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Lopressor HCT (hydrochlorothiazide / metoprolol) Disease Interactions

There are 30 disease interactions with Lopressor HCT (hydrochlorothiazide / metoprolol):

Major

Beta-blockers (applies to Lopressor HCT) bradyarrhythmia/AV block

Major Potential Hazard, High plausibility. Applicable conditions: Heart Block, Sinus Node Dysfunction

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to exacerbate these conditions.

References

  1. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  2. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  3. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  4. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  5. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  6. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  7. Treseder AS, Thomas TP "Sinus arrest due to timolol eye drops." Br J Clin Pract 40 (1986): 256-8
  8. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  9. Frishman WH "Carvedilol." N Engl J Med 339 (1998): 1759-65
  10. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  11. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.
  12. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  14. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  15. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  16. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  17. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  18. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  19. Crean PA, Williams DO "Effect of intravenous and oral acebutolol in patients with bundle branch block." Int J Cardiol 10 (1986): 119-26
  20. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  21. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
View all 21 references
Major

Beta-blockers (applies to Lopressor HCT) cardiogenic shock/hypotension

Major Potential Hazard, High plausibility.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with hypotension or cardiogenic shock. Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to further depress cardiac output and blood pressure, which can be detrimental in these patients.

References

  1. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  2. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Betagan Liquifilm (levobunolol)." Allergan Inc, Irvine, CA.
  4. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  5. "Product Information. Acupress (carteolol ophthalmic)." Otsuka American Pharmaceuticals Inc, Rockville, MD.
  6. Kholeif M, Isles C "Profound hypotension after atenolol in severe hypertension." Br Med J 298 (1989): 161-2
  7. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  9. Tirlapur VG, Evans PJ, Jones MK "Shock syndrome after acebutolol." Br J Clin Pract 40 (1986): 33-4
  10. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.
  11. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  12. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  13. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  14. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  15. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  16. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  17. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  18. Frishman WH "Carvedilol." N Engl J Med 339 (1998): 1759-65
  19. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  20. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  21. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  22. "Product Information. OptiPranolol (metipranolol)." Bausch and Lomb, Tampa, FL.
  23. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
View all 23 references
Major

Beta-blockers (applies to Lopressor HCT) CHF

Major Potential Hazard, High plausibility. Applicable conditions: Congestive Heart Failure

Beta-adrenergic receptor blocking agents (aka beta-blockers) in general should not be used in patients with overt congestive heart failure (CHF). Sympathetic stimulation may be important in maintaining the hemodynamic function in these patients, thus beta-blockade can worsen the heart failure. However, therapy with beta-blockers may be beneficial and can be administered cautiously in some CHF patients provided they are well compensated and receiving digitalis, diuretics, an ACE inhibitor, and/or nitrates. Carvedilol, specifically, is indicated for use with these agents in the treatment of mild to severe heart failure of ischemic or cardiomyopathic origin. There is also increasing evidence that the addition of a beta-blocker to standard therapy can improve morbidity and mortality in patients with advanced heart failure, although it is uncertain whether effectiveness varies significantly with the different agents. Data from one meta-analysis study suggest a greater reduction of mortality risk for nonselective beta-blockers than for beta-1 selective agents.

References

  1. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  2. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  3. Kalman J, Buchholz C, Steinmetz M, Courtney M, Gass A, Lansman S, Kukin ML "Safety and efficacy of beta blockade in patients with chronic congestive heart failure awaiting transplantation." J Heart Lung Transplant 14 (1995): 1212-7
  4. Australia-New Zealand Heart Failure Research Collaborative Group. "Effects of carvedilol, a vasodilator-B-blocker, in patients with congestive heart failure due to ischemic heart disease." Circulation 92 (1995): 212-8
  5. Olsen SL, Gilbert EM, Renlund DG, Taylor DO, Yanowitz FD, Bristow MR "Carvedilol improves left ventricular function and symptoms in chronic heart failure: a double-blind randomized study." J Am Coll Cardiol 25 (1995): 1225-31
  6. Cleland JGF, Swedberg K "Carvedilol for heart failure, with care." Lancet 347 (1996): 1199-201
  7. Altus P "Timolol-induced congestive heart failure." South Med J 74 (1981): 88
  8. Myers J, Morgan T, Waga S, et al "Long-term experiences with labetalol." Med J Aust 1 (1980): 665-6
  9. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  10. Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, Shusterman NH "The effect of carvedilol on morbidity and mortality in patients with chronic heart failure." N Engl J Med 334 (1996): 1349-55
  11. Frishman WH "Carvedilol." N Engl J Med 339 (1998): 1759-65
  12. Moye LA, Abernethy D "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1318
  13. Michelson EL, Frishman WH, Lewis JE, et al "Multicenter clinical evaluation of long-term efficacy and safety of labetalol in treatment of hypertension." Am J Med Oct 17 (1983): 68-80
  14. Bristow MR, Gilbert EM, Abraham WT, et al. "Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. MOCHA Investigators." Circulation 94 (1996): 2807-16
  15. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  16. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  17. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  18. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  19. Adams KF Jr "Current perspectives on B-receptor antagonists in the treatment of symptomatic ventricular dysfunction." Pharmacotherapy 16(2 Pt 2) (1996): 69-77
  20. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  21. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  22. Krum H, Sackner-Bernstein JD, Goldsmith RL, et al. "Double-blind, placebo-controlled study of the long-term efficacy of carvedilol in patients with severe chronic heart failure." Circulation 92 (1995): 1499-506
  23. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.
  24. Packer M, Colucci WS, Sackner-Bernstein JD, Liang CS, Goldscher DA, Freeman I, Kukin ML, Kinhal V, Udelson JE, Klapholz M, Gottlieb SS, Pearle D "Double-blind, placebo-controlled study of the effects of carvedilol in patients with moderate to severe heart failure. The PRECISE Trial Prospective Randomized Evaluation of Carvedilol on Symptoms an Exercise." Circulation 94 (1996): 2793-9
  25. Phillips KA, Shlipak MG, Coxson P, et al. "Health and economic benefits of increased B-blocker use following myocardial infarction." JAMA 284 (2000): 2748-54
  26. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  27. Macmahon S, Sharpe N, Doughty R, Krum H, Tonkin A, Trotter A, Burton R, Garrett J, Lane G, Owensby D, Ryan J, Shepherd J, Sing "Randomised, placebo-controlled trial of carvedilol in patients with congestive heart failure due to ischaemic heart disease." Lancet 349 (1997): 375-80
  28. Kelly DT "Carvedilol in heart failure." Cardiology 82 Suppl 3 (1993): 45-9
  29. Macdonald PS, Keogh AM, Aboyoun CL, Lund M, Amor R, McCaffrey DJ "Tolerability and efficacy of carvedilol in patients with New York Heart Association class IV heart failure." J Am Coll Cardiol 33 (1999): 924-31
  30. CIBIS-II Investigators and Committees. "The cardiac insufficiency bisoprolol study II (CIBIS-II): a randomised trial." Lancet 353 (1999): 9-13
  31. Packer M, Cohn JN, Colucci WS "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1310-20
  32. Lechat P, Packer M, Chalon S, Cucherat M, Arab T, Boissel JP "Clinical effects of beta-adrenergic blockade in chronic heart failure: A meta-analysis of double-blind, placebo-controlled, randomized trials." Circulation 98 (1998): 1184-91
  33. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  34. Persson H, Rythenalder E, Melcher A, Erhardt L "Effects of beta receptor antagonists in patients with clinical evidence of heart failure after myocardial infarction: double blind comparison of metoprolol and xamoterol." Br Heart J 74 (1995): 140-8
  35. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  36. Lechat P, Jaillon P, Fontaine ML, Chanton E, Mesenge C, Gagey S, Guillardeau A, Dussous V "A randomized trial of beta-blockade in heart failure - the cardiac insufficiency bisoprolol study (CIBIS)." Circulation 90 (1994): 1765-73
  37. Tcherdakoff P "Side-effects with long-term labetalol: an open study of 251 patients in a single centre." Pharmatherapeutica 3 (1983): 342-8
  38. Doughty RN, Whalley GA, Gamble G, MacMahon S, Sharpe N "Left ventricular remodeling with carvedilol in patients with congestive heart failure due to ischemic heart disease. Australia-Ne Zealand Heart Failure Research Collaborative Group." J Am Coll Cardiol 29 (1997): 1060-6
  39. Colucci WS, Packer M, Bristow MR, Gilbert EM, Cohn JN, Fowler MB, Krueger SK, Hershberger R, Uretsky BF, Bowers JA, Sackne "Carvedilol inhibits clinical progression in patients with mild symptoms of heart failure." Circulation 94 (1996): 2800-6
  40. Hjalmarson A, Goldstein S, Fagerberg B, et al. "Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF)." JAMA 283 (2000): 1295-302
  41. Persson SV, Erhardt L "Effects of beta receptor antagonists on left ventricular function in patients with clinical evidence of heart failure after myocardial infarction. A double-blind comparison of metoprolol and xamoterol: echocardiographic results from the Metoprolol and..." Eur Heart J 17 (1996): 741-9
  42. Maisel AS "Beneficial effects of metoprolol treatment in congestive heart failure - reversal of sympathetic-induced alterations of immunologic function." Circulation 90 (1994): 1774-80
  43. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  44. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  45. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  46. Von Olshausen K, Pop T, Berger J "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1318-20
  47. Hart SM "Influence of B-blockers on mortality in chronic heart failure." Ann Pharmacother 34 (2000): 1440-51
View all 47 references
Major

