Hydrochlorothiazide/

Timolol

Generic Name: Hydrochlorothiazide/Timolol (hye-droe-klor-oh-THYE-a-zide/TIM-oh-lole)
Brand Name: Timolide

Hydrochlorothiazide/Timolol is used for:

Treating high blood pressure.

Hydrochlorothiazide/Timolol is a beta-blocker and diuretic combination. It works by decreasing the force and slowing down the heartbeat, helping the heart beat more regularly and reducing the amount of work the heart has to do. It also increases the elimination of excessive fluid, which helps to decrease blood pressure.

Do NOT use Hydrochlorothiazide/Timolol if:

• you are allergic to any ingredient in Hydrochlorothiazide/Timolol or to sulfonamide medicines (eg, sulfamethoxazole, probenecid, glyburide)
• you have uncontrolled heart failure, heart block, heart shock, a very slow heart rate, or low blood pressure
• you are unable to urinate or have a history of asthma or severe chronic obstructive pulmonary disease (COPD)
• you are taking other beta-blockers (eg, propranolol), dofetilide, or mibefradil

Contact your doctor or health care provider right away if any of these apply to you.

Before using Hydrochlorothiazide/Timolol:

Some medical conditions may interact with Hydrochlorothiazide/Timolol. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances
• if you have a history of bronchitis, lung disease (eg, COPD), diabetes, gout, an overactive thyroid, heart problems (eg, congestive heart failure), blood vessel problems, pheochromocytoma, lupus, liver disease, kidney problems, or abnormal blood electrolyte (eg, potassium sodium) levels
• if you are having surgery, receiving anesthesia, or you are dehydrated

Some MEDICINES MAY INTERACT with Hydrochlorothiazide/Timolol. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Barbiturates (eg, phenobarbital), cimetidine, clonidine, corticosteroids (eg, prednisone), guanethidine, other beta-blockers (eg, propranolol), or reserpine because they may increase the risk of Hydrochlorothiazide/Timolol’s side effects
• Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen), phenytoin, or rifampin because they may decrease Hydrochlorothiazide/Timolol’s effectiveness
• Antiarrhythmics (eg, disopyramide), calcium channel blockers (eg, verapamil, diltiazem), or cimetidine because side effects, such as slow or irregular heart beat or low blood pressure, may occur
• Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), barbiturates (eg, phenobarbital), chlorpromazine, clonidine, diazoxide, flecainide, mefloquine, mibefradil, narcotics (eg, codeine), or nifedipine because the risk of side effects of both medicines may be increased
• Allopurinol, amantadine, digitalis (eg, digoxin), dofetilide, insulin or other medicines for diabetes (eg, glyburide), ketanserin, lithium, theophylline, or thyroxine because the risk of their side effects may be increased by Hydrochlorothiazide/Timolol

This may not be a complete list of all interactions that may occur. Ask your health care provider if Hydrochlorothiazide/Timolol may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Hydrochlorothiazide/Timolol:

Use Hydrochlorothiazide/Timolol as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Hydrochlorothiazide/Timolol by mouth with or without food.
• If you also take cholestyramine or colestipol, do not take them within 1 before or 2 hours after taking Hydrochlorothiazide/Timolol. Check with your doctor if you have questions.
• Hydrochlorothiazide/Timolol may increase the amount of urine or cause you to urinate more often when you first start taking it. To keep this from disturbing your sleep, try to take your dose before 6 pm.
• If you miss a dose of Hydrochlorothiazide/Timolol, take the missed dose if you remember the same day. Skip the missed dose if you do not remember the same day. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Hydrochlorothiazide/Timolol.

Important safety information:

• Hydrochlorothiazide/Timolol may cause drowsiness, dizziness, or lightheadedness. These effects may be worse if you take it with alcohol or certain medicines. Use Hydrochlorothiazide/Timolol with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
• Hydrochlorothiazide/Timolol may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.
• Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel “normal.” Tell your doctor if you develop any new symptoms.
• Hydrochlorothiazide/Timolol may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Hydrochlorothiazide/Timolol. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.
• Tell your doctor or dentist that you take Hydrochlorothiazide/Timolol before you receive any medical or dental care, emergency care, or surgery.
• If you have high blood pressure, do not use nonprescription products that contain stimulants. These products may include diet pills or cold medicines. Contact your doctor if you have any questions or concerns.
• Diabetes patients – Hydrochlorothiazide/Timolol may hide signs of low blood sugar, such as a rapid heartbeat. Be sure to watch for other signs of low blood sugar. Low blood sugar may make you anxious, sweaty, weak, dizzy, drowsy, or faint. It may also make your vision change; give you a headache, chills, or tremors; or make you more hungry. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.
• Hydrochlorothiazide/Timolol may interfere with certain lab tests, including parathyroid function tests. Be sure your doctor and lab personnel know you are taking Hydrochlorothiazide/Timolol.
• Lab tests, including blood pressure, blood electrolyte levels, and heart rate, may be performed while you use Hydrochlorothiazide/Timolol. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
• Use Hydrochlorothiazide/Timolol with caution in the ELDERLY; they may be more sensitive to its effects.
• Hydrochlorothiazide/Timolol should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.
• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Hydrochlorothiazide/Timolol while you are pregnant. Hydrochlorothiazide/Timolol is found in breast milk. Do not breast-feed while taking Hydrochlorothiazide/Timolol.

Possible side effects of Hydrochlorothiazide/Timolol:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Cough; dizziness; drowsiness; lightheadedness; tiredness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; confusion; decreased urination; dry mouth; loss of consciousness; muscle pain or weakness; nausea; slow or irregular heartbeat; swelling of ankles or feet; tremors; unusual thirst or fatigue; vomiting.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org), or emergency room immediately. Symptoms may include coughing; dizziness; drowsiness; fainting; loss of consciousness; muscular weakness; nausea; seizures; slow heartbeat; trouble breathing; upset stomach; vomiting; weakness.

Proper storage of Hydrochlorothiazide/Timolol:

Store Hydrochlorothiazide/Timolol at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Hydrochlorothiazide/Timolol out of the reach of children and away from pets.

General information:

• If you have any questions about Hydrochlorothiazide/Timolol, please talk with your doctor, pharmacist, or other health care provider.
• Hydrochlorothiazide/Timolol is to be used only by the patient for whom it is prescribed. Do not share it with other people.
• If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Hydrochlorothiazide/Timolol. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Pronunciation: (high-droe-klor-oh-THIGH-uh-zide/try-AM-tur-een)
Class: Diuretic combination

Trade Names:
Maxzide-25MG
- Tablets 37.5 mg triamterene/25 mg hydrochlorothiazide

Trade Names:
Dyazide
- Capsules 37.5 mg triamterene/25 mg hydrochlorothiazide

Trade Names:
Maxzide
- Tablets 75 mg triamterene/50 mg hydrochlorothiazide

Apo-Triazide (Canada)
Nu-Triazide (Canada)

Pharmacology

Hydrochlorothiazide inhibits reabsorption of sodium and chloride in ascending loop of Henle and early distal tubules. Triamterene interferes with sodium reabsorption at distal tubule. Combination provides additive diuretic activity and antihypertensive effects and minimizes potassium depletion.

Indications and Usage

Treatment of edema or hypertension in patients who have or are at risk of developing hypokalemia.

Contraindications

Anuria; renal decompensation; severe hepatic disease; hypersensitivity to thiazides, triamterene, or sulfonamide-derived drugs; patients receiving spironolactone, amiloride, or potassium supplements; hyperkalemia; metabolic or respiratory acidosis.

Dosage and Administration

Adults

PO 1 to 2 tablets or capsules daily.

