hydrochlorothiazide and spironolactone

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 purposes not listed in this medication guide.

What is the most important information I should know about hydrochlorothiazide and spironolactone? You should 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, glaucoma, diabetes, a breathing disorder, gout, lupus, a pancreas disorder, an allergy to sulfa drugs or penicillin. Tell your doctor if you use a steroid or another blood pressure medicine.

Drinking alcohol can increase certain 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 may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. What should I discuss with my doctor before taking hydrochlorothiazide and spironolactone? You should 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.

To make sure you can safely take hydrochlorothiazide and spironolactone, tell your doctor if you have any of these other conditions:

diabetes;

heart disease;

cirrhosis or other liver disease;

glaucoma;

a breathing disorder;

gout;

lupus;

an allergy to sulfa drugs or penicillin;

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 will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. 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 exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

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

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 often. Your kidney or liver function may also need to be tested. Visit your doctor regularly.

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 surgery, tell the surgeon ahead of time that you are using 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 well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life. Store at room temperature away from moisture and heat.

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. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include drowsiness, confusion, red skin rash, nausea, vomiting, or diarrhea.

What should I avoid while taking hydrochlorothiazide and spironolactone? Drinking alcohol can increase certain 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 may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be 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:

eye pain, vision problems;

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;

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

severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

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.

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

lithium (Eskalith, Lithobid);

digoxin (Lanoxin);

steroids (prednisone and others);

a blood thinner such as warfarin (Coumadin, Jantoven);

insulin or diabetes medicine taken by mouth;

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

indomethacin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), and others.

This list is not complete and other drugs may interact with hydrochlorothiazide and spironolactone. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More hydrochlorothiazide and spironolactone resources Hydrochlorothiazide and spironolactone Side Effects (in more detail) Hydrochlorothiazide and spironolactone Dosage Hydrochlorothiazide and spironolactone Use in Pregnancy & Breastfeeding Drug Images Hydrochlorothiazide and spironolactone Drug Interactions Hydrochlorothiazide and spironolactone Support Group 2 Reviews for Hydrochlorothiazide and spironolactone - Add your own review/rating Compare hydrochlorothiazide and spironolactone with other medications Ascites Edema Heart Failure High Blood Pressure Nephrotic Syndrome Where can I get more information? Your pharmacist can provide more information about hydrochlorothiazide and spironolactone.

See also: hydrochlorothiazide and spironolactone side effects (in more detail)

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Hydrochlorothiazide/Spironolactone

Pronunciation: spir-ON-oh-LAK-tone/HYE-droe-KLOR-oh-THYE-a-zide
Generic Name: Spironolactone/Hydrochlorothiazide
Brand Name: Aldactazide

Spironolactone, an ingredient in Hydrochlorothiazide/Spironolactone, has been shown to cause tumors in laboratory animals. Hydrochlorothiazide/Spironolactone should be used for the conditions for which it is indicated. Avoid unnecessary use of Hydrochlorothiazide/Spironolactone.

Hydrochlorothiazide/Spironolactone may not be appropriate for all patients. Tell your doctor if you have never taken any medicine for high blood pressure or for swelling or fluid retention.

Be sure to keep all doctor and lab appointments while you are taking Hydrochlorothiazide/Spironolactone.

Hydrochlorothiazide/Spironolactone is used for:

Treating swelling and fluid retention in patients who have congestive heart failure, cirrhosis of the liver, or a certain kidney problem (nephrotic syndrome) when other treatments are not effective or appropriate. It is also used to treat high blood pressure in patients for whom other treatments are not effective or appropriate. It may also be used for other conditions as determined by your doctor.

Hydrochlorothiazide/Spironolactone is a combination of a potassium-sparing diuretic (spironolactone) and a thiazide diuretic (hydrochlorothiazide). It works by making the kidneys eliminate sodium (salt) and water from the body, which helps to lower blood pressure. The spironolactone component helps minimize potassium loss.

Do NOT use Hydrochlorothiazide/Spironolactone if: you are allergic to any ingredient in Hydrochlorothiazide/Spironolactone, to thiazide diuretics (eg, indapamide), or to any other sulfonamide (eg, sulfamethoxazole) you are unable to urinate, have severe kidney problems, severe liver problems, or high blood potassium levels you are taking another potassium-sparing diuretic (eg, amiloride, triamterene), another aldosterone-blocker (eg, eplerenone), or dofetilide

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

Before using Hydrochlorothiazide/Spironolactone:

Some medical conditions may interact with Hydrochlorothiazide/Spironolactone. 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 cirrhosis or other liver problems, diabetes, gout, kidney problems (eg, kidney stones), asthma, heart problems (eg, heart failure), menstrual problems, or systemic lupus erythematosus (SLE or lupus) if you have high cholesterol or triglyceride levels, elevated blood acid, low folic acid levels, or electrolyte problems (eg, low blood sodium levels), or are dehydrated if you have a history of high blood potassium levels if you have recently had a certain type of nerve surgery (sympathectomy) if you have never taken medicines for high blood pressure or for swelling or fluid retention

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

Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), angiotensin II receptor antagonists (eg, valsartan), cyclosporine, macrolide immunosuppressives (eg, tacrolimus), other aldosterone-blockers (eg, eplerenone), other potassium-sparing diuretics (eg, amiloride, triamterene), potassium supplements, or salt substitutes containing potassium because the risk of high blood potassium levels may be increased Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, indomethacin) because they may decrease Hydrochlorothiazide/Spironolactone's effectiveness, and the risk of high blood potassium or kidney problems may be increased Corticosteroids (eg, prednisone), corticotrophin (ACTH), or loop diuretics (eg, furosemide) because the risk of low blood potassium levels may be increased Cholestyramine or colestipol because they may decrease Hydrochlorothiazide/Spironolactone's effectiveness Barbiturates (eg, phenobarbital), diazoxide, digoxin, dofetilide, ketanserin, lithium, narcotic pain medicines (eg, codeine), or medicines for high blood pressure because the risk of their side effects may be increased by Hydrochlorothiazide/Spironolactone Insulin or other diabetes medicines (eg, glipizide) because their effectiveness may be decreased by Hydrochlorothiazide/Spironolactone

This may not be a complete list of all interactions that may occur. Ask your health care provider if Hydrochlorothiazide/Spironolactone 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/Spironolactone:

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

Take Hydrochlorothiazide/Spironolactone by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation. Hydrochlorothiazide/Spironolactone 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 take cholestyramine or colestipol, ask your doctor or pharmacist how to take it with Hydrochlorothiazide/Spironolactone. If you miss a dose of Hydrochlorothiazide/Spironolactone, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

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

Important safety information: Hydrochlorothiazide/Spironolactone may cause dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use Hydrochlorothiazide/Spironolactone with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Hydrochlorothiazide/Spironolactone may cause dizziness, light-headedness, 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. Check with your doctor before you drink alcohol while you are using Hydrochlorothiazide/Spironolactone. Hydrochlorothiazide/Spironolactone can raise your blood potassium level. The risk may be increased in people with kidney or liver problems, or in the elderly. High blood potassium levels may lead to serious and possibly fatal irregular heartbeat. Discuss any questions or concerns with your doctor. Hydrochlorothiazide/Spironolactone contains a sulfonamide called hydrochlorothiazide, which can cause certain eye problems (eg, myopia, angle-closure glaucoma). Your risk may be increased if you are allergic to sulfonamide medicines (eg, sulfamethoxazole) or to penicillin antibiotics (eg, amoxicillin). Untreated angle-closure glaucoma can lead to permanent vision loss. If these eye problems occur, symptoms usually occur within hours to weeks of starting Hydrochlorothiazide/Spironolactone. Contact your doctor right away if you experience symptoms such as vision changes (eg, decreased vision clearness) or eye pain. Hydrochlorothiazide/Spironolactone may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Hydrochlorothiazide/Spironolactone. Use a sunscreen or wear protective clothing if you must be outside for more than a short time. Hydrochlorothiazide/Spironolactone may cause enlarged breasts in some men who take it. This effect is normally reversible after Hydrochlorothiazide/Spironolactone is stopped, but may rarely persist after stopping it. Contact your doctor if you experience enlarged breasts. Tell your doctor or dentist that you take Hydrochlorothiazide/Spironolactone before you receive any medical or dental care, emergency care, or surgery. 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. Check with your doctor before you use a salt substitute or a product that has potassium in it. Hydrochlorothiazide/Spironolactone may raise your blood sugar. High blood sugar may make you feel confused, drowsy, or thirsty. It can also make you flush, breathe faster, or have a fruit-like breath odor. If these symptoms occur, tell your doctor right away. Diabetes patients - Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine. Hydrochlorothiazide/Spironolactone may raise your blood sugar. High blood sugar may make you feel confused, drowsy, or thirsty. It can also make you flush, breathe faster, or have a fruit-like breath odor. If these symptoms occur, tell your doctor right away. Hydrochlorothiazide/Spironolactone may interfere with certain lab tests, including parathyroid function. Be sure your doctor and lab personnel know you are taking Hydrochlorothiazide/Spironolactone. Lab tests, including liver function, kidney function, lung function, blood pressure, blood electrolytes, and fasting blood glucose, may be performed while you use Hydrochlorothiazide/Spironolactone. 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/Spironolactone with caution in the ELDERLY; they may be more sensitive to its effects, especially high blood potassium levels. Hydrochlorothiazide/Spironolactone 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/Spironolactone while you are pregnant. Hydrochlorothiazide/Spironolactone is found in breast milk. Do not breast-feed while taking Hydrochlorothiazide/Spironolactone. Possible side effects of Hydrochlorothiazide/Spironolactone:

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:

Constipation; diarrhea; dizziness; headache; loss of appetite; nausea; stomach upset or cramping; tiredness; vomiting; weakness.

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); bloody, black, or tarry stools; burning, numbness, or tingling; confusion; dark urine; decreased coordination; decreased sexual ability; decreased urination or change in the amount of urine produced; dry mouth; excessive thirst; eye pain; fainting; fast, slow, or irregular heartbeat; fever, chills, or persistent sore throat; leg or muscle cramps, pain, or weakness; menstrual changes; mental or mood changes; red, swollen, blistered, or peeling skin; restlessness; severe or persistent dizziness, weakness, or tiredness; severe or persistent nausea or vomiting; sluggishness; stomach pain; unusual bruising or bleeding; unusual drowsiness; unusual weight loss; vision changes (eg, blurred vision, decreased vision clearness); vomit that looks like coffee grounds; yellowing of the skin or eyes.

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. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Hydrochlorothiazide/Spironolactone side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include diarrhea; light-headedness, especially upon standing; nausea; symptoms of blood electrolyte problems (eg, confusion; dizziness; irregular heartbeat; mental or mood changes; muscle pain, weakness, or cramping; seizures; sluggishness; trouble breathing); unusual drowsiness; vomiting; weakness.

Proper storage of Hydrochlorothiazide/Spironolactone:

Store Hydrochlorothiazide/Spironolactone at room temperature, below 77 degrees F (25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Hydrochlorothiazide/Spironolactone out of the reach of children and away from pets.

General information: If you have any questions about Hydrochlorothiazide/Spironolactone, please talk with your doctor, pharmacist, or other health care provider. Hydrochlorothiazide/Spironolactone 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. Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Hydrochlorothiazide/Spironolactone. 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.

Issue Date: February 1, 2012 Database Edition 12.1.1.002 Copyright © 2012 Wolters Kluwer Health, Inc. More Hydrochlorothiazide/Spironolactone resources Hydrochlorothiazide/Spironolactone Side Effects (in more detail) Hydrochlorothiazide/Spironolactone Use in Pregnancy & Breastfeeding Drug Images Hydrochlorothiazide/Spironolactone Drug Interactions Hydrochlorothiazide/Spironolactone Support Group 2 Reviews for Hydrochlorothiazide/Spironolactone - Add your own review/rating Compare Hydrochlorothiazide/Spironolactone with other medications Ascites Edema Heart Failure High Blood Pressure Nephrotic Syndrome

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Spironolactone

Pronunciation: spir-ON-oh-LAK-tone
Generic Name: Spironolactone
Brand Name: Aldactone

Spironolactone has been shown to cause tumors in laboratory animals. Spironolactone should only be used for the conditions for which it is indicated. Avoid unnecessary use of Spironolactone.

Spironolactone is used for:

Treating swelling and fluid retention in patients with congestive heart failure, liver cirrhosis, or a certain kidney problem (nephrotic syndrome). It is also used for treatment of high blood pressure, for increasing survival and reducing the need to go to the hospital for heart failure in certain patients, or for treating or preventing low blood potassium. It may also be used to treat excess secretion of the hormone aldosterone by the adrenal gland. It may also be used for other conditions as determined by your doctor.

Spironolactone is a potassium-sparing diuretic. It works by blocking the hormone aldosterone, causing the kidney to eliminate excess water, save potassium, and lower blood pressure.

Do NOT use Spironolactone if: you are allergic to any ingredient in Spironolactone you are unable to urinate, have severe kidney problems, or have high blood potassium levels you are taking another potassium-sparing diuretic (eg, amiloride, triamterene), another aldosterone-blocker (eg, eplerenone), or tacrolimus

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

Before using Spironolactone:

Some medical conditions may interact with Spironolactone. 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 high acidity in your body fluids; dehydration; low blood sodium levels; kidney or liver problems; heart problems (eg, heart failure); or diabetes if you have menstrual disease if you have a history of high blood potassium levels

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

Adrenocorticotropic hormone (corticotropin) (ACTH) or corticosteroids (eg, prednisone) because low blood electrolyte levels may occur Barbiturates (eg, phenobarbital) or narcotics (eg, morphine) because the risk of dizziness upon standing may be increased Aliskiren, angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), angiotensin II receptor antagonists (eg, valsartan), other aldosterone-blockers (eg, eplerenone), other potassium-sparing diuretics (eg, amiloride, triamterene), potassium supplements, or tacrolimus because the risk of high blood potassium levels may be increased Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, indomethacin) because they may decrease Spironolactone's effectiveness and increase the risk of kidney problems and high blood potassium Digoxin or lithium because the risk of their side effects and toxicity may be increased by Spironolactone

This may not be a complete list of all interactions that may occur. Ask your health care provider if Spironolactone 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 Spironolactone:

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

Take Spironolactone by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation. Spironolactone 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 Spironolactone, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Spironolactone.

Important safety information: Spironolactone may cause dizziness or drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use Spironolactone with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Check with your doctor before you drink alcohol while you are using Spironolactone. Spironolactone can raise your blood potassium level. The risk may be increased in people with kidney or liver problems, or in the elderly. High blood potassium levels may lead to serious and possibly fatal irregular heartbeat. Discuss any questions or concerns with your doctor. Spironolactone may cause enlarged breasts in some men who take it. This effect is normally reversible after Spironolactone is stopped, but may rarely persist after stopping it. Contact your doctor if you experience enlarged breasts. Check with your doctor before you use a salt substitute or a product that has potassium in it. Tell your doctor or dentist that you take Spironolactone before you receive any medical or dental care, emergency care, or surgery. Spironolactone may interfere with certain lab tests. Be sure your doctor and lab personnel know you are taking Spironolactone. Lab tests, including kidney function, blood pressure, and blood electrolyte levels (eg, potassium), may be performed while you use Spironolactone. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments. Use Spironolactone with caution in the ELDERLY; they may be more sensitive to its effects, especially high blood potassium levels. Spironolactone 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 Spironolactone while you are pregnant. Spironolactone is found in breast milk. Do not breast-feed while taking Spironolactone. Possible side effects of Spironolactone:

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:

Diarrhea; drowsiness; headache; nausea; stomach cramping; vomiting.

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); black, tarry, or bloody stools; change in the amount of urine produced; confusion; dark urine; decreased coordination; decreased sexual ability; fever, chills, or persistent sore throat; irregular or missed menstrual periods; pale stools; red, swollen, blistered, or peeling skin; severe or persistent stomach pain; symptoms of abnormal fluid or electrolyte levels (eg, burning, numbness, or tingling; fainting; fast, slow, or irregular heartbeat; increased thirst; muscle pain, weakness, or cramping; restlessness; severe or persistent dry mouth, nausea, or vomiting; severe or persistent dizziness or drowsiness; unusual fatigue or sluggishness); vomit that looks like coffee grounds; yellowing of the skin or eyes.

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. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Spironolactone side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include confusion; diarrhea; dizziness; drowsiness; irregular heartbeat; nausea; vomiting.

Proper storage of Spironolactone:

Store Spironolactone at room temperature, below 77 degrees F (25 degrees C), in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Spironolactone out of the reach of children and away from pets.