Beta-blockers (applies to Lopressor HCT) diabetes

Major Potential Hazard, High plausibility. Applicable conditions: Diabetes Mellitus

Beta-adrenergic receptor blocking agents (aka beta-blockers) may mask symptoms of hypoglycemia such as tremors, tachycardia and blood pressure changes. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may inhibit catecholamine-mediated glycogenolysis, thereby potentiating insulin-induced hypoglycemia and delaying the recovery of normal blood glucose levels. Since cardioselectivity is not absolute, larger doses of beta-1 selective agents may demonstrate these effects as well. Therapy with beta-blockers should be administered cautiously in patients with diabetes or predisposed to spontaneous hypoglycemia.

References

  1. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  2. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  3. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  5. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  6. Grimaldi A, Bennett P, Delas B, et al "Beta-blockers and hypoglycaemia: assessment of cardioselective and intrinsic sympathomimetic properties in relation to severity of hypoglycaemia." Curr Ther Res Clin Exp 36 (1984): 361-73
  7. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  9. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  10. Velde TM, Kaiser FE "Ophthalmic timolol treatment causing altered hypoglycemic response in a diabetic patient." Arch Intern Med 143 (1983): 1627
  11. Giugliano D, Acampora R, Marfella R, DeRosa N, Ziccardi P, Ragone R, DeAngelis L, DOnofrio F "Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension - A randomized, controlled trial." Ann Intern Med 126 (1997): 955-9
  12. Darga LL, Hakim MJ, Lucas CP, Franklin BA "Comparison of the effects of guanadrel sulfate and propranolol on blood pressure, functional capacity, serum lipoproteins and glucose in systemic hypertension." Am J Cardiol 67 (1991): 590-6
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  14. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  15. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.
  16. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  17. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  18. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  19. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  20. Uusitupa M, Aro A, Pietikainen M "Severe hypoglycaemia caused by physical strain and pindolol therapy." Ann Clin Res 12 (1980): 25-7
  21. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
View all 21 references
Major

Beta-blockers (applies to Lopressor HCT) hemodialysis

Major Potential Hazard, High plausibility.

Therapy with beta-adrenergic receptor blocking agents (aka beta-blockers) should be administered cautiously in patients requiring hemodialysis. When given after dialysis, hemodynamic stability should be established prior to drug administration to avoid marked falls in blood pressure. The hemodynamic status should be closely monitored before and after the dose.

References

  1. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  2. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  5. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  6. Miki S, Masumura H, Kaifu Y, Yuasa S "Pharmacokinetics and efficacy of carvedilol in chronic hemodialysis patients with hypertension." J Cardiovasc Pharmacol 18 Suppl 4 (1991): s62-8
  7. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  9. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  10. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  11. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  12. Deetjen A, Heidland A, Pangerl A, Meyer-Sabellek W, Schaefer RM "Antihypertensive treatment with a vasodilating beta-blocker, carvedilol, in chronic hemodialysis patients." Clin Nephrol 43 (1995): 47-52
  13. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  14. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
View all 14 references
Major

Beta-blockers (applies to Lopressor HCT) hypersensitivity

Major Potential Hazard, High plausibility. Applicable conditions: Allergies

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) in patients with a history of allergic reactions or anaphylaxis may be associated with heightened reactivity to culprit allergens. The frequency and/or severity of attacks may be increased during beta-blocker therapy. In addition, these patients may be refractory to the usual doses of epinephrine used to treat acute hypersensitivity reactions and may require a beta-agonist such as isoproterenol.

References

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  3. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  5. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  6. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  8. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  9. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  11. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  12. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  13. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.
  14. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  15. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  16. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
View all 16 references
Major

Beta-blockers (applies to Lopressor HCT) ischemic heart disease

Major Potential Hazard, High plausibility.

Heightened sensitivity to catecholamines may occur after prolonged use of beta-adrenergic receptor blocking agents (aka beta-blockers). Exacerbation of angina, myocardial infarction and ventricular arrhythmias have been reported in patients with coronary artery disease following abrupt withdrawal of therapy. Cessation of beta-blocker therapy, whenever necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks in patients with coronary insufficiency. Patients should be advised not to discontinue treatment without first consulting with the physician. In patients who experience an exacerbation of angina following discontinuation of beta-blocker therapy, the medication should generally be reinstituted, at least temporarily, along with other clinically appropriate measures.

References

  1. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  2. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  3. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  4. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  5. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  6. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  9. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  10. Rangno RE, Langlois S "Comparison of withdrawal phenomena after propranolol, metoprolol, and pindolol." Am Heart J 104 (1982): 473-8
  11. Szecsi E, Kohlschutter S, Schiess W, Lang E "Abrupt withdrawal of pindolol or metoprolol after chronic therapy." Br J Clin Pharmacol 13 (1982): s353-7
  12. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  13. Miller RR, Olson HG, Amsterdam EA, Mason DT "Propranolol-withdrawal rebound phenomenon: exacerbation of coronary events after abrupt cessation of antianginal therapy." N Engl J Med 293 (1975): 416-8
  14. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  15. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  16. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  17. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  18. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  19. Walden RJ, Hernandez J, Yu Y, et al "Withdrawal of beta-blocking drugs." Am Heart J 104 (1982): 515-20
View all 19 references
Major

Beta-blockers (applies to Lopressor HCT) PVD

Major Potential Hazard, High plausibility. Applicable conditions: Peripheral Arterial Disease

Due to their negative inotropic and chronotropic effects on the heart, beta-adrenergic receptor blocking agents (aka beta-blockers) reduce cardiac output and may precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may attenuate catecholamine-mediated vasodilation during exercise by blocking beta-2 receptors in peripheral vessels. Therapy with beta-blockers should be administered cautiously in patients with peripheral vascular disease. Close monitoring for progression of arterial obstruction is advised.

References

  1. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  2. Coppeto JR "Transient ischemic attacks and amaurosis fugax from timolol." Ann Ophthalmol 17 (1985): 64-5
  3. Michelson EL, Frishman WH, Lewis JE, et al "Multicenter clinical evaluation of long-term efficacy and safety of labetalol in treatment of hypertension." Am J Med Oct 17 (1983): 68-80
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  5. Broeder CE, Thomas EL, Martin NB, Hofman Z, Jesek JK, Scruggs KD, Wambsgans KC, Wilmore JH "Effects of propranolol and pindolol on cardiac output during extended periods of low-intensity physical activity." Am J Cardiol 72 (1993): 1188-95
  6. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. Breckenridge A, Roberts DH "Antihypertensive treatment in concomitant peripheral vascular disease: current experience and the potential of carvedilol." J Cardiovasc Pharmacol 18 Suppl 4 (1991): s78-81
  8. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  9. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  10. Lepantalo M "Beta blockade and intermittent claudication." Acta Med Scand 700 (1985): 1-48
  11. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  12. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  13. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  14. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  15. Eliasson K, Danielson M, Hylander B, Lindblad LE "Raynaud's phenomenon caused by beta-receptor blocking drugs." Acta Med Scand 215 (1984): 333-9
  16. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  17. Eliasson K, Lins L-E, Sundqvist K "Peripheral vasospasm during beta-receptor blockade: a comparison between metoprolol and pindolol." Acta Med Scand 665 (1982): 109-12
  18. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  19. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  20. Holti G "A double-blind study of the peripheral vasoconstrictor effects of the beta-blocking drug penbutolol in patients with Raynaud's phenomenon." Curr Med Res Opin 6 (1979): 267-70
  21. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  22. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  23. Tcherdakoff P "Side-effects with long-term labetalol: an open study of 251 patients in a single centre." Pharmatherapeutica 3 (1983): 342-8
  24. Myers J, Morgan T, Waga S, et al "Long-term experiences with labetalol." Med J Aust 1 (1980): 665-6
  25. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
View all 25 references
Major

Metoprolol (applies to Lopressor HCT) liver disease

Major Potential Hazard, High plausibility.

