Beta-adrenergic Blocking Agents and Thiazide Diuretics (Systemic)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For the beta-blocker and thiazide diuretic combinations, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to beta-blockers, sulfonamides (sulfa drugs), bumetanide, furosemide, acetazolamide, dichlorphenamide, methazolamide, or any of the thiazide diuretics. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy - Use of some beta-blockers during pregnancy has been associated with low blood sugar, breathing problems, a slower heart rate, and low blood pressure in the newborn infant. Other reports have not shown unwanted effects in the newborn infant. Animal studies have shown some beta-blockers to cause problems in pregnancy when used in doses many times the usual human dose.

Studies with thiazide diuretics have not been done in pregnant women. However, use of thiazide diuretics during pregnancy may cause side effects such as jaundice, blood problems, and low potassium in the newborn infant. Animal studies have not shown thiazide diuretic medicines to cause birth defects even when used in doses several times the usual human dose.

Before taking a beta-blocker and thiazide diuretic combination, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding - Atenolol, metoprolol, nadolol, propranolol, pindolol, timolol, and thiazide diuretics pass into breast milk. It is not known whether bisoprolol passes into breast milk. Thiazide diuretics may decrease the flow of breast milk.

Children - Although there is no specific information comparing use of this combination medicine in children with use in other age groups, this medicine is not expected to cause different side effects or problems in children than it does in adults. However, extra caution may be necessary in infants with jaundice, because these medicines can make the condition worse.

Older adults - Some side effects, especially dizziness or lightheadedness and signs and symptoms of too much potassium loss, may be more likely to occur in the elderly, who are usually more sensitive to the effects of this medicine. Also, beta-blockers may reduce tolerance to cold temperatures in elderly patients.

Other medicines - Although certain medicines should not be used together at all, in other cases 2 different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking beta-blocker and thiazide diuretic combinations, it is especially important that your health care professional know if you are taking any of the following:

• Allergy shots or
• Allergy skin tests - The beta-blocker contained in this medicine may increase the risk of a serious allergic reaction to these medicines

• Aminophylline (e.g., Somophyllin) or
• Caffeine (e.g., NoDoz) or
• Dyphylline (e.g., Lufylline) or
• Oxtriphylline (e.g., Choledyl) or
• Theophylline (e.g., Somophyllin-T) - The effects of these medicines and beta-blockers may be blocked; in addition, theophylline levels in the body may be increased, especially in patients who smoke

• Antidiabetics, oral (diabetes medicine you take by mouth) or
• Insulin - There is an increased risk of hyperglycemia (high blood sugar); the beta-blocker contained in this medicine may also cover up certain symptoms of hypoglycemia (low blood sugar), such as increases in pulse rate and blood pressure, and may make the hypoglycemia last longer

• Calcium channel blockers (amlodipine [e.g., Norvasc], bepridil [e.g., Bepadin], diltiazem [e.g., Cardizem], felodipine [e.g., Plendil], flunarizine [e.g., Sibelium], isradipine [e.g., DynaCirc], nicardipine [e.g., Cardene], nifedipine [e.g., Procardia], nimodipine [e.g., Nimotop], verapamil [e.g., Calan]) or
• Clonidine (e.g., Catapres) or
• Guanabenz (e.g., Wytensin) - Effects on blood pressure may be increased. In addition, unwanted effects may occur if clonidine, guanabenz, or a beta-blocker are stopped suddenly after use together. Unwanted effects on the heart may occur when beta-blocker and thiazide diuretic combinations are used with calcium channel blockers

• Cocaine - Cocaine may block the effects of beta-blockers; in addition, there is an increased risk of high blood pressure, fast heartbeat, and possibly heart problems if you use cocaine while taking a beta-blocker and thiazide diuretic combination

• Digitalis glycosides (heart medicine) - Use with beta-blocker and thiazide diuretic combinations may cause high blood levels of digoxin, which may increase the chance of side effects

• Lithium - The thiazide diuretic contained in this combination may cause high blood levels of lithium, which may increase the chance of side effects

• Monoamine oxidase (MAO) inhibitors (furazolidone [e.g., Furoxone], isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate]) - Taking a beta-blocker and thiazide diuretic combination while you are taking or within 2 weeks of taking monoamine oxidase (MAO) inhibitors may cause severe high blood pressure

Other medical problems - The presence of other medical problems may affect the use of the beta-blockers and thiazide diuretics. Make sure you tell your doctor if you have any other medical problems, especially:

• Allergy, history of (asthma, eczema, hay fever, hives), or
• Bronchitis or
• Emphysema - This combination medicine may make allergic reactions to other substances more severe or make the reaction last longer; in addition, the beta-blocker contained in this combination can increase trouble in breathing

• Bradycardia (unusually slow heartbeat) or
• Heart or blood vessel disease - This combination medicine may make these heart problems worse; also, if treatment is stopped suddenly, unwanted effects may occur

• Diabetes mellitus (sugar diabetes) - The beta-blocker contained in this medicine may cause hyperglycemia (high blood sugar) and circulation problems; in addition, if your diabetes medicine causes your blood sugar to be too low, beta-blockers may cover up some of the symptoms (fast heartbeat), although they will not cover up other symptoms such as dizziness or sweating; the thiazide diuretic contained in this medicine may increase the amount of sugar in the blood

• Gout (history of) or
• Lupus erythematosus (history of) or
• Pancreatitis (inflammation of the pancreas) - The thiazide diuretic contained in this medicine may make these conditions worse

• Kidney disease or
• Liver disease - Effects of this medicine may be increased because of slower removal from the body

• Mental depression (or history of) or
• Myasthenia gravis or
• Pheochromocytoma or
• Psoriasis or
• Raynaud's syndrome - The beta-blocker contained in this medicine may make these conditions worse

• Overactive thyroid - Stopping this medicine suddenly may increase symptoms of overactive thyroid; the beta-blocker contained in this medicine may cover up fast heartbeat, which is a sign of overactive thyroid