General information: If you have any questions about Spironolactone, please talk with your doctor, pharmacist, or other health care provider. Spironolactone 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. Check with your pharmacist about how to dispose of unused medicine.

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

Issue Date: February 1, 2012 Database Edition 12.1.1.002 Copyright © 2012 Wolters Kluwer Health, Inc. More Spironolactone resources Spironolactone Side Effects (in more detail) Spironolactone Use in Pregnancy & Breastfeeding Drug Images Spironolactone Drug Interactions Spironolactone Support Group 46 Reviews for Spironolactone - Add your own review/rating Spironolactone Prescribing Information (FDA) Spironolactone Professional Patient Advice (Wolters Kluwer) Spironolactone Monograph (AHFS DI) spironolactone Advanced Consumer (Micromedex) - Includes Dosage Information Aldactone Prescribing Information (FDA) Aldactone Consumer Overview Compare Spironolactone with other medications Acne Alopecia Edema Heart Failure High Blood Pressure Hirsutism Hypokalemia Primary Hyperaldosteronism Primary Hyperaldosteronism Diagnosis

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Hydrochlorothiazide/Olmesartan

Pronunciation: OL-me-SAR-tan/HYE-droe-KLOR-oh-THYE-a-zide
Generic Name: Olmesartan/Hydrochlorothiazide
Brand Name: Benicar HCT

Hydrochlorothiazide/Olmesartan can cause injury or even death to a developing fetus when used during pregnancy. Contact your doctor immediately if you suspect that you are pregnant.

Hydrochlorothiazide/Olmesartan is used for:

Treating high blood pressure. It may also be used for other conditions as determined by your doctor.

Hydrochlorothiazide/Olmesartan is a combination angiotensin II receptor blocker and diuretic. The angiotensin II receptor blocker works by relaxing the blood vessels. Exactly how the diuretic works to decrease blood pressure is not known, but it helps the kidneys to eliminate fluid and sodium from the body.

Do NOT use Hydrochlorothiazide/Olmesartan if: you are allergic to any ingredient in Hydrochlorothiazide/Olmesartan or to any other sulfonamide medicine (eg, sulfamethoxazole) you are pregnant you are unable to urinate you are taking dofetilide or ketanserin

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

Before using Hydrochlorothiazide/Olmesartan:

Some medical conditions may interact with Hydrochlorothiazide/Olmesartan. 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 are able to become pregnant if you have ever had a severe reaction (eg, swelling of the hands, face, lips, eyes, throat, or tongue; trouble swallowing or breathing; hoarseness) after taking any other angiotensin II receptor blocker or an angiotensin-converting enzyme (ACE) inhibitor (eg, captopril) if you have dehydration; low blood volume; low blood sodium, chloride, potassium, or magnesium levels; high blood calcium levels; or severe or persistent vomiting if you have asthma; gout; heart problems (eg, congestive heart failure); liver, gall bladder, or kidney problems; high blood cholesterol or lipid levels; or systemic lupus erythematosus if you are on a low-salt (sodium) diet or you drink alcohol if you have diabetes, especially if you are also taking aliskiren if you have recently had a certain type of nerve surgery (sympathectomy) if you have never taken another medicine for high blood pressure

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

Dofetilide or ketanserin because the risk of irregular heartbeat may be increased Aliskiren, potassium-sparing diuretics (eg, spironolactone), or potassium supplements because the risk of high blood potassium levels may be increased ACE inhibitors (eg, lisinopril) because the risk of kidney problems and high blood potassium levels may be increased Adrenocorticotropic hormone (ACTH), barbiturates (eg, phenobarbital), corticosteroids (eg, prednisone), diuretics (eg, furosemide), narcotic pain medicines (eg, morphine), or other medicines for high blood pressure because they may increase the risk of Hydrochlorothiazide/Olmesartan's side effects Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, celecoxib, ibuprofen) because they may decrease Hydrochlorothiazide/Olmesartan's effectiveness and the risk of serious kidney problems may be increased Cholestyramine or colestipol because they may decrease Hydrochlorothiazide/Olmesartan's effectiveness Diazoxide, digoxin, lithium, potassium, or potassium-sparing diuretics (eg, spironolactone) because risk of their side effects and toxic effects may be increased by Hydrochlorothiazide/Olmesartan Insulin or other diabetes medicine (eg, glipizide, metformin) because their effectiveness may be decreased by Hydrochlorothiazide/Olmesartan

This may not be a complete list of all interactions that may occur. Ask your health care provider if Hydrochlorothiazide/Olmesartan 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/Olmesartan:

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

Hydrochlorothiazide/Olmesartan may be taken with or without food. Drinking extra fluids while you are taking Hydrochlorothiazide/Olmesartan is recommended. Check with your doctor for instructions. Hydrochlorothiazide/Olmesartan 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 take cholestyramine or colestipol, ask your doctor or pharmacist how to take it with Hydrochlorothiazide/Olmesartan. Continue to take Hydrochlorothiazide/Olmesartan even if you feel well. Do not miss any doses. If you miss a dose of Hydrochlorothiazide/Olmesartan, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

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

Important safety information: Hydrochlorothiazide/Olmesartan may cause drowsiness, dizziness, or light-headedness. These effects may be worse if you take it with alcohol or certain medicines. Use Hydrochlorothiazide/Olmesartan with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Hydrochlorothiazide/Olmesartan may cause dizziness, light-headedness, 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. Report any light-headedness or fainting to your doctor immediately. Your risk of light-headedness or fainting may be increased if you experience diarrhea, vomiting, or excessive sweating; if you do not drink enough fluids; or if you are on a low-salt diet. Hydrochlorothiazide/Olmesartan contains hydrochlorothiazide, a sulfonamide, which can cause certain eye problems (myopia, angle-closure glaucoma). Your risk may be increased if you are allergic to sulfonamide medicines (eg, sulfamethoxazole) or to penicillin antibiotics (eg, amoxicillin). Untreated angle-closure glaucoma can lead to permanent vision loss. If these eye problems occur, symptoms usually occur within hours to weeks of starting Hydrochlorothiazide/Olmesartan. Contact your doctor immediately if you experience symptoms such as vision changes (eg, decreased vision clearness) or eye pain. 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/Olmesartan may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Hydrochlorothiazide/Olmesartan. 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/Olmesartan 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. Your doctor may have also prescribed a potassium supplement for you. If so, follow the dosing carefully. Do not start taking additional potassium on your own or change your diet to include more potassium without first checking with your doctor. Check with your doctor before you use a salt substitute or a product that has potassium in it. Diabetes patients - Hydrochlorothiazide/Olmesartan may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine. Hydrochlorothiazide/Olmesartan may raise your blood sugar. High blood sugar may make you feel confused, drowsy, or thirsty. It can also make you flush, breathe faster, or have a fruit-like breath odor. If these symptoms occur, tell your doctor right away. Hydrochlorothiazide/Olmesartan may interfere with certain lab tests, including parathyroid function. Be sure your doctor and lab personnel know you are taking Hydrochlorothiazide/Olmesartan. Lab tests, including kidney function, blood pressure, and blood electrolytes, may be performed while you use Hydrochlorothiazide/Olmesartan. 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/Olmesartan with caution in the ELDERLY; they may be more sensitive to its effects. Hydrochlorothiazide/Olmesartan should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed. PREGNANCY and BREAST-FEEDING: Hydrochlorothiazide/Olmesartan may cause birth defects or fetal death if you take it while you are pregnant. If you think you may be pregnant, contact your doctor right away. Hydrochlorothiazide/Olmesartan is found in breast milk. Do not breast-feed while taking Hydrochlorothiazide/Olmesartan. Possible side effects of Hydrochlorothiazide/Olmesartan:

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:

Dizziness; nausea.

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; unusual hoarseness); chest pain; decrease in sexual ability; decreased urination; depression; drowsiness; eye pain; fainting; fast or irregular heartbeat; fever, chills, or persistent sore throat; hoarseness; muscle pain, tenderness, or cramps; red, swollen, blistered, or peeling skin; restlessness; severe or persistent dizziness or light-headedness; severe or persistent dry mouth, nausea, or stomach pain; shortness of breath; swelling of the arms or legs; symptoms of low blood sodium levels (eg, confusion, mental or mood changes, seizures, sluggishness); unusual bruising or bleeding; unusual thirst, tiredness, or weakness; vision changes (eg, decreased vision clearness); vomiting; yellowing of the skin or eyes.

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. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Hydrochlorothiazide/Olmesartan side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include fainting; fast, slow, or irregular heartbeat; severe or unusual dizziness; symptoms of blood electrolyte problems (eg, confusion; irregular heartbeat; mental or mood changes; muscle pain, weakness, or cramping; seizures; sluggishness); symptoms of dehydration (eg, drowsiness; dry eyes; fast heartbeat; nausea; restlessness; unusual thirst, tiredness, or weakness; vomiting).

Proper storage of Hydrochlorothiazide/Olmesartan:

Store Hydrochlorothiazide/Olmesartan between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Hydrochlorothiazide/Olmesartan out of the reach of children and away from pets.

General information: If you have any questions about Hydrochlorothiazide/Olmesartan, please talk with your doctor, pharmacist, or other health care provider. Hydrochlorothiazide/Olmesartan 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. Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Hydrochlorothiazide/Olmesartan. 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.

Issue Date: February 1, 2012 Database Edition 12.1.1.002 Copyright © 2012 Wolters Kluwer Health, Inc. More Hydrochlorothiazide/Olmesartan resources Hydrochlorothiazide/Olmesartan Side Effects (in more detail) Hydrochlorothiazide/Olmesartan Use in Pregnancy & Breastfeeding Hydrochlorothiazide/Olmesartan Drug Interactions Hydrochlorothiazide/Olmesartan Support Group 11 Reviews for Hydrochlorothiazide/Olmesartan - Add your own review/rating Compare Hydrochlorothiazide/Olmesartan with other medications High Blood Pressure

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Maxzide

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 Maxzide (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 purposes not listed in this medication guide.

What is the most important information I should know about Maxzide (hydrochlorothiazide and triamterene)? You should not use this medication if you are allergic to hydrochlorothiazide or triamterene, or if you have kidney disease, urination problems, high levels of potassium in your blood, or if you are taking other diuretics similar to triamterene. Do not use potassium supplements unless your doctor has told you to.

Before using this medication, tell your doctor if you have heart or liver disease, glaucoma, diabetes, a breathing disorder, gout, lupus, kidney stones, a pancreas disorder, or an allergy to sulfa drugs or penicillin.

Drinking alcohol can further lower your blood pressure and may increase certain 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 potassium supplements, salt substitutes, or low-sodium milk while you are taking hydrochlorothiazide and triamterene, unless your doctor has told you to.

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.

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 Maxzide (hydrochlorothiazide and triamterene)? You should not use this medication if you are allergic to hydrochlorothiazide (HCTZ, HydroDiuril, Lotensin HCT, Prinzide, Zestoretic, Ziac, and others) or triamterene (Dyrenium), or if you have: kidney disease or are unable to urinate;

high potassium levels (hyperkalemia);

if you are taking diuretics similar to triamterene, such as amiloride (Midamor, Moduretic), spironolactone (Aldactone, Aldactazide); or

if you are taking potassium supplements (unless your doctor tells you to).

To make sure you can safely take hydrochlorothiazide and triamterene, tell your doctor if you have any of these other conditions:

diabetes;

heart disease;

cirrhosis or other liver disease;

glaucoma;

a breathing disorder;

gout;

lupus;

a history of kidney stones;

a pancreas disorder; or

an allergy to sulfa drugs or penicillin.

FDA pregnancy category C. It is not known whether hydrochlorothiazide and triamterene will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Hydrochlorothiazide and triamterene can pass into breast milk and may harm a nursing baby. You should not breast-feed while taking hydrochlorothiazide and triamterene. How should I take Maxzide (hydrochlorothiazide and triamterene)?

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

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

You will need regular medical tests to be sure this medication is not causing harmful effects. Visit your doctor regularly.

This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using hydrochlorothiazide and triamterene.

If you need surgery or a blood transfusion, tell the doctor ahead of time that you are using hydrochlorothiazide and triamterene.

Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Store at room temperature away from moisture, heat, and light. What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

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 Maxzide (hydrochlorothiazide and triamterene)? Drinking alcohol can further lower your blood pressure and may increase certain 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 potassium supplements, salt substitutes, or low-sodium milk while you are taking hydrochlorothiazide and triamterene, unless your doctor has told you to. Hydrochlorothiazide and triamterene may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be 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.

Maxzide (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 hydrochlorothiazide and triamterene and call your doctor at once if you have a serious side effect such as:

eye pain, vision problems;

slow, fast, or uneven heartbeat;

feeling like you might pass out;

swelling or rapid weight gain;

urinating less than usual or not at all;

headache, trouble concentrating, memory problems, weakness, loss of appetite, feeling unsteady, hallucinations, fainting, seizure, shallow breathing or breathing that stops;

low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling);

high potassium (irregular heart rate, weak pulse, muscle weakness, tingly feeling);

severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate;

easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

patchy skin color, red spots, or a butterfly-shaped skin rash over your cheeks and nose (worsens in sunlight);

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

jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

mild nausea, diarrhea, constipation;

dizziness, headache;

blurred vision;

dry mouth;

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.

What other drugs can affect Maxzide (hydrochlorothiazide and triamterene)? Before using hydrochlorothiazide and triamterene, tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by hydrochlorothiazide and triamterene.

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

lithium (Eskalith, LithoBid);

amphotericin B (Amphotec, AmBisome, Abelcet);

methenamine (Hipprex, Mandelamine, Urex);

gout medication such as allopurinol (Zyloprim), colchicine (Colcrys), or probenecid (Benemid);

steroid medication (prednisone and others);

a blood thinner such as warfarin (Coumadin, Jantoven);

insulin or oral diabetes medication;

laxatives;

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

indomethacin (Indocin) or other NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), and others.

This list is not complete and other drugs may interact with hydrochlorothiazide and triamterene. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More Maxzide resources Maxzide Side Effects (in more detail)Maxzide Use in Pregnancy & BreastfeedingDrug ImagesMaxzide Drug InteractionsMaxzide Support Group2 Reviews for Maxzide - Add your own review/rating Maxzide Prescribing Information (FDA) Maxzide Advanced Consumer (Micromedex) - Includes Dosage Information Maxzide MedFacts Consumer Leaflet (Wolters Kluwer) Dyazide Prescribing Information (FDA) Dyazide Consumer Overview Compare Maxzide with other medications EdemaHigh Blood Pressure Where can I get more information? Your pharmacist can provide more information about hydrochlorothiazide and triamterene.

See also: Maxzide side effects (in more detail)

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Fosinopril/Hydrochlorothiazide

Pronunciation: fos-IN-oh-pril/HYE-droe-KLOR-oh-THYE-a-zide
Generic Name: Fosinopril/Hydrochlorothiazide
Brand Name: Monopril HCT

Fosinopril/Hydrochlorothiazide can cause injury or death to the fetus if taken during pregnancy. If you think you may be pregnant, contact your doctor right away.

Fosinopril/Hydrochlorothiazide is used for:

Treating high blood pressure.

Fosinopril/Hydrochlorothiazide is an angiotensin-converting enzyme (ACE) inhibitor and thiazide diuretic combination. It works to lower your blood pressure by removing excess fluid from the body and causing blood vessels to relax or widen.