Metoprolol is primarily metabolized by the liver. Patients with liver disease may be at greater risk for adverse effects from metoprolol due to decreased drug clearance. Therapy with metoprolol should be administered cautiously in patients with liver disease. Dosage adjustments may be necessary.

References

  1. Silas JH, McGourty JC, Lennard MS, Tucker GT, Woods HF "Polymorphic metabolism of metoprolol: clinical studies." Eur J Clin Pharmacol 28 (1985): 85-8
  2. Regardh CG, Borg KO, Johansson R, et al "Pharmacokinetic studies on the selective beta1-receptor antagonist metoprolol in man." J Pharmacokinet Biopharm 2 (1974): 347-64
  3. Johnson JA, Burlew BS "Metoprolol metabolism via cytochrome p4502d6 in ethnic populations." Drug Metab Dispos 24 (1996): 350-5
  4. Regardh C-G, Jordo L, Ervik M, et al "Pharmacokinetics of metoprolol in patients with hepatic cirrhosis." Clin Pharmacokinet 6 (1981): 375-88
View all 4 references
Major

Thiazides (applies to Lopressor HCT) anuria

Major Potential Hazard, High plausibility.

The use of thiazide diuretics is contraindicated in patients with anuria.

References

  1. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  2. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  3. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL.
  4. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  5. "Product Information. Lozol (indapamide)." Rhone-Poulenc Rorer, Collegeville, PA.
  6. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co, Inc, West Point, PA.
  8. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  9. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
View all 9 references
Major

Thiazides (applies to Lopressor HCT) electrolyte losses

Major Potential Hazard, High plausibility. Applicable conditions: Hypokalemia, Diarrhea, Electrolyte Abnormalities, Hyperaldosteronism, Hyponatremia, Magnesium Imbalance, Malnourished, Vomiting, Ventricular Arrhythmia, Dehydration

The use of thiazide diuretics is commonly associated with loss of electrolytes, most significantly potassium but also sodium, chloride, bicarbonate, and magnesium. The loss of other electrolytes such as phosphate, bromide and iodide is usually slight. Potassium and magnesium depletion may lead to cardiac arrhythmias and cardiac arrest. Other electrolyte-related complications include metabolic alkalosis and hyponatremia, which are rarely life-threatening. Therapy with thiazide diuretics should be administered cautiously in patients with or predisposed to fluid and electrolyte depletion, including patients with primary or secondary aldosteronism (may have low potassium levels); those with severe or prolonged diarrhea or vomiting; and those with poor nutritional status. Fluid and electrolyte abnormalities should be corrected prior to initiating therapy, and blood pressure as well as serum electrolyte concentrations monitored periodically and maintained at normal ranges during therapy. Patients should be advised to immediately report signs and symptoms of fluid or electrolyte imbalance, including dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, arrhythmia, or gastrointestinal disturbances such as nausea and vomiting. Digitalized patients and patients with a history of ventricular arrhythmias should be monitored carefully, since development of hypokalemia may be particularly dangerous in these patients. The risk of hypokalemia may be minimized by slow diuresis, a lower thiazide dosage, potassium supplementation, or combined use with a potassium-sparing diuretic.

