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Hydrochlorothiazide/timolol and Alcohol/Food Interactions

There are 7 alcohol/food/lifestyle interactions with hydrochlorothiazide / timolol.

Moderate

Timolol Alcohol (Ethanol)

Moderate Drug Interaction

MONITOR: Although they are often combined in clinical practice, diuretics and beta-blockers may increase the risk of hyperglycemia and hypertriglyceridemia in some patients, especially in patients with diabetes or latent diabetes. In addition, the risk of QT interval prolongation and arrhythmias (e.g. torsades de pointes) due to sotalol may be increased by potassium-depleting diuretics.

MANAGEMENT: Monitoring of serum potassium levels, blood pressure, and blood glucose is recommended during coadministration. Patients should be advised to seek medical assistance if they experience dizziness, weakness, fainting, fast or irregular heartbeats, or loss of blood glucose control.

References (5)
  1. Dornhorst A, Powell SH, Pensky J (1985) "Aggravation by propranolol of hyperglycaemic effect of hydrochlorothiazide in type II diabetics without alteration of insulin secretion." Lancet, 1, p. 123-6
  2. Roux A, Le Liboux A, Delhotal B, Gaillot J, Flouvat B (1983) "Pharmacokinetics in man of acebutolol and hydrochlorothiazide as single agents and in combination." Eur J Clin Pharmacol, 24, p. 801-6
  3. Dean S, Kendall MJ, Potter S, Thompson MH, Jackson DA (1985) "Nadolol in combination with indapamide and xipamide in resistant hypertensives." Eur J Clin Pharmacol, 28, p. 29-33
  4. (2002) "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer
  5. Marcy TR, Ripley TL (2006) "Aldosterone antagonists in the treatment of heart failure." Am J Health Syst Pharm, 63, p. 49-58
Moderate

Timolol Alcohol (Ethanol)

Moderate Drug Interaction

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia. Patients should also avoid driving or operating hazardous machinery until they know how the medications affect them.

References (10)
  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
  9. (2023) "Product Information. Buprenorphine (buprenorphine)." G.L. Pharma UK Ltd
  10. (2023) "Product Information. Temgesic (buprenorphine)." Reckitt Benckiser Pty Ltd
Moderate

Hydrochlorothiazide Alcohol (Ethanol)

Moderate Drug Interaction

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia. Patients should also avoid driving or operating hazardous machinery until they know how the medications affect them.

References (10)
  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
  9. (2023) "Product Information. Buprenorphine (buprenorphine)." G.L. Pharma UK Ltd
  10. (2023) "Product Information. Temgesic (buprenorphine)." Reckitt Benckiser Pty Ltd
Moderate

Timolol Multivitamins With Minerals

Moderate Drug Interaction

MONITOR: Although they are often combined in clinical practice, diuretics and beta-blockers may increase the risk of hyperglycemia and hypertriglyceridemia in some patients, especially in patients with diabetes or latent diabetes. In addition, the risk of QT interval prolongation and arrhythmias (e.g. torsades de pointes) due to sotalol may be increased by potassium-depleting diuretics.

MANAGEMENT: Monitoring of serum potassium levels, blood pressure, and blood glucose is recommended during coadministration. Patients should be advised to seek medical assistance if they experience dizziness, weakness, fainting, fast or irregular heartbeats, or loss of blood glucose control.

References (5)
  1. Dornhorst A, Powell SH, Pensky J (1985) "Aggravation by propranolol of hyperglycaemic effect of hydrochlorothiazide in type II diabetics without alteration of insulin secretion." Lancet, 1, p. 123-6
  2. Roux A, Le Liboux A, Delhotal B, Gaillot J, Flouvat B (1983) "Pharmacokinetics in man of acebutolol and hydrochlorothiazide as single agents and in combination." Eur J Clin Pharmacol, 24, p. 801-6
  3. Dean S, Kendall MJ, Potter S, Thompson MH, Jackson DA (1985) "Nadolol in combination with indapamide and xipamide in resistant hypertensives." Eur J Clin Pharmacol, 28, p. 29-33
  4. (2002) "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer
  5. Marcy TR, Ripley TL (2006) "Aldosterone antagonists in the treatment of heart failure." Am J Health Syst Pharm, 63, p. 49-58
Moderate

Timolol Multivitamins With Minerals

Moderate Drug Interaction

ADJUST DOSING INTERVAL: Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers. The exact mechanism of interaction is unknown. In six healthy subjects, calcium 500 mg (as lactate, carbonate, and gluconate) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of atenolol (100 mg) by 51% and 32%, respectively. The elimination half-life increased by 44%. Twelve hours after the combination, beta-blocking activity (as indicated by inhibition of exercise tachycardia) was reduced compared to that with atenolol alone. However, during a 4-week treatment in six hypertensive patients, there was no difference in blood pressure values between treatments. The investigators suggest that prolongation of the elimination half-life induced by calcium coadministration may have led to atenolol cumulation during long-term dosing, which compensated for the reduced bioavailability.

MANAGEMENT: It may help to separate the administration times of beta-blockers and calcium products by at least 2 hours. Patients should be monitored for potentially diminished beta-blocking effects following the addition of calcium therapy.