Do NOT use Fosinopril/Hydrochlorothiazide if: you are allergic to any ingredient in Fosinopril/Hydrochlorothiazide, other sulfonamide medicines (eg, sulfamethoxazole, glyburide, probenecid), or other ACE inhibitors (eg, lisinopril) you have a history of angioedema (swelling of the hands, face, lips, eyes, throat, or tongue; difficulty swallowing or breathing; or unusual hoarseness), including angioedema caused by treatment with an ACE inhibitor you are unable to urinate you are pregnant you are also taking dofetilide or ketanserin

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

Before using Fosinopril/Hydrochlorothiazide:

Some medical conditions may interact with Fosinopril/Hydrochlorothiazide. 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 able to become pregnant 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 heart problems (eg, heart failure, aortic stenosis), blood vessel problems, blood flow problems, bone marrow problems, kidney or liver problems, high blood cholesterol or lipid levels, or gout if you have a history of a stroke, a recent heart attack, kidney transplant, allergies, or asthma if you have an autoimmune disease (eg, rheumatoid arthritis, lupus, scleroderma) if you are dehydrated, have low blood volume, severe diarrhea or vomiting, or low blood pressure if you have high blood potassium levels, low blood sodium levels, or are on a low-salt (sodium) diet if you have diabetes, especially if you are also taking aliskiren if you are receiving treatments to reduce sensitivity to bee or wasp stings if you are having dialysis or apheresis, or are scheduled to have major surgery if you have recently had a certain type of nerve surgery (sympathectomy) if you have never taken another medicine for high blood pressure

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

Digoxin, dofetilide, or ketanserin because the risk of irregular heartbeat may be increased Adrenocorticotropic hormone (ACTH), corticosteroids (eg, prednisone), dextran sulfate, diazoxide, diuretics (eg, furosemide), or other medicines for high blood pressure because they may increase the risk of Fosinopril/Hydrochlorothiazide's side effects, including low blood pressure and blood potassium problems Angiotensin receptor blockers (ARBs) (eg, losartan) because the risk of serious kidney problems and high blood potassium levels may be increased Aldosterone blockers (eg, eplerenone), potassium-sparing diuretics (eg, spironolactone, triamterene), potassium supplements, salt substitutes containing potassium, or trimethoprim because the risk of high blood potassium levels may be increased Certain gold-containing medicines (eg, sodium aurothiomalate) because flushing, nausea, vomiting, and low blood pressure may occur Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, indomethacin) because the risk of serious damage to the kidneys (eg, decrease in amount of urine produced) may be increased or they may decrease Fosinopril/Hydrochlorothiazide's effectiveness Lithium, or thiopurines (eg, azathioprine) because the risk of their side effects may be increased by Fosinopril/Hydrochlorothiazide Insulin or other diabetes medicines (eg, glyburide), or methenamine because their effectiveness may be decreased by Fosinopril/Hydrochlorothiazide

This may not be a complete list of all interactions that may occur. Ask your health care provider if Fosinopril/Hydrochlorothiazide 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 Fosinopril/Hydrochlorothiazide:

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

Take Fosinopril/Hydrochlorothiazide by mouth with or without food. Do not take an antacid that has aluminum, magnesium, or simethicone in it within 2 hours before or 2 hours after you take Fosinopril/Hydrochlorothiazide. If you take cholestyramine or colestipol, do not take it at the same time that you take Fosinopril/Hydrochlorothiazide. Talk with your doctor about how you should take cholestyramine or colestipol with Fosinopril/Hydrochlorothiazide. Take Fosinopril/Hydrochlorothiazide on a regular schedule to get the most benefit from it. Taking Fosinopril/Hydrochlorothiazide at the same time each day will help you remember to take it. Continue to use Fosinopril/Hydrochlorothiazide even if you feel well. Do not miss any doses. If you miss a dose of Fosinopril/Hydrochlorothiazide, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

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

Important safety information: Fosinopril/Hydrochlorothiazide may cause dizziness, light-headedness, or fainting. These effects may be worse if you take it with alcohol or certain medicines. Use Fosinopril/Hydrochlorothiazide with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Fosinopril/Hydrochlorothiazide may cause dizziness, light-headedness, 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. Fosinopril/Hydrochlorothiazide may cause a serious side effect called angioedema. Black patients may be at greater risk of developing this side effect. Contact your doctor at once if you develop swelling of the hands, face, lips, eyes, throat, or tongue; difficulty swallowing or breathing; or hoarseness. Fosinopril/Hydrochlorothiazide contains hydrochlorothiazide, a sulfonamide, which can cause certain eye problems (myopia, angle-closure glaucoma). Your risk may be increased if you are allergic to sulfonamide medicines (eg, sulfamethoxazole) or to penicillin antibiotics (eg, amoxicillin). Untreated angle-closure glaucoma can lead to permanent vision loss. If these eye problems occur, symptoms usually occur within hours to weeks of starting Fosinopril/Hydrochlorothiazide. Contact your doctor immediately if you experience symptoms such as vision changes (eg, decreased vision clearness) or eye pain. Check with your doctor before you use a salt substitute or a product that has potassium in it. Drink plenty of fluids while taking Fosinopril/Hydrochlorothiazide and avoid engaging in activities that cause excessive sweating. Dehydration, excessive sweating, vomiting, or diarrhea may lead to a fall in blood pressure. Contact your health care provider at once if any of these occur. A persistent, unproductive cough may occur. Tell your doctor if this occurs. If caused by Fosinopril/Hydrochlorothiazide, recovery is rapid when the medicine is stopped. 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. Tell your doctor or dentist that you take Fosinopril/Hydrochlorothiazide before you receive any medical or dental care, emergency care, or surgery. Fosinopril/Hydrochlorothiazide may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Fosinopril/Hydrochlorothiazide. Use a sunscreen or wear protective clothing if you must be outside for more than a short time. Fosinopril/Hydrochlorothiazide may raise your blood sugar. High blood sugar may make you feel confused, drowsy, or thirsty. It can also make you flush, breathe faster, or have a fruit-like breath odor. If these symptoms occur, tell your doctor right away. Diabetes patients - Fosinopril/Hydrochlorothiazide may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine. Fosinopril/Hydrochlorothiazide may interfere with certain lab tests, including parathyroid function and digoxin blood levels. Be sure your doctor and lab personnel know you are taking Fosinopril/Hydrochlorothiazide. Lab tests, including blood electrolytes, blood pressure, complete blood cell counts, kidney function, and liver function, may be performed while you use Fosinopril/Hydrochlorothiazide. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments. Use Fosinopril/Hydrochlorothiazide with caution in the ELDERLY; they may be more sensitive to its effects. Fosinopril/Hydrochlorothiazide should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed. PREGNANCY and BREAST-FEEDING: Fosinopril/Hydrochlorothiazide may cause birth defects, or fetal or newborn death if you take it while you are pregnant. Do not become pregnant while you take Fosinopril/Hydrochlorothiazide. If you think you may be pregnant, contact your doctor right away. Fosinopril/Hydrochlorothiazide is found in breast milk. Do not breast-feed while taking Fosinopril/Hydrochlorothiazide. Possible side effects of Fosinopril/Hydrochlorothiazide:

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:

Dizziness or light-headedness when sitting up or standing; dry cough.

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

Severe allergic reactions (rash; hives; itching; difficulty swallowing or breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); blurred vision or other vision changes (eg, vision clearness); change in the amount of urine produced; chest pain; dark urine; difficult or painful urination; drowsiness; dry mouth; eye pain; fainting; fast, slow, or irregular heartbeat; fever, chills, or persistent sore throat; joint pain or swelling; loss of appetite; mental or mood changes (eg, depression); muscle cramps, pain, or weakness; numbness or tingling; one-sided weakness; pale stools; red, swollen, blistered, or peeling skin; restlessness; severe or persistent cough; severe or persistent headache, dizziness, or light-headedness; severe or persistent nausea or vomiting; slurred speech; stomach pain (with or without nausea or vomiting); symptoms of high blood sugar (eg, fast breathing; flushing; fruit-like breath odor; increased thirst, hunger, or urination); symptoms of low blood sodium (eg, confusion, mental or mood changes, seizures, sluggishness); tremor; unusual bruising or bleeding; unusual thirst, tiredness, or weakness; yellowing of the skin or eyes.

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. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Fosinopril/Hydrochlorothiazide side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include fainting; severe or persistent dizziness or light-headedness; symptoms of blood electrolyte problems (eg, confusion; irregular heartbeat; mental or mood changes; muscle pain, weakness, or cramping; seizures; sluggishness); symptoms of dehydration (eg, drowsiness; dry eyes; fast heartbeat; nausea; restlessness; unusual thirst, tiredness, or weakness; vomiting).

Proper storage of Fosinopril/Hydrochlorothiazide:

Store Fosinopril/Hydrochlorothiazide between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Fosinopril/Hydrochlorothiazide out of the reach of children and away from pets.

General information: If you have any questions about Fosinopril/Hydrochlorothiazide, please talk with your doctor, pharmacist, or other health care provider. Fosinopril/Hydrochlorothiazide 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. Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Fosinopril/Hydrochlorothiazide. 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.

Issue Date: February 1, 2012 Database Edition 12.1.1.002 Copyright © 2012 Wolters Kluwer Health, Inc. More Fosinopril/Hydrochlorothiazide resources Fosinopril/Hydrochlorothiazide Side Effects (in more detail) Fosinopril/Hydrochlorothiazide Use in Pregnancy & Breastfeeding Drug Images Fosinopril/Hydrochlorothiazide Drug Interactions Fosinopril/Hydrochlorothiazide Support Group 0 Reviews for Fosinopril/Hydrochlorothiazide - Add your own review/rating Compare Fosinopril/Hydrochlorothiazide with other medications High Blood Pressure

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Aquazide H

Generic Name: hydrochlorothiazide (hye dro klor o THY a zide)
Brand Names: Aquazide H, HydroDIURIL, Microzide

What is Aquazide H (hydrochlorothiazide)?

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

Hydrochlorothiazide treats fluid retention (edema) in people with congestive heart failure, cirrhosis of the liver, or kidney disorders, or edema caused by taking steroids or estrogen. This medication is also used to treat high blood pressure (hypertension).

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

What is the most important information I should know about Aquazide H (hydrochlorothiazide)? You should not use this medication if you are allergic to hydrochlorothiazide or if you are unable to urinate.

Before using this medication, tell your doctor if you have liver disease, kidney disease, glaucoma, asthma or allergies, gout, diabetes, or if you are allergic to sulfa drugs or penicillin.

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

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.

There are many other drugs that can interact with hydrochlorothiazide. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

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 Aquazide H (hydrochlorothiazide)? You should not use this medication if you are allergic to hydrochlorothiazide, or if you are unable to urinate.

To make sure you can safely take hydrochlorothiazide, tell your doctor if you have any of these other conditions:

kidney disease; liver disease;

glaucoma;

asthma or allergies;

gout;

diabetes; or

an allergy to sulfa drugs or penicillin.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Hydrochlorothiazide 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 Aquazide H (hydrochlorothiazide)?

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

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

Your blood pressure will need to be checked often. Visit your doctor regularly.

Conditions that may cause very low blood pressure include: vomiting, diarrhea, heavy sweating, heart disease, dialysis, a low salt diet, or taking diuretics (water pills). Follow your doctor's instructions about the type and amount of liquids you should drink while taking hydrochlorothiazide. Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

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

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 are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Store at room temperature away from moisture, heat, and light. What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, weakness, dizziness, dry mouth, thirst, and muscle pain or weakness.

What should I avoid while taking Aquazide H (hydrochlorothiazide)? Drinking alcohol can increase certain side effects of hydrochlorothiazide.

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.

Aquazide H (hydrochlorothiazide) 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:

eye pain, vision problems;

dry mouth, thirst, nausea, vomiting;

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

fast or uneven heartbeat;

muscle pain or weakness;

numbness or tingly feeling;

a red, blistering, peeling skin rash; or

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

Less serious side effects may include:

diarrhea;

mild stomach pain;

constipation; 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.

What other drugs will affect Aquazide H (hydrochlorothiazide)? Tell your doctor if you regularly use other medicines that make you light-headed (such as cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to the side effects of hydrochlorothiazide.

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

lithium (Eskalith, Lithobid);

digoxin (Lanoxin);

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

steroids (prednisone and others);

other blood pressure medications;

NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), and others; or

insulin or oral diabetes medication.

This list is not complete and other drugs may interact with hydrochlorothiazide. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More Aquazide H resources Aquazide H Side Effects (in more detail) Aquazide H Use in Pregnancy & Breastfeeding Aquazide H Drug Interactions Aquazide H Support Group 0 Reviews for Aquazide H - Add your own review/rating Aquazide H Advanced Consumer (Micromedex) - Includes Dosage Information Hydrochlorothiazide Prescribing Information (FDA) Hydrochlorothiazide Professional Patient Advice (Wolters Kluwer) Hydrochlorothiazide Monograph (AHFS DI) Hydrochlorothiazide MedFacts Consumer Leaflet (Wolters Kluwer) Esidrix Prescribing Information (FDA) Microzide Prescribing Information (FDA) Microzide MedFacts Consumer Leaflet (Wolters Kluwer) Compare Aquazide H with other medications Diabetes Insipidus Edema High Blood Pressure Nephrocalcinosis Osteoporosis Where can I get more information? Your pharmacist can provide more information about hydrochlorothiazide.

See also: Aquazide H side effects (in more detail)

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hydrochlorothiazide and irbesartan

Generic Name: hydrochlorothiazide and irbesartan (HYE droe KLOR oh THYE a zide and ir be SAR tan)
Brand Names: Avalide

What is hydrochlorothiazide and irbesartan?

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

Irbesartan is an angiotensin II receptor antagonist. Irbesartan keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow.

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

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

What is the most important information I should know about hydrochlorothiazide and irbesartan? Do not use hydrochlorothiazide and irbesartan if you are pregnant. Stop using this medication and tell your doctor right away if you become pregnant. You should not use this medication if you are allergic to irbesartan or hydrochlorothiazide (Carozide, Diaqua, Ezide HCTZ, HydroDiuril, Microzide, and others), or if you are unable to urinate. Drinking alcohol can further lower your blood pressure and may increase certain side effects of hydrochlorothiazide and irbesartan. In rare cases, hydrochlorothiazide and irbesartan 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 irbesartan? You should not use this medication if you are allergic to irbesartan or hydrochlorothiazide (Carozide, Diaqua, Ezide HCTZ, HydroDiuril, Microzide, and others), or if you are unable to urinate.

To make sure you can safely take hydrochlorothiazide and irbesartan, tell your doctor if you have any of these other conditions:

kidney disease; liver disease;

congestive heart failure;

glaucoma;

low or high levels of potassium in your blood;

asthma or allergies;

high cholesterol or triglyceride levels;

gout;

lupus;

diabetes; or

an allergy to sulfa drugs or penicillin.

FDA pregnancy category D. Do not use hydrochlorothiazide and irbesartan if you are pregnant. Stop using this medication and tell your doctor right away if you become pregnant. Irbesartan can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control while taking hydrochlorothiazide and irbesartan. It is not known whether hydrochlorothiazide and irbesartan passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using hydrochlorothiazide and irbesartan. How should I take hydrochlorothiazide and irbesartan?

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

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

Your blood pressure will need to be checked often. Visit your doctor regularly.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking this medication, which can lead to severely low blood pressure or a serious electrolyte imbalance.

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

It may take up to 4 weeks for this medication to control your blood pressure. Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life. If you need surgery, tell the surgeon ahead of time that you are using hydrochlorothiazide and irbesartan. You may need to stop using the medicine for a short time. Store at room temperature away from moisture and heat.

See also: Hydrochlorothiazide and irbesartan dosage (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

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

What should I avoid while taking hydrochlorothiazide and irbesartan? Drinking alcohol can further lower your blood pressure and may increase certain side effects of hydrochlorothiazide and irbesartan.

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 irbesartan, unless your doctor has told you to. Hydrochlorothiazide and irbesartan 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 irbesartan 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. Call your doctor at once if you have any other serious side effects, such as:

eye pain, vision problems;

feeling like you might pass out;

chest pain, feeling short of breath, even with mild exertion;

fever;

swelling, rapid weight gain;

urinating more or 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, feeling light-headed, fainting, or seizure (convulsions).

Less serious side effects may include:

stomach pain, heartburn;

muscle pain;

dizziness, drowsiness;

headache;

runny or stuffy nose, sore throat; or

dry cough.

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 irbesartan Dosing Information

Usual Adult Dose for Hypertension:

For use in patients not adequately controlled on monotherapy and as initial therapy in patients likely to require multiple drugs to achieve their blood pressure goals:
Initial dose: 1 tablet (12.5 mg-150 mg) orally once a day.
Maintenance dose: Up to 25 mg-300 mg orally once a day.
For use as replacement therapy when substituted for titrated components:
Patients may be given the combination of HCTZ-irbesartan tablets equivalent to the established necessary and safe dose of each drug.

What other drugs will affect hydrochlorothiazide and irbesartan?

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

any other diuretics or blood pressure medications;

steroids (prednisone and others);

lithium (Eskalith, Lithobid);

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

insulin or oral diabetes medications;

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

aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), 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); or

a narcotic medication such as hydrocodone (Lortab, Vicodin), meperidine (Demerol), methadone (Methadose), oxycodone (OxyContin), propoxyphene (Darvon, Darvocet), and others.

This list is not complete and other drugs may interact with hydrochlorothiazide and irbesartan. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More hydrochlorothiazide and irbesartan resources Hydrochlorothiazide and irbesartan Dosage Hydrochlorothiazide and irbesartan Use in Pregnancy & Breastfeeding Hydrochlorothiazide and irbesartan Drug Interactions Hydrochlorothiazide and irbesartan Support Group 4 Reviews for Hydrochlorothiazide and irbesartan - Add your own review/rating Compare hydrochlorothiazide and irbesartan with other medications High Blood Pressure Where can I get more information? Your pharmacist can provide more information about hydrochlorothiazide and irbesartan.