Storage/Stability

Store in tightly closed container at room temperature.

Drug Interactions

Angiotensin-converting enzyme inhibitors

May result in severely elevated serum potassium levels.

Allopurinol

May increase incidence of hypersensitivity reactions to allopurinol.

Amantadine

May increase amantadine plasma levels and risk for adverse reactions.

Anticoagulants

May diminish anticoagulant effects.

Bile acid sequestrants

May reduce thiazide absorption; give thiazide at least 2 h before sequestrant.

Diazoxide

May cause hyperglycemia.

Digitalis glycosides

Diuretic-induced hypokalemia and hypomagnesemia may precipitate digitalis-induced arrhythmias.

Indomethacin

May cause rapid progression into acute renal failure.

Lithium

May decrease renal excretion of lithium; monitor lithium levels.

Loop diuretics

May cause synergistic effects that may result in profound diuresis and serious electrolyte abnormalities.

Methenamines, NSAIDs

May decrease effectiveness of thiazide.

Potassium preparations

May severely increase serum potassium levels, possibly resulting in cardiac arrhythmias or cardiac arrest. Monitor serum potassium closely if potassium is coadministered.

Sulfonylureas, insulin

May decrease hypoglycemic effect of sulfonylureas. May need to adjust dosage of sulfonylureas or insulin.

Laboratory Test Interactions

May interfere with the fluorescent measurement of quinidine serum levels. May decrease serum protein-bound iodine levels without signs of thyroid disturbance.

Adverse Reactions

Cardiovascular

Orthostatic hypotension.

CNS

Dizziness; lightheadedness; vertigo; headache; paresthesias; weakness; restlessness; insomnia; fatigue.

Dermatologic

Purpura; photosensitivity; rash; urticaria; necrotizing angiitis, vasculitis, cutaneous vasculitis; alopecia; exfoliative dermatitis; toxic epidermal necrolysis; erythema multiforme; Stevens-Johnson syndrome.

EENT

Blurred vision; xanthopsia (yellow vision).

GI

Anorexia; gastric irritation; nausea; vomiting; abdominal pain or cramping; bloating; diarrhea; constipation; pancreatitis; sialadenitis; dry mouth.

Genitourinary

Impotence; reduced libido; interstitial nephritis; azotemia; elevated BUN and creatinine.

Hematologic

Leukopenia; thrombocytopenia; agranulocytosis; aplastic or hypoplastic anemia; hemolytic anemia; megaloblastic anemia.

Hepatic

Jaundice; liver enzyme abnormalities.

Metabolic

Hyperglycemia; glycosuria; hyperuricemia; hyperkalemia; electrolyte imbalance; hypochloremia; hyponatremia.

Miscellaneous

Muscle cramp or spasm; fever; anaphylactic reactions.

Precautions

Pregnancy

Category C .

Lactation

Excreted in breast milk.

Children

Safety and efficacy have not been established.

Hypersensitivity

May occur in patients with or without history of allergy or bronchial asthma; cross-sensitivity with sulfonamides may also occur.

Renal Function

May precipitate azotemia or hypermagnesemia; use drug with caution.

Hepatic Function

Minor alterations of fluid and electrolyte balance may precipitate hepatic coma; use drug with caution.

Electrolyte imbalances and BUN increase

Hyperkalemia (serum potassium greater than 5.5 mEq/L), hyponatremia, hypochloremia, and increases in BUN may occur.

Hematologic effects

Triamterene is a weak folic acid antagonist and may contribute to megaloblastosis.

Lipids

May affect total serum cholesterol, total triglycerides, and LDL in some patients.

Postsympathectomy

Antihypertensive effects may be enhanced.

Renal stones

Triamterene has been found in renal stones; use drug with caution in patients with histories of stone formation.

Overdosage

Symptoms

Orthostatic or general hypotension, tachycardia, syncope, electrolyte abnormalities, potassium deficiency, vomiting, nausea, shock, weakness, confusion, dizziness, cramps of calf muscles, thirst, polyuria, anuria, lethargy.

Patient Information

• Instruct patient to take medication early in day to avoid diuretic effect at night.
• Tell patient to take drug with food or milk and to report GI symptoms.
• Advise patient to limit sodium intake for optimal drug effect.
• Advise patient to limit exposure to sun and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
• Instruct diabetic patients to report increased levels of blood glucose.
• Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
• Tell patient to report these symptoms to health care provider: decrease in urinary output, jaundice, muscle cramps, weakness, nausea, blurred vision, dizziness.
• Instruct patient to drink 2 to 3 L/day of water unless contraindicated.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.

Copyright © 2009 Wolters Kluwer Health.

Generic Name: psyllium (SIL ee um)
Brand Names: Fiberall, Genfiber, Hydrocil, Konsyl, Konsyl Orange Sugar-free, Konsyl-D, Konsyl-Orange, Laxmar, Laxmar Orange, Laxmar Sugar Free, Metamucil, Metamucil Berry Burst Smooth Texture Sugar Free, Metamucil Orange Coarse Milled Original Texture, Metamucil Orange Smooth Texture, Metamucil Orange Smooth Texture Sugar Free, Metamucil Unflavored Coarse Milled Original Texture, Metamucil Unflavored Smooth Texture Sugar Free, Natural Fiber Therapy, Perdiem Fiber Powder, Reguloid, V-Lax

What is Hydrocil (psyllium)?

Psyllium is a bulk-forming fiber laxative. Psyllium works by absorbing liquid in the intestines and swelling to create a softer, bulky stool that is easier to pass.

Psyllium is used to treat occasional constipation or bowel irregularity. Psyllium may also be used to treat diarrhea and may help lower cholesterol when used together with a diet low in cholesterol and saturated fat.

Psyllium may also be used for other purposes not listed in this product guide.

What is the most important information I should know about Hydrocil (psyllium)?

Laxatives may be habit-forming if they are used too often or for too long. This can lead to damage of intestinal nerves or muscle tissues. Do not take psyllium for longer than directed on the label or prescribed by your doctor. You should not take this product if you are allergic to psyllium, or if you have trouble swallowing, a sudden change in bowel habits that lasts longer than 2 weeks, severe nausea, vomiting, or stomach pain, or if you have ever had a skin rash while taking psyllium.

Also talk with your doctor before using psyllium if you have a colostomy or ileostomy, rectal bleeding, or a blockage in your intestines.

Stop using psyllium and call your doctor at once if you have choking or trouble swallowing, severe stomach pain or cramping, nausea or vomiting, constipation that lasts longer than 7 days, rectal bleeding, or itchy skin rash. Do not take psyllium for longer than 7 days in a row unless your doctor has told you to.

What should I discuss with my healthcare provider before taking Hydrocil (psyllium)?

Laxatives may be habit-forming if they are used too often or for too long. This can lead to damage of intestinal nerves or muscle tissues. Do not take psyllium for longer than directed on the label or prescribed by your doctor. You should not take this product if you are allergic to psyllium, or if you have:

• trouble swallowing;

• a sudden change in bowel habits that lasts longer than 2 weeks;

• severe nausea, vomiting, or stomach pain; or

• if you have ever had a skin rash while taking psyllium.

If you have certain conditions, you may need a dose adjustment or special tests to safely use this product. Before you take psyllium, tell your doctor if you have:

• a colostomy or ileostomy;

• rectal bleeding; or

• a blockage in your intestines.

Psyllium products may contain sugar, sodium, or artificial sweeteners. This may be of concern to you if you have diabetes, high blood pressure, or phenylketonuria (PKU). Check the product label if you have any of these conditions.

