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Pronunciation:

(proe PRAN oh lole & hye droe klor oh THYE a zide)

U.S. Brand Names:

Inderide®

Synonyms:

Hydrochlorothiazide and Propranolol

Generic Available:

Yes

Use:

Management of hypertension

Pregnancy Risk Factor:

Pregnancy Implications:

See individual agents.

Lactation:

Enters breast milk/compatible

Adverse Reactions:

See individual agents.

Drug Interactions:

Propranolol: Substrate of CYP1A2 (major), 2C19 (major), 2D6 (major), 3A4 (minor); Inhibits CYP1A2 (weak), 2D6 (weak)

Also see individual agents.

Pharmacodynamics/Kinetics:

See individual agents.

Dosage:

Oral: Adults: Hypertension: Dose is individualized; typical dosages of hydrochlorothiazide: 12.5-50 mg/day; initial dose of propranolol: 80 mg/day

Daily dose of tablet form should be divided into 2 daily doses; may be used to maximum dosage of up to 160 mg of propranolol; higher dosages would result in higher than optimal thiazide dosages.

Patient Education:

See individual agents. Pregnancy precaution: Inform prescriber if you are or intend to become pregnant.

Cardiovascular Considerations:

Combination therapy for the treatment of hypertension should be individualized for each patient. Potential advantages for propranolol and hydrochlorothiazide combination therapy may include improved compliance and synergistic reductions in blood pressure with an accompanied reduction in side effects. See Special Cardiovascular Considerations for individual agents.

Dental Health: Effects on Dental Treatment:

Noncardioselective beta-blockers (ie, propranolol, nadolol) enhance the pressor response to epinephrine, resulting in hypertension and bradycardia. Many nonsteroidal anti-inflammatory drugs, such as ibuprofen and indomethacin, can reduce the hypotensive effect of beta-blockers after 3 or more weeks of therapy with the NSAID. Short-term NSAID use (ie, 3 days) requires no special precautions in patients taking beta-blockers.

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Use with caution; epinephrine has interacted with nonselective beta-blockers to result in initial hypertensive episode followed by bradycardia

Mental Health: Effects on Mental Status:

Propranolol may cause fatigue and malaise which are commonly mistaken for depression; may also cause dizziness, confusion, insomnia, or hallucinations

Mental Health: Effects on Psychiatric Treatment:

Concurrent use with psychotropic drugs may produce additive hypotensive effects; monitor blood pressure. May decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels. Cutaneous reactions, including Stevens-Johnson syndrome, have been reported with use of propranolol; use caution with lamotrigine or valproic combination as combined usage with propranolol has been associated with these reactions.

Dosage Forms:

Tablet (Inderide®):

40/25: Propranolol hydrochloride 40 mg and hydrochlorothiazide 25 mg

80/25: Propranolol hydrochloride 80 mg and hydrochlorothiazide 25 mg

References

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,"JAMA, 2003, 289(19):2560-71.

Kaplan NM and Sever PS, "Combination Therapy: A Key to Comprehensive Patient Care,"Am J Hypertens, 1997, 10(7 Pt 2):127S.

Moser M and Black HR, "The Role of Combination Therapy in the Treatment of Hypertension,"Am J Hypertens, 1998, 11(6 Pt 2):73S-8S, 95S-100S.

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