausea or vomiting, unusual tiredness or weakness, severe drowsiness or dizziness, seizures, a decrease in urine, or a fast heartbeat while you are using this medicine. These may be symptoms of dehydration or mineral imbalance.

Stop using this medicine and check with your doctor immediately if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment. This could be a sign of a serious eye problem. Your doctor will want you to have your eyes checked by an ophthalmologist (eye doctor).

Do not take other medicines unless they have been discussed with your doctor. This especially includes prescription or nonprescription (over-the-counter) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may increase your blood pressure.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not known
Abdominal or stomach pain, usually after eating a meal
abdominal or stomach tenderness
black, tarry stools
bleeding gums
blistering, peeling, or loosening of the skin
bloating
blood in the urine
bloody nose
bloody stools
blurred or loss of vision
body aches or pain
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
chest pain or discomfort
clay-colored stools
cold sweats
confusion about identity, place, and time
congestion
constipation
cough
coughing up blood
cracks in the skin
crying
darkened urine
decreased awareness or responsiveness
decreased urine output
depersonalization
diarrhea
difficulty with breathing or swallowing
dilated neck veins
disturbed color perception
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
double vision
dry mouth
dryness or soreness of the throat
dysphoria
euphoria
extreme fatigue
fast, pounding, slow, or irregular heartbeat
fever or chills
flushing or redness of the skin
fruit-like breath odor
general feeling of discomfort or illness
general feeling of tiredness or weakness
hair loss
halos around lights
headaches
heavier menstrual periods
hives or welts
hoarseness
increased hunger
increased sensitivity of the skin to sunlight
increased thirst
increased urination
indigestion
irregular breathing
irregular heartbeat
itching
joint pain, stiffness, or swelling
lightheadedness, dizziness, or fainting
loss of appetite
loss of heat from the body
loss of strength or energy
lower back or side pain
mental depression
mimicry of speech or movements
muscle pain or weakness
mutism
nausea or vomiting
negativism
night blindness
noisy breathing
overbright appearance of lights
painful or difficult urination
pains in the stomach, side, or abdomen, possibly radiating to the back
paleness or cold feeling in the fingertips and toes
paranoia
peculiar postures or movements, mannerisms or grimacing
pinpoint red or purple spots on the skin
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
quick to react or overreact emotionally
rapidly changing moods
rectal bleeding
red skin lesions, often with a purple center
red, irritated eyes
red, swollen skin
reddening of the skin, especially around the ears
runny nose
scaly skin
seeing, hearing, or feeling things that are not there
severe sleepiness
severe sunburn
short-term memory loss
shortness of breath
skin irritation or rash, including rash that looks like psoriasis
sleeplessness
sore throat
sores, ulcers, or white spots on the lips or in the mouth
sugar in the urine
sweating
swelling of the eyes, face, or inside of the nose
swelling of the fingers, feet, or lower legs
tender, swollen, or painful glands in the neck
tenderness of salivary glands
tenderness, burning, or peeling of the skin
thickening of bronchial secretions
tightness in the chest
tingling or pain in the fingers or toes when exposed to cold
trouble with sleeping
trouble with swallowing
troubled breathing
tunnel vision
unable to sleep
unpleasant breath odor
unusual bleeding or bruising
unusual tiredness or weakness
unusual weight loss
unusually warm skin
voice changes
vomiting of blood
weight gain
wheezing
yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
Change in consciousness
decreased urination
fast, slow, or shallow breathing
gas
heartburn
increase in heart rate
increased sweating
indigestion
loss of consciousness
low blood pressure
muscle cramps
pale or blue lips, fingernails, or skin
rapid breathing
seizures
sunken eyes
unusual drowsiness, dullness, or feeling of sluggishness
unusual paleness
weakness and heaviness of the legs
wrinkled skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known
Decreased interest in sexual intercourse
dry eyes
feeling of constant movement of self or surroundings
inability to have or keep an erection
loss in sexual ability, desire, drive, or performance
muscle spasm
pain of the penis on erection
pain or discomfort in the chest, upper stomach, or throat
restlessness
sensation of spinning
stomach cramps
thinning of the hair
vivid dreams

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 4/4/2014

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