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Hydrochlorothiazide Capsules

Pronunciation: HYE-droe-KLOR-oh-THYE-a-zide
Generic Name: Hydrochlorothiazide
Brand Name: Microzide
Hydrochlorothiazide Capsules is used for:

Treating high blood pressure. It may be used alone or with other medicines. It may also be used for other conditions as determined by your doctor.

Hydrochlorothiazide Capsules is a thiazide diuretic. It works by helping the kidneys to remove fluid from the body.

Do NOT use Hydrochlorothiazide Capsules if: you are allergic to any ingredient in Hydrochlorothiazide Capsules or to another sulfonamide medicine (eg, sulfamethoxazole) you are unable to urinate you are taking dofetilide or ketanserin

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

Before using Hydrochlorothiazide Capsules:

Some medical conditions may interact with Hydrochlorothiazide Capsules. 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 gout, liver problems, (eg, cirrhosis), lupus, kidney problems, diabetes or high blood sugar, asthma, parathyroid gland problems, or high blood cholesterol or lipid levels if you have high or low blood electrolyte levels (eg, sodium, potassium, magnesium, calcium) if you are taking another medicine for high blood pressure

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

Digoxin, dofetilide, or ketanserin because the risk of irregular heartbeat may be increased Barbiturates (eg, phenobarbital), corticosteroids (eg, prednisone), corticotropin, other diuretics (eg, furosemide), or narcotic pain medicines (eg, codeine) because they may increase the risk of Hydrochlorothiazide Capsules's side effects Cholestyramine, colestipol, or nonsteroidal anti-inflammatory medicines (NSAIDs) (eg, ibuprofen) because they may decrease Hydrochlorothiazide Capsules's effectiveness Diazoxide or lithium because the risk of their side effects may be increased by Hydrochlorothiazide Capsules Diabetes medicines (eg, glipizide, metformin) or insulin because their effectiveness may be decreased by Hydrochlorothiazide Capsules

This may not be a complete list of all interactions that may occur. Ask your health care provider if Hydrochlorothiazide Capsules 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 Capsules:

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

Take Hydrochlorothiazide Capsules by mouth with or without food. If you take colestipol or cholestyramine for high cholesterol, ask your doctor or pharmacist how to take it with Hydrochlorothiazide Capsules. Hydrochlorothiazide Capsules 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 Capsules, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

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

Important safety information: Hydrochlorothiazide Capsules may cause dizziness or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Hydrochlorothiazide Capsules with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Hydrochlorothiazide Capsules may cause dizziness, light-headedness, 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. Report any light-headedness or fainting to your doctor immediately. Your risk of light-headedness or fainting may be increased if you experience diarrhea, vomiting, or excessive sweating; if you do not drink enough fluids; or if you are on a low-salt (sodium) diet. Contact your health care provider at once if any of these events occur. Hydrochlorothiazide Capsules is a sulfonamide. It can cause certain eye problems (myopia, angle-closure glaucoma). Your risk may be increased if you are allergic to sulfonamide medicines (eg, sulfamethoxazole) or to penicillin antibiotics (eg, amoxicillin). Untreated angle-closure glaucoma can lead to permanent vision loss. If these eye problems occur, symptoms usually occur within hours to weeks of starting Hydrochlorothiazide Capsules. Contact your doctor right away if you experience symptoms such as vision changes (eg, decreased vision clearness) or eye pain. Your doctor may also prescribe a potassium supplement for you. If so, take the potassium supplement exactly as prescribed. Do not start taking additional potassium on your own or change your diet to include more potassium without first checking with your doctor. Tell your doctor or dentist that you take Hydrochlorothiazide Capsules before you receive any medical or dental care, emergency care, or surgery. Tell your doctor if you will be exposed to high temperatures. The risk of certain side effects (eg, low blood sodium levels) may be increased in hot weather. Hydrochlorothiazide Capsules may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to Hydrochlorothiazide Capsules. Use a sunscreen or wear protective clothing if you must be outside for more than a short time. 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 Capsules may raise your blood sugar. High blood sugar may make you feel confused, drowsy, or thirsty. It can also make you flush, breathe faster, or have a fruit-like breath odor. If these symptoms occur, tell your doctor right away. Diabetes patients - Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine. Hydrochlorothiazide Capsules may interfere with certain lab tests, including parathyroid function. Be sure your doctor and lab personnel know you are taking Hydrochlorothiazide Capsules. Lab tests, including kidney function, blood pressure, and electrolyte levels, may be performed while you take Hydrochlorothiazide Capsules. 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 Capsules with caution in the ELDERLY; they may be more sensitive to its effects, especially dizziness. Hydrochlorothiazide Capsules should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed. PREGNANCY and BREAST-FEEDING: Hydrochlorothiazide Capsules may cause harm to the fetus. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of taking Hydrochlorothiazide Capsules while you are pregnant. Hydrochlorothiazide Capsules is found in breast milk. If you are or will be breast-feeding while you take Hydrochlorothiazide Capsules, check with your doctor. Discuss any possible risks to your baby. Do not breast-feed while taking Hydrochlorothiazide Capsules. Possible side effects of Hydrochlorothiazide Capsules:

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:

Constipation; diarrhea; dizziness; light-headedness; loss of appetite; nausea; temporary blurred vision.

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); dark urine; decreased urination; eye pain; fainting; fast or irregular heartbeat; fever, chills, or persistent sore throat; increased thirst; joint pain, swelling, warmth, or redness (especially of the big toe joint); muscle pain, weakness, or cramps; numbness or tingling; red, swollen, blistered, or peeling skin; severe or persistent dizziness or light-headedness; severe or persistent nausea or stomach pain; shortness of breath; symptoms of low blood sodium levels (eg, confusion, mental or mood changes, seizures, sluggishness); unusual bruising or bleeding; unusual drowsiness, restlessness, tiredness, or weakness; unusually dry mouth; vision changes (eg, decreased vision clearness); vomiting; yellowing of the eyes or skin.

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. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Hydrochlorothiazide side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include severe dizziness; symptoms of blood electrolyte problems (eg, confusion; irregular heartbeat; mental or mood changes; muscle pain, weakness, or cramping; seizures; sluggishness); symptoms of dehydration (eg, dry mouth or eyes; decreased urination; fast heartbeat; unusual thirst, tiredness, or weakness).

Proper storage of Hydrochlorothiazide Capsules:

Store Hydrochlorothiazide Capsules 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 Capsules out of the reach of children and away from pets.

General information: If you have any questions about Hydrochlorothiazide Capsules, please talk with your doctor, pharmacist, or other health care provider. Hydrochlorothiazide Capsules 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. Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Hydrochlorothiazide Capsules. 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.

Issue Date: February 1, 2012 Database Edition 12.1.1.002 Copyright © 2012 Wolters Kluwer Health, Inc. More Hydrochlorothiazide resources Hydrochlorothiazide Side Effects (in more detail) Hydrochlorothiazide Dosage Hydrochlorothiazide Use in Pregnancy & Breastfeeding Drug Images Hydrochlorothiazide Drug Interactions Hydrochlorothiazide Support Group 42 Reviews for Hydrochlorothiazide - Add your own review/rating Compare Hydrochlorothiazide with other medications Diabetes Insipidus Edema High Blood Pressure Nephrocalcinosis Osteoporosis

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Avalide

Generic Name: hydrochlorothiazide and irbesartan (HYE droe KLOR oh THYE a zide and ir be SAR tan)
Brand Names: Avalide

What is hydrochlorothiazide and irbesartan?

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

Irbesartan is an angiotensin II receptor antagonist. Irbesartan keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow.

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

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

What is the most important information I should know about hydrochlorothiazide and irbesartan? Do not use hydrochlorothiazide and irbesartan if you are pregnant. Stop using this medication and tell your doctor right away if you become pregnant. You should not use this medication if you are allergic to irbesartan or hydrochlorothiazide (Carozide, Diaqua, Ezide HCTZ, HydroDiuril, Microzide, and others), or if you are unable to urinate. Drinking alcohol can further lower your blood pressure and may increase certain side effects of hydrochlorothiazide and irbesartan. In rare cases, hydrochlorothiazide and irbesartan 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 irbesartan? You should not use this medication if you are allergic to irbesartan or hydrochlorothiazide (Carozide, Diaqua, Ezide HCTZ, HydroDiuril, Microzide, and others), or if you are unable to urinate.

To make sure you can safely take hydrochlorothiazide and irbesartan, tell your doctor if you have any of these other conditions:

kidney disease; liver disease;

congestive heart failure;

glaucoma;

low or high levels of potassium in your blood;

asthma or allergies;

high cholesterol or triglyceride levels;

gout;

lupus;

diabetes; or

an allergy to sulfa drugs or penicillin.

FDA pregnancy category D. Do not use hydrochlorothiazide and irbesartan if you are pregnant. Stop using this medication and tell your doctor right away if you become pregnant. Irbesartan can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control while taking hydrochlorothiazide and irbesartan. It is not known whether hydrochlorothiazide and irbesartan passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using hydrochlorothiazide and irbesartan. How should I take hydrochlorothiazide and irbesartan?

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

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

Your blood pressure will need to be checked often. Visit your doctor regularly.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking this medication, which can lead to severely low blood pressure or a serious electrolyte imbalance.

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

It may take up to 4 weeks for this medication to control your blood pressure. Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life. If you need surgery, tell the surgeon ahead of time that you are using hydrochlorothiazide and irbesartan. You may need to stop using the medicine for a short time. Store at room temperature away from moisture and heat. What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

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

What should I avoid while taking hydrochlorothiazide and irbesartan? Drinking alcohol can further lower your blood pressure and may increase certain side effects of hydrochlorothiazide and irbesartan.

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 irbesartan, unless your doctor has told you to. Hydrochlorothiazide and irbesartan 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 irbesartan 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. Call your doctor at once if you have any other serious side effects, such as:

eye pain, vision problems;

feeling like you might pass out;

chest pain, feeling short of breath, even with mild exertion;

fever;

swelling, rapid weight gain;

urinating more or 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, feeling light-headed, fainting, or seizure (convulsions).

Less serious side effects may include:

stomach pain, heartburn;

muscle pain;

dizziness, drowsiness;

headache;

runny or stuffy nose, sore throat; or

dry cough.

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 hydrochlorothiazide and irbesartan?

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

any other diuretics or blood pressure medications;

steroids (prednisone and others);

lithium (Eskalith, Lithobid);

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

insulin or oral diabetes medications;

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

aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), 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); or

a narcotic medication such as hydrocodone (Lortab, Vicodin), meperidine (Demerol), methadone (Methadose), oxycodone (OxyContin), propoxyphene (Darvon, Darvocet), and others.

This list is not complete and other drugs may interact with hydrochlorothiazide and irbesartan. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More Avalide resources Avalide Side Effects (in more detail) Avalide Use in Pregnancy & Breastfeeding Drug Images Avalide Drug Interactions Avalide Support Group 4 Reviews for Avalide - Add your own review/rating Avalide Prescribing Information (FDA) Avalide Advanced Consumer (Micromedex) - Includes Dosage Information Avalide MedFacts Consumer Leaflet (Wolters Kluwer) Avalide Consumer Overview Compare Avalide with other medications High Blood Pressure Where can I get more information? Your pharmacist can provide more information about hydrochlorothiazide and irbesartan.

See also: Avalide side effects (in more detail)

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hydrochlorothiazide and captopril

Generic Name: hydrochlorothiazide and captopril (hye droe klor oh THY a zide and KAP toe pril)
Brand Names: Capozide 25/15, Capozide 25/25, Capozide 50/15, Capozide 50/25

What is hydrochlorothiazide and captopril?

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

Captopril is in a group of drugs called ACE inhibitors. ACE stands for angiotensin converting enzyme. Captopril lowers blood pressure and also relieves symptoms of fluid retention.

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

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

What is the most important information I should know about hydrochlorothiazide and captopril? You should not use this medication if you are allergic to hydrochlorothiazide or captopril, or if you have a history of asthma or allergies, or you are unable to urinate.

You should not use this medication if you are allergic to any other ACE inhibitor, such as benazepril (Lotensin), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), or trandolapril (Mavik).

Before taking hydrochlorothiazide and captopril, tell your doctor if you have kidney disease (or are on dialysis), liver disease, glaucoma, congestive heart failure, gout, lupus, diabetes, or an allergy to sulfa drugs or penicillin.

Do not use hydrochlorothiazide and captopril if you are pregnant. It could harm the unborn baby.

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

Conditions that may cause very low blood pressure include: vomiting, diarrhea, heavy sweating, heart disease, dialysis, a low-salt diet, or taking diuretics (water pills). Follow your doctor's instructions about the type and amount of liquids you should drink while taking hydrochlorothiazide and captopril. Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

What should I discuss with my healthcare provider before taking hydrochlorothiazide and captopril? Do not use this medication if you are allergic to hydrochlorothiazide or captopril, or if you have:

a history of asthma or allergies; or

if you are unable to urinate.

You should not use this medication if you are allergic to any other ACE inhibitor, such as benazepril (Lotensin), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), or trandolapril (Mavik).

To make sure you can safely take hydrochlorothiazide and captopril, tell your doctor if you have any of these other conditions:

kidney disease (or if you are on dialysis); liver disease;

glaucoma;

congestive heart failure;

gout;

lupus;

diabetes; or

an allergy to sulfa drugs or penicillin

FDA pregnancy category D. Do not use hydrochlorothiazide and captopril if you are pregnant. It could harm the unborn baby. Stop using this medication and tell your doctor right away if you become pregnant. Use effective birth control while taking hydrochlorothiazide and captopril. Hydrochlorothiazide 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 captopril?

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

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

Take each dose with a full glass of water.

Conditions that may cause very low blood pressure include: vomiting, diarrhea, heavy sweating, heart disease, dialysis, a low-salt diet, or taking diuretics (water pills). Follow your doctor's instructions about the type and amount of liquids you should drink while taking hydrochlorothiazide and captopril. Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

Your blood pressure will need to be checked often. Your blood and urine may also be tested if you have been vomiting or are dehydrated. Visit your doctor regularly.

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

Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

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

See also: Hydrochlorothiazide and captopril dosage (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, weakness, dizziness, dry mouth, thirst, muscle pain or weakness, or feeling like you might pass out.

What should I avoid while taking hydrochlorothiazide and captopril?

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. Drinking alcohol can further lower your blood pressure and may increase certain side effects of hydrochlorothiazide and captopril.

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

Hydrochlorothiazide and captopril side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; severe stomach pain; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

eye pain, vision problems;

high potassium (slow heart rate, weak pulse, muscle weakness, tingly feeling);

low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling);

dry mouth, thirst, nausea, vomiting;

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

a red, blistering, peeling skin rash;

jaundice (yellowing of the skin or eyes);

urinating less than usual or not at all;

swelling, weight gain, feeling short of breath; or

fever, chills, body aches, flu symptoms.

Less serious side effects may include:

cough;

dizziness, headache, tired feeling;

blurred vision;

diarrhea, constipation, upset stomach; or

mild skin rash, increased 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.

Hydrochlorothiazide and captopril Dosing Information

Usual Adult Dose for Congestive Heart Failure:

Initial dose: 1 tablet of (captopril-hydrochlorothiazide 25 mg/15 mg) orally once a day, one hour before meals. Determine dosage by individual titration.
Maintenance dose: May use additional captopril or hydrochlorothiazide as individual components or change to an increased strength of the combination tablet. May give the combination tablet in divided doses up to 3 times a day. In general, daily doses of captopril should not exceed 150 mg and of hydrochlorothiazide should not exceed 50 mg.

Usual Adult Dose for Hypertension:

Initial dose: 1 tablet of (captopril-hydrochlorothiazide 25 mg/15 mg) orally once a day, one hour before meals. Determine dosage by individual titration.
Maintenance dose: May use additional captopril or hydrochlorothiazide as individual components or change to an increased strength of the combination tablet. May give the combination tablet in divided doses up to 3 times a day. In general, daily doses of captopril should not exceed 150 mg and of hydrochlorothiazide should not exceed 50 mg.

What other drugs will affect hydrochlorothiazide and captopril? Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to the side effects of hydrochlorothiazide and captopril. Tell your doctor if you regularly use any of these medicines, or any other blood pressure medications.