References

  1. Bain PG, Egner W, Walker PR "Thiazide-induced dilutional hyponatraemia masquerading as subarachnoid haemorrhage ." Lancet 2 (1986): 634
  2. Peters RW, Hamilton J, Hamilton BP "Incidence of cardiac arrhythmias associated with mild hypokalemia induced by low-dose diuretic therapy for hypertension." South Med J 82 (1989): 966-9,
  3. Jorgensen FS, Brunner S "The long-term effect of bendroflumethiazide on renal calcium and magnesium excretion and stone formation in patients with recurring renal stones." Scand J Urol Nephrol 8 (1974): 128-31
  4. Hollifield JW, Slaton PE "Thiazide diuretics, hypokalemia and cardiac arrhythmias." Acta Med Scand Suppl 647 (1981): 67-73
  5. Mroczek WJ "Indapamide: clinical pharmacology, therapeutic efficacy in hypertension, and adverse effects." Pharmacotherapy 3 (1983): 61-7
  6. Brors O, Jacobsen S, Foss OP, Aakvaag A "Effect of repeated doses of hydroflumethiazide on renal excretion of electrolytes and uric acid in healthy subjects." Acta Pharmacol Toxicol (Copenh) 48 (1981): 145-50
  7. Starr JM, Whalley LJ "Hypertensive Old People in Edinburgh (HOPE) Study: electrocardiographic changes after captopril or bendrofluazide treatment." Age Ageing 22 (1993): 343-8
  8. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  9. Landmann-Suter R, Struyvenberg A "Initial potassium loss and hypokalaemia during chlorthalidone administration in patients with essential hypertension: the influence of dietary sodium restriction." Eur J Clin Invest 8 (1978): 155-64
  10. Brater DC "Drug therapy: Diuretic therapy." N Engl J Med 339 (1998): 387-95
  11. Pinnock CA "Hyponatraemia associated with hydrochlorothiazide treatment ." Br Med J 1 (1978): 48
  12. Husby S, Marthedal NJ "Hyponatraemia due to a thiazide diuretic. A case report." Acta Med Scand 210 (1981): 523-4
  13. Gudbrandsson T, Hansson L "Combination therapy with saluretics and atenolol in essential hypertension. Effects on blood pressure, electrolytes and uric acid." Acta Med Scand Suppl 625 (1979): 86-91
  14. Ljunghall S, Backman U, Danielson BG, Fellstrom B, Johansson G, Wikstrom B "Calcium and magnesium metabolism during long-term treatment with thiazides." Scand J Urol Nephrol 15 (1981): 257-62
  15. Oh SJ, Douglas JE, Brown RA "Hypokalemic vacuolar myopathy associated with chlorthalidone treatment." JAMA 216 (1971): 1858-9
  16. Gould L, Reddy CV, Zen B, Singh BK "Life-threatening reaction to thiazides." N Y State J Med 80 (1980): 1975-6
  17. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  18. Berglund G, Andersson O, Larsson O, Wilhelmsen L "Antihypertensive effect and side-effects of bendroflumethiazide and propranolol." Acta Med Scand 199 (1976): 499-506
  19. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl 672 (1983): 79-83
  20. Sumiye L, Vivian AS, Frisof KB, Podany EC "Potassium loss associated with hydrochlorothiazide versus chlorthalidone." Clin Ther 4 (1981): 308-20
  21. el-Meheiry MM, Nabih AE, Soliman MD "A clinical study of a new diuretic, Trichlormethiazide." J Trop Med Hyg 69 (1966): 209-14
  22. Navarro RP, O'Brien DK, Nuffort P, Spencer DL "Diuretic induced hypokalemia in the elderly." J Fam Pract 14 (1982): 685-9
  23. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
  24. Kuller L, Farrier N, Caggiula A, Borhani N, Dunkle S "Relationship of diuretic therapy and serum magnesium levels among participants in the Multiple Risk Factor Intervention Trial." Am J Epidemiol 122 (1985): 1045-59
  25. Holland OB, Kuhnert L, Pollard J, Padia M, Anderson RJ, Blomqvist G "Ventricular ectopic activity with diuretic therapy." Am J Hypertens 1 (1988): 380-5
  26. Condon JR, Nassim R "Hypophosphataemia and hypokalaemia." Br Med J 1 (1970): 110
  27. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co, Inc, West Point, PA.
  28. Black W, Shiner P, Roman J "Severe electrolyte disturbances associated with metolazone and furosemide." South Med J 71 (1978): 381
  29. Medical Research Council Working Party on Mild to Moderate Hypertension. "Ventricular extrasystoles during thiazide treatment: substudy of MRC mild hypertension trial." Br Med J (Clin Res Ed) 287 (1983): 1249-53
  30. Simunic M, Rumboldt Z, Ljutic D, Sardelic S "Ramipril decreases chlorthalidone-induced loss of magnesium and potassium in hypertensive patients." J Clin Pharmacol 35 (1995): 1150-5
  31. Lindy S, Tarssanen L "Serum calcium and phosphorus in patients treated with thiazides and furosemide." Acta Med Scand 194 (1973): 319-22
  32. "Product Information. Lozol (indapamide)." Rhone-Poulenc Rorer, Collegeville, PA.
  33. Katz FH, Eckert RC, Gebott MD "Hypokalemia caused by surreptitious self-administration of diuretics." Ann Intern Med 76 (1972): 85-90
  34. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
  35. Polanska AI, Baron DN "Hyponatraemia associated with hydrochlorothiazide treatment ." Br Med J 1 (1978): 175-6
  36. Papademetriou V, Price M, Notargiacomo A, Gottdiener J, Fletcher RD, Freis ED "Effect of diuretic therapy on ventricular arrhythmias in hypertensive patients with or without left ventricular hypertrophy." Am Heart J 110 (1985): 595-9
  37. Mouallem M, Friedman E, Shemesh Y, Mayan H, Pauzner R, Farfel Z "Cardiac conduction defects associated with hyponatremia." Clin Cardiol 14 (1991): 165-8
  38. Benfield GF, Haffner C, Harris P, Stableforth DE "Dilutional hyponatraemia masquerading as subarachnoid haemorrhage in patient on hydrochlorothiazide/amiloride/timolol combined drug ." Lancet 2 (1986): 341
  39. Falch DK, Schreiner AM "Changes in urinary electrolytes versus serum electrolytes during treatment of primary hypertension with chlorthalidone alone and in combination with spironolactone." Acta Med Scand 209 (1981): 111-4
  40. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  41. Toner JM, Ramsay LE "Thiazide-induced hypokalaemia; prevalence higher in women." Br J Clin Pharmacol 18 (1984): 449-52
  42. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL.
  43. Stern A "Metolazone, a diuretic agent." Am Heart J 91 (1976): 262-3
  44. Hesp R, Wilkinson PR "Potassium supplementation of thiazide therapy." Lancet 2 (1976): 1144
  45. Mozes B, Pines A, Werner D, Olchovsky D, Lieberman P, Frankl O "Thiazide-induced hyponatremia: an unusual neurologic course." South Med J 79 (1986): 629-31
  46. Jensen OB, Mosdal C, Reske-Nielsen E "Hypokalemic myopathy during treatment with diuretics." Acta Neurol Scand 55 (1977): 465-82
  47. Remenchik AP, Johnston LC "Potassium depletion produced by administration of chlorthalidone to nonedematous patients with arterial hypertensin." Am J Med Sci 252 (1966): 171-6
  48. Berg KJ, Gisholt K, Wideroe TE "Potassium deficiency in hypertensives treated with diuretics. Analysis of three alternative treatments by an oral test for potassium deficiency." Eur J Clin Pharmacol 7 (1974): 401-5
  49. Moore TD, Bechtel TP "Hyponatremia secondary to tolbutamide and chlorothiazide." Am J Hosp Pharm 36 (1979): 1107-10
  50. Krishna GG, Narins RG "Hemodynamic consequences of diuretic-induced hypokalemia." Am J Kidney Dis 12 (1988): 329-31
  51. Stewart DE, Ikram H, Espiner EA, Nicholls MG "Arrhythmogenic potential of diuretic induced hypokalaemia in patients with mild hypertension and ischaemic heart disease." Br Heart J 54 (1985): 290-7
  52. Ghose RR "Letter: Hyponatraemia and diuretics." Lancet 1 (1975): 578-9
  53. Papademetriou V, Fletcher R, Khatri IM, Freis ED "Diuretic-induced hypokalemia in uncomplicated systemic hypertension: effect of plasma potassium correction on cardiac arrhythmias." Am J Cardiol 52 (1983): 1017-22
  54. Leigh H "Letter: Factitious hypokalemia." Ann Intern Med 80 (1974): 111-2
  55. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  56. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  57. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing 15 (1986): 151-5
  58. Brors O, Enger E, Jacobsen S, Aakvaag A, Foss OP "Effects of hydroflumethiazide in congestive heart failure: renal electrolyte excretion related to urinary thiazide excretion and aldosterone." Acta Pharmacol Toxicol (Copenh) 49 (1981): 399-406
  59. Fichman MP, Vorherr H, Kleeman CR, Telfer N "Diuretic-induced hyponatremia." Ann Intern Med 75 (1971): 853-63
  60. Kuller LH, Hulley SB, Cohen JD, Neaton J "Unexpected effects of treating hypertension in men with electrocardiographic abnormalities: a critical analysis." Circulation 73 (1986): 114-23
  61. Lee MR, Morgan DB "Familial hyperkalaemia responsive to benzothiadiazine diuretic." Lancet 1 (1980): 879
  62. Chan TY "Indapamide-induced severe hyponatremia and hypokalemia." Ann Pharmacother 29 (1995): 1124-8
  63. Seelig CB "Magnesium deficiency in two hypertensive patient groups." South Med J 83 (1990): 739-42
  64. Struthers AD, Whitesmith R, Reid JL "Prior thiazide diuretic treatment increases adrenaline-induced hypokalaemia." Lancet 1 (1983): 1358-61
  65. Itescu S, Haskell LP, Tannenberg AM "Thiazide-induced clinically significant hypophosphatemia ." Clin Nephrol 27 (1987): 161-2
  66. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther 28 (1980): 611-8
  67. Chowdhury FR, Bleicher SJ "Chlorthalidone--induced hypokalemia and abnormal carbohydrate metabolism." Horm Metab Res 2 (1970): 13-6
  68. Cembrowski GS, Huntington RW, 3d "Probable fatal cardiac dysrhythmia secondary to diuretic-induced hypokalemia." Am J Forensic Med Pathol 2 (1981): 243-8
  69. Byatt CM, Millard PH, Levin GE "Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions." J R Soc Med 83 (1990): 704-8
  70. Ragnarsson J, Hardarson T, Snorrason SP "Ventricular dysrhythmias in middle-aged hypertensive men treated either with a diuretic agent or a beta-blocker." Acta Med Scand 221 (1987): 143-8
  71. Read SJ, Trenerry HM, Whiting GF "Hyponatraemia and raised creatine kinase level associated with indapamide." Med J Aust 161 (1994): 607-8
  72. Kone B, Gimenez L, Watson AJ "Thiazide-induced hyponatremia." South Med J 79 (1986): 1456-7
  73. Beling S, Vukovich RA, Neiss ES, Zisblatt M, Webb E, Losi M "Long-term experience with indapamide." Am Heart J 106 (1983): 258-62
  74. Kaur J, Wahi PL "Polythiazide as a diuretic. A clinical trial." J Indian Med Assoc 48 (1967): 13-7
  75. Papademetriou V, Fletcher R, Khatri IM, Freis ED "Diuretic-induced hypokalemia in uncomplicated systemic hypertension: effect of plasma potassium correction on cardiac arrhythmias." Am J Cardiol 52 (1983): 1017-22
  76. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  77. Carney SL, Morgan TO "Diuretic-induced hypokalemia and altered renal function." Int J Clin Pharmacol Ther Toxicol 24 (1986): 665-7
View all 77 references
Major

Thiazides (applies to Lopressor HCT) liver disease

Major Potential Hazard, High plausibility.

Patients with severe liver disease or cirrhosis are very susceptible to thiazide-induced hypokalemic hypochloremic alkalosis. Blood ammonia concentrations may be further increased in patients with previously elevated concentrations. Hepatic encephalopathy and death have occurred secondary to the electrolyte alterations accompanying diuretic use. Therapy with thiazide diuretics should be administered cautiously in patients with impaired hepatic function or progressive liver disease, and discontinued promptly if signs of impending hepatic coma appear (e.g., tremors, confusion, and increased jaundice).

References

  1. Sherlock S, Senewiratne B, Scott A, Walker JG "Complications of diuretic therapy in hepatic cirrhosis." Lancet 1 (1966): 1049-52
  2. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  3. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  5. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL.
  6. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  7. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  8. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co, Inc, West Point, PA.
  9. Sherlock S, Walker JG, Senewiratne B, Scott A "The complications of diuretic therapy in patients with cirrhosis." Ann N Y Acad Sci 139 (1966): 497-505
  10. "Product Information. Lozol (indapamide)." Rhone-Poulenc Rorer, Collegeville, PA.
  11. Aneckstein AG, Weingold AB "Chlorothiazide-induced hepatic coma in pregnancy." Am J Obstet Gynecol 95 (1966): 136-7
  12. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
View all 12 references
Major

Thiazides (applies to Lopressor HCT) lupus erythematosus

Major Potential Hazard, Moderate plausibility.

The use of thiazide diuretics has been reported to possibly exacerbate or activate systemic lupus erythematosus. Reported cases have generally been associated with chlorothiazide and hydrochlorothiazide. Therapy with thiazide diuretics should be administered cautiously in patients with a history or risk of SLE.

