Beta-adrenergic blocking agent (more commonly, beta-blockers) and thiazide diuretic combinations belong to the group of medicines known as antihypertensives (high blood pressure medicine). Both ingredients of the combination control high blood pressure, but they work in different ways. Beta-blockers (atenolol, bisoprolol, metoprolol, nadolol, pindolol, propranolol, and timolol) reduce the work load on the heart as well as having other effects. Thiazide diuretics (bendroflumethiazide, chlorthalidone, and hydrochlorothiazide) reduce the amount of fluid pressure in the body by increasing the flow of urine.
High blood pressure adds to the work load 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.
Beta-blocker and thiazide diuretic combinations are available only with your doctor's prescription.
Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group 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.
Although there is no specific information comparing use of this combination medicine in children with use in other age groups, this medicine is not expected to cause different side effects or problems in children than it does in adults. However, extra caution may be necessary in infants with jaundice, because these medicines can make the condition worse.
Some side effects, especially dizziness or lightheadedness and signs and symptoms of too much potassium loss, may be more likely to occur in the elderly, who are usually more sensitive to the effects of this medicine. Also, beta-blockers may reduce tolerance to cold temperatures in elderly patients.
Use of some beta-blockers during pregnancy has been associated with low blood sugar, breathing problems, a slower heart rate, and low blood pressure in the newborn infant. Other reports have not shown unwanted effects in the newborn infant. Animal studies have shown some beta-blockers to cause problems in pregnancy when used in doses many times the usual human dose.
Studies with thiazide diuretics have not been done in pregnant women. However, use of thiazide diuretics during pregnancy may cause side effects such as jaundice, blood problems, and low potassium in the newborn infant. Animal studies have not shown thiazide diuretic medicines to cause birth defects even when used in doses several times the usual human dose.
Before taking a beta-blocker and thiazide diuretic combination, make sure your doctor knows if you are pregnant or if you may become pregnant.
Atenolol, metoprolol, nadolol, propranolol, pindolol, timolol, and thiazide diuretics pass into breast milk. It is not known whether bisoprolol passes into breast milk. Thiazide diuretics may decrease the flow of breast milk.
Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.
Using medicines in this class 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.
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. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other medical problems
The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:
In addition to the use of the medicine your doctor has prescribed, treatment for your high blood pressure may include weight control and care 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. Therefore, 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.
For patients taking the extended-release tablet form of this medicine:
To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.
Ask your doctor about checking your pulse rate before and after taking beta-blocking agents. Then, while you are taking this medicine, check your pulse regularly. If it is much slower than your usual rate (or less than 50 beats per minute), check with your doctor. A pulse rate that is too slow may cause circulation problems.
The thiazide diuretic (e.g., bendroflumethiazide, chlorthalidone, or hydrochlorothiazide) contained in this combination medicine may cause you to have an unusual feeling of tiredness when you begin to take it. You may also notice an increase in the amount of urine or in your frequency of urination. After you take the medicine for a while, these effects should lessen. To keep the increase in urine from affecting your sleep:
However, it is best to plan your dose or doses according to a schedule that will least affect your personal activities and sleep. Ask your health care professional to help you plan the best time to take this medicine.
Do not miss any doses. This is especially important when you are taking only one dose per day. Some conditions may become worse when this medicine is not taken regularly.
The dose medicines in this class 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 these medicines. 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.
Call your doctor or pharmacist for instructions.
If you miss a dose of this medicine, take it as soon as possible. However, if it is within 4 hours of your next dose (8 hours if you are using atenolol and chlorthalidone, bisoprolol and hydrochlorothiazide, nadolol and bendroflumethiazide, or extended-release propranolol and hydrochlorothiazide), skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Keep out of the reach of children.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Do not keep outdated medicine or medicine no longer needed.
It is important that your doctor check your progress at regular visits. This is to make sure the medicine is properly controlling your blood pressure and to allow the dosage to be changed if needed.
Make sure that you have enough medicine on hand to last through weekends, holidays, or vacations. You may want to carry an extra written prescription in your billfold or purse in case of an emergency. You can then have it filled if you run out of medicine while you are away from home.
Your doctor may want you to carry medical identification stating that you are taking this medicine.
Do not take other medicines unless they have been discussed with your doctor. This especially includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems since they may increase your blood pressure.
For diabetic patients:
The thiazide diuretic contained in this medicine may cause a loss of potassium from your body.
Check with your doctor if you become sick and have severe or continuing vomiting or diarrhea. These problems may cause you to lose additional water and potassium.
This medicine may cause some people to become dizzy, drowsy, lightheaded, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert. If the problem continues or gets worse, check with your doctor.
The beta-blocker (atenolol, bisoprolol, metoprolol, nadolol, pindolol, propranolol, or timolol) contained in this medicine may make you more sensitive to cold temperatures, especially if you have blood circulation problems. Beta-blockers tend to decrease blood circulation in the skin, fingers, and toes. Dress warmly during cold weather and be careful during prolonged exposure to cold, such as in winter sports.
This medicine may cause your skin to be more sensitive to sunlight than it is normally. Exposure to sunlight, even for brief periods of time, may cause a skin rash, itching, redness or other discoloration of the skin, or a severe sunburn. When you begin taking this medicine:
If you have a severe reaction from the sun, check with your doctor.
Before you have any medical tests, tell the doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine.
For patients with allergies to foods, medicines, or insect stings:
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 as soon as possible if any of the following side effects occur:
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:
Although not all of the above side effects have been reported for all of these medicines, they have been reported for at least one of the beta-blockers or thiazide diuretics. Since all of the beta-blockers are very similar and the thiazide diuretics are also very similar, any of the above side effects may occur with any of these medicines. However, they may be more common with some combinations than with others.
After you have been taking this medicine for a while, it may cause unpleasant or even harmful effects if you stop taking it too suddenly. After you stop taking this medicine or while you are gradually reducing the amount you are taking, check with your doctor right away if any of the following occur:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.