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

gold injections to treat arthritis;

other diuretics (water pills) or blood pressure medications;

lithium (Lithobid, Eskalith);

a blood thinner such as warfarin (Coumadin, Jantoven);

digoxin (Lanoxin);

nitroglycerin (Nitrolingual, Nitrostat, Nitro-Dur, and others);

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

steroids (prednisone and others);

NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), and others; or

insulin or diabetes medicine taken by mouth.

This list is not complete and other drugs may interact with hydrochlorothiazide and captopril. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More hydrochlorothiazide and captopril resources Hydrochlorothiazide and captopril Side Effects (in more detail) Hydrochlorothiazide and captopril Dosage Hydrochlorothiazide and captopril Use in Pregnancy & Breastfeeding Drug Images Hydrochlorothiazide and captopril Drug Interactions Hydrochlorothiazide and captopril Support Group 0 Reviews for Hydrochlorothiazide and captopril - Add your own review/rating Compare hydrochlorothiazide and captopril with other medications Heart Failure High Blood Pressure Where can I get more information? Your pharmacist can provide more information about hydrochlorothiazide and captopril.

See also: hydrochlorothiazide and captopril side effects (in more detail)

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Spironolactone and Hydrochlorothiazide

SPIRONOLACTONE AND
HYDROCHLOROTHIAZIDE TABLETS USP
25 mg / 25 mg

Rx only

WARNING

Spironolactone, an ingredient of Spironolactone and Hydrochlorothiazide, has been shown to be a tumorigen in chronic toxicity studies in rats (see Precautions). Spironolactone and Hydrochlorothiazide should be used only in those conditions described under Indications and Usage. Unnecessary use of this drug should be avoided.

Fixed-dose combination drugs are not indicated for initial therapy of edema or hypertension. Edema or hypertension requires therapy titrated to the individual patient. If the fixed combination represents the dosage so determined, its use may be more convenient in patient management. The treatment of hypertension and edema is not static but must be reevaluated as conditions in each patient warrant.

DESCRIPTION

Spironolactone and Hydrochlorothiazide oral tablets contain:

spironolactone 25 mg     hydrochlorothiazide 25 mg

Spironolactone, an aldosterone antagonist, is 17-hydroxy-7?-mercapto-3-oxo-17?-pregn-4-ene-21-carboxylic acid ?-lactone acetate and has the following structural formula:

Spironolactone is practically insoluble in water, soluble in alcohol, and freely soluble in benzene and in chloroform.

Hydrochlorothiazide, a diuretic and antihypertensive, is 6-chloro-3,4-dihydro-2H-1,2,4-benzothiadiazine-7-sulfonamide 1,1-dioxide and has the following structural formula:

Hydrochlorothiazide is slightly soluble in water and freely soluble in sodium hydroxide solution.

Inactive ingredients include anhydrous lactose, colloidal silicon dioxide, D&C yellow #10 lake, docusate sodium, FD&C yellow #6 lake, magnesium stearate, microcrystalline cellulose, peppermint flavor, povidone, sodium benzoate, and sodium starch glycolate.

ACTIONS / CLINICAL PHARMACOLOGY

Mechanism of action: Spironolactone and Hydrochlorothiazide is a combination of two diuretic agents with different but complementary mechanisms and sites of action, thereby providing additive diuretic and antihypertensive effects. Additionally, the spironolactone component helps to minimize the potassium loss characteristically induced by the thiazide component.

The diuretic effect of spironolactone is mediated through its action as a specific pharmacologic antagonist of aldosterone, primarily by competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule. Hydrochlorothiazide promotes the excretion of sodium and water primarily by inhibiting their reabsorption in the cortical diluting segment of the distal renal tubule.

Spironolactone and Hydrochlorothiazide is effective in significantly lowering the systolic and diastolic blood pressure in many patients with essential hypertension, even when aldosterone secretion is within normal limits.

Both Spironolactone and Hydrochlorothiazide reduce exchangeable sodium, plasma volume, body weight, and blood pressure. The diuretic and antihypertensive effects of the individual components are potentiated when Spironolactone and Hydrochlorothiazide are given concurrently.

Pharmacokinetics: Spironolactone is rapidly and extensively metabolized. Sulfur-containing products are the predominant metabolites and are thought to be primarily responsible, together with spironolactone, for the therapeutic effects of the drug. The following pharmacokinetic data were obtained from 12 healthy volunteers following the administration of 100 mg of spironolactone (as tablets) daily for 15 days. On the 15th day, spironolactone was given immediately after a lowfat breakfast and blood was drawn thereafter.

Accumulation Factor: AUC (0–24 hr, day 15)/AUC (0–24 hr, day 1) Mean Peak Serum Concentration Mean (SD) Post-Steady State Half-Life 7-?-(thiomethyl) spirolactone (TMS) 1.25 391 ng/mL at 3.2 hr 13.8 hr (6.4)
(terminal) 6-?-hydroxy-7-?-(thiomethyl) spirolactone (HTMS) 1.50 125 ng/mL at 5.1 hr 15.0 hr (4.0)
(terminal) Canrenone (C) 1.41 181 ng/mL at 4.3 hr 16.5 hr (6.3)
(terminal) Spironolactone 1.30 80 ng/mL at 2.6 hr Approximately 1.4 hr (0.5)
(? half-life)

The pharmacological activity of spironolactone metabolites in man is not known. However, in the adrenalectomized rat the antimineralocorticoid activities of the metabolites C, TMS, and HTMS, relative to spironolactone, were 1.10, 1.28, and 0.32, respectively. Relative to spironolactone, their binding affinities to the aldosterone receptors in rat kidney slices were 0.19, 0.86, and 0.06, respectively.

In humans, the potencies of TMS and 7-?-thiospirolactone in reversing the effects of the synthetic mineralocorticoid, fludrocortisone, on urinary electrolyte composition were 0.33 and 0.26, respectively, relative to spironolactone. However, since the serum concentrations of these steroids were not determined, their incomplete absorption and/or first-pass metabolism could not be ruled out as a reason for their reduced in vivo activities.

Spironolactone and its metabolites are more than 90% bound to plasma proteins. The metabolites are excreted primarily in the urine and secondarily in bile.

The effect of food on spironolactone absorption (two 100 mg spironolactone tablets) was assessed in a single dose study of 9 healthy, drug-free volunteers. Food increased the bioavailability of unmetabolized spironolactone by almost 100%. The clinical importance of this finding is not known.

Hydrochlorothiazide is rapidly absorbed following oral administration. Onset of action of hydrochlorothiazide is observed within one hour and persists for 6 to 12 hours. Hydrochlorothiazide plasma concentrations attain peak levels at one to two hours and decline with a half-life of four to five hours. Hydrochlorothiazide undergoes only slight metabolic alteration and is excreted in urine. It is distributed throughout the extracellular space, with essentially no tissue accumulation except in the kidney.

INDICATIONS AND USAGE

Spironolactone, an ingredient of Spironolactone and Hydrochlorothiazide, has been shown to be a tumorigen in chronic toxicity studies in rats (see Precautions section). Spironolactone and Hydrochlorothiazide should be used only in those conditions described below. Unnecessary use of this drug should be avoided.

Spironolactone and Hydrochlorothiazide is indicated for:

Edematous conditions for patients with:

Congestive heart failure:

For the management of edema and sodium retention when the patient is only partially responsive to, or is intolerant of, other therapeutic measures; The treatment of diuretic-induced hypokalemia in patients with congestive heart failure when other measures are considered inappropriate; The treatment of patients with congestive heart failure taking digitalis when other therapies are considered inadequate or inappropriate.

Cirrhosis of the liver accompanied by edema and/or ascites:

Aldosterone levels may be exceptionally high in this condition. Spironolactone and Hydrochlorothiazide tablets are indicated for maintenance therapy together with bed rest and the restriction of fluid and sodium.

The nephrotic syndrome:

For nephrotic patients when treatment of the underlying disease, restriction of fluid and sodium intake, and the use of other diuretics do not provide an adequate response.

Essential hypertension:

For patients with essential hypertension in whom other measures are considered inadequate or inappropriate; In hypertensive patients for the treatment of a diuretic-induced hypokalemia when other measures are considered inappropriate.

Usage in Pregnancy. The routine use of diuretics in an otherwise healthy woman is inappropriate and exposes mother and fetus to unnecessary hazard. Diuretics do not prevent development of toxemia of pregnancy, and there is no satisfactory evidence that they are useful in the treatment of developing toxemia.

Edema during pregnancy may arise from pathologic causes or from the physiologic and mechanical consequences of pregnancy. Spironolactone and Hydrochlorothiazide tablets are indicated in pregnancy when edema is due to pathologic causes just as it is in the absence of pregnancy (however, see Precautions: Pregnancy). Dependent edema in pregnancy, resulting from restriction of venous return by the expanded uterus, is properly treated through elevation of the lower extremities and use of support hose; use of diuretics to lower intravascular volume in this case is unsupported and unnecessary. There is hypervolemia during normal pregnancy which is not harmful to either the fetus or the mother (in the absence of cardiovascular disease), but which is associated with edema, including generalized edema, in the majority of pregnant women. If this edema produces discomfort, increased recumbency will often provide relief. In rare instances, this edema may cause extreme discomfort that is not relieved by rest. In these cases, a short course of diuretics may provide relief and may be appropriate.

CONTRAINDICATIONS

Spironolactone and Hydrochlorothiazide tablets are contraindicated in patients with anuria, acute renal insufficiency, significant impairment of renal excretory function, or hyperkalemia, and in patients who are allergic to thiazide diuretics or to other sulfonamide-derived drugs. Spironolactone and Hydrochlorothiazide may also be contraindicated in acute or severe hepatic failure.

WARNINGS

Potassium supplementation, either in the form of medication or as a diet rich in potassium, should not ordinarily be given in association with Spironolactone and Hydrochlorothiazide therapy. Excessive potassium intake may cause hyperkalemia in patients receiving Spironolactone and Hydrochlorothiazide (see Precautions: General). Spironolactone and Hydrochlorothiazide should not be administered concurrently with other potassium-sparing diuretics. Spironolactone, when used with ACE inhibitors or indomethacin, even in the presence of a diuretic, has been associated with severe hyperkalemia. Extreme caution should be exercised when Spironolactone and Hydrochlorothiazide is given concomitantly with these drugs (see Precautions: Drug interactions).

Spironolactone and Hydrochlorothiazide should be used with caution in patients with impaired hepatic function because minor alterations of fluid and electrolyte balance may precipitate hepatic coma.

Lithium generally should not be given with diuretics (see Precautions: Drug interactions).

Thiazides should be used with caution in severe renal disease. In patients with renal disease, thiazides may precipitate azotemia. Cumulative effects of the drug may develop in patients with impaired renal function.

Thiazides may add to or potentiate the action of other antihypertensive drugs.

Sensitivity reactions to thiazides may occur in patients with or without a history of allergy or bronchial asthma.

Sulfonamide derivatives, including thiazides, have been reported to exacerbate or activate systemic lupus erythematosus.

Acute Myopia and Secondary Angle-Closure Glaucoma

Hydrochlorothiazide, a sulfonamide, can cause an idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma. Symptoms include acute onset of decreased visual acuity or ocular pain and typically occur within hours to weeks of drug initiation. Untreated acute angle-closure glaucoma can lead to permanent vision loss. The primary treatment is to discontinue hydrochlorothiazide as rapidly as possible. Prompt medical or surgical treatments may need to be considered if the intraocular pressure remains uncontrolled. Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy.

PRECAUTIONS

General: All patients receiving diuretic therapy should be observed for evidence of fluid or electrolyte imbalance, e.g., hypomagnesemia, hyponatremia, hypochloremic alkalosis, and hypokalemia or hyperkalemia.

Serum and urine electrolyte determinations are particularly important when the patient is vomiting excessively or receiving parenteral fluids. Warning signs or symptoms of fluid and electrolyte imbalance, irrespective of cause, include dryness of the mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, and gastrointestinal disturbances such as nausea and vomiting. Hyperkalemia may occur in patients with impaired renal function or excessive potassium intake and can cause cardiac irregularities, which may be fatal. Consequently, no potassium supplement should ordinarily be given with Spironolactone and Hydrochlorothiazide.

Concomitant administration of potassium-sparing diuretics and ACE inhibitors or nonsteroidal anti-inflammatory drugs (NSAIDs), e.g., indomethacin, has been associated with severe hyperkalemia.

If hyperkalemia is suspected (warning signs include paresthesia, muscle weakness, fatigue, flaccid paralysis of the extremities, bradycardia, and shock), an electrocardiogram (ECG) should be obtained. However, it is important to monitor serum potassium levels because mild hyperkalemia may not be associated with ECG changes.

If hyperkalemia is present, Spironolactone and Hydrochlorothiazide should be discontinued immediately. With severe hyperkalemia, the clinical situation dictates the procedures to be employed. These include the intravenous administration of calcium chloride solution, sodium bicarbonate solution, and/or the oral or parenteral administration of glucose with a rapid-acting insulin preparation. These are temporary measures to be repeated as required. Cationic exchange resins such as sodium polystyrene sulfonate may be orally or rectally administered. Persistent hyperkalemia may require dialysis.

Hypokalemia may develop as a result of profound diuresis, particularly when Spironolactone and Hydrochlorothiazide is used concomitantly with loop diuretics, glucocorticoids, or ACTH, when severe cirrhosis is present, or after prolonged therapy. Interference with adequate oral electrolyte intake will also contribute to hypokalemia. Hypokalemia may cause cardiac arrhythmias and may exaggerate the effects of digitalis therapy. Potassium depletion may induce signs of digitalis intoxication at previously tolerated dosage levels. Although any chloride deficit is generally mild and usually does not require specific treatment except under extraordinary circumstances (as in liver disease or renal disease), chloride replacement may be required in the treatment of metabolic alkalosis.

Spironolactone and Hydrochlorothiazide therapy may cause a transient elevation of BUN. This appears to represent a concentration phenomenon rather than renal toxicity, since the BUN level returns to normal after use of Spironolactone and Hydrochlorothiazide is discontinued. Progressive elevation of BUN is suggestive of the presence of preexisting renal impairment.

Reversible hyperchloremic metabolic acidosis, usually in association with hyperkalemia, has been reported to occur in some patients with decompensated hepatic cirrhosis, even in the presence of normal renal function.

Dilutional hyponatremia, manifested by dryness of the mouth, thirst, lethargy, and drowsiness, and confirmed by a low serum sodium level, may be induced, especially when Spironolactone and Hydrochlorothiazide is administered in combination with other diuretics, and dilutional hyponatremia may occur in edematous patients in hot weather; appropriate therapy is water restriction rather than administration of sodium, except in rare instances when the hyponatremia is life-threatening. A true low-salt syndrome may rarely develop with Spironolactone and Hydrochlorothiazide therapy and may be manifested by increasing mental confusion similar to that observed with hepatic coma. This syndrome is differentiated from dilutional hyponatremia in that it does not occur with obvious fluid retention. Its treatment requires that diuretic therapy be discontinued and sodium administered.

Hyperuricemia may occur or acute gout may be precipitated in certain patients receiving thiazides. Thiazides have been shown to increase the urinary excretion of magnesium; this may result in hypomagnesemia. Increases in cholesterol and triglyceride levels may be associated with thiazide diuretic therapy.

In diabetic patients, dosage adjustments of insulin or oral hypoglycemic agents may be required. Hyperglycemia may occur with thiazide diuretics. Thus, latent diabetes mellitus may become manifest during thiazide therapy.

The antihypertensive effects of Spironolactone and Hydrochlorothiazide may be enhanced in the post-sympathectomy patient. If progressive renal impairment becomes evident, consider withholding or discontinuing diuretic therapy.

Thiazides may decrease urinary calcium excretion. Thiazides may cause intermittent and slight elevation of serum calcium in the absence of known disorders of calcium metabolism. Marked hypercalcemia may be evidence of hidden hyperparathyroidism. Thiazides should be discontinued before carrying out tests for parathyroid function. Pathologic changes in the parathyroid gland with hypercalcemia and hypophosphatemia have been observed in patients on prolonged thiazide therapy.

Gynecomastia may develop in association with the use of spironolactone; physicians should be alert to its possible onset. The development of gynecomastia appears to be related to both dosage level and duration of therapy and is normally reversible when Spironolactone and Hydrochlorothiazide is discontinued. In rare instances, some breast enlargement may persist when Spironolactone and Hydrochlorothiazide is discontinued.

Information for patients: Patients who receive Spironolactone and Hydrochlorothiazide should be advised to avoid potassium supplements and foods containing high levels of potassium including salt substitutes.