References

  1. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  3. "Product Information. Lozol (indapamide)." Rhone-Poulenc Rorer, Collegeville, PA.
  4. Parodi A, Romagnoli M, Rebora A "Subacute cutaneous lupus erythematosus-like eruption caused by hydrochlorothiazide." Photodermatol 6 (1989): 100-2
  5. Rich MW, Eckman JM "Can hydrochlorothiazide cause lupus?" J Rheumatol 22 (1995): 1001
  6. Reed BR, Huff JC, Jones SK, Orton PW, Lee LA, Norris DA "Subacute cutaneous lupus erythematosus associated with hydrochlorothiazide therapy." Ann Intern Med 103 (1985): 49-51
  7. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  8. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  10. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  11. Goodrich AL, Kohn SR "Hydrochlorothiazide-induced lupus erythematosus: a new variant?" J Am Acad Dermatol 28 (1993): 1001-2
  12. Brown CW, Deng JS "Thiazide diuretics induce cutaneous lupus-like adverse reaction." J Toxicol Clin Toxicol 33 (1995): 729-33
  13. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  14. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL.
View all 14 references
Major

Thiazides (applies to Lopressor HCT) renal function disorders

Major Potential Hazard, High plausibility. Applicable conditions: Renal Dysfunction

Thiazide diuretics may be ineffective when the glomerular filtration rate is low (GFR < 25 mL/min) because they are not expected to be filtered into the renal tubule, their site of action. In addition, thiazide diuretics decrease the GFR and may precipitate azotemia in renal disease. Cumulative effects may also develop because most of these drugs are excreted unchanged in the urine by glomerular filtration and active tubular secretion. Therapy with thiazide diuretics should be administered cautiously at reduced dosages in patients with renal impairment. If renal function becomes progressively worse, as indicated by rising BUN or serum creatinine levels, an interruption or discontinuation of thiazide therapy should be considered.

References

  1. Klunk LJ, Ringel S, Neiss ES "The disposition of 14C-indapamide in man." J Clin Pharmacol 23 (1983): 377-84
  2. el-Meheiry MM, Nabih AE, Soliman MD "A clinical study of a new diuretic, Trichlormethiazide." J Trop Med Hyg 69 (1966): 209-14
  3. Brennan L, Wu MJ, Laquer UJ "A multicenter study of indapamide in hypertensive patients with impaired renal function." Clin Ther 5 (1982): 121-8
  4. Craswell PW, Ezzat E, Kopstein J, Varghese Z, Moorhead JF "Use of metolazone, a new diuretic, in patients with renal disease." Nephron 12 (1974): 63-73
  5. Magil AB "Drug-induced acute interstitial nephritis with granulomas." Hum Pathol 14 (1983): 36-41
  6. Gehr TW, Sica DA, Brater DC, et al "Metolazone pharmacokinetics and pharmacodynamics in renal transplantation." Int J Clin Pharmacol Ther Toxicol 29 (1991): 116-23
  7. Hobbs DC, Twomey TM "Kinetics of polythiazide." Clin Pharmacol Ther 23 (1978): 241-6
  8. Magil AB, Ballon HS, Cameron EC, Rae A "Acute interstitial nephritis associated with thiazide diuretics. Clinical and pathologic observations in three cases." Am J Med 69 (1980): 939-43
  9. Beermann B, Groschinsky-Grind M, Lindstrom B, Wikland B "Pharmacokinetics of bendroflumenthiazide in hypertensive patients." Eur J Clin Pharmacol 13 (1978): 119-24
  10. "Product Information. Lozol (indapamide)." Rhone-Poulenc Rorer, Collegeville, PA.
  11. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL.
  12. Larsson GB, Langer L, Nassberger L "Thiazide-induced kidney damage with circulating antibodies against myeloperoxidase and cardiolipin." J Intern Med 233 (1993): 493-4
  13. Acchiardo SR, Skoutakis VA "Clinical efficacy, safety, and pharmacokinetics of indapamide in renal impairment." Am Heart J 106 (1983): 237-44
  14. Madkour H, Gadallah M, Plante GE, Massry SG "Comparison between the effects of indapamide and hydrochlorothiazide on creatinine clearance in patients with impaired renal function and hypertension." Am J Nephrol 15 (1995): 251-5
  15. Yakatan GJ, Smith RB, Frome EL, Doluisio JT "Pharmacokinetics of orally administered hydroflumethiazide in man." J Clin Pharmacol 17 (1977): 37-47
  16. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  17. Riess W, Dubach UC, Burckhardt D, Theobald W, Vuillard P, Zimmerli M "Pharmacokinetic studies with chlorthalidone (Hygroton) in man." Eur J Clin Pharmacol 12 (1977): 375-82
  18. Delevett AF, Recalde M "Diuretic-induced renal colic." JAMA 225 (1973): 992
  19. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  20. Seyffart, G "Drug Dosage in Renal Insufficiency." Dordrecht, The Netherlands: Kluwer Academic Publishers 1 (1991): 227-8
  21. Newstead CG, Moore RH, Barnes AJ "Interstitial nephritis associated with indapamide." BMJ 300 (1990): 1344
  22. Niemeyer C, Hasenfub G, Wais U, et al "Pharmacokinetics of hydrochlorothiazide in relation to renal function." Eur J Clin Pharmacol 24 (1983): 661-5
  23. Beermann B, Groschinsky-Grind M, Lindstrom B "Pharmacokinetics of bendroflumethiazide." Clin Pharmacol Ther 22 (1977): 385-8
  24. Brors O, Jacobsen S "Distribution of elimination of hydroflumethiazide in man." Eur J Clin Pharmacol 16 (1979): 125-31
  25. Brors O, Haffner JF, Jacobsen S "Excretion of hydroflumethiazide in bile and urine of man." Eur J Clin Pharmacol 15 (1979): 287-9
  26. Bennett WM, Porter GA "Efficacy and safety of metolazone in renal failure and the nephrotic syndrome." J Clin Pharmacol 13 (1973): 357-64
  27. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co, Inc, West Point, PA.
  28. Jones B, Nanra RS "Double-blind trial of antihypertensive effect of chlorothiazide in severe renal failure." Lancet 2 (1979): 1258-60
  29. Sketris IS, Skoutakis VA, Acchiardo SR, Meyer MC "The pharmacokinetics of trichlormethiazide in hypertensive patients with normal and compromised renal function." Eur J Clin Pharmacol 20 (1981): 453-7
  30. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  31. Fleuren HLJ, Verwey-van Wissen C, van Rossum JM "Dose-dependent urinary excretion of chlorthalidone." Clin Pharmacol Ther 25 (1979): 806-12
  32. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  33. Lant AF, Baba WI, Wilson GM "Localization of the site of action of oral diuretics in the human kidney." Clin Sci 33 (1967): 11-27
  34. Read SJ, Trenerry HM, Whiting GF "Hyponatraemia and raised creatine kinase level associated with indapamide." Med J Aust 161 (1994): 607-8
  35. Beermann B, Groschinsky-Grind M, Rosen A "Absorption, metabolism, and excretion of hydrochlorothiazide." Clin Pharmacol Ther 19 (1975): 531-7
  36. Carney SL, Morgan TO "Diuretic-induced hypokalemia and altered renal function." Int J Clin Pharmacol Ther Toxicol 24 (1986): 665-7
  37. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  38. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  39. Gilman AG, Rall TW, Nies AS, Taylor P, eds. "Goodman and Gilman's the Pharmacological Basis of Therapeutics. 8th ed." New York, NY: Pergamon Press Inc. (1990):
  40. Tilstone WJ, Dargie H, Dargie EN, Morgan HG, Kennedy AC "Pharmacokinetics of metolazone in normal subjects and in patients with cardiac or renal failure." Clin Pharmacol Ther 16 (1974): 322-9
  41. Brater DC "Drug therapy: Diuretic therapy." N Engl J Med 339 (1998): 387-95
View all 41 references
Moderate

Beta-blockers (applies to Lopressor HCT) cerebrovascular insufficiency

Moderate Potential Hazard, Moderate plausibility.

Beta-adrenergic blocking agents (beta-blockers), should be used with caution in patients with cerebrovascular insufficiency because of their potential effects relative to blood pressure and pulse. If signs or symptoms suggesting reduced cerebral blood flow are observed, consideration should be given to discontinuing these agents.

Moderate

Beta-blockers (applies to Lopressor HCT) glaucoma

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension

Systemic beta-adrenergic receptor blocking agents (aka beta-blockers) may lower intraocular pressure. Therefore, patients with glaucoma or intraocular hypertension may require adjustments in their ophthalmic regimen following a dosing change or discontinuation of beta-blocker therapy.