FDA pregnancy category B. Psyllium is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether psyllium passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Hydrocil (psyllium)?

Use this medication exactly as directed on the label, or as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Psyllium is intended to be used for a short time only.

Take psyllium with a full glass (at least 8 ounces) of water or another liquid. Taking psyllium without enough liquid may cause it to swell in your throat and cause choking. Drinking plenty of fluids each day while you are taking psyllium will also help improve bowel regularity.

The psyllium wafer must be chewed before you swallow it.

Do not swallow psyllium powder dry. It must be mixed with liquid. Place the psyllium powder into an empty glass and add at least 8 ounces of water or other liquid such as fruit juice. Stir this mixture and drink all of it right away.

If the powder and liquid mixture is too thick, add more liquid. After drinking the entire mixture, add a little more liquid to the same glass, swirl gently and drink right away to make sure you get the entire dose of psyllium.

Psyllium may be only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

It may take up to 3 days of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 2 or 3 days of treatment.

Do not take psyllium for longer than 7 days in a row unless your doctor has told you to. Store psyllium at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include nausea, vomiting, and stomach pain. Using a laxative too often or for too long may cause severe medical problems involving your intestines.

What should I avoid while taking Hydrocil (psyllium)?

Avoid taking other oral (by mouth) medications within 2 hours before or after you take psyllium. Bulk-forming laxatives can make it harder for your body to absorb other medications, possibly making them less effective.

Avoid breathing in the dust from psyllium powder when mixing. Inhaling psyllium dust may cause an allergic reaction.

If you take psyllium as part of a cholesterol-lowering treatment plan, avoid eating foods that are high in fat or cholesterol. Your treatment will not be as effective in lowering your cholesterol if you do not follow a cholesterol-lowering diet plan.

Hydrocil (psyllium) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using psyllium and call your doctor at once if you have a serious side effect such as:

• choking or trouble swallowing;

• severe stomach pain, cramping, nausea or vomiting;

• constipation that lasts longer than 7 days;

• rectal bleeding; or

• itchy skin rash.

Less serious side effects may include:

• bloating; or

• minor change in your bowel habits.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Hydrocil (psyllium)?

Tell your doctor about all other medications you use, especially:

• a blood thinner such as warfarin (Coumadin); or

• demeclocycline (Declomycin), doxycycline (Adoxa, Doryx, Oracea, Vibramycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).

This list is not complete and there may be other drugs that can interact with psyllium. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about psyllium.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 5.01. Revision Date: 08/05/2009 9:56:41 AM.

Generic Name: guaifenesin and hydrocodone (gwye FEN e sin and HYE droe KOE done)
Brand Names: A-Cof DH, Canges-XP, Codiclear DH, Condasin, Cotuss V, Execlear, Extendryl HC, Hycotuss Expectorant, Hydrocod-GF, Kwelcof, Monte-G HC, Narcof, Pancof XP, Pneumotussin 2.5, Relasin-HCX, Touro HC, Tussicle, Tusso-DF, Vi-Q-Tuss, Vitussin Expectorant, Xpect-HC, Z-Cof HCX

What is Hydrocod-GF (guaifenesin and hydrocodone)?

Guaifenesin is an expectorant. It helps loosen congestion in your chest and throat, making it easier to cough out through your mouth.

Hydrocodone is a narcotic cough suppressant.

Guaifenesin and hydrocodone is used to treat cough and reduce chest congestion caused by the common cold, flu, or allergies.

Guaifenesin and hydrocodone may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Hydrocod-GF (guaifenesin and hydrocodone)?

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. It may increase drowsiness and dizziness caused by guaifenesin and hydrocodone. Tell your doctor if you regularly use other medicines that make you sleepy (such as other cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by guaifenesin and hydrocodone. Hydrocodone may be habit-forming and should be used only by the person it was prescribed for. Hydrocodone should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it.

What should I discuss with my healthcare provider before taking Hydrocod-GF (guaifenesin and hydrocodone)?

Hydrocodone may be habit-forming and should be used only by the person it was prescribed for. Hydrocodone should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Do not use this medicine if you are allergic to hydrocodone or guaifenesin.

Before taking this medication, tell your doctor if you have:

• kidney disease;
• liver disease;

• asthma;

• urination problems;

• an enlarged prostate;

• a thyroid disorder;

• seizures or epilepsy;

• gallbladder disease;

• a head injury; or

• Addison’s disease.

If you have any of these conditions, you may not be able to take guaifenesin and hydrocodone, or you may need a dose adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Guaifenesin and hydrocodone passes into breast milk and may be harmful to a nursing baby. Do not take guaifenesin and hydrocodone without telling your doctor if you are breast-feeding a baby.

How should I take Hydrocod-GF (guaifenesin and hydrocodone)?

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Guaifenesin and hydrocodone can be taken with or without food.

Measure liquid medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Do not take more of this medication or take it for longer than is recommended. Call your doctor if your symptoms do not improve, or if they get worse. Store guaifenesin and hydrocodone at room temperature away from moisture and heat. Keep track of how many pills have been used from each new bottle of this medicine. Hydrocodone is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include extreme drowsiness, sweating, pinpoint pupils, nausea, vomiting, dry mouth, confusion, cold and clammy skin, muscle weakness, fainting, weak pulse, slow heart rate, seizure (convulsions), weak or shallow breathing, or breathing that stops.

What should I avoid while taking Hydrocod-GF (guaifenesin and hydrocodone)?

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol. It may increase drowsiness and dizziness caused by guaifenesin and hydrocodone. Tell your doctor if you regularly use other medicines that make you sleepy (such as other cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by guaifenesin and hydrocodone.

Do not take other over-the-counter cough, cold, allergy, pain, or sleep medications without first asking your doctor or pharmacist. Guaifenesin is contained in many medicines available over the counter. If you take certain products together you may accidentally take too much guaifenesin. Read the label of any other medicine you are using to see if it contains guaifenesin.

Hydrocod-GF (guaifenesin and hydrocodone) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have a serious side effect such as:

• slow heart rate, weak or shallow breathing;

• feeling like you might pass out;

• confusion, fear, unusual thoughts or behavior;

• seizure (convulsions); or

• urinating less than usual or not at all.

Less serious side effects may include:

• dizziness, drowsiness;

• nausea, vomiting, upset stomach;

• blurred vision;

• constipation;

• dry mouth; or

• sweating.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Hydrocod-GF (guaifenesin and hydrocodone)?

Before taking this medication, tell your doctor if you are using any of the following drugs:

• antidepressants such as amitriptyline (Elavil, Etrafon), clomipramine (Anafranil), imipramine (Janimine, Tofranil), and others;

• atropine (Donnatal, and others), benztropine (Cogentin), dimenhydrinate (Dramamine), glycopyrrolate (Robinul), mepenzolate (Cantil), methscopolamine (Pamine), or scopolamine (Transderm-Scop);

• bladder or urinary medications such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare);

• a bronchodilator such as ipratropium (Atrovent) or tiotropium (Spiriva); or

• irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Anaspaz, Cystospaz, Levsin, and others), or propantheline (Pro-Banthine).

This list is not complete and there may be other drugs that can interact with guaifenesin and hydrocodone. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about guaifenesin and hydrocodone.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 2.02. Revision Date: 4/12/2009 4:41:00 PM.

Generic Name: hydrochlorothiazide and spironolactone (HYE dro KLOR oh THY a zide and spir ON oh LAK tone)
Brand Names: Aldactazide

What is hydrochlorothiazide and spironolactone?

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.

Spironolactone is a potassium-sparing diuretic that also prevents your body from absorbing too much salt and keeps your potassium levels from getting too low.

