$Unique_ID{BRK02046}
$Pretitle{}
$Title{NADOLOL AND BENDROFLUMETHIAZIDE COMBINATION}
$Subject{Corzide (Princeton)}
$Volume{}
$Log{}

Copyright (C) 1991 Publications International, Ltd.


NADOLOL AND BENDROFLUMETHIAZIDE COMBINATION
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BRAND NAME (Manufacturer):
     Corzide (Princeton)
TYPE OF DRUG:
     Beta-adrenergic blocking agent and diuretic
INGREDIENTS:
     nadolol and bendroflumethiazide
DOSAGE FORM:
     Tablets (40 mg nadolol and 5 mg bendroflumethiazide; 80 mg nadolol and 5
       mg bendroflumethiazide)
STORAGE:
     Nadolol and bendroflumethiazide combination tablets should be stored at
       room temperature in a tightly closed container.

USES

     Nadolol and bendroflumethiazide combination is prescribed to treat high
blood pressure.  Bendroflumethiazide is a diuretic (water pill), which reduces
fluid accumulation in the body by increasing the elimination of sodium and
water through the kidneys.  Nadolol belongs to a group of medicines known as
beta-adrenergic blocking agents or beta blockers.  They work by controlling
impulses along certain nerve pathways.

TREATMENT

     Nadolol and bendroflumethiazide can be taken with a glass of water, with
a meal, immediately after a meal, 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 nadolol and bendroflumethiazide combination, take
the missed dose as soon as possible, unless it is almost time for the next
dose.  In that case, do not take the missed dose of medication at all; just
wait until the next scheduled dose.  Do not double the dose.
     Nadolol and bendroflumethiazide 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.

     Abdominal discomfort, constipation, diarrhea, dizziness, drowsiness, dry
eyes or skin, fatigue, gas, headache, loss of appetite, or stomach discomfort.
These minor side effects should disappear as your body adjusts to therapy with
this medication.
     Bendroflumethiazide 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.
     Plain, nonmedicated eye drops (artificial tears) may help to relieve eye
dryness.
     To relieve constipation, increase the amount of fiber in your diet (fresh
fruits and vegetables, salads, bran, and whole-grain breads) and exercise more
(unless your doctor directs you to do otherwise).
     To avoid dizziness or light-headedness when you stand, contract and relax
the muscles of your legs for a few moments before rising.  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, depression, dry mouth, fever, hair loss, itching, muscle pain
or spasm, nausea, numbness or tingling in the fingers or toes, rapid weight
gain (three to five pounds within a week), rash, ringing in the ears,
shortness of breath, thirst, vomiting, weakness, or yellowing of the eyes or
skin.

INTERACTIONS

     This medicine interacts with several other types of medications:
     1. Indomethacin, aspirin, and other salicylates may decrease the
blood-pressure-lowering effects of beta blockers.
     2. Concurrent use of nadolol and disopyramide or calcium channel blockers
(diltiazem, nifedipine, verapamil) can lead to heart failure or very low blood
pressure.
     3. Side effects may be increased when nadolol is taken with cimetidine,
clonidine, digoxin, epinephrine, hydralazine, oral contraceptives (birth
control pills), phenylephrine, phenylpropanolamine, phenothiazine
tranquilizers, prazosin, reserpine, or monoamine oxidase (MAO) inhibitors.  At
least 14 days should separate the use of nadolol and the use of an MAO
inhibitor.
     4. Nadolol can antagonize (act against) the effects of theophylline,
aminophylline, albuterol, isoproterenol, metaproterenol, and terbutaline.
     5. Nadolol can also interact with insulin and oral antidiabetic agents,
raising or lowering blood sugar levels and masking the symptoms of low blood
sugar.
     6. Alcohol, barbiturates, and rifampin can decrease the blood
concentrations of beta blockers, which can result in a decrease of
effectiveness.
     7. The action of beta blockers may be increased if they are used with
chlorpromazine, furosemide, or hydralazine, which may have a negative effect.
     8. Bendroflumethiazide can decrease the effectiveness of oral
anticoagulants (blood thinners, such as warfarin), antigout medications, and
methenamine.
     9. Fenfluramine may increase the blood-pressure-lowering effects of this
drug, which can be dangerous.
     10. Cholestyramine and colestipol can decrease the absorption of
bendroflumethiazide from the gastrointestinal tract; this medication should,
therefore, be taken one hour before or four hours after a dose of
cholestyramine or colestipol (if you have also been prescribed one of these
medications).
     11. Bendroflumethiazide may increase the side effects of amphotericin B,
calcium, cortisone and cortisone-like steroids (such as dexamethasone,
hydrocortisone, prednisolone, and prednisone), digitalis, digoxin, lithium,
quinidine, sulfonamide antibiotics, and vitamin D.
     Before starting nadolol and bendroflumethiazide combination, 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
any medications, especially to nadolol or any other beta blocker (acebutolol,
atenolol, carteolol, esmolol, labetalol, metoprolol, penbutolol, pindolol,
propranolol, or timolol), to bendroflumethiazide or other diuretics (such as
benzthiazide, chlorothiazide, chlorthalidone, cyclothiazide,
hydrochlorothiazide, hydroflumethiazide, methyclothiazide, metolozone,
polythiazide, quinethazone, trichlormethiazide, and furosemide), or to any
other sulfa drug (oral antidiabetic medication, sulfonamide antibiotic).
     * Tell your doctor if you now have or 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.
     * Bendroflumethiazide 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 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.
     * Nadolol can affect your body's response to exercise.  Make sure that
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 medical or dental treatment, tell your
doctor or dentist about this drug.  It may be discontinued 48 hours prior to
any major surgery.
     * This medication can cause dizziness, drowsiness, light-headedness, or
decreased alertness.  Exercise caution while driving a car or operating
potentially dangerous machinery.
     * 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.
     * 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.
     * 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.  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 effects on newborn infants.
Also, tell your doctor if you are breast-feeding an infant.  Although problems
in humans have not yet been reported, small amounts of nadolol and
bendroflumethiazide 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.