References

  1. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  3. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  5. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  6. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  7. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  9. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  10. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  11. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  12. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  13. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  14. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  15. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
View all 15 references
Moderate

Beta-blockers (applies to Lopressor HCT) hyperlipidemia

Moderate Potential Hazard, Moderate plausibility.

Beta-adrenergic receptor blocking agents (aka beta-blockers) may alter serum lipid profiles. Increases in serum VLDL and LDL cholesterol and triglycerides, as well as decreases in HDL cholesterol, have been reported with some beta-blockers. Patients with preexisting hyperlipidemia may require closer monitoring during beta-blocker therapy, and adjustments made accordingly in their lipid-lowering regimen.

References

  1. Samuel P, Chin B, Schoenfeld BH, et al "Comparison of the effect of pindolol versus propranolol on the lipid profile in patients treated for hypertension." Br J Clin Pharmacol 24 (1987): s63-4
  2. Rossner S, Weiner L "Atenolol and metoprolol: comparison of effects on blood pressure and serum lipoproteins, and side effects." Eur J Clin Pharmacol 24 (1983): 573-7
  3. Gordon NF, Scott CB, Duncan JJ "Effects of atenolol versus enalapril on cardiovascular fitness and serum lipids in physically active hypertensive men." Am J Cardiol 79 (1997): 1065-9
  4. Lithell H, Andersson PE "Metabolic effects of carvedilol in hypertensive patients." Eur J Clin Pharmacol 52 (1997): 13-7
  5. Szollar LG, Meszaros I, Tornoci L, et al "Effect of metoprolol and pindolol monotherapy on plasma lipid- and lipoprotein-cholesterol levels (including the HDL subclasses) in mild hypertensive males and females." J Cardiovasc Pharmacol 15 (1990): 911-7
  6. Rossner S, Weiner L "Atenolol and metoprolol: comparison of effects on blood pressure and serum lipoproteins, and side effects." Eur J Clin Pharmacol 24 (1983): 573-7
  7. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  8. Darga LL, Hakim MJ, Lucas CP, Franklin BA "Comparison of the effects of guanadrel sulfate and propranolol on blood pressure, functional capacity, serum lipoproteins and glucose in systemic hypertension." Am J Cardiol 67 (1991): 590-6
  9. Ferrara LA, Marotta T, Scilla A, et al "Effect of oxprenolol and metoprolol on serum lipid concentration." Eur J Clin Pharmacol 26 (1984): 331-4
  10. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  11. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  12. Terent A, Ribacke M, Carlson LA "Long-term effect of pindolol on lipids and lipoproteins in men with newly diagnosed hypertension." Eur J Clin Pharmacol 36 (1989): 347-50
  13. Safran AB, Simona F, Sansonetti A, Pometta D, James R "Effects of ocular carteolol and timolol on plasma high-density lipoprotein cholesterol level." Am J Ophthalmol 117 (1994): 683
  14. Northcote RJ, Packard CJ, Ballantyne D "The effect of sotalol on plasma lipoproteins and apolipoproteins." Clin Chim Acta 158 (1986): 187-91
  15. Sasaki J, Saku K, Ideishi M, et al "Effects of pindolol on serum lipids, apolipoproteins, and lipoproteins in patients with mild to moderate essential hypertension." Clin Ther 11 (1989): 219-24
  16. Clucas A, Miller N "Effects of acebutolol on the serum lipid profile." Drugs 36 Suppl 2 (1988): 41-50
  17. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  18. Valimaki M, Maass L, Harno K, Nikkila EA "Lipoprotein lipids and apoproteins during beta-blocker administration: comparison of penbutolol and atenolol." Eur J Clin Pharmacol 30 (1986): 17-20
  19. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  20. Sasaki J, Kajiyama G, Kusukawa R, Mori H, Koga S, Takagi R, Tanaka N, Ogawa N, Arakawa K "Effect of bevantolol and propranolol on serum lipids in patients with essential hypertension." Int J Clin Pharmacol Ther 32 (1994): 660-4
  21. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  22. Pasotti C, Capra A, Fiorella G, et al "Effects of pindolol and metoprolol on plasma lipids and lipoproteins." Br J Clin Pharmacol 13 (1982): s435-9
  23. Harvengt C, Heller FR, Martiat P, Nieuwenhuyze YV "Short-term effects of beta blockers atenolol, nadolol, pindolol, and propranolol on lipoprotein metabolism in normolipemic subjects." J Clin Pharmacol 27 (1987): 475-80
  24. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  25. Disler LJ, Joffe BI, Seftel HC "Massive hypertriglyceridemia associated with atenolol." Am J Med 85 (1988): 586-7
  26. Kasiske BL, Ma JZ, Kalil RS, Louis TA "Effects of antihypertensive therapy on serum lipids." Ann Intern Med 122 (1995): 133-41
  27. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  28. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  29. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  30. Lehtonen A, Hietanen E, Marniemi J, Peltonen P, Nikkila EA "Effect of sotalol withdrawal on serum lipids and lipoprotein lipase activity." Int J Clin Pharmacol Ther Toxicol 21 (1983): 73-6
  31. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  32. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  33. Carlson LA, Ribacke M, Terent A "A long-term study on the effect of pindolol on serum lipoproteins: a preliminary report." Br J Clin Pharmacol 24 (1987): s61-2
  34. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  35. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  36. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  37. Lind L, Pollare T, Berne C, Lithell H "Long-term metabolic effects of antihypertensive drugs." Am Heart J 128 (1994): 1177-83
  38. Leren P, Foss PO, Nordvik B, Fossbakk B "The effect of enalapril and timolol on blood lipids." Acta Med Scand 223 (1988): 321-6
  39. Weiner L, Rossner S "Atenolol 50 mg or metoprolol 200 mg: a comparison of antihypertensive efficacy, side effects and lipoprotein changes." Acta Med Scand 677 (1983): 153-7
View all 39 references
Moderate

Beta-blockers (applies to Lopressor HCT) hyperthyroidism

Moderate Potential Hazard, High plausibility.

When beta-adrenergic receptor blocking agents (aka beta-blockers) are used to alleviate symptoms of hyperthyroidism such as tachycardia, anxiety, tremor and heat intolerance, abrupt withdrawal can exacerbate thyrotoxicosis or precipitate a thyroid storm. To minimize this risk, cessation of beta-blocker therapy, when necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks. Patients should be advised not to discontinue treatment without first consulting with the physician. Close monitoring is recommended during and after therapy withdrawal.

References

  1. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  3. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  4. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  5. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  6. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  7. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  8. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  10. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  11. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  12. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  14. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  15. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
View all 15 references
Moderate

Beta-blockers (applies to Lopressor HCT) hyperthyroidism PKs

Moderate Potential Hazard, High plausibility.

During chronic administration, the clearance of beta-blockers that are primarily metabolized by the liver (e.g., labetalol, metoprolol, penbutolol, propranolol) may be increased in patients with hyperthyroidism due to increased liver blood flow and enhanced activity of drug-metabolizing enzymes. Pharmacokinetic studies have demonstrated an approximately 50% increase in systemic clearance of propranolol during long-term therapy. In general, the dosage required to achieve therapeutic blood concentrations in such patients may be higher than that required in euthyroid patients and should be individualized.

References

  1. Feely J "Clinical pharmacokinetics of beta-adrenoceptor blocking drugs in thyroid disease." Clin Pharmacokinet 8 (1983): 1-16
  2. O'Connor P, Feely J "Clinical pharmacokinetics and endocrine disorders. Therapeutic implications." Clin Pharmacokinet 13 (1987): 345-64
Moderate

Beta-blockers (applies to Lopressor HCT) myasthenia gravis

Moderate Potential Hazard, Low plausibility. Applicable conditions: Myoneural Disorder

Beta-adrenergic receptor blocking agents (aka beta-blockers) may potentiate muscle weakness consistent with certain myasthenic symptoms such as diplopia, ptosis, and generalized weakness. Several beta-blockers have been associated rarely with aggravation of muscle weakness in patients with preexisting myasthenia gravis or myasthenic symptoms. Use cautiously in patients with myasthenia gravis.