References (1)
  1. Kirch W, Schafer-Korting M, Axthelm T, Kohler H, Mutschler E (1981) "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther, 30, p. 429-35

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Moderate

Timolol High Cholesterol (Hyperlipoproteinemia, Hypertriglyceridemia, Sitosterolemia)

Moderate Potential Hazard, Moderate plausibility

beta-blockers - hyperlipidemia

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 (39)
  1. Rossner S, Weiner L (1983) "Atenolol and metoprolol: comparison of effects on blood pressure and serum lipoproteins, and side effects." Eur J Clin Pharmacol, 24, p. 573-7
  2. Valimaki M, Maass L, Harno K, Nikkila EA (1986) "Lipoprotein lipids and apoproteins during beta-blocker administration: comparison of penbutolol and atenolol." Eur J Clin Pharmacol, 30, p. 17-20
  3. Disler LJ, Joffe BI, Seftel HC (1988) "Massive hypertriglyceridemia associated with atenolol." Am J Med, 85, p. 586-7
  4. Harvengt C, Heller FR, Martiat P, Nieuwenhuyze YV (1987) "Short-term effects of beta blockers atenolol, nadolol, pindolol, and propranolol on lipoprotein metabolism in normolipemic subjects." J Clin Pharmacol, 27, p. 475-80
  5. Darga LL, Hakim MJ, Lucas CP, Franklin BA (1991) "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, p. 590-6
  6. Weiner L, Rossner S (1983) "Atenolol 50 mg or metoprolol 200 mg: a comparison of antihypertensive efficacy, side effects and lipoprotein changes." Acta Med Scand, 677, p. 153-7
  7. Ferrara LA, Marotta T, Scilla A, et al. (1984) "Effect of oxprenolol and metoprolol on serum lipid concentration." Eur J Clin Pharmacol, 26, p. 331-4
  8. Pasotti C, Capra A, Fiorella G, et al. (1982) "Effects of pindolol and metoprolol on plasma lipids and lipoproteins." Br J Clin Pharmacol, 13, s435-9
  9. Carlson LA, Ribacke M, Terent A (1987) "A long-term study on the effect of pindolol on serum lipoproteins: a preliminary report." Br J Clin Pharmacol, 24, s61-2
  10. Samuel P, Chin B, Schoenfeld BH, et al. (1987) "Comparison of the effect of pindolol versus propranolol on the lipid profile in patients treated for hypertension." Br J Clin Pharmacol, 24, s63-4
  11. Terent A, Ribacke M, Carlson LA (1989) "Long-term effect of pindolol on lipids and lipoproteins in men with newly diagnosed hypertension." Eur J Clin Pharmacol, 36, p. 347-50
  12. Sasaki J, Saku K, Ideishi M, et al. (1989) "Effects of pindolol on serum lipids, apolipoproteins, and lipoproteins in patients with mild to moderate essential hypertension." Clin Ther, 11, p. 219-24
  13. Szollar LG, Meszaros I, Tornoci L, et al. (1990) "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, p. 911-7
  14. Leren P, Foss PO, Nordvik B, Fossbakk B (1988) "The effect of enalapril and timolol on blood lipids." Acta Med Scand, 223, p. 321-6
  15. (2002) "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories
  16. (2002) "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc
  17. (2002) "Product Information. Normodyne (labetalol)." Schering Corporation
  18. (2002) "Product Information. Trandate (labetalol)." Glaxo Wellcome
  19. (2002) "Product Information. Corgard (nadolol)." Bristol-Myers Squibb
  20. (2001) "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories
  21. (2001) "Product Information. Blocadren (timolol)." Merck & Co., Inc
  22. Northcote RJ, Packard CJ, Ballantyne D (1986) "The effect of sotalol on plasma lipoproteins and apolipoproteins." Clin Chim Acta, 158, p. 187-91
  23. Lehtonen A, Hietanen E, Marniemi J, Peltonen P, Nikkila EA (1983) "Effect of sotalol withdrawal on serum lipids and lipoprotein lipase activity." Int J Clin Pharmacol Ther Toxicol, 21, p. 73-6
  24. (2001) "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical
  25. (2001) "Product Information. Kerlone (betaxolol)." Searle
  26. (2001) "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals
  27. (2001) "Product Information. Betapace (sotalol)." Berlex Laboratories
  28. (2001) "Product Information. Zebeta (bisoprolol)." Lederle Laboratories
  29. Safran AB, Simona F, Sansonetti A, Pometta D, James R (1994) "Effects of ocular carteolol and timolol on plasma high-density lipoprotein cholesterol level." Am J Ophthalmol, 117, p. 683
  30. (2001) "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation
  31. Clucas A, Miller N (1988) "Effects of acebutolol on the serum lipid profile." Drugs, 36 Suppl 2, p. 41-50
  32. (2001) "Product Information. Levatol (penbutolol)." Reed and Carnrick
  33. Kasiske BL, Ma JZ, Kalil RS, Louis TA (1995) "Effects of antihypertensive therapy on serum lipids." Ann Intern Med, 122, p. 133-41
  34. Lind L, Pollare T, Berne C, Lithell H (1994) "Long-term metabolic effects of antihypertensive drugs." Am Heart J, 128, p. 1177-83
  35. Sasaki J, Kajiyama G, Kusukawa R, Mori H, Koga S, Takagi R, Tanaka N, Ogawa N, Arakawa K (1994) "Effect of bevantolol and propranolol on serum lipids in patients with essential hypertension." Int J Clin Pharmacol Ther, