$Unique_ID{BRK02117}
$Pretitle{}
$Title{PROPRANOLOL AND HYDROCHLOROTHIAZIDE COMBINATION}
$Subject{Inderide (Wyeth-Ayerst)
Inderide LA (Wyeth-Ayerst)}
$Volume{}
$Log{
Inderide*0211701.scf}

Copyright (C) 1991 Publications International, Ltd.


PROPRANOLOL AND HYDROCHLOROTHIAZIDE COMBINATION
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BRAND NAMES (Manufacturers):
     Inderide (Wyeth-Ayerst)
     Inderide LA (Wyeth-Ayerst)
TYPE OF DRUG:
     Beta-adrenergic blocking agent and diuretic
INGREDIENTS:
     propranolol and hydrochlorothiazide
DOSAGE FORMS:
     Tablets (40 mg propranolol and 25 mg hydrochlorothiazide; 80 mg
       propranolol and 25 mg hydrochlorothiazide)
     Long-acting capsules (80 mg propranolol and 50 mg hydrochlorothiazide;
       120 mg propranolol and 50 mg hydrochlorothiazide; and 160 mg
       propranolol and 50 mg hydrochlorothiazide)
STORAGE:
     Store at room temperature in a tightly closed, light-resistant container.

USES

     This drug is prescribed to treat high blood pressure.
Hydrochlorothiazide is a diuretic (water pill), which reduces fluid
accumulation in the body by increasing the elimination of salt and water
through the kidneys.  Propranolol belongs to a group of drugs known as
beta-adrenergic blocking agents or, more commonly, beta blockers.  They work
by controlling nerve impulses along certain nerve pathways.

TREATMENT

     This medication can be taken with a glass of water, with meals,
immediately following meals, or on an empty stomach (depending on your
doctor's instructions).
     Try to take the medication at the same time(s) each day.  Avoid taking a
dose after 6:00 P.M.; otherwise, you may have to get up during the night to
urinate.  If you miss a dose of this medication, take the missed dose as soon
as possible, unless it is almost time for your next dose.  In that case, do
not take the missed dose at all; just wait until the next scheduled dose.  Do
not double the dose.
     Propranolol and hydrochlorothiazide combination does not cure high blood
pressure, but it will help to control the condition as long as you continue to
take it.

SIDE EFFECTS

     Minor.

     Anxiety, constipation, cramps, decreased sexual ability, diarrhea,
difficulty in sleeping, drowsiness, dizziness, dryness of the eyes and skin,
headache, heartburn, loss of appetite, nervousness, stomach discomfort,
restlessness, or tiredness.  These side effects should disappear as your body
adjusts to the medication.
     Hydrochlorothiazide can cause increased sensitivity to sunlight.  It is,
therefore, important to avoid prolonged exposure to sunlight and sunlamps.
Wear protective clothing and sunglasses, and use an effective sunscreen.
     If you become extra-sensitive to the cold, be sure to dress warmly during
cold weather.
     To relieve constipation, increase the amount of fiber in your diet (fresh
fruits and vegetables, salads, bran, and whole-grain breads) unless your
doctor directs you to do otherwise.
     Plain, nonmedicated eye drops (artificial tears) may help to relieve eye
dryness.
     To avoid dizziness or light-headedness when you stand, contract and relax
the muscles of your legs for a few moments before rising from a sitting or
reclining position.  Do this by pushing one foot against the floor while
raising the other foot slightly, alternating feet so that you are "pumping"
your legs in a pedaling motion.

     Major.

     Tell your doctor about any side effects that are persistent or
particularly bothersome.  IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about
blurred vision, cold hands and feet (due to decreased blood circulation to
skin, fingers, and toes), confusion, depression, difficulty in breathing, dry
mouth, excessive thirst, excessive weakness, fever, hair loss, hallucinations,
itching, joint pain, mood changes, muscle spasms, nausea, nightmares, numbness
or tingling in the fingers or toes, palpitations, rapid weight gain (three to
five pounds within a week), reduced alertness, skin rash, sore throat,
swelling, unusual bleeding or bruising, vomiting, or yellowing of the eyes or
skin.

INTERACTIONS

     This medicine interacts with other types of drugs:
     1. Indomethacin, aspirin, and other salicylates may decrease the
blood-pressure-lowering effects of beta blockers.
     2. Concurrent use of propranolol and calcium channel blockers (diltiazem,
nifedipine, verapamil) or disopyramide can lead to heart failure or very low
blood pressure.
     3. Cimetidine and oral contraceptives (birth control pills) can increase
the blood levels of propranolol, which can result in greater side effects.
Side effects may also be increased when propranolol is taken with clonidine,
digoxin, epinephrine, phenylephrine, phenylpropanolamine, phenothiazine
tranquilizers, prazosin, reserpine, or monoamine oxidase (MAO) inhibitors.  At
least 14 days should separate the use of propranolol and an MAO inhibitor.
     4. Barbiturates, alcohol, and rifampin can increase the breakdown of
propranolol, which can lead to a decrease in its effectiveness.
     5. The action of beta blockers may be increased if they are used with
chlorpromazine, furosemide, or hydralazine, which may have a negative effect.
     6. Propranolol can antagonize (act against) the effects of theophylline,
aminophylline, albuterol, isoproterenol, metaproterenol, and terbutaline.
     7. Propranolol can also interact with insulin and oral antidiabetic
agents, raising or lowering blood sugar levels and masking the symptoms of low
blood sugar.
     8. Hydrochlorothiazide can decrease the effectiveness of oral
anticoagulants (blood thinners, such as warfarin), antigout medications, and
methenamine.
     9. Antihypertensive medications may increase the blood-pressure-lowering
effects of propranolol and hydrochlorothiazide combination, which can be
dangerous.
     10. Cholestyramine and colestipol can decrease the absorption of
hydrochlorothiazide from the gastrointestinal tract; therefore,
hydrochlorothiazide should be taken one hour before or four hours after a dose
of cholestyramine or colestipol if one of these medications has also been
prescribed for you.
     11. Hydrochlorothiazide may increase the side effects of amphotericin B,
calcium, cortisone and cortisone-like steroids (such as dexamethasone,
hydrocortisone, prednisone, and prednisolone), digoxin, digitoxin, lithium,
quinidine, sulfonamide antibiotics, and vitamin D.
     BE SURE TO TELL YOUR DOCTOR about any medications you are currently
taking, especially any of those listed above.

WARNINGS

     * Tell your doctor about unusual or allergic reactions you have had to
medications, especially to propranolol or any other beta blocker (such as
acebutolol, atenolol, betaxolol, carteolol, esmolol, labetalol, metoprolol,
nadolol, penbutolol, pindolol, or timolol), to hydrochlorothiazide or other
diuretics (such as bendroflumethiazide, benzthiazide, chlorothiazide,
chlorthalidone, cyclothiazide, hydroflumethiazide methyclothiazide,
metolazone, polythiazide, quinethazone, trichlormethiazide, and furosemide),
or to any sulfa drug (oral antidiabetic medication and sulfonamide
antibiotic).
     * Tell your doctor if you have ever had asthma, diabetes mellitus, heart
disease, gout, kidney disease or problems with urination, liver disease,
pancreatitis, systemic lupus erythematosus, thyroid disease, or poor
circulation in the fingers or toes.
     * Hydrochlorothiazide can cause potassium loss.  Signs of potassium loss
include dry mouth, thirst, weakness, muscle pain or cramps, nausea, and
vomiting.  If you experience any of these symptoms, call your doctor.  To help
prevent this problem, your doctor may have blood tests performed periodically
to monitor your potassium levels.  To help avoid potassium loss, take this
medication with a glass of fresh or frozen orange juice or cranberry juice, or
eat a banana every day.  The use of a salt substitute also helps to prevent
potassium loss.  Do not change your diet, however, until you discuss it with
your doctor.  Too much potassium may also be dangerous.
     * While you are taking this medication, limit your intake of alcohol, in
order to prevent dizziness and light-headedness.
     * Do not take any over-the-counter (nonprescription) medication for
weight control or for allergy, asthma, cough, cold, or sinus problems unless
you first check with your doctor.
     * To prevent severe water loss (dehydration) while taking this
medication, check with your doctor if you have any illness that causes severe
or continuous nausea, vomiting, or diarrhea.
     * This medication can raise blood sugar levels in diabetic patients.
Blood sugar levels should be monitored carefully with blood or urine tests
when this medication is being taken.
     * You may want to check your pulse while taking this medication.  If your
pulse is much slower than your usual rate (or if it is less than 50 beats per
minute), check with your doctor.  A pulse rate that is too slow may cause
circulation problems.
     * Propranolol can affect your body's response to exercise.  Make sure you
ask your doctor what an appropriate amount of exercise would be for you,
taking into account your medical condition.
     * Before having surgery or any other medical or dental treatment, tell
your doctor or dentist that you are taking this medicine.  Often, this
medication will be discontinued 48 hours prior to any major surgery.
     * This medication can cause dizziness, drowsiness, light-headedness, or
decreased alertness.  Therefore, you must exercise caution while driving a car
or operating potentially dangerous machinery.
     * It is important that you do not stop taking this medicine unless you
first check with your doctor.  Some conditions worsen when this medicine is
stopped suddenly, and the danger of a heart attack is increased in some
patients.  Your doctor may, therefore, want you to gradually reduce the amount
of medicine you take before stopping completely.  Make sure that you have
enough medicine on hand to last through vacations, holidays, and weekends.
     * A doctor does not usually prescribe a "fixed-dose" drug like this as
the first choice in the treatment of high blood pressure.  Usually, the
patient first receives each ingredient singly.  If there is an adequate
response to the fixed dose contained in this product, it can then be
substituted.  The advantage of a combination product is increased convenience
and (often) decreased cost.
     * Be sure to tell your doctor if you are pregnant.  Animal studies have
shown that some beta blockers can cause problems in pregnancy when used at
very high doses.  Adequate studies have not been conducted in humans, but
there has been some association between beta blockers used during pregnancy
and low birth weight, as well as breathing problems and slow heart rate in
newborn infants.  However, other reports have shown no such effects in newborn
infants.  Hydrochlorothiazide has been associated with jaundice, blood
problems, and low potassium in the newborn.  Also, tell your doctor if you are
breast-feeding an infant.  Although problems in humans have not been reported,
small amounts of propranolol and hydrochlorothiazide pass into breast milk, so
caution is warranted.

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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