The combination of hydrochlorothiazide and spironolactone is used to treat fluid retention (edema) in people with congestive heart failure, cirrhosis of the liver, or a kidney disorder called nephrotic syndrome. This medication also treats high blood pressure (hypertension).

Hydrochlorothiazide and spironolactone may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about hydrochlorothiazide and spironolactone?

Do not use this medication if you have kidney disease, urination problems, or high levels of potassium in your blood. Do not use potassium supplements while you are taking hydrochlorothiazide and spironolactone.

Before using this medication, tell your doctor if you have heart or liver disease, diabetes, a breathing disorder, gout, lupus, an allergy to sulfa drugs, or a pancreas disorder. Tell your doctor if you use a steroid or another blood pressure medicine.

Avoid drinking alcohol, which can increase some of the side effects of hydrochlorothiazide and spironolactone.

Avoid a diet high in salt. Too much salt will cause your body to retain water and can make this medication less effective.

Do not use salt substitutes or low-sodium milk products that contain potassium. These products could cause your potassium levels to get too high while you are taking hydrochlorothiazide and spironolactone.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor’s instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What should I discuss with my doctor before taking hydrochlorothiazide and spironolactone?

Do not use this medication if you are allergic to hydrochlorothiazide or spironolactone, or if you have:

• kidney disease or are unable to urinate;

• high potassium levels (hyperkalemia); or

• if you are taking potassium supplements.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use this medication:

• diabetes;

• heart disease;

• cirrhosis or other liver disease;

• a breathing disorder;

• gout;

• lupus;

• an allergy to sulfa drugs;

• a pancreas disorder; or

• if you are using another blood pressure medication or a steroid.

FDA pregnancy category C. It is not known whether hydrochlorothiazide and spironolactone is harmful to an unborn baby. Before taking this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment. Hydrochlorothiazide passes into breast milk and could cause harm to a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take hydrochlorothiazide and spironolactone?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Take each dose with a full glass of water.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested. Do not miss any scheduled appointments.

Hydrochlorothiazide can interfere with the results of a thyroid test. Tell any doctor who treats you that you are using a thiazide diuretic.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking hydrochlorothiazide and spironolactone. You may need to stop using the medicine for a short time.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.

Store the tablets at room temperature away from heat, light, and moisture.

See also: Hydrochlorothiazide and spironolactone dosage in more detail

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include drowsiness, confusion, red skin rash, nausea, vomiting, or diarrhea.

What should I avoid while taking hydrochlorothiazide and spironolactone?

Avoid drinking alcohol, which can increase some of the side effects of hydrochlorothiazide and spironolactone. Do not use salt substitutes or low-sodium milk products that contain potassium. These products could cause your potassium levels to get too high while you are taking hydrochlorothiazide and spironolactone.

Avoid a diet high in salt. Too much salt will cause your body to retain water and can make this medication less effective.

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor’s instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Hydrochlorothiazide and spironolactone side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have a serious side effect such as:

• numbness or tingly feeling;

• muscle pain or weakness;

• slow, fast, or uneven heartbeat;

• feeling drowsy, restless, or light-headed;

• urinating less than usual or not at all;

• shallow breathing;

• tremors, confusion; or

• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

• mild nausea or vomiting;

• dizziness, headache;

• gas, stomach pain; or

• skin rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Hydrochlorothiazide and spironolactone Dosing Information

Usual Adult Dose for Hypertension:

Initial dose: 2 tablets (hydrochlorothiazide 25 mg-spironolactone 25 mg) orally once a day or 1 tablet (hydrochlorothiazide 50 mg-spironolactone 50 mg) orally once a day.

Maintenance dose: The initial dosage may be divided into two daily doses, and increased as tolerated approximately every two to four days to a maximum recommended total daily dose of hydrochlorothiazide 100 mg-spironolactone 100 mg.

Usual Adult Dose for Edema:

Initial dose: 4 tablets (hydrochlorothiazide 25 mg-spironolactone 25 mg) orally once a day or 2 tablets (hydrochlorothiazide 50 mg-spironolactone 50 mg) orally once a day.

Maintenance dose: The initial dosage may be divided into two to four daily doses, and increased as tolerated approximately every two to four days to a maximum recommended total daily dose of hydrochlorothiazide 200 mg-spironolactone 200 mg. The risk of side effects increases significantly with dosages greater than the maximum recommended dose.

Usual Adult Dose for Congestive Heart Failure:

Initial dose: 4 tablets (hydrochlorothiazide 25 mg-spironolactone 25 mg) orally once a day or 2 tablets (hydrochlorothiazide 50 mg-spironolactone 50 mg) orally once a day.

Maintenance dose: The initial dosage may be divided into two to four daily doses, and increased as tolerated approximately every two to four days to a maximum recommended total daily dose of hydrochlorothiazide 200 mg-spironolactone 200 mg. The risk of side effects increases significantly with dosages greater than the maximum recommended dose.

Usual Adult Dose for Ascites:

Initial dose: 4 tablets (hydrochlorothiazide 25 mg-spironolactone 25 mg) orally once a day or 2 tablets (hydrochlorothiazide 50 mg-spironolactone 50 mg) orally once a day.

Maintenance dose: If there is inadequate diuresis after two to four days, this dosage should be increased as tolerated approximately every two to three days to a maximum recommended total daily dose of hydrochlorothiazide 200 mg-spironolactone 200 mg.

Usual Adult Dose for Nephrotic Syndrome:

Initial dose: 4 tablets (hydrochlorothiazide 25 mg-spironolactone 25 mg) orally once a day or 2 tablets (hydrochlorothiazide 50 mg-spironolactone 50 mg) orally once a day.

Maintenance dose: The initial dosage may be divided into two to four daily doses, and increased as tolerated approximately every two to four days to a maximum recommended total daily dose of hydrochlorothiazide 200 mg-spironolactone 200 mg. The risk of side effects increases significantly with dosages greater than the maximum recommended dose.

What other drugs will affect hydrochlorothiazide and spironolactone?

Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to light-headedness caused by hydrochlorothiazide and spironolactone. Tell your doctor if you regularly use any of these medicines, or any other blood pressure medications.

Before taking this medication, tell your doctor if you are using any of the following drugs:

• lithium;

• digoxin (Lanoxin);

• steroids (prednisone and others);

• a blood thinner such as warfarin (Coumadin);

• insulin or diabetes medicine taken by mouth;

• an ACE inhibitor such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), ramipril (Altace), and others; or

• indomethacin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Motrin, Advil), diclofenac (Voltaren), naproxen (Aleve, Naprosyn), piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others.

This list is not complete and there may be other drugs that can interact with hydrochlorothiazide and spironolactone. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about hydrochlorothiazide and spironolactone.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 5.01. Revision Date: 04/06/2009 10:43:56 AM.

Generic Name: hydrochlorothiazide and telmisartan (hye droe klor oh THYE a zide and TEL mi SAR tan)
Brand Names: Micardis HCT

What is hydrochlorothiazide and telmisartan?

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.

Telmisartan is in a group of drugs called angiotensin II receptor antagonists. Telmisartan keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow.

The combination of hydrochlorothiazide and telmisartan is used to treat high blood pressure (hypertension).

Hydrochlorothiazide and telmisartan may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about hydrochlorothiazide and telmisartan?

Do not use this medication if you are allergic to hydrochlorothiazide or telmisartan, or if you are unable to urinate. Do not use this medication without telling your doctor if you are pregnant. Telmisartan may cause injury and even death to the unborn baby if you take it during the second and third trimesters of pregnancy. Use an effective form of birth control. Stop using this medication and tell your doctor right away if you become pregnant during treatment.