Laboratory tests: Periodic determination of serum electrolytes to detect possible electrolyte imbalance should be done at appropriate intervals, particularly in the elderly and those with significant renal or hepatic impairments.

Drug interactions:

ACE inhibitors: Concomitant administration of ACE inhibitors with potassium-sparing diuretics has been associated with severe hyperkalemia.

Alcohol, barbiturates, or narcotics: Potentiation of orthostatic hypotension may occur.

Antidiabetic drugs (e.g., oral agents, insulin): Dosage adjustment of the antidiabetic drug may be required.

Corticosteroids, ACTH: Intensified electrolyte depletion, particularly hypokalemia, may occur.

Pressor amines (e.g., norepinephrine): Both Spironolactone and Hydrochlorothiazide reduce the vascular responsiveness to norepinephrine. Therefore, caution should be exercised in the management of patients subjected to regional or general anesthesia while they are being treated with Spironolactone and Hydrochlorothiazide.

Skeletal muscle relaxants, nondepolarizing (e.g., tubocurarine): Possible increased responsiveness to the muscle relaxant may result.

Lithium: Lithium generally should not be given with diuretics. Diuretic agents reduce the renal clearance of lithium and add a high risk of lithium toxicity.

Nonsteroidal anti-inflammatory drugs (NSAIDs): In some patients, the administration of an NSAID can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing, and thiazide diuretics. Combination of NSAIDs, e.g., indomethacin, with potassium-sparing diuretics has been associated with severe hyperkalemia. Therefore, when Spironolactone and Hydrochlorothiazide and NSAIDs are used concomitantly, the patient should be observed closely to determine if the desired effect of the diuretic is obtained.

Digoxin: Spironolactone has been shown to increase the half-life of digoxin. This may result in increased serum digoxin levels and subsequent digitalis toxicity. It may be necessary to reduce the maintenance and digitalization doses when spironolactone is administered, and the patient should be carefully monitored to avoid over- or underdigitalization.

Drug/Laboratory test interactions: Thiazides should be discontinued before carrying out tests for parathyroid function (see Precautions: General). Thiazides may also decrease serum PBI levels without evidence of alteration of thyroid function.

Several reports of possible interference with digoxin radioimmunoassays by spironolactone or its metabolites have appeared in the literature. Neither the extent nor the potential clinical significance of its interference (which may be assay specific) has been fully established.

Carcinogenesis, mutagenesis, impairment of fertility:

Spironolactone: Orally administered spironolactone has been shown to be a tumorigen in dietary administration studies performed in rats, with its proliferative effects manifested on endocrine organs and the liver. In an 18-month study using doses of about 50, 150, and 500 mg/kg/day, there were statistically significant increases in benign adenomas of the thyroid and testes and, in male rats, a dose-related increase in proliferative changes in the liver (including hepatocytomegaly and hyperplastic nodules). In a 24-month study in which the same strain of rat was administered doses of about 10, 30, 100, and 150 mg spironolactone/kg/day, the range of proliferative effects included significant increases in hepatocellular adenomas and testicular interstitial cell tumors in males, and significant increases in thyroid follicular cell adenomas and carcinomas in both sexes. There was also a statistically significant, but not dose-related, increase in benign uterine endometrial stromal polyps in females.

A dose-related (above 20 mg/kg/day) incidence of myelocytic leukemia was observed in rats fed daily doses of potassium canrenoate (a compound chemically similar to spironolactone and whose primary metabolite, canrenone, is also a major product of spironolactone in man) for a period of one year. In two year studies in the rat, oral administration of potassium canrenoate was associated with myelocytic leukemia and hepatic, thyroid, testicular, and mammary tumors.

Neither spironolactone nor potassium canrenoate produced mutagenic effects in tests using bacteria or yeast. In the absence of metabolic activation, neither spironolactone nor potassium canrenoate has been shown to be mutagenic in mammalian tests in vitro. In the presence of metabolic activation, spironolactone has been reported to be negative in some mammalian mutagenicity tests in vitro and inconclusive (but slightly positive) for mutagenicity in other mammalian tests in vitro. In the presence of metabolic activation, potassium canrenoate has been reported to test positive for mutagenicity in some mammalian tests in vitro, inconclusive in others, and negative in still others.

In a three-litter reproduction study in which female rats received dietary doses of 15 and 50 mg spironolactone/kg/day, there were no effects on mating and fertility, but there was a small increase in incidence of stillborn pups at 50 mg/kg/day. When injected into female rats (100 mg/kg/day for 7 days, i.p.), spironolactone was found to increase the length of the estrous cycle by prolonging diestrus during treatment and inducing constant diestrus during a two week posttreatment observation period. These effects were associated with retarded ovarian follicle development and a reduction in circulating estrogen levels, which would be expected to impair mating, fertility, and fecundity. Spironolactone (100 mg/kg/day), administered i.p. to female mice during a two week cohabitation period with untreated males, decreased the number of mated mice that conceived (effect shown to be caused by an inhibition of ovulation) and decreased the number of implanted embryos in those that became pregnant (effect shown to be caused by an inhibition of implantation), and at 200 mg/kg, also increased the latency period to mating.

Hydrochlorothiazide: Two year feeding studies in mice and rats conducted under the auspices of the National Toxicology Program (NTP) uncovered no evidence of a carcinogenic potential of hydrochlorothiazide in female mice (at doses of up to approximately 600 mg/kg/day) or in male and female rats (at doses of up to approximately 100 mg/kg/day). The NTP, however, found equivocal evidence for hepatocarcinogenicity in male mice.

Hydrochlorothiazide was not genotoxic in in vitro assays using strains TA 98, TA 100, TA 1535, TA 1537, and TA 1538 of Salmonella typhimurium (Ames assay) and in the Chinese Hamster Ovary (CHO) test for chromosomal aberrations, or in in vivo assays using mouse germinal cell chromosomes, Chinese hamster bone marrow chromosomes, and the Drosophila sex-linked recessive lethal trait gene. Positive test results were obtained only in the in vitro CHO Sister Chromatid Exchange (clastogenicity) and in the Mouse Lymphoma Cell (mutagenicity) assays, using concentrations of hydrochlorothiazide from 43 to 1300 µg/mL, and in the Aspergillus nidulans non-disjunction assay at an unspecified concentration.

Hydrochlorothiazide had no adverse effects on the fertility of mice and rats of either sex in studies wherein these species were exposed, via their diet, to doses of up to 100 and 4 mg/kg, respectively, prior to mating and throughout gestation.

Pregnancy:

Teratogenic effects. Pregnancy Category C.

Hydrochlorothiazide: Studies in which hydrochlorothiazide was orally administered to pregnant mice and rats during their respective periods of major organogenesis at doses up to 3000 and 1000 mg hydrochlorothiazide/kg, respectively, provided no evidence of harm to the fetus. There are, however, no adequate and well-controlled studies in pregnant women.

Spironolactone: Teratology studies with spironolactone have been carried out in mice and rabbits at doses of up to 20 mg/kg/day. On a body surface area basis, this dose in the mouse is substantially below the maximum recommended human dose and, in the rabbit, approximates the maximum recommended human dose. No teratogenic or other embryo-toxic effects were observed in mice, but the 20 mg/kg dose caused an increased rate of resorption and a lower number of live fetuses in rabbits. Because of its antiandrogenic activity and the requirement of testosterone for male morphogenesis, spironolactone may have the potential for adversely affecting sex differentiation of the male during embryogenesis. When administered to rats at 200 mg/kg/day between gestation days 13 and 21 (late embryogenesis and fetal development), feminization of male fetuses was observed. Offspring exposed during late pregnancy to 50 and 100 mg/kg/day doses of spironolactone exhibited changes in the reproductive tract including dose-dependent decreases in weights of the ventral prostate and seminal vesicle in males, ovaries and uteri that were enlarged in females, and other indications of endocrine dysfunction, that persisted into adulthood. There are no adequate and well-controlled studies with Spironolactone and Hydrochlorothiazide in pregnant women. Spironolactone has known endocrine effects in animals including progestational and antiandrogenic effects. The antiandrogenic effects can result in apparent estrogenic side effects in humans, such as gynecomastia. Therefore, the use of Spironolactone and Hydrochlorothiazide in pregnant women requires that the anticipated benefit be weighed against the possible hazards to the fetus.

Non-teratogenic effects

Spironolactone or its metabolites may, and hydrochlorothiazide does, cross the placental barrier and appear in cord blood. Therefore, the use of Spironolactone and Hydrochlorothiazide in pregnant women requires that the anticipated benefit be weighed against possible hazards to the fetus. The hazards include fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions that have occurred in adults.

Nursing mothers: Canrenone, a major (and active) metabolite of spironolactone, appears in human breast milk. Because spironolactone has been found to be tumorigenic in rats, a decision should be made whether to discontinue the drug, taking into account the importance of the drug to the mother. If use of the drug is deemed essential, an alternative method of infant feeding should be instituted.

Pediatric use: Safety and effectiveness in pediatric patients have not been established.

ADVERSE REACTIONS

The following adverse reactions have been reported and, within each category (body system), are listed in order of decreasing severity.

Hydrochlorothiazide:

Body as a whole: Weakness.

Cardiovascular: Hypotension including orthostatic hypotension (may be aggravated by alcohol, barbiturates, narcotics, or antihypertensive drugs).

Digestive: Pancreatitis, jaundice (intrahepatic cholestatic jaundice), diarrhea, vomiting, sialoadenitis, cramping, constipation, gastric irritation, nausea, anorexia.

Hematologic: Aplastic anemia, agranulocytosis, leukopenia, hemolytic anemia, thrombocytopenia.

Hypersensitivity: Anaphylactic reactions, necrotizing angitis (vasculitis and cutaneous vasculitis), respiratory distress including pneumonitis and pulmonary edema, photosensitivity, fever, urticaria, rash, purpura.

Metabolic: Electrolyte imbalance (see Precautions), hyperglycemia, glycosuria, hyperuricemia.

Musculoskeletal: Muscle spasm.

Nervous system/psychiatric: Vertigo, paresthesias, dizziness, headache, restlessness.

Renal: Renal failure, renal dysfunction, interstitial nephritis (see Warnings).

Skin: Erythema multiforme, pruritus.

Special senses: Transient blurred vision, xanthopsia.

Spironolactone:

Digestive: Gastric bleeding, ulceration, gastritis, diarrhea and cramping, nausea, vomiting.

Endocrine: Gynecomastia (see Precautions), inability to achieve or maintain erection, irregular menses or amenorrhea, postmenopausal bleeding. Carcinoma of the breast has been reported in patients taking spironolactone but a cause and effect relationship has not been established.

Hematologic: Agranulocytosis.

Hypersensitivity: Fever, urticaria, maculopapular or erythematous cutaneous eruptions, anaphylactic reactions, vasculitis.

Nervous system/psychiatric: Mental confusion, ataxia, headache, drowsiness, lethargy.

Liver/biliary: A very few cases of mixed cholestatic/hepatocellular toxicity, with one reported fatality, have been reported with spironolactone administration.

Renal: Renal dysfunction (including renal failure).

Skin: Stevens-Johnson Syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms (DRESS).

OVERDOSAGE

The oral LD50 of spironolactone is greater than 1000 mg/kg in mice, rats, and rabbits. The oral LD50 of hydrochlorothiazide is greater than 10 g/kg in both mice and rats.

Acute overdosage of spironolactone may be manifested by drowsiness, mental confusion, maculopapular or erythematous rash, nausea, vomiting, dizziness, or diarrhea. Rarely, instances of hyponatremia, hyperkalemia (less commonly seen with Spironolactone and Hydrochlorothiazide because the hydrochlorothiazide component tends to produce hypokalemia), or hepatic coma may occur in patients with severe liver disease, but these are unlikely due to acute overdosage.

However, because Spironolactone and Hydrochlorothiazide tablets contain both Spironolactone and Hydrochlorothiazide, the toxic effects may be intensified, and signs of thiazide overdosage may be present. These include electrolyte imbalance such as hypokalemia and/or hyponatremia. The potassium-sparing action of spironolactone may predominate and hyperkalemia may occur, especially in patients with impaired renal function. BUN determinations have been reported to rise transiently with hydrochlorothiazide. There may be CNS depression with lethargy or even coma.

Treatment: Induce vomiting or evacuate the stomach by lavage. There is no specific antidote. Treatment is supportive to maintain hydration, electrolyte balance, and vital functions.

Patients who have renal impairment may develop spironolactone-induced hyperkalemia. In such cases, Spironolactone and Hydrochlorothiazide should be discontinued immediately. With severe hyperkalemia, the clinical situation dictates the procedures to be employed. These include the intravenous administration of calcium chloride solution, sodium bicarbonate solution, and/or the oral or parenteral administration of glucose with a rapid-acting insulin preparation. These are temporary measures to be repeated as required. Cationic exchange resins such as sodium polystyrene sulfonate may be orally or rectally administered. Persistent hyperkalemia may require dialysis.

DOSAGE AND ADMINISTRATION

Optimal dosage should be established by individual titration of the components (see boxed Warning).

Edema in adults (congestive heart failure, hepatic cirrhosis, or nephrotic syndrome). The usual maintenance dose of Spironolactone and Hydrochlorothiazide is 100 mg each of Spironolactone and Hydrochlorothiazide daily, administered in a single dose or in divided doses, but may range from 25 mg to 200 mg of each component daily depending on the response to the initial titration. In some instances it may be desirable to administer separate tablets of either spironolactone or hydrochlorothiazide in addition to Spironolactone and Hydrochlorothiazide tablets in order to provide optimal individual therapy.

The onset of diuresis with Spironolactone and Hydrochlorothiazide tablets occurs promptly and, due to prolonged effect of the spironolactone component, persists for two to three days after Spironolactone and Hydrochlorothiazide tablets are discontinued.

Essential hypertension. Although the dosage will vary depending on the results of titration of the individual ingredients, many patients will be found to have an optimal response to 50 mg to 100 mg each of Spironolactone and Hydrochlorothiazide daily, given in a single dose or in divided doses.

Concurrent potassium supplementation is not recommended when Spironolactone and Hydrochlorothiazide tablets are used in the long-term management of hypertension or in the treatment of most edematous conditions, since the spironolactone content of Spironolactone and Hydrochlorothiazide tablets is usually sufficient to minimize loss induced by the hydrochlorothiazide component.

HOW SUPPLIED

Spironolactone and Hydrochlorothiazide tablets, USP are supplied as follows:

Spironolactone and Hydrochlorothiazide tablets, 25 mg/25 mg are buff, round, unscored, debossed MP 40.

Bottles of 100 NDC 53489-144-01 Bottles of 500 NDC 53489-144-05 Bottles of 1000 NDC 53489-144-10

Store at 20° to 25°C (68° to 77°F).

[See USP Controlled Room Temperature]

DISPENSE IN TIGHT, LIGHT-RESISTANT CONTAINER.

Manufactured by:
MUTUAL PHARMACEUTICAL COMPANY, INC.
Philadelphia, PA 19124 USA

Rev 03, September 2011

PRINCIPAL DISPLAY PANEL - 25 mg Bottle Label

MP

NDC 53489-144-01

SPIRONOLACTONE AND
HYDROCHLOROTHIAZIDE TABLETS USP

25 mg/25 mg

100 TABLETS

Rx only

MUTUAL PHARMACEUTICAL CO., INC.
PHILADELPHIA, PA 19124 USA

Spironolactone and Hydrochlorothiazide 
Spironolactone and Hydrochlorothiazide  tablet Product Information Product Type HUMAN PRESCRIPTION DRUG NDC Product Code (Source) 53489-144 Route of Administration ORAL DEA Schedule      Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength Spironolactone (Spironolactone) Spironolactone 25 mg Hydrochlorothiazide (Hydrochlorothiazide) Hydrochlorothiazide 25 mg Inactive Ingredients Ingredient Name Strength anhydrous lactose   silicon dioxide   D&C yellow No. 10   docusate sodium   FD&C yellow no. 6   Aluminum Oxide   magnesium stearate   cellulose, microcrystalline   peppermint   povidone   sodium benzoate   Sodium Starch Glycolate Type A Potato   Product Characteristics Color WHITE (off-white, buff) Score no score Shape ROUND Size 10mm Flavor PEPPERMINT Imprint Code MP;40 Contains          Packaging # NDC Package Description Multilevel Packaging 1 53489-144-01 100 TABLET In 1 BOTTLE None 2 53489-144-05 500 TABLET In 1 BOTTLE None 3 53489-144-10 1000 TABLET In 1 BOTTLE None
Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date ANDA ANDA089534 07/02/1987
Labeler - Mutual Pharmaceutical Company, Inc. (121735955) Revised: 10/2011Mutual Pharmaceutical Company, Inc.
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hydrochlorothiazide and aliskiren

Generic Name: hydrochlorothiazide and aliskiren (HYE droe KLOR oh THYE a zide and a LIS ke rin)
Brand Names: Tekturna HCT

What is hydrochlorothiazide and aliskiren?