References

  1. Coppeto JR "Timolol-associated myasthenia gravis." Am J Ophthalmol 98 (1984): 244-5
  2. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  3. Confavreux C, Charles N, Aimard G "Fulminant myasthenia gravis soon after initiation of acebutolol therapy." Eur Neurol 30 (1990): 279-81
  4. Herishanu Y, Rosenberg P "Beta-blockers and myasthenia gravis." Ann Intern Med 83 (1975): 834-5
  5. Berstein LP, Henkind P "Additional information on adverse reactions to timolol." Am J Ophthalmol 92 (1981): 295-6
  6. Choi KL, Wat MS, Ip TP, Kung AWC, Lam KSL "Phaeochromocytoma associated with myasthenia gravis precipitated by propranolol treatment." Aust N Z J Med 25 (1995): 257
  7. Verkijk A "Worsening of myasthenia gravis with timolol maleate eyedrops." Ann Neurol 17 (1985): 211-2
View all 7 references
Moderate

Beta-blockers (applies to Lopressor HCT) pheochromocytoma

Moderate Potential Hazard, Moderate plausibility.

Administration of beta-blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta-mediated vasodilatation in skeletal muscle. In patients with pheochromocytoma, an alpha-blocking agent should be initiated prior to the use of any beta-blocking agent. Caution should be taken in the administration of these agents to patients suspected of having pheochromocytoma.

Moderate

Beta-blockers (applies to Lopressor HCT) psoriasis

Moderate Potential Hazard, Moderate plausibility.

The use of beta-blockers in psoriatic patients should be carefully weighed since the use of these agents may cause an aggravation in psoriasis.

Moderate

Beta-blockers (applies to Lopressor HCT) tachycardia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Tachyarrhythmia

Beta-adrenergic blockade in patients with Wolff-Parkinson-White syndrome and tachycardia has been associated with severe bradycardia requiring treatment with a pacemaker. In one case, this result was reported after an initial dose of 5 mg propranolol. The use of beta-adrenergic receptor blocking agents (aka beta-blockers) should be administered cautiously in these patients.

Moderate

Cardioselective beta-blockers (applies to Lopressor HCT) asthma/COPD

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Chronic Obstructive Pulmonary Disease

Patients with bronchospastic disease, should, in general, not receive beta blockers, including cardioselective beta-blockers. Because of the relative beta-1 selectivity, cardioselective beta-blockers may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Because beta-1 selectivity is not absolute, the lowest possible dose of these agents should be used. Consider administering in smaller doses to avoid the higher plasma levels associated with the longer dosing intervals. If dosage must be increased, dividing the dose should be considered to achieve lower peak blood levels. It is recommended to have bronchodilators, including beta-2 agonists, readily available or administered concomitantly if necessary.

Moderate

Thiazides (applies to Lopressor HCT) asthma

Moderate Potential Hazard, Moderate plausibility.

Thiazide diuretics should be used with caution in patients with history of bronchial asthma as sensitivity reactions may occur.

Moderate

Thiazides (applies to Lopressor HCT) diabetes

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus, Abnormal Glucose Tolerance

Thiazide diuretics may cause hyperglycemia and glycosuria in patients with diabetes. They may also precipitate diabetes in prediabetic patients. These effects are usually reversible following discontinuation of the drugs. Therapy with thiazide diuretics should be administered cautiously in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Patients with diabetes mellitus should be monitored more closely during thiazide therapy, and their antidiabetic regimen adjusted accordingly.

References

  1. Nielsen S, Schmitz A, Knudsen RE, Dollerup J, Mogensen CE "Enalapril versus bendroflumethiazide in type 2 diabetes complicated by hypertension." Q J Med 87 (1994): 747-54
  2. Diamond MT "Hyperglycemic hyperosmolar coma associated with hydrochlorothiazide and pancreatitis." N Y State J Med 72 (1972): 1741-2
  3. Blayac JP, Ribes G, Buys D, Puech R, Loubatieres-Mariani MM "Effects of a new benzothiadiazine derivative, LN 5330, on insulin secretion." Arch Int Pharmacodyn Ther 253 (1981): 154-63
  4. Andersen OO, Persson I "Carbohydrate metabolism during treatment with chlorthalidone and ethacrynic acid." Br Med J 2 (1968): 798-801
  5. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing 15 (1986): 151-5
  6. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  7. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  8. Pickkers P, Schachter M, Hughes AD, Feher MD, Sever PS "Thiazide-induced hyperglycaemia: a role for calcium-activated potassium channels?" Diabetologia 39 (1996): 861-4
  9. Berglund G, Andersson O, Widgren B "Low-dose antihypertensive treatment with a thiazide diuretic is not diabetogenic. A 10-year controlled trial with bendroflumethiazide." Acta Med Scand 220 (1986): 419-24
  10. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL.
  11. Berlin I "Prazosin, diuretics, and glucose intolerance." Ann Intern Med 119 (1993): 860
  12. Murphy MB, Kohner E, Lewis PJ, Schumer B, Dollery CT "Glucose intolerance in hypertensive patients treated with diuretics: a fourteen-year follow-up." Lancet 2 (1982): 1293-5
  13. Pollare T, Lithell H, Berne C "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." N Engl J Med 321 (1989): 868-73
  14. Bell DS "Insulin resistance. An often unrecognized problem accompanying chronic medical disorders." Postgrad Med 93 (1993): 99-103,
  15. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  16. Goldman JA, Neri A, Ovadia J, Eckerling B, Vries A, de "Effect of chlorothiazide on intravenous glucose tolerance in pregnancy." Am J Obstet Gynecol 105 (1969): 556-60
  17. Harper R, Ennis CN, Heaney AP, Sheridan B, Gormley M, Atkinson AB, Johnston GD, Bell PM "A comparison of the effects of low- and conventional-dose thiazide diuretic on insulin action in hypertensive patients with NIDDM." Diabetologia 38 (1995): 853-9
  18. Beling S, Vukovich RA, Neiss ES, Zisblatt M, Webb E, Losi M "Long-term experience with indapamide." Am Heart J 106 (1983): 258-62
  19. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
  20. Curtis J, Horrigan F, Ahearn D, Varney R, Sandler SG "Chlorthalidone-induced hyperosmolar hyperglycemic nonketotic coma." JAMA 220 (1972): 1592-3
  21. Rowe P, Mather H "Hyperosmolar non-ketotic diabetes mellitus associated with metolazone." Br Med J 291 (1985): 25-6
  22. Schmitz O, Hermansen K, Nielsen OH, Christensen CK, Arnfred J, Hansen HE, Mogensen CE, Orskov H, Beck-Nielsen H "Insulin action in insulin-dependent diabetics after short-term thiazide therapy." Diabetes Care 9 (1986): 631-6
  23. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther 28 (1980): 611-8
  24. Kansal PC, Buse J, Buse MG "Thiazide diuretics and control of diabetes mellitus." South Med J 62 (1969): 1372-9
  25. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  26. Chowdhury FR, Bleicher SJ "Chlorthalidone--induced hypokalemia and abnormal carbohydrate metabolism." Horm Metab Res 2 (1970): 13-6
  27. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
  28. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co, Inc, West Point, PA.
  29. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  30. Jones IG, Pickens PT "Diabetes mellitus following oral diuretics." Practitioner 199 (1967): 209-10
  31. Domenet JG "Diabetogenic effect of oral diuretics." Br Med J 3 (1968): 188
  32. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  33. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl 672 (1983): 79-83
  34. Seltzer HS, Allen EW "Hyperglycemia and inhibition of insulin secretion during administration of diazoxide and trichlormethiazide in man." Diabetes 18 (1969): 19-28
  35. Miller NR, Moses H "Transient oculomotor nerve palsy. Association with thiazide-induced glucose intolerance." JAMA 240 (1978): 1887-8
  36. "Product Information. Lozol (indapamide)." Rhone-Poulenc Rorer, Collegeville, PA.
View all 36 references
Moderate

Thiazides (applies to Lopressor HCT) hyperlipidemia

Moderate Potential Hazard, Moderate plausibility.