Before using hydrochlorothiazide and telmisartan, tell your doctor if you have congestive heart failure, kidney or liver disease, asthma, low or high blood levels of potassium, gout, lupus, diabetes, or an allergy to sulfa drugs.

Avoid drinking alcohol. It can lower your blood pressure and may increase some of the side effects of hydrochlorothiazide and telmisartan.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor’s instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Do not use potassium supplements or salt substitutes while you are taking hydrochlorothiazide and telmisartan, unless your doctor has told you to. In rare cases, hydrochlorothiazide and telmisartan can cause a condition that results in the breakdown of skeletal muscle tissue, leading to kidney failure. Call your doctor right away if you have muscle pain, tenderness, or weakness especially if you also have fever, nausea or vomiting, and dark colored urine.

What should I discuss with my healthcare provider before taking hydrochlorothiazide and telmisartan?

Do not use this medication if you are allergic to hydrochlorothiazide or telmisartan, or if you are unable to urinate.

Before using hydrochlorothiazide and telmisartan, tell your doctor if you have:

• kidney disease;
• liver disease;

• congestive heart failure;

• asthma or allergies;

• low or high levels of magnesium or potassium in your blood;

• gout;

• lupus,

• diabetes; or

• an allergy to sulfa drugs.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take hydrochlorothiazide and telmisartan.

FDA pregnancy category D. This medication can cause harm to an unborn baby. Do not use this medication without telling your doctor if you are pregnant. Telmisartan may cause injury and even death to the unborn baby if you take it during the second and third trimesters of pregnancy. Use an effective form of birth control. Stop using this medication and tell your doctor right away if you become pregnant during treatment. It is not known whether hydrochlorothiazide and telmisartan passes into breast milk. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.

How should I take hydrochlorothiazide and telmisartan?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Take this medication with a full glass (8 ounces) of water.

To be sure this medication is helping your condition, your blood pressure will need to be checked on a regular basis. Do not miss any scheduled appointments.

Hydrochlorothiazide can interfere with the results of a thyroid test. Tell any doctor who treats you that you are using this medication.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.

Store hydrochlorothiazide and telmisartan at room temperature away from moisture and heat.

See also: Hydrochlorothiazide and telmisartan dosage in more detail

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include fast or slow heartbeat, feeling light-headed, or fainting.

What should I avoid while taking hydrochlorothiazide and telmisartan?

Avoid drinking alcohol. It can lower your blood pressure and may increase some of the side effects of hydrochlorothiazide and telmisartan.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor’s instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Do not use potassium supplements or salt substitutes while you are taking hydrochlorothiazide and telmisartan, unless your doctor has told you to.

Hydrochlorothiazide and telmisartan side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. In rare cases, hydrochlorothiazide and telmisartan can cause a condition that results in the breakdown of skeletal muscle tissue, leading to kidney failure. Call your doctor right away if you have muscle pain, tenderness, or weakness especially if you also have fever, nausea or vomiting, and dark colored urine. Stop using this medication and call your doctor at once if you have any other serious side effects, such as:

• feeling light-headed, fainting;

• swelling, rapid weight gain;

• fast or pounding heartbeats;

• urinating less than usual, or not at all;

• jaundice (yellowing of the skin or eyes); or

• dry mouth, increased thirst, drowsiness, restless feeling, confusion, increased urination, fast heart rate, fainting, or seizure (convulsions).

Less serious side effects may include:

• stomach pain, diarrhea;

• back pain;

• headache, tired feeling, dizziness;

• skin rash;

• stuffy nose, sore throat; or

• dry cough.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Hydrochlorothiazide and telmisartan Dosing Information

Usual Adult Dose for Hypertension:

Initial dose: The initial dosage of hydrochlorothiazide-telmisartan recommended for this patient should be based on this patient’s requirements for each drug. The usual recommended dosage range for hypertension is 40 to 80 mg (telmisartan) and 12.5 mg (hydrochlorothiazide) per day.

What other drugs will affect hydrochlorothiazide and telmisartan?

Before taking hydrochlorothiazide and telmisartan, tell your doctor if you are using any of the following drugs:

• any other blood pressure medications;

• digoxin (digitalis, Lanoxin, Lanoxicaps);

• a blood thinner such as warfarin (Coumadin);

• steroids (prednisone and others);

• lithium (Eskalith, Lithobid);

• cholestyramine (Prevalite, Questran) or colestipol (Colestid);

• insulin or diabetes medications you take by mouth;

• a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton);

• any other diuretics, such as amiloride (Midamor), bumetanide (Bumex), chlorthalidone (Hygroton, Thalitone), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril), indapamide (Lozol), metolazone (Mykrox, Zarxolyn), spironolactone (Aldactone), triamterene (Dyrenium, Maxzide, Dyazide), torsemide (Demadex), and others;

• aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others;

• a muscle relaxer such as baclofen (Lioresal), carisoprodol (Soma), cyclobenzaprine (Flexeril), dantrolene (Dantrium), metaxalone (Skelaxin), or methocarbamol (Robaxin), orphenadrine (Norflex), or tizanidine (Zanaflex);

• a narcotic medication such as hydrocodone (Lortab, Vicodin), hydromorphone (Dilaudid, Palladone), levorphanol (Levo-Dromoran), meperidine (Demerol), methadone (Methadose), morphine (Kadian, MS Contin), oxycodone (OxyContin), oxymorphone (Numorphan), or propoxyphene (Darvon, Darvocet).

This list is not complete and there may be other drugs that can interact with hydrochlorothiazide and telmisartan. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about hydrochlorothiazide and telmisartan.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 2.02. Revision Date: 4/12/2009 4:44:31 PM.

Generic Name: hydrochlorothiazide and timolol (HYE droe klor oh THYE a zide and TYE moe lol)
Brand Names: Timolide 10-25

What is hydrochlorothiazide and timolol?

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.

Timolol is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).

The combination of hydrochlorothiazide and timolol is used to treat high blood pressure (hypertension).

Hydrochlorothiazide and timolol may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about hydrochlorothiazide and timolol?

You should not use this medication if you have a history of asthma or severe chronic obstructive pulmonary disease (COPD), severe or uncontrolled heart failure, a heart condition called “sick sinus syndrome” or “AV block,” an allergy to sulfa drugs, or if you are unable to urinate.

Before using this medication, tell your doctor if you have congestive heart failure, kidney or liver disease, cirrhosis, bronchospastic lung disease, gout, lupus, diabetes, a muscle disorder such as myasthenia gravis, a history of stroke, a thyroid disorder, or if you are allergic to sulfa drugs..

If you are diabetic, check your blood sugar carefully. Using timolol can make it harder for you to tell when you have low blood sugar. Your insulin or diabetic medication needs may change while you are taking hydrochlorothiazide and timolol. Talk with your doctor before changing any doses.

Avoid drinking alcohol, which can lower your blood pressure and may add to the side effects of hydrochlorothiazide and timolol.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor’s instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Keep using this medication even if you feel fine. High blood pressure often has no symptoms.

There are many other medicines that can interact with hydrochlorothiazide and timolol. Tell your doctor about all the prescription and over-the-counter medications you use.

What should I discuss with my doctor before taking hydrochlorothiazide and timolol?

You should not use this medication if you are allergic to hydrochlorothiazide or timolol, or if you have:

• a history of asthma or severe chronic obstructive pulmonary disease (COPD);

• severe or uncontrolled heart failure;

• a heart condition called “sick sinus syndrome” or “AV block” (2nd or 3rd degree); or

• if you are unable to urinate.

