Brand Names:

• Corzide
• Dutoprol
• Inderide
• Lopressor HCT
• Tenoretic 100
• Tenoretic 50
• Timolide
• Ziac
• Alti-Nadolol

Dosage Forms:

• Tablet, Extended Release
• Tablet
• Capsule, Extended Release

Uses of This Medicine:

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.

Before Using This Medicine:

Allergies

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.

Children

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.

Older adults

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.

Pregnancy

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.

Breast-feeding

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.

Other medicines

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.

• Dofetilide

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.

• Acetyldigoxin
• Albuterol
• Amiodarone
• Arformoterol
• Arsenic Trioxide
• Bambuterol
• Bepridil
• Bitolterol
• Broxaterol
• Clenbuterol
• Clonidine
• Colterol
• Deslanoside
• Digitalis
• Digitoxin
• Digoxin
• Diltiazem
• Dofetilide
• Droperidol
• Epinephrine
• Fenoldopam
• Fenoterol
• Fentanyl
• Flecainide
• Formoterol
• Hexoprenaline
• Isoetharine
• Ketanserin
• Levalbuterol
• Levomethadyl
• Lidocaine
• Lithium
• Metaproterenol
• Metildigoxin
• Ouabain
• Pirbuterol
• Procaterol
• Proscillaridin
• Reproterol
• Rimiterol
• Ritodrine
• Salmeterol
• Sotalol
• Terbutaline
• Tretoquinol
• Tulobuterol
• Verapamil

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. 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:

• Allergy, history of (asthma, eczema, hay fever, hives), or
• Bronchitis or
• Emphysema This combination medicine may make allergic reactions to other substances more severe or make the reaction last longer. In addition, the beta-blocker contained in this combination can increase trouble in breathing.

• Bradycardia (unusually slow heartbeat) or
• Heart or blood vessel disease This combination medicine may make these heart problems worse; also, if treatment is stopped suddenly, unwanted effects may occur

• Type 2 diabetes mellitus The beta-blocker contained in this medicine may cause hyperglycemia (high blood sugar) and circulation problems. In addition, if your diabetes medicine causes your blood sugar to be too low, beta-blockers may cover up some of the symptoms (fast heartbeat), although they will not cover up other symptoms such as dizziness or sweating; the thiazide diuretic contained in this medicine may increase the amount of sugar in the blood.

• Gout (history of) or
• Lupus erythematosus (history of) or
• Pancreatitis (inflammation of the pancreas) The thiazide diuretic contained in this medicine may make these conditions worse.

• Kidney disease or
• Liver disease Effects of this medicine may be increased because of slower removal from the body.

• Mental depression (or history of) or
• Myasthenia gravis or
• Pheochromocytoma or
• Psoriasis or
• Raynaud's syndrome The beta-blocker contained in this medicine may make these conditions worse.

• Overactive thyroid Stopping this medicine suddenly may increase symptoms of overactive thyroid; the beta-blocker contained in this medicine may cover up fast heartbeat, which is a sign of overactive thyroid.

Proper Use of This Medicine:

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:

• Swallow the tablet whole.
• Do not crush, break, or chew before swallowing.

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:

• If you are to take a single dose a day, take it in the morning after breakfast.
• If you are to take more than one dose a day, take the last dose no later than 6 p.m., unless otherwise directed by your doctor.

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.

Dosing

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.

• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 or 2 tablets once a day.
    • Children Dose must be determined by your doctor.

• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 or 2 tablets once a day.
    • Children Dose must be determined by your doctor.

• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 or 2 tablets a day.
    • Children Dose must be determined by your doctor.

• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 tablet once a day.
    • Children Dose must be determined by your doctor.

• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 or 2 tablets once a day.
    • Children Dose must be determined by your doctor.

• For regular (short-acting) oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 or 2 tablets two times a day.
    • Children Dose must be determined by your doctor.
• For long-acting oral dosage form (extended-release capsules):
  • For high blood pressure:
    • Adults 1 capsule a day.
    • Children Dose must be determined by your doctor.

• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 tablet two times a day or 2 tablets once a day.
    • Children Dose must be determined by your doctor.

Missed dose

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.

Storage

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.

Precautions While Using This Medicine:

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:

• This medicine may increase your blood sugar levels. Also, this medicine may cover up signs of hypoglycemia (low blood sugar), such as change in pulse rate. While you are taking this medicine, be especially careful in testing for sugar in your urine. If you have any questions about this, check with your doctor.

The thiazide diuretic contained in this medicine may cause a loss of potassium from your body.

• To help prevent this, your doctor may want you to:
  • eat or drink foods that have a high potassium content (for example, orange or other citrus fruit juices), or
  • take a potassium supplement, or
  • take another medicine to help prevent the loss of the potassium in the first place.
• It is very important to follow these directions. Also, it is important not to change your diet on your own. This is more important if you are already on a special diet (as for diabetes), or if you are taking a potassium supplement or a medicine to reduce potassium loss. Extra potassium may not be necessary and, in some cases, too much potassium could be harmful.

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:

• Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible.
• Wear protective clothing, including a hat. Also, wear sunglasses.
• Apply a sun block product that has a skin protection factor (SPF) of at least 15. Some patients may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your health care professional.
• Apply a sun block lipstick that has an SPF of at least 15 to protect your lips.
• Do not use a sunlamp or tanning bed or booth.

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:

• There is a chance that this medicine will make allergic reactions worse and harder to treat. If you have a severe allergic reaction while you are being treated with this medicine, check with a doctor right away so that it can be treated.

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 as soon as possible if any of the following side effects occur:

Less common

Breathing difficulty and/or wheezing

cold hands and feet

mental depression

slow heartbeat (especially less than 50 beats per minute)

swelling of ankles, feet, and/or lower legs

Rare

Black, tarry stools

blood in urine or stools

chest pain

dark urine

fever, chills, cough, or sore throat

hallucinations (seeing, hearing, or feeling things that are not there)

joint pain

lower back or side pain

pinpoint red spots on skin

red, scaling, or crusted skin

skin rash or hives

stomach pain (severe) with nausea and vomiting

unusual bleeding or bruising

yellow eyes or skin

Signs and symptoms of too much potassium or sodium loss

Confusion

convulsions (seizures)

dryness of mouth

increased thirst

irregular heartbeats

irritability

mood or mental changes

muscle cramps or pain

nausea or vomiting

unusual tiredness or weakness

weak pulse

Signs and symptoms of overdose

(in the order in which they may occur)

Slow heartbeat

dizziness (severe) or fainting

difficulty in breathing

bluish-colored fingernails or palms of hands

convulsions (seizures)

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:

More common

Decreased sexual ability

dizziness or lightheadedness

drowsiness (mild)

trouble in sleeping

Less common

Anxiety or nervousness

constipation

diarrhea

increased sensitivity of skin to sunlight (skin rash, itching, redness or other discoloration of skin, or severe sunburn)

loss of appetite

numbness or tingling of fingers and toes

stomach discomfort or upset

stuffy nose

Rare

Changes in taste

dry, sore eyes

itching of skin

nightmares and vivid dreams

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:

Chest pain

fast or irregular heartbeat

general feeling of discomfort, illness, or weakness

headache

shortness of breath (sudden)

sweating

trembling

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