Beta-adrenergic Blocking Agents and Thiazide Diuretics (Systemic)

Proper Use of This Medicine

In addition to the use of the medicine your doctor has prescribed, treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that this medicine will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life . If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

For patients taking the extended-release tablet form of this medicine:

• Swallow the tablet whole.
• Do not crush, break, or chew before swallowing.

To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.

Ask your doctor about checking your pulse rate before and after taking beta-blocking agents. Then, while you are taking this medicine, check your pulse regularly. If it is much slower than your usual rate (or less than 50 beats per minute), check with your doctor. A pulse rate that is too slow may cause circulation problems.

The thiazide diuretic (e.g., bendroflumethiazide, chlorthalidone, or hydrochlorothiazide) contained in this combination medicine may cause you to have an unusual feeling of tiredness when you begin to take it. You may also notice an increase in the amount of urine or in your frequency of urination. After you take the medicine for a while, these effects should lessen. To keep the increase in urine from affecting your sleep:

• If you are to take a single dose a day, take it in the morning after breakfast.
• If you are to take more than one dose a day, take the last dose no later than 6 p.m., unless otherwise directed by your doctor.

However, it is best to plan your dose or doses according to a schedule that will least affect your personal activities and sleep. Ask your health care professional to help you plan the best time to take this medicine.

Do not miss any doses . This is especially important when you are taking only one dose per day. Some conditions may become worse when this medicine is not taken regularly.

Dosing - The dose of beta-blocker and thiazide diuretic combinations will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of beta-blocker and thiazide diuretic combinations. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules or tablets that you take depends on the strength of the medicine.

For atenolol and chlorthalidone combination
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 1 or 2 tablets once a day.
    • Children - Dose must be determined by your doctor.

For bisoprolol and hydrochlorothiazide combination
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 1 or 2 tablets once a day.
    • Children - Dose must be determined by your doctor.

For metoprolol and hydrochlorothiazide combination
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 1 or 2 tablets a day.
    • Children - Dose must be determined by your doctor.

For nadolol and bendroflumethiazide combination
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 1 tablet once a day.
    • Children - Dose must be determined by your doctor.

For pindolol and hydrochlorothiazide combination
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 1 or 2 tablets once a day.
    • Children - Dose must be determined by your doctor.

For propranolol and hydrochlorothiazide combination
• For regular (short-acting) oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 1 or 2 tablets two times a day.
    • Children - Dose must be determined by your doctor.
• For long-acting oral dosage form (capsules):
  • For high blood pressure:
    • Adults - 1 capsule a day.
    • Children - Dose must be determined by your doctor.

For timolol and hydrochlorothiazide combination
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 1 tablet two times a day or 2 tablets once a day.
    • Children - Dose must be determined by your doctor.

Missed dose - If you miss a dose of this medicine, take it as soon as possible. However, if it is within 4 hours of your next dose (8 hours if you are using atenolol and chlorthalidone, bisoprolol and hydrochlorothiazide, nadolol and bendroflumethiazide, or extended-release propranolol and hydrochlorothiazide), skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage - To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.