Before using hydrochlorothiazide and timolol, tell your doctor if you are allergic to any drugs, or if you have:

• congestive heart failure;

• kidney disease;
• liver disease (or cirrhosis);

• bronchospastic lung disease;

• a thyroid disorder;

• a muscle disorder such as myasthenia gravis;

• a history of stroke;

• lupus;

• gout;

• diabetes; or

• if you are allergic to sulfa drugs.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Hydrochlorothiazide and timolol can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take hydrochlorothiazide and timolol?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take the medicine with a meal or right after you eat.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Do not stop using hydrochlorothiazide and timolol suddenly, or you could have a serious or life-threatening heart problem. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication.

To be sure this medication is not causing harmful effects, your blood pressure will need to be checked on a regular basis, and you may need blood tests. Do not miss any scheduled appointments.

Your blood and urine may both be tested if you have been vomiting or are dehydrated.

If you are diabetic, check your blood sugar carefully. Using timolol can make it harder for you to tell when you have low blood sugar. Your insulin or diabetic medication needs may change while you are taking hydrochlorothiazide and timolol. Talk with your doctor before changing any doses.

Hydrochlorothiazide and timolol can affect the results of certain thyroid tests. Tell any doctor who treats you that you are using this medication.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using hydrochlorothiazide and timolol. You may need to stop using the medicine for a short time. Keep using hydrochlorothiazide and timolol even if you feel fine. High blood pressure often has no symptoms. Store this medication in a tightly closed container at room temperature, away from heat, moisture, and light.

See also: Hydrochlorothiazide and timolol dosage in more detail

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include fast or slow heart rate, dizziness, ringing in your ears, or feeling like you might pass out.

What should I avoid while taking hydrochlorothiazide and timolol?

Avoid drinking alcohol, which can lower your blood pressure and may add to the side effects of hydrochlorothiazide and timolol.

Avoid using other medicines that make you light-headed (especially narcotic pain medication or barbiturates). They can add to the side effects of hydrochlorothiazide and timolol. Tell your doctor if you regularly use any of these medicines.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor’s instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Hydrochlorothiazide and timolol side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have any of these serious side effects:

• swelling, rapid weight gain, feeling short of breath, even with mild exertion;

• fast, slow, or uneven heartbeat;

• easy bruising or bleeding;

• sudden numbness or weakness on one side of the body, problems with vision or speech, chest pain, or pain in one or both legs;

• numbness or tingly feeling in your hands or feet;

• feeling weak, drowsy, restless, or light-headed;

• nausea, vomiting, dry mouth, extreme thirst, headache, confusion, hallucinations, seizure (convulsions);

• increased urination, leg discomfort, muscle pain or weakness or limp feeling;

• urinating less than usual or not at all;

• fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; or

• upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

• diarrhea, constipation, upset stomach;

• dizziness, spinning sensation;

• depressed mood; or

• blurred vision.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Hydrochlorothiazide and timolol Dosing Information

Usual Adult Dose for Hypertension:

Initial and maintenance dose: 1 tablet orally twice a day or 2 tablets orally once a day.

What other drugs will affect hydrochlorothiazide and timolol?

Many drugs can interact with hydrochlorothiazide and timolol. Below is just a partial list. Tell your doctor if you are using:

• insulin or diabetes medicine you take by mouth;

• colestipol (Colestid) or cholestyramine (Prevalite, Questran);

• steroids (prednisone and others);

• lithium (Lithobid);

• NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Motrin, Advil), diclofenac (Voltaren), etodolac (Lodine), indomethacin, naproxen (Aleve, Naprosyn), and others;

• other heart or blood pressure medications such as clonidine (Catapres), digoxin (digitalis, Lanoxin), quinidine (Quinidex, Quin-Release Quin-G), or reserpine; or

• a calcium channel blocker such as diltiazem (Tiazac, Cartia, Cardizem), isradipine (Dynacirc), felodipine (Plendil), nifedipine (Procardia, Adalat), or verapamil (Calan, Covera, Isoptin, Verelan).

This list is not complete and there may be other drugs that can interact with hydrochlorothiazide and timolol. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about hydrochlorothiazide and timolol.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 3.06. Revision Date: 4/12/2009 4:40:36 PM.

Generic Name: hydrochlorothiazide and triamterene (hye dro klor oh THY a zide and trye AM ter een)
Brand Names: Dyazide, Maxzide, Maxzide-25

What is hydrochlorothiazide and triamterene?

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.

Triamterene is a potassium-sparing diuretic that also prevents your body from absorbing too much salt and keeps your potassium levels from getting too low.

The combination of hydrochlorothiazide and triamterene is used to treat fluid retention (edema) and high blood pressure (hypertension).

Hydrochlorothiazide and triamterene may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about hydrochlorothiazide and triamterene?

Do not use this medication if you have kidney disease, urination problems, or high levels of potassium in your blood. Do not use potassium supplements or other diuretics while you are taking hydrochlorothiazide and triamterene.

Before using this medication, tell your doctor if you have heart or liver disease, diabetes, a breathing disorder, gout, lupus, or a pancreas disorder. Tell your doctor if you use a steroid or another blood pressure medicine.

Avoid drinking alcohol, which can increase some of the side effects of hydrochlorothiazide and triamterene.

Avoid a diet high in salt. Too much salt will cause your body to retain water and can make this medication less effective.

Do not use salt substitutes or low-sodium milk products that contain potassium. These products could cause your potassium levels to get too high while you are taking hydrochlorothiazide and triamterene.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor’s instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.

What should I discuss with my doctor before taking hydrochlorothiazide and triamterene?

Do not use this medication if you have:

• kidney disease or are unable to urinate;

• high potassium levels (hyperkalemia); or

• if you are taking other diuretics or potassium supplements.

Before using hydrochlorothiazide and triamterene, tell your doctor if you have:

• diabetes;

• heart disease;

• cirrhosis or other liver disease;

• a breathing disorder;

• gout;

• lupus;

• a history of kidney stones;

• an allergy to sulfa drugs;

• a pancreas disorder; or

• if you are using another blood pressure medication or a steroid.

If you have any of these conditions, you may not be able to use hydrochlorothiazide and triamterene, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Hydrochlorothiazide passes into breast milk and could cause harm to a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take hydrochlorothiazide and triamterene?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Take each dose with a full glass of water.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested. Do not miss any scheduled appointments.

Hydrochlorothiazide and triamterene can interfere with the results of certain medical tests. Tell any doctor who treats you that you are using a thiazide diuretic.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking hydrochlorothiazide and triamterene. You may need to stop using the medicine for a short time.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.

Store this medication at room temperature away from heat, light, and moisture.

See also: Hydrochlorothiazide and triamterene dosage in more detail

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include increased urination, nausea, vomiting, weakness, fever, warmth or flushing in your face, or muscle spasms.

What should I avoid while taking hydrochlorothiazide and triamterene?

Avoid drinking alcohol, which can increase some of the side effects of hydrochlorothiazide and triamterene. Do not use salt substitutes or low-sodium milk products that contain potassium. These products could cause your potassium levels to get too high while you are taking hydrochlorothiazide and triamterene.

Avoid a diet high in salt. Too much salt will cause your body to retain water and can make this medication less effective.

