$Unique_ID{BRK02158}
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$Title{TIMOLOL AND HYDROCHLOROTHIAZIDE COMBINATION}
$Subject{Timolide (Merck Sharp & Dohme)}
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Copyright (C) 1991 Publications International, Ltd.


TIMOLOL AND HYDROCHLOROTHIAZIDE COMBINATION
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BRAND NAME (Manufacturer):
     Timolide (Merck Sharp & Dohme)
TYPE OF DRUG:
     Beta-adrenergic blocking agent and diuretic
INGREDIENT:
     Stimolol and hydrochlorothiazide
DOSAGE FORM:
     Tablets (10 mg timolol and 25 mg hydrochlorothiazide)
STORAGE:
     Timolol and hydrochlorothiazide combination tablets should be stored at
       room temperature in a tightly closed, light-resistant container.

USES

     Timolol and hydrochlorothiazide combination is prescribed to treat high
blood pressure.  Hydrochlorothiazide is a diuretic, which reduces fluid
accumulation in the body by increasing the elimination of salt and water
through the kidneys.  Timolol belongs to a group of medicines known as
beta-adrenergic blocking agents or, more commonly, beta blockers.  They work
by controlling 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.
     Timolol 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.

     Abdominal pain, constipation, diarrhea, dizziness, drowsiness, dryness of
the eyes and skin, headache, heartburn, loss of appetite, or tiredness.  These
side effects should disappear as your body adjusts to the medication.
     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.
     Sucking on ice chips or chewing sugarless gum helps to relieve mouth and
throat dryness.
     To relieve constipation, increase the amount of fiber in your diet (fresh
fruits and vegetables, salads, bran, and whole-grain breads) and drink more
water 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.
     Hydrochlorothiazide can cause increased sensitivity to sunlight.  Avoid
prolonged exposure to sunlight and sunlamps, wear protective clothing and
sunglasses, and use an effective sunscreen.

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, chest pain, cold hands or feet (due to decreased blood
circulation to skin, fingers, and toes), confusion, decreased sexual ability,
depression, difficulty in breathing, dry mouth, fever, hair loss,
hallucinations, itching, joint pain, mood changes, muscle pain or cramps,
nausea, numbness or tingling in your fingers or toes, palpitations, rapid
weight gain (three to five pounds within a week), ringing in the ears, skin
rash, sore throat, thirst, unusual bleeding or bruising, vomiting, weakness,
or yellowing of the eyes or skin.

INTERACTIONS

     This medicine interacts with other types of medications:
     1. Indomethacin, aspirin, and other salicylates may decrease the
blood-pressure-lowering effects of beta blockers.
     2. Concurrent use of timolol and disopyramide or calcium channel blockers
(diltiazem, nifedipine, verapamil) can lead to heart failure or very low blood
pressure.
     3. Side effects can be increased when timolol is taken with cimetidine,
clonidine, digoxin, epinephrine, phenylephrine, phenylpropanolamine,
phenothiazine tranquilizers, prazosin, reserpine, chlorpromazine, furosemide,
hydralazine, oral contraceptives (birth control pills), or monoamine oxidase
(MAO) inhibitors.  At least 14 days should separate the use of timolol and the
use of an MAO inhibitor.
     4. Timolol can antagonize (act against) the effects of theophylline,
aminophylline, albuterol, isoproterenol, metaproterenol, and terbutaline.
     5. Timolol 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. Hydrochlorothiazide can decrease the effectiveness of oral
anticoagulants (blood thinners, such as warfarin), antigout medications, and
methenamine.
     8. Fenfluramine may increase the blood-pressure-lowering effects of this
drug, which can be dangerous.
     9. Cholestyramine and colestipol can decrease the absorption of
hydrochlorothiazide 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).
     10. Hydrochlorothiazide may increase the side effects of amphotericin B,
calcium, cortisone and cortisone-like steroids (such as dexamethasone,
hydrocortisone, prednisone, and prednisolone), digoxin, digitalis, lithium,
quinidine, sulfonamide antibiotics, and vitamin D.
     Before starting to take timolol and hydrochlorothiazide combination, BE
SURE TO TELL YOUR DOCTOR about any medications you are currently taking,
especially any of the medications that are listed above.

WARNINGS

     * Tell your doctor about unusual or allergic reactions you have had to
any medications, especially to timolol or any other beta blockers (acebutolol,
atenolol, betaxolol, carteolol, esmolol, labetalol, metoprolol, nadolol,
penbutolol, pindolol, propranolol), to hydrochlorothiazide or other diuretics
(such as bendroflumethiazide, benzthiazide, chlorothiazide, chlorthalidone,
cyclothiazide, hydroflumethiazide, methyclothiazide, metolazone, 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.
     * 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 taking this medication, limit your intake of alcohol in order to
prevent dizziness and light-headedness.
     * While taking this medication, 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.
     * Timolol 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 should 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 advantages of a combination product are 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 weekends, holidays, and vacations.
     * 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.  Extensive 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
timolol and hydrochlorothiazide may 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.