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

Aliskiren is an anti-hypertensive (blood pressure lowering) medication. It works by decreasing substances in the body that narrow blood vessels and raise blood pressure.

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

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

What is the most important information I should know about hydrochlorothiazide and aliskiren? You should not use this medication if you are allergic to aliskiren or hydrochlorothiazide, if you are unable to urinate, or if you are also using itraconazole (Sporanox) or cyclosporine (Gengraf, Neoral, Sandimmune). FDA pregnancy category D. Do not use hydrochlorothiazide and aliskiren if you are pregnant. Stop using this medication and tell your doctor right away if you become pregnant.

Before you take hydrochlorothiazide and aliskiren, tell your doctor if you have asthma, low or high levels of potassium in your blood, kidney or liver disease, glaucoma, gout, lupus, diabetes, or an allergy to sulfa drugs or penicillin.

Do not use potassium supplements or salt substitutes while you are taking hydrochlorothiazide and aliskiren, unless your doctor has told you to. It may take up to 4 weeks for this medication to control your blood pressure. Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life. What should I discuss with my healthcare provider before taking hydrochlorothiazide and aliskiren? You should not use this medication if:

you are allergic to aliskiren (Tekturna) or hydrochlorothiazide (Carozide, Diaqua, Ezide HCTZ, HydroDiuril, Microzide, and others);

you are unable to urinate; or

you are also using itraconazole (Sporanox) or cyclosporine (Gengraf, Neoral, Sandimmune).

To make sure you can safely take hydrochlorothiazide and aliskiren, tell your doctor if you have any of these other conditions:

low or high levels of potassium in your blood;

asthma;

glaucoma;

kidney disease; liver disease;

gout;

systemic lupus erythematosus (SLE);

diabetes; or

an allergy to sulfa drugs or penicillin.

FDA pregnancy category D. Do not use hydrochlorothiazide and aliskiren if you are pregnant. Stop using this medication and tell your doctor right away if you become pregnant. Hydrochlorothiazide and aliskiren can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control while taking hydrochlorothiazide and aliskiren. It is not known whether hydrochlorothiazide and aliskiren passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using hydrochlorothiazide and aliskiren. Do not give this medication to anyone under 18 years old without medical advice. How should I take hydrochlorothiazide and aliskiren?

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

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

You may take this medication with or without food, but take it the same way every time.

Conditions that may cause very low blood pressure include: vomiting, diarrhea, heavy sweating, heart disease, dialysis, a low salt diet, or taking diuretics (water pills). Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

Your blood pressure will need to be checked often. Visit your doctor regularly.

It may take up to 4 weeks for this medication to control your blood pressure. Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

High blood pressure is sometimes treated with a combination of drugs. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor's advice.

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

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

Store at room temperature away from moisture and heat.

See also: Hydrochlorothiazide and aliskiren dosage (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include dry mouth, increased thirst, drowsiness, restless feeling, confusion, nausea, vomiting, increased urination, muscle pain or weakness, fast heart rate, feeling light-headed, fainting, or seizure (convulsions).

What should I avoid while taking hydrochlorothiazide and aliskiren?

Avoid taking this medication with a high-fat meal, which can make it harder for your body to absorb hydrochlorothiazide and aliskiren.

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

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.

Drinking alcohol can further lower your blood pressure and may increase certain side effects of hydrochlorothiazide and aliskiren.

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 aliskiren 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 hydrochlorothiazide and aliskiren and call your doctor at once if you have a serious side effect such as:

eye pain, vision problems;

feeling like you might pass out;

high potassium (slow heart rate, weak pulse, muscle weakness, tingly feeling);

low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling);

urinating less than usual, or not at all;

joint pain or swelling with fever, swollen glands, muscle aches, nausea, vomiting, chest pain, unusual thoughts or behavior, and/or seizure (convulsions); or

severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Less serious side effects may include:

dizziness, spinning sensation;

diarrhea, stomach pain, indigestion;

tired feeling;

flu symptoms; or

dry cough.

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 aliskiren Dosing Information

Usual Adult Dose for Hypertension:

Initial: 150 mg-12.5 mg or 150 mg-25 mg once a day to a maximum of 300 mg-25 mg once a day. Patients should establish a routine pattern for taking aliskiren-hydrochlorothiazide with regard to meals since high-fat meals substantially decrease absorption.
The antihypertensive effect is generally seen within 1 week, with maximal effects seen at around 4 weeks. If blood pressure remains uncontrolled after 2 to 4 weeks of therapy, the dose may be titrated up to a maximum of 300 mg-25 mg.

What other drugs will affect hydrochlorothiazide and aliskiren?

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

lithium (Eskalith, Lithobid);

a blood thinner such as warfarin (Coumadin, Jantoven);

aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), and others;

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

cholesterol medication such as atorvastatin (Lipitor), cholestyramine (Prevalite, Questran) or colestipol (Colestid);

insulin or diabetes medicine you take by mouth; or

steroid medication such as prednisone (Deltasone, Sterapred), methylprednisolone (Medrol), fluticasone (Advair , Flonase, Flovent, Veramyst), beclomethasone (Qvar), budesonide (Pulmicort, Rhinocort, Symbicort), dexamethasone (Cortastat, Dexasone, Solurex, DexPak), mometasone (Asmanex, Nasonex), triamcinolone (Nasacort), and others.

This list is not complete and other drugs may interact with hydrochlorothiazide and aliskiren. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More hydrochlorothiazide and aliskiren resources Hydrochlorothiazide and aliskiren Side Effects (in more detail)Hydrochlorothiazide and aliskiren DosageHydrochlorothiazide and aliskiren Use in Pregnancy & BreastfeedingHydrochlorothiazide and aliskiren Drug InteractionsHydrochlorothiazide and aliskiren Support Group4 Reviews for Hydrochlorothiazide and aliskiren - Add your own review/rating Compare hydrochlorothiazide and aliskiren with other medications High Blood Pressure Where can I get more information? Your pharmacist can provide more information about hydrochlorothiazide and aliskiren.

See also: hydrochlorothiazide and aliskiren side effects (in more detail)

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hydralazine/hydrochlorothiazide/reserpine

Generic Name: hydralazine/hydrochlorothiazide/reserpine (hye DRAL a zeen/hye droe klor oh THYE a zide/re SER peen)
Brand names: Diuretic Ap-Es, Hydrap-ES, Ser-Ap-Es, Serpazide, Tri-Hydroserpine, Uni Serp, Marpres, Serathide, Unipres, Serpex, HHR

What is hydralazine/hydrochlorothiazide/reserpine?

Hydralazine is a vasodilator. It lowers blood pressure by relaxing (widening) blood vessels (veins and arteries) and making it easier for your heart to pump.

Hydrochlorothiazide is a thiazide diuretic (water pill). It helps to lower your blood pressure and decrease edema (swelling or water retention) by increasing the amount of salt and water you lose in your urine.

Reserpine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels (veins and arteries) to relax and your heart to beat more slowly and easily.

The combination, hydralazine/hydrochlorothiazide/reserpine, is used to lower high blood pressure.

Hydralazine/hydrochlorothiazide/reserpine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about hydralazine/hydrochlorothiazide/reserpine? Stand up slowly from a sitting or lying position. Hydralazine/hydrochlorothiazide/reserpine may make you feel dizzy. Do not stop taking hydralazine/hydrochlorothiazide/reserpine suddenly. Even if you feel better, you need this medication to control your condition. Stopping suddenly could cause severely high blood pressure, anxiety, and other dangerous side effects. Use caution when driving, operating machinery, or performing other hazardous activities. Hydralazine/hydrochlorothiazide/reserpine may cause dizziness. If you experience dizziness, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking this medication. What should I discuss with my healthcare provider before taking hydralazine/hydrochlorothiazide/reserpine? Do not take hydralazine/hydrochlorothiazide/reserpine without first talking to your doctor if you

have an allergy to sulfa-based drugs such as sulfa antibiotics;

have coronary heart disease or mitral valvular rheumatic heart disease;

have peptic ulcer disease (stomach ulcers);

have ulcerative colitis;

are suffering from depression (especially if you have suicidal thoughts);

are receiving electroconvulsive shock therapy; or

have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days.

You may not be able to take hydralazine/hydrochlorothiazide/reserpine if you have any of the conditions listed above.

Before taking this medication, tell your doctor if you

have gallstones,

have kidney or liver disease,

have diabetes,

have gout,

have a collagen vascular disease such as systemic lupus erythematosus,

have pancreatitis,

have asthma,

have any type of heart disease,

have had a stroke or a transient ischemic attack (mini-stroke),

have high cholesterol or high levels of fat in your blood, or

have pulmonary hypertension (a type of lung disease).

You may require a dosage adjustment or special monitoring during therapy with hydralazine/hydrochlorothiazide/reserpine if you have any of the conditions listed above.

Hydralazine/hydrochlorothiazide/reserpine is in the FDA pregnancy category C. This means that it is not known whether hydralazine/hydrochlorothiazide/reserpine will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant. Hydralazine/hydrochlorothiazide/reserpine passes into breast milk and may harm a nursing infant. Do not take this medication without first talking to your doctor if you are breast-feeding a baby. If you are over 60 years of age, you may be more likely to experience side effects from hydralazine/hydrochlorothiazide/reserpine therapy. You may require a lower dose of this medication. How should I take hydralazine/hydrochlorothiazide/reserpine?

Take the medication exactly as directed. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water. Take the medication with food or milk if it upsets your stomach.

Do not suddenly stop taking hydralazine/hydrochlorothiazide/reserpine. Stopping suddenly could make your condition much worse or cause very serious side effects. Talk to your doctor before you stop taking this medication.

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

See also: Hydralazine/hydrochlorothiazide/reserpine dosage (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose? Seek emergency medical attention.

Symptoms of an overdose include low blood pressure (fainting, dizziness, weakness), slow pulse or an irregular heartbeat, low body temperature, diarrhea, increased urination, vomiting, headache, flushing of the skin, and slow breathing.

What should I avoid while taking hydralazine/hydrochlorothiazide/reserpine? Use caution when driving, operating machinery, or performing other hazardous activities. This medicine may cause dizziness. If you experience dizziness, avoid these activities. Avoid alcohol while taking hydralazine/hydrochlorothiazide/reserpine. Alcohol may increase the drowsiness caused by this medication and may increase dizziness. Use caution even with small amounts of alcohol. Use caution when rising from a sitting or lying position, especially first thing in the morning. You may become dizzy while taking hydralazine/hydrochlorothiazide/reserpine, and you may fall and injure yourself.

Do not let yourself become overheated in hot weather or during exercise, and use caution if you have a fever. Dehydration may increase the effects of hydralazine/hydrochlorothiazide/reserpine, and you may become very dizzy.

Avoid prolonged exposure to sunlight. Hydrochlorothiazide may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable. Hydralazine/hydrochlorothiazide/reserpine side effects If you experience any of the following serious side effects, stop taking hydralazine/hydrochlorothiazide/reserpine and seek emergency medical attention:

an allergic reaction (difficulty breathing, closing of your throat, swelling of your lips, tongue or face, hives);

irregular or fast heartbeats or a fluttering feeling in your chest;

new or worsening chest pain;

heart failure (shortness of breath, swelling of ankles or legs, sudden weight gain of 2 pounds in one day or 5 pounds in one week);

unusual fatigue or confusion;

abnormal bleeding or bruising;

yellow skin or eyes;

blood in your urine or stools;

little or no urine;

numbness, tingling, pain, or weakness of your arms or legs; or

fainting.

Other, less serious side effects are more likely to occur. Continue to take hydralazine/hydrochlorothiazide/reserpine and talk to your doctor if you experience

mild fatigue, drowsiness, or dizziness;

headache;

water retention (swelling of the hands, feet, or ankles);

anxiety, depression, or nightmares;

diarrhea, nausea, vomiting , abdominal pain;

stuffy nose or a dry mouth;

muscle weakness or cramps;

increased hunger, thirst, or urination;

a rash;

sensitivity to sunlight; or

impotence or difficulty ejaculating.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Hydralazine/hydrochlorothiazide/reserpine Dosing Information

Usual Adult Dose for Hypertension:

Initial dose: 1 tablet orally once a day.
Maintenance dose: 1 to 2 tablets/day in 1 to 2 divided doses. Dosage should be determined by individual titration.
Dosage regimens that exceed 0.25 mg of reserpine per day are not recommended.

What other drugs will affect hydralazine/hydrochlorothiazide/reserpine?

Do not take this medication if you have taken a monoamine oxidase inhibitor (MAOI), such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate), in the last 14 days.

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

digoxin (Lanoxin, Lanoxicaps);

quinidine (Cardioquin, others);

lithium (Lithobid, Eskalith, others);

a tricyclic antidepressant such as amitriptyline (Elavil, Endep), imipramine (Tofranil), nortriptyline (Pamelor), doxepin (Sinequan), and others; a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil), ketoprofen (Orudis, Orudis KT, Oruvail), naproxen (Naprosyn, Anaprox, Aleve), and others;

an antidiabetic medicine such as glipizide (Glucotrol), glyburide (Micronase, Glynase, Diabeta), and others; or

a steroid medicine such as prednisone (Orasone, Deltasone), prednisolone (Delta Cortef, Prelone), methylprednisolone (Medrol), and others.

You may not be able to take hydralazine/hydrochlorothiazide/reserpine, or you may require a dosage adjustment or special monitoring during your treatment if you are taking any of the medicines listed above.

Also, before taking hydralazine/hydrochlorothiazide/reserpine, tell your doctor if you are taking any medicine to treat high blood pressure, water retention, heart problems, prostate problems, or another condition. Some medicines used to treat these conditions may interact with hydralazine/hydrochlorothiazide/reserpine, and the interaction may increase the effects on your heart.

Hydralazine/hydrochlorothiazide/reserpine may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine unless your doctor approves.

Drugs other than those listed here may also interact with hydralazine/hydrochlorothiazide/reserpine or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

More hydralazine/hydrochlorothiazide/reserpine resources Hydralazine/hydrochlorothiazide/reserpine Side Effects (in more detail) Hydralazine/hydrochlorothiazide/reserpine Dosage Hydralazine/hydrochlorothiazide/reserpine Use in Pregnancy & Breastfeeding Hydralazine/hydrochlorothiazide/reserpine Drug Interactions Hydralazine/hydrochlorothiazide/reserpine Support Group 0 Reviews for Hydralazine/hydrochlorothiazide/reserpine - Add your own review/rating Ser-Ap-Es Prescribing Information (FDA) Compare hydralazine/hydrochlorothiazide/reserpine with other medications High Blood Pressure Where can I get more information? Your pharmacist has additional information about hydralazine/hydrochlorothiazide/reserpine written for health professionals that you may read. What does my medication look like?

Hydralazine/hydrochlorothiazide/reserpine is available with a prescription under the brand name Ser-Ap-Es. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Hydralazine/hydrochlorothiazide/reserpine strengths are as follows:

Ser-Ap-Es (25 mg/15 mg/0.1mg)--round, salmon-pink, dry-coated tablets

See also: hydralazine/hydrochlorothiazide/reserpine side effects (in more detail)

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hydrochlorothiazide and timolol

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.

More hydrochlorothiazide and timolol resources Hydrochlorothiazide and timolol Side Effects (in more detail) Hydrochlorothiazide and timolol Dosage Hydrochlorothiazide and timolol Use in Pregnancy & Breastfeeding Hydrochlorothiazide and timolol Drug Interactions Hydrochlorothiazide and timolol Support Group 0 Reviews for Hydrochlorothiazide and timolol - Add your own review/rating Compare hydrochlorothiazide and timolol with other medications High Blood Pressure Where can I get more information? Your pharmacist can provide more information about hydrochlorothiazide and timolol.

See also: hydrochlorothiazide and timolol side effects (in more detail)

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Hydrap-ES

Generic Name: hydralazine/hydrochlorothiazide/reserpine (hye DRAL a zeen/hye droe klor oh THYE a zide/re SER peen)
Brand Names: Diuretic Ap-Es, Hydrap-ES, Ser-Ap-Es, Serpazide, Tri-Hydroserpine, Uni Serp

What is Hydrap-ES (hydralazine/hydrochlorothiazide/reserpine)?

Hydralazine is a vasodilator. It lowers blood pressure by relaxing (widening) blood vessels (veins and arteries) and making it easier for your heart to pump.