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor’s instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Hydrochlorothiazide and triamterene side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have a serious side effect such as:

• numbness or tingly feeling;

• muscle pain or weakness;

• slow, fast, or uneven heartbeat;

• feeling drowsy, restless, or light-headed;

• urinating less than usual or not at all;

• shallow breathing;

• tremors, confusion; or

• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

• mild nausea or vomiting;

• dizziness, headache;

• gas, stomach pain; or

• skin rash.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Hydrochlorothiazide and triamterene Dosing Information

Usual Adult Dose for Edema:

1 to 2 tablets or capsules (hydrochlorothiazide/triamterene 25 mg-37.5 mg) orally once a day or
1 to 2 capsules (hydrochlorothiazide/triamterene 25 mg-50 mg) orally once a day after meals or
1 tablet (hydrochlorothiazide/triamterene 50 mg-75 mg) orally once a day.

Usual Adult Dose for Hypertension:

1 to 2 tablets or capsules (hydrochlorothiazide/triamterene 25 mg-37.5 mg) orally once a day or
1 to 2 capsules (hydrochlorothiazide/triamterene 25 mg-50 mg) orally once a day after meals or
1 tablet (hydrochlorothiazide/triamterene 50 mg-75 mg) orally once a day.

What other drugs can affect hydrochlorothiazide and triamterene?

Before you take this medication, tell your doctor if you regularly use other medicines that make you light-headed (such as cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to the side effects of hydrochlorothiazide and triamterene.

Before taking this medication, tell your doctor if you are using any of the following drugs:

• lithium;

• amphotericin (Amphocin, Fungizone, AmBisome);

• methenamine (Hipprex, Mandelamine, Urex);

• steroids (prednisone and others);

• a blood thinner such as warfarin (Coumadin);

• insulin or diabetes medicine taken by mouth;

• laxatives;

• an ACE inhibitor such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), ramipril (Altace), and others; or

• indomethacin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Motrin, Advil), diclofenac (Voltaren), indomethacin, naproxen (Aleve, Naprosyn), piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others.

This list is not complete and there may be other drugs that can interact with hydrochlorothiazide. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about hydrochlorothiazide and triamterene.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 7.02. Revision Date: 4/12/2009 4:40:02 PM.

Generic Name: hydrochlorothiazide and valsartan (HYE droe klor oh THYE a zide and val SAR tan)
Brand Names: Diovan HCT

What is hydrochlorothiazide and valsartan?

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.

Valsartan is in a group of drugs called angiotensin II receptor antagonists. Valsartan keeps blood vessels from narrowing, which lowers blood pressure improves blood flow.

The combination of hydrochlorothiazide and valsartan is used to treat high blood pressure (hypertension).

Hydrochlorothiazide and valsartan may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about hydrochlorothiazide and valsartan?

Do not use this medication if you are allergic to hydrochlorothiazide or valsartan, or if you are unable to urinate. Do not use this medication without telling your doctor if you are pregnant. Valsartan may cause injury and even death to the unborn baby if you take it during the second and third trimesters of pregnancy. Use an effective form of birth control. Stop using this medication and tell your doctor right away if you become pregnant during treatment.

Before using hydrochlorothiazide and valsartan, tell your doctor if you have congestive heart failure, kidney or liver disease, asthma, low or high blood levels of potassium, gout, lupus, diabetes, or an allergy to sulfa drugs.

Avoid drinking alcohol. It can lower your blood pressure and may increase some of the side effects of hydrochlorothiazide and valsartan.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor’s instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Do not use potassium supplements or salt substitutes while you are taking hydrochlorothiazide and valsartan, unless your doctor has told you to. In rare cases, hydrochlorothiazide and valsartan can cause a condition that results in the breakdown of skeletal muscle tissue, leading to kidney failure. Call your doctor right away if you have muscle pain, tenderness, or weakness especially if you also have fever, nausea or vomiting, and dark colored urine.

What should I discuss with my healthcare provider before taking hydrochlorothiazide and valsartan?

Do not use this medication if you are allergic to hydrochlorothiazide or valsartan (Diovan), or if you are unable to urinate.

Before using hydrochlorothiazide and valsartan, tell your doctor if you have:

• kidney disease;
• liver disease;

• congestive heart failure;

• asthma or allergies;

• low or high levels of magnesium or potassium in your blood;

• gout;

• lupus;

• diabetes; or

• an allergy to sulfa drugs.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take hydrochlorothiazide and valsartan.

FDA pregnancy category D. This medication can cause harm to an unborn baby. Do not use this medication without telling your doctor if you are pregnant. Valsartan may cause injury and even death to the unborn baby if you take it during the second and third trimesters of pregnancy. Use an effective form of birth control. Stop using this medication and tell your doctor right away if you become pregnant during treatment. It is not known whether hydrochlorothiazide and valsartan passes into breast milk. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.

How should I take hydrochlorothiazide and valsartan?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Take this medication with a full glass (8 ounces) of water.

To be sure this medication is helping your condition, your blood pressure will need to be checked on a regular basis. Do not miss any scheduled appointments.

Hydrochlorothiazide can interfere with the results of a thyroid test. Tell any doctor who treats you that you are using this medication.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.

Store hydrochlorothiazide and valsartan at room temperature away from moisture and heat.

See also: Hydrochlorothiazide and valsartan dosage in more detail

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include fast or slow heartbeat, feeling light-headed, or fainting.

What should I avoid while taking hydrochlorothiazide and valsartan?

Avoid drinking alcohol. It can lower your blood pressure and may increase some of the side effects of hydrochlorothiazide and valsartan.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor’s instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Do not use potassium supplements or salt substitutes while you are taking hydrochlorothiazide and valsartan, unless your doctor has told you to.

Hydrochlorothiazide and valsartan side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. In rare cases, hydrochlorothiazide and valsartan can cause a condition that results in the breakdown of skeletal muscle tissue, leading to kidney failure. Call your doctor right away if you have muscle pain, tenderness, or weakness especially if you also have fever, nausea or vomiting, and dark colored urine. Stop using this medication and call your doctor at once if you have a serious side effect such as:

• feeling light-headed, fainting;

• swelling, rapid weight gain;

• fast or pounding heartbeats;

• urinating less than usual, or not at all;

• jaundice (yellowing of the skin or eyes); or

• dry mouth, increased thirst, drowsiness, restless feeling, confusion, increased urination, fast heart rate, fainting, or seizure (convulsions).

Less serious side effects may include:

• stomach pain, diarrhea;

• back pain;

• headache, tired feeling, dizziness;

• skin rash;

• stuffy nose, sore throat; or

• dry cough.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Hydrochlorothiazide and valsartan Dosing Information

Usual Adult Dose for Hypertension:

Initial dose: 1 tablet (12.5 mg-80 mg) orally once a day.
Maintenance dose: Titrate as necessary up to a maximum of 50 mg-320 mg orally once a day.

What other drugs will affect hydrochlorothiazide and valsartan?

Before taking hydrochlorothiazide and valsartan, tell your doctor if you are using any of the following drugs:

• any other blood pressure medications;

• steroids (prednisone and others);

• lithium (Eskalith, Lithobid);

• celecoxib (Celebrex) or valdecoxib (Bextra);

• cholestyramine (Prevalite, Questran) or colestipol (Colestid);

• insulin or diabetes medications you take by mouth;

• rifampin (Rifadin, Rimactane, Rifater);

• a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton);

• any other diuretics, such as amiloride (Midamor), bumetanide (Bumex), chlorthalidone (Hygroton, Thalitone), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril), indapamide (Lozol), metolazone (Mykrox, Zarxolyn), spironolactone (Aldactone), triamterene (Dyrenium, Maxzide, Dyazide), torsemide (Demadex), and others;

• aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others;

• a muscle relaxer such as baclofen (Lioresal), carisoprodol (Soma), cyclobenzaprine (Flexeril), dantrolene (Dantrium), metaxalone (Skelaxin), or methocarbamol (Robaxin), orphenadrine (Norflex), or tizanidine (Zanaflex);

• a narcotic medication such as hydrocodone (Lortab, Vicodin), hydromorphone (Dilaudid, Palladone), levorphanol (Levo-Dromoran), meperidine (Demerol), methadone (Methadose), morphine (Kadian, MS Contin), oxycodone (OxyContin), oxymorphone (Numorphan), or propoxyphene (Darvon, Darvocet).