Thiazide diuretics may increase serum triglyceride and cholesterol levels, primarily LDL and VLDL. Whether these effects are dose-related and sustained during chronic therapy are unknown. Patients with preexisting hyperlipidemia may require closer monitoring during thiazide therapy, and adjustments made accordingly in their lipid-lowering regimen

References

  1. Ames RP "A comparison of blood lipid and blood pressure responses during the treatment of systemic hypertension with indapamide and with thiazides." Am J Cardiol 77 (1996): b12-6
  2. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
  3. "Product Information. Lozol (indapamide)." Rhone-Poulenc Rorer, Collegeville, PA.
  4. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
  5. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther 28 (1980): 611-8
  6. Ames RP, Hill P "Increase in serum-lipids during treatment of hypertension with chlorthalidone." Lancet 1 (1976): 721-3
  7. Smith WM "Diuretics and cholesterol elevation." JAMA 242 (1979): 1612
  8. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL.
  9. Pollare T, Lithell H, Berne C "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." N Engl J Med 321 (1989): 868-73
  10. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing 15 (1986): 151-5
  11. Luther RR, Glassman HN, Estep CB, Maurath CJ, Jordan DC "The effects of terazosin and methyclothiazide on blood pressure and serum lipids." Am Heart J 117 (1989): 842-7
  12. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  13. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  14. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  15. Pollare T, Lithell H, Berne C "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." N Engl J Med 321 (1989): 868-73
  16. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co, Inc, West Point, PA.
  17. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl 672 (1983): 79-83
  18. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  19. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  20. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  21. Kasiske BL, Ma JZ, Kalil RS, Louis TA "Effects of antihypertensive therapy on serum lipids." Ann Intern Med 122 (1995): 133-41
  22. Beling S, Vukovich RA, Neiss ES, Zisblatt M, Webb E, Losi M "Long-term experience with indapamide." Am Heart J 106 (1983): 258-62
  23. Fager G, Berglund G, Bondjers G, Elmfeldt D, Lager I, Olofsson SO, Smith U, Wiklund O "Effects of anti-hypertensive therapy on serum lipoproteins. Treatment with metoprolol, propranolol and hydrochlorothiazide." Artery 11 (1983): 283-96
View all 23 references
Moderate

Thiazides (applies to Lopressor HCT) hyperparathyroidism

Moderate Potential Hazard, Moderate plausibility.

Urinary calcium excretion is decreased by thiazide diuretics during chronic administration. Pathologic changes in the parathyroid gland with hypercalcemia and hypophosphatemia have been reported during prolonged therapy. However, the common complications of hyperparathyroidism such as renal lithiasis, bone resorption, and peptic ulceration have not been seen. Clinicians should be cognizant of these effects when prescribing or administering thiazide therapy to patients with hyperparathyroidism. These drugs should be discontinued before carrying out tests for parathyroid function.

References

  1. Lindy S, Tarssanen L "Serum calcium and phosphorus in patients treated with thiazides and furosemide." Acta Med Scand 194 (1973): 319-22
  2. Paloyan E, Farland M, Pickleman JR "Hyperparathyroidism coexisting with hypertension and prolonged thiazide administration." JAMA 210 (1969): 1243-5
  3. Itescu S, Haskell LP, Tannenberg AM "Thiazide-induced clinically significant hypophosphatemia ." Clin Nephrol 27 (1987): 161-2
  4. Jorgensen FS, Brunner S "The long-term effect of bendroflumethiazide on renal calcium and magnesium excretion and stone formation in patients with recurring renal stones." Scand J Urol Nephrol 8 (1974): 128-31
  5. Gammon GD, Docherty JP "Thiazide-induced hypercalcemia in a manic-depressive patient." Am J Psychiatry 137 (1980): 1453-5
  6. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  7. Parfitt AM "Thiazide-induced hypercalcemia in vitamin D-treated hypoparathyroidism." Ann Intern Med 77 (1972): 557-63
  8. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  9. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co, Inc, West Point, PA.
  10. Balizet L "Recurrent parathyroid adenoma. Association with prolonged thiazide administration." JAMA 225 (1973): 1238-9
  11. Klimiuk PS, Davies M, Adams PH "Primary hyperparathyroidism and thiazide diuretics." Postgrad Med J 57 (1981): 80-3
  12. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  13. Anderson PE, Ellis GG, Austin SM "Case report: metolazone-associated hypercalcemia and acute pancreatitis." Am J Med Sci 302 (1991): 235-7
  14. Palmer FJ "Letter: Chlorthalidone-induced hypercalcemia." JAMA 229 (1974): 267
  15. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  16. Hakim R, Tolis G, Goltzman D, Meltzer S, Friedman R "Severe hypercalcemia associated with hydrochlorothiazide and calcium carbonate therapy." Can Med Assoc J 121 (1979): 591-4
  17. Paloyan E, Farland M, Pickleman JR "Hyperparathyroidism coexisting with hypertension and prolonged thiazide administration." JAMA 210 (1969): 1243-5
  18. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  19. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  20. Parfitt AM "Chlorothiazide-induced hypercalcemia in juvenile osteoporosis and hyperparathyroidism." N Engl J Med 281 (1969): 55-9
  21. Ljunghall S, Backman U, Danielson BG, Fellstrom B, Johansson G, Wikstrom B "Calcium and magnesium metabolism during long-term treatment with thiazides." Scand J Urol Nephrol 15 (1981): 257-62
  22. Byatt CM, Millard PH, Levin GE "Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions." J R Soc Med 83 (1990): 704-8
  23. Hilker RR "Reversible hypercalcemia associated with prolonged thiazide administration to control hypertension." J Occup Med 12 (1970): 444-5
  24. "Product Information. Lozol (indapamide)." Rhone-Poulenc Rorer, Collegeville, PA.
  25. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL.
  26. Duarte CG, Winnacker JL, Becker KL, Pace A "Thiazide-induced hypercalcemia." N Engl J Med 284 (1971): 828-30
  27. Popovtzer MM, Subryan VL, Alfrey AC, Reeve EB, Schrier RW "The acute effect of chlorothiazide on serum-ionized calcium. Evidence for a parathyroid hormone-dependent mechanism." J Clin Invest 55 (1975): 1295-302
View all 27 references
Moderate

Thiazides (applies to Lopressor HCT) hyperuricemia

Moderate Potential Hazard, High plausibility. Applicable conditions: Gout

Thiazide diuretics decrease the rate of uric acid excretion. Hyperuricemia occurs frequently but is usually asymptomatic and rarely leads to clinical gout except in patients with a history of gout or chronic renal failure. Therapy with thiazide diuretics should be administered cautiously in such patients.

References

  1. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  2. Beling S, Vukovich RA, Neiss ES, Zisblatt M, Webb E, Losi M "Long-term experience with indapamide." Am Heart J 106 (1983): 258-62
  3. Lapidus PW, Guidotti FP "Gout in orthopaedic practice: review of 232 cases." Clin Orthop 28 (1963): 97-110
  4. "Product Information. Lozol (indapamide)." Rhone-Poulenc Rorer, Collegeville, PA.
  5. Labeeuw M, Pozet N, Aissa AH, Zech PY, Sassard J, Laville M "Uric acid renal handling: spontaneous changes and influence of a thiazide alone or associated with triamterene." Int J Clin Pharmacol Ther Toxicol 26 (1988): 79-83
  6. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co, Inc, West Point, PA.
  7. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  8. Gudbrandsson T, Hansson L "Combination therapy with saluretics and atenolol in essential hypertension. Effects on blood pressure, electrolytes and uric acid." Acta Med Scand Suppl 625 (1979): 86-91
  9. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl 672 (1983): 79-83
  10. Ljunghall S, Backman U, Danielson BG, Fellstrom B, Johansson G, Odlind B, Wikstrom B "Effects of bendroflumethiazide on urate metabolism during treatment of patients with renal stones." J Urol 127 (1982): 1207-10
  11. Brors O, Jacobsen S, Foss OP, Aakvaag A "Effect of repeated doses of hydroflumethiazide on renal excretion of electrolytes and uric acid in healthy subjects." Acta Pharmacol Toxicol (Copenh) 48 (1981): 145-50
  12. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  13. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL.
  14. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  15. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  16. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing 15 (1986): 151-5
  17. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
  18. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  19. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
  20. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther 28 (1980): 611-8
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Moderate

Thiazides (applies to Lopressor HCT) thyroid function tests

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Thyroid Disease

Thiazide diuretics may decrease serum PBI (protein-bound iodine) levels without associated thyroid disturbance. Clinicians should be cognizant of this effect when prescribing or administering thiazide therapy to patients with thyroid disorders.

References

  1. Bech K, Skovsted L, Siersbaek-Nielsen K, Hansen JM "Influence of thiazides on thyroid parameters in man." Acta Endocrinol (Copenh) 89 (1978): 673-8
  2. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc, Bristol, TN.
  3. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  4. "Product Information. Zaroxolyn (metolazone)." Rhone-Poulenc Rorer, Collegeville, PA.
  5. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  6. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co, Inc, West Point, PA.
  7. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical, Abbott Park, IL.
  9. "Product Information. Diuril (chlorothiazide)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Lozol (indapamide)." Rhone-Poulenc Rorer, Collegeville, PA.
View all 10 references

Lopressor HCT (hydrochlorothiazide / metoprolol) drug interactions

There are 619 drug interactions with Lopressor HCT (hydrochlorothiazide / metoprolol)

Lopressor HCT (hydrochlorothiazide / metoprolol) alcohol/food interactions

There are 5 alcohol/food interactions with Lopressor HCT (hydrochlorothiazide / metoprolol)

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.