Hydrochlorothiazide is a thiazide diuretic (water pill). It helps to lower your blood pressure and decrease edema (swelling or water retention) by increasing the amount of salt and water you lose in your urine.

Reserpine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels (veins and arteries) to relax and your heart to beat more slowly and easily.

The combination, hydralazine/hydrochlorothiazide/reserpine, is used to lower high blood pressure.

Hydralazine/hydrochlorothiazide/reserpine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Hydrap-ES (hydralazine/hydrochlorothiazide/reserpine)? Stand up slowly from a sitting or lying position. Hydralazine/hydrochlorothiazide/reserpine may make you feel dizzy. Do not stop taking hydralazine/hydrochlorothiazide/reserpine suddenly. Even if you feel better, you need this medication to control your condition. Stopping suddenly could cause severely high blood pressure, anxiety, and other dangerous side effects. Use caution when driving, operating machinery, or performing other hazardous activities. Hydralazine/hydrochlorothiazide/reserpine may cause dizziness. If you experience dizziness, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking this medication. What should I discuss with my healthcare provider before taking Hydrap-ES (hydralazine/hydrochlorothiazide/reserpine)? Do not take hydralazine/hydrochlorothiazide/reserpine without first talking to your doctor if you

have an allergy to sulfa-based drugs such as sulfa antibiotics;

have coronary heart disease or mitral valvular rheumatic heart disease;

have peptic ulcer disease (stomach ulcers);

have ulcerative colitis;

are suffering from depression (especially if you have suicidal thoughts);

are receiving electroconvulsive shock therapy; or

have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days.

You may not be able to take hydralazine/hydrochlorothiazide/reserpine if you have any of the conditions listed above.

Before taking this medication, tell your doctor if you

have gallstones,

have kidney or liver disease,

have diabetes,

have gout,

have a collagen vascular disease such as systemic lupus erythematosus,

have pancreatitis,

have asthma,

have any type of heart disease,

have had a stroke or a transient ischemic attack (mini-stroke),

have high cholesterol or high levels of fat in your blood, or

have pulmonary hypertension (a type of lung disease).

You may require a dosage adjustment or special monitoring during therapy with hydralazine/hydrochlorothiazide/reserpine if you have any of the conditions listed above.

Hydralazine/hydrochlorothiazide/reserpine is in the FDA pregnancy category C. This means that it is not known whether hydralazine/hydrochlorothiazide/reserpine will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant. Hydralazine/hydrochlorothiazide/reserpine passes into breast milk and may harm a nursing infant. Do not take this medication without first talking to your doctor if you are breast-feeding a baby. If you are over 60 years of age, you may be more likely to experience side effects from hydralazine/hydrochlorothiazide/reserpine therapy. You may require a lower dose of this medication. How should I take Hydrap-ES (hydralazine/hydrochlorothiazide/reserpine)?

Take the medication exactly as directed. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water. Take the medication with food or milk if it upsets your stomach.

Do not suddenly stop taking hydralazine/hydrochlorothiazide/reserpine. Stopping suddenly could make your condition much worse or cause very serious side effects. Talk to your doctor before you stop taking this medication.

Store this medication at room temperature away from moisture and heat. What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose? Seek emergency medical attention.

Symptoms of an overdose include low blood pressure (fainting, dizziness, weakness), slow pulse or an irregular heartbeat, low body temperature, diarrhea, increased urination, vomiting, headache, flushing of the skin, and slow breathing.

What should I avoid while taking Hydrap-ES (hydralazine/hydrochlorothiazide/reserpine)? Use caution when driving, operating machinery, or performing other hazardous activities. This medicine may cause dizziness. If you experience dizziness, avoid these activities. Avoid alcohol while taking hydralazine/hydrochlorothiazide/reserpine. Alcohol may increase the drowsiness caused by this medication and may increase dizziness. Use caution even with small amounts of alcohol. Use caution when rising from a sitting or lying position, especially first thing in the morning. You may become dizzy while taking hydralazine/hydrochlorothiazide/reserpine, and you may fall and injure yourself.

Do not let yourself become overheated in hot weather or during exercise, and use caution if you have a fever. Dehydration may increase the effects of hydralazine/hydrochlorothiazide/reserpine, and you may become very dizzy.

Avoid prolonged exposure to sunlight. Hydrochlorothiazide may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable. Hydrap-ES (hydralazine/hydrochlorothiazide/reserpine) side effects If you experience any of the following serious side effects, stop taking hydralazine/hydrochlorothiazide/reserpine and seek emergency medical attention:

an allergic reaction (difficulty breathing, closing of your throat, swelling of your lips, tongue or face, hives);

irregular or fast heartbeats or a fluttering feeling in your chest;

new or worsening chest pain;

heart failure (shortness of breath, swelling of ankles or legs, sudden weight gain of 2 pounds in one day or 5 pounds in one week);

unusual fatigue or confusion;

abnormal bleeding or bruising;

yellow skin or eyes;

blood in your urine or stools;

little or no urine;

numbness, tingling, pain, or weakness of your arms or legs; or

fainting.

Other, less serious side effects are more likely to occur. Continue to take hydralazine/hydrochlorothiazide/reserpine and talk to your doctor if you experience

mild fatigue, drowsiness, or dizziness;

headache;

water retention (swelling of the hands, feet, or ankles);

anxiety, depression, or nightmares;

diarrhea, nausea, vomiting , abdominal pain;

stuffy nose or a dry mouth;

muscle weakness or cramps;

increased hunger, thirst, or urination;

a rash;

sensitivity to sunlight; or

impotence or difficulty ejaculating.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Hydrap-ES (hydralazine/hydrochlorothiazide/reserpine)?

Do not take this medication if you have taken a monoamine oxidase inhibitor (MAOI), such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate), in the last 14 days.

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

digoxin (Lanoxin, Lanoxicaps);

quinidine (Cardioquin, others);

lithium (Lithobid, Eskalith, others);

a tricyclic antidepressant such as amitriptyline (Elavil, Endep), imipramine (Tofranil), nortriptyline (Pamelor), doxepin (Sinequan), and others; a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil), ketoprofen (Orudis, Orudis KT, Oruvail), naproxen (Naprosyn, Anaprox, Aleve), and others;

an antidiabetic medicine such as glipizide (Glucotrol), glyburide (Micronase, Glynase, Diabeta), and others; or

a steroid medicine such as prednisone (Orasone, Deltasone), prednisolone (Delta Cortef, Prelone), methylprednisolone (Medrol), and others.

You may not be able to take hydralazine/hydrochlorothiazide/reserpine, or you may require a dosage adjustment or special monitoring during your treatment if you are taking any of the medicines listed above.

Also, before taking hydralazine/hydrochlorothiazide/reserpine, tell your doctor if you are taking any medicine to treat high blood pressure, water retention, heart problems, prostate problems, or another condition. Some medicines used to treat these conditions may interact with hydralazine/hydrochlorothiazide/reserpine, and the interaction may increase the effects on your heart.

Hydralazine/hydrochlorothiazide/reserpine may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine unless your doctor approves.

Drugs other than those listed here may also interact with hydralazine/hydrochlorothiazide/reserpine or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

More Hydrap-ES resources Hydrap-ES Side Effects (in more detail)Hydrap-ES Use in Pregnancy & BreastfeedingHydrap-ES Drug InteractionsHydrap-ES Support Group0 Reviews for Hydrap-ES - Add your own review/rating Ser-Ap-Es Prescribing Information (FDA) Compare Hydrap-ES with other medications High Blood Pressure Where can I get more information? Your pharmacist has additional information about hydralazine/hydrochlorothiazide/reserpine written for health professionals that you may read. What does my medication look like?

Hydralazine/hydrochlorothiazide/reserpine is available with a prescription under the brand name Ser-Ap-Es. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Hydralazine/hydrochlorothiazide/reserpine strengths are as follows:

Ser-Ap-Es (25 mg/15 mg/0.1mg)--round, salmon-pink, dry-coated tablets

See also: Hydrap-ES side effects (in more detail)

Read More:

Uni Serp

Generic Name: hydralazine/hydrochlorothiazide/reserpine (hye DRAL a zeen/hye droe klor oh THYE a zide/re SER peen)
Brand Names: Diuretic Ap-Es, Hydrap-ES, Ser-Ap-Es, Serpazide, Tri-Hydroserpine, Uni Serp

What is Uni Serp (hydralazine/hydrochlorothiazide/reserpine)?

Hydralazine is a vasodilator. It lowers blood pressure by relaxing (widening) blood vessels (veins and arteries) and making it easier for your heart to pump.

Hydrochlorothiazide is a thiazide diuretic (water pill). It helps to lower your blood pressure and decrease edema (swelling or water retention) by increasing the amount of salt and water you lose in your urine.

Reserpine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels (veins and arteries) to relax and your heart to beat more slowly and easily.

The combination, hydralazine/hydrochlorothiazide/reserpine, is used to lower high blood pressure.

Hydralazine/hydrochlorothiazide/reserpine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Uni Serp (hydralazine/hydrochlorothiazide/reserpine)? Stand up slowly from a sitting or lying position. Hydralazine/hydrochlorothiazide/reserpine may make you feel dizzy. Do not stop taking hydralazine/hydrochlorothiazide/reserpine suddenly. Even if you feel better, you need this medication to control your condition. Stopping suddenly could cause severely high blood pressure, anxiety, and other dangerous side effects. Use caution when driving, operating machinery, or performing other hazardous activities. Hydralazine/hydrochlorothiazide/reserpine may cause dizziness. If you experience dizziness, avoid these activities. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking this medication. What should I discuss with my healthcare provider before taking Uni Serp (hydralazine/hydrochlorothiazide/reserpine)? Do not take hydralazine/hydrochlorothiazide/reserpine without first talking to your doctor if you

have an allergy to sulfa-based drugs such as sulfa antibiotics;

have coronary heart disease or mitral valvular rheumatic heart disease;

have peptic ulcer disease (stomach ulcers);

have ulcerative colitis;

are suffering from depression (especially if you have suicidal thoughts);

are receiving electroconvulsive shock therapy; or

have taken a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days.

You may not be able to take hydralazine/hydrochlorothiazide/reserpine if you have any of the conditions listed above.

Before taking this medication, tell your doctor if you

have gallstones,

have kidney or liver disease,

have diabetes,

have gout,

have a collagen vascular disease such as systemic lupus erythematosus,

have pancreatitis,

have asthma,

have any type of heart disease,

have had a stroke or a transient ischemic attack (mini-stroke),

have high cholesterol or high levels of fat in your blood, or

have pulmonary hypertension (a type of lung disease).

You may require a dosage adjustment or special monitoring during therapy with hydralazine/hydrochlorothiazide/reserpine if you have any of the conditions listed above.

Hydralazine/hydrochlorothiazide/reserpine is in the FDA pregnancy category C. This means that it is not known whether hydralazine/hydrochlorothiazide/reserpine will harm an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant. Hydralazine/hydrochlorothiazide/reserpine passes into breast milk and may harm a nursing infant. Do not take this medication without first talking to your doctor if you are breast-feeding a baby. If you are over 60 years of age, you may be more likely to experience side effects from hydralazine/hydrochlorothiazide/reserpine therapy. You may require a lower dose of this medication. How should I take Uni Serp (hydralazine/hydrochlorothiazide/reserpine)?

Take the medication exactly as directed. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water. Take the medication with food or milk if it upsets your stomach.

Do not suddenly stop taking hydralazine/hydrochlorothiazide/reserpine. Stopping suddenly could make your condition much worse or cause very serious side effects. Talk to your doctor before you stop taking this medication.

Store this medication at room temperature away from moisture and heat. What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose? Seek emergency medical attention.

Symptoms of an overdose include low blood pressure (fainting, dizziness, weakness), slow pulse or an irregular heartbeat, low body temperature, diarrhea, increased urination, vomiting, headache, flushing of the skin, and slow breathing.

What should I avoid while taking Uni Serp (hydralazine/hydrochlorothiazide/reserpine)? Use caution when driving, operating machinery, or performing other hazardous activities. This medicine may cause dizziness. If you experience dizziness, avoid these activities. Avoid alcohol while taking hydralazine/hydrochlorothiazide/reserpine. Alcohol may increase the drowsiness caused by this medication and may increase dizziness. Use caution even with small amounts of alcohol. Use caution when rising from a sitting or lying position, especially first thing in the morning. You may become dizzy while taking hydralazine/hydrochlorothiazide/reserpine, and you may fall and injure yourself.

Do not let yourself become overheated in hot weather or during exercise, and use caution if you have a fever. Dehydration may increase the effects of hydralazine/hydrochlorothiazide/reserpine, and you may become very dizzy.

Avoid prolonged exposure to sunlight. Hydrochlorothiazide may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable. Uni Serp (hydralazine/hydrochlorothiazide/reserpine) side effects If you experience any of the following serious side effects, stop taking hydralazine/hydrochlorothiazide/reserpine and seek emergency medical attention:

an allergic reaction (difficulty breathing, closing of your throat, swelling of your lips, tongue or face, hives);

irregular or fast heartbeats or a fluttering feeling in your chest;

new or worsening chest pain;

heart failure (shortness of breath, swelling of ankles or legs, sudden weight gain of 2 pounds in one day or 5 pounds in one week);

unusual fatigue or confusion;

abnormal bleeding or bruising;

yellow skin or eyes;

blood in your urine or stools;

little or no urine;

numbness, tingling, pain, or weakness of your arms or legs; or

fainting.

Other, less serious side effects are more likely to occur. Continue to take hydralazine/hydrochlorothiazide/reserpine and talk to your doctor if you experience

mild fatigue, drowsiness, or dizziness;

headache;

water retention (swelling of the hands, feet, or ankles);

anxiety, depression, or nightmares;

diarrhea, nausea, vomiting , abdominal pain;

stuffy nose or a dry mouth;

muscle weakness or cramps;

increased hunger, thirst, or urination;

a rash;

sensitivity to sunlight; or

impotence or difficulty ejaculating.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Uni Serp (hydralazine/hydrochlorothiazide/reserpine)?

Do not take this medication if you have taken a monoamine oxidase inhibitor (MAOI), such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate), in the last 14 days.

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

digoxin (Lanoxin, Lanoxicaps);

quinidine (Cardioquin, others);

lithium (Lithobid, Eskalith, others);

a tricyclic antidepressant such as amitriptyline (Elavil, Endep), imipramine (Tofranil), nortriptyline (Pamelor), doxepin (Sinequan), and others; a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil), ketoprofen (Orudis, Orudis KT, Oruvail), naproxen (Naprosyn, Anaprox, Aleve), and others;

an antidiabetic medicine such as glipizide (Glucotrol), glyburide (Micronase, Glynase, Diabeta), and others; or

a steroid medicine such as prednisone (Orasone, Deltasone), prednisolone (Delta Cortef, Prelone), methylprednisolone (Medrol), and others.

You may not be able to take hydralazine/hydrochlorothiazide/reserpine, or you may require a dosage adjustment or special monitoring during your treatment if you are taking any of the medicines listed above.

Also, before taking hydralazine/hydrochlorothiazide/reserpine, tell your doctor if you are taking any medicine to treat high blood pressure, water retention, heart problems, prostate problems, or another condition. Some medicines used to treat these conditions may interact with hydralazine/hydrochlorothiazide/reserpine, and the interaction may increase the effects on your heart.

Hydralazine/hydrochlorothiazide/reserpine may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives (used to treat insomnia), pain relievers, anxiety medicines, and muscle relaxants. Tell your doctor about all medicines that you are taking, and do not take any medicine unless your doctor approves.

Drugs other than those listed here may also interact with hydralazine/hydrochlorothiazide/reserpine or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

More Uni Serp resources Uni Serp Side Effects (in more detail) Uni Serp Use in Pregnancy & Breastfeeding Uni Serp Drug Interactions Uni Serp Support Group 0 Reviews for Uni Serp - Add your own review/rating Ser-Ap-Es Prescribing Information (FDA) Compare Uni Serp with other medications High Blood Pressure Where can I get more information? Your pharmacist has additional information about hydralazine/hydrochlorothiazide/reserpine written for health professionals that you may read. What does my medication look like?

Hydralazine/hydrochlorothiazide/reserpine is available with a prescription under the brand name Ser-Ap-Es. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Hydralazine/hydrochlorothiazide/reserpine strengths are as follows:

Ser-Ap-Es (25 mg/15 mg/0.1mg)--round, salmon-pink, dry-coated tablets

See also: Uni Serp side effects (in more detail)

Read More:

Uni Serp

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