This list is not complete and there may be other drugs not listed that can affect hydrochlorothiazide and valsartan. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about hydrochlorothiazide and valsartan.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 6.02. Revision Date: 4/12/2009 4:43:17 PM.

Generic Name: hydrochlorothiazide and metoprolol (HYE droe klor oh THYE a zide and me TOE proe lole)
Brand Names: Lopressor HCT

What is hydrochlorothiazide and metoprolol?

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.

Metoprolol is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).

The combination of hydrochlorothiazide and metoprolol is used to treat high blood pressure (hypertension).

Hydrochlorothiazide and metoprolol may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about hydrochlorothiazide and metoprolol?

You should not use this medication if you have severe or uncontrolled heart failure, a heart condition called “sick sinus syndrome” or “AV block,” severe blood circulation problems, an adrenal gland tumor, an allergy to beta-blockers, or if you are unable to urinate.

Before using this medication, tell your doctor if you have congestive heart failure, kidney or liver disease, cirrhosis, asthma or bronchospasm, gout, lupus, diabetes, a thyroid disorder, or if you are allergic to sulfa drugs.

If you are diabetic, check your blood sugar carefully. Using metoprolol can make it harder for you to tell when you have low blood sugar. Your insulin or diabetic medication needs may change while you are taking hydrochlorothiazide and metoprolol. Talk with your doctor before changing any doses.

Avoid drinking alcohol, which can lower your blood pressure and may add to the side effects of hydrochlorothiazide and metoprolol.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor’s instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Keep taking this medication even if you feel fine. High blood pressure often has no symptoms.

There are many other medicines that can interact with hydrochlorothiazide and metoprolol. Tell your doctor about all the prescription and over-the-counter medications you use.

What should I discuss with my doctor before taking hydrochlorothiazide and metoprolol?

You should not use this medication if you are allergic to hydrochlorothiazide or metoprolol, or if you have:

• severe or uncontrolled heart failure;

• a heart condition called “sick sinus syndrome” or “AV block” (2nd or 3rd degree);

• severe blood circulation problems;

• an adrenal gland tumor (pheochromocytoma);

• if you are unable to urinate;

• if you are allergic to any beta-blocker medication, such as atenolol (Tenormin), bisoprolol (Zebeta), labetalol (Normodyne, Trandate), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), timolol (Blocadren), and others.

Before using hydrochlorothiazide and metoprolol, tell your doctor if you are allergic to any drugs, or if you have:

• congestive heart failure;

• kidney disease;
• liver disease (or cirrhosis);

• asthma or bronchospasm;

• a thyroid disorder;

• lupus;

• gout;

• diabetes; or

• if you are allergic to sulfa drugs.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Hydrochlorothiazide and metoprolol can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take hydrochlorothiazide and metoprolol?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take the medicine with a meal or right after you eat.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Do not stop using hydrochlorothiazide and metoprolol suddenly, or you could have a serious or life-threatening heart problem. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication.

To be sure this medication is not causing harmful effects, your blood pressure will need to be checked on a regular basis, and you may need blood tests. Do not miss any scheduled appointments.

Your blood and urine may both be tested if you have been vomiting or are dehydrated.

If you are diabetic, check your blood sugar carefully. Using metoprolol can make it harder for you to tell when you have low blood sugar. Your insulin or diabetic medication needs may change while you are taking hydrochlorothiazide and metoprolol. Talk with your doctor before changing any doses.

Hydrochlorothiazide and metoprolol can affect the results of certain thyroid tests. Tell any doctor who treats you that you are using this medication.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using hydrochlorothiazide and metoprolol. You may need to stop using the medicine for a short time. Keep taking this medication even if you feel fine. High blood pressure often has no symptoms. Store this medication in a tightly closed container at room temperature, away from heat, moisture, and light.

See also: Hydrochlorothiazide and metoprolol dosage in more detail

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include fast or slow heart rate, feeling like you might pass out, trouble breathing, or increased urination.

What should I avoid while taking hydrochlorothiazide and metoprolol?

Avoid drinking alcohol, which can lower your blood pressure and may add to the side effects of hydrochlorothiazide and metoprolol.

Avoid using other medicines that make you light-headed (especially narcotic pain medication or barbiturates). They can add to the side effects of hydrochlorothiazide and metoprolol. Tell your doctor if you regularly use any of these medicines.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor’s instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Hydrochlorothiazide and metoprolol side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have any of these serious side effects:

• swelling, rapid weight gain, feeling short of breath, even with mild exertion;

• fast, slow, or uneven heartbeat;

• easy bruising or bleeding;

• numbness or tingly feeling in your hands or feet;

• feeling weak, drowsy, restless, or light-headed;

• nausea, vomiting, dry mouth, extreme thirst, headache, confusion, hallucinations, seizure (convulsions);

• increased urination, leg discomfort, muscle pain or weakness or limp feeling;

• urinating less than usual or not at all;

• fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; or

• upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

• diarrhea, constipation, upset stomach;

• dizziness, spinning sensation;

• sore throat, body aches;

• blurred vision; or

• ringing in your ears.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Hydrochlorothiazide and metoprolol Dosing Information

Usual Adult Dose for Hypertension:

Initial dose: 2 tablets of hydrochlorothiazide-metoprolol 25 mg-50 mg per day in single or divided doses, or 1 to 2 tablets of hydrochlorothiazide-metoprolol 25 mg-100 mg per day in single or divided doses, or 1 tablet of hydrochlorothiazide-metoprolol 50 mg-100 mg per day in single or divided doses. Determine dosage by individual titration.

What other drugs will affect hydrochlorothiazide and metoprolol?

Many drugs can interact with hydrochlorothiazide and metoprolol. Below is just a partial list. Tell your doctor if you are using:

• insulin or diabetes medicine you take by mouth;

• colestipol (Colestid) or cholestyramine (Prevalite, Questran);

• theophylline (Elixophyllin, Respbid, Slo-Bid, Theo-Dur, Uniphyl, and others);

• steroids (prednisone and others);

• HIV or AIDS medicine such as ritonavir (Norvir);

• an antidepressant such as bupropion (Wellbutrin, Zyban), fluoxetine (Prozac), or paroxetine (Paxil);

• an antibiotic such as rifampin (Rifadin, Rifamate, Rimactane) or terbinafine (Lamisil);

• anti-malaria medication such as hydroxychloroquine (Plaquenil);

• medicine to treat psychiatric or mood disorders, such as chlorpromazine (Thorazine), haloperidol (Haldol), lithium (Lithobid), or thioridazine (Mellaril);

• NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Motrin, Advil), diclofenac (Voltaren), etodolac (Lodine), indomethacin, naproxen (Aleve, Naprosyn), and others; or

• other heart or blood pressure medications such as clonidine (Catapres), propafenone (Rythmol), quinidine (Quinidex, Quin-Release Quin-G) reserpine, or verapamil (Calan, Covera, Isoptin, Verelan).

This list is not complete and there may be other drugs that can interact with hydrochlorothiazide and metoprolol. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about hydrochlorothiazide and metoprolol.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 3.06. Revision Date: 4/12/2009 4:40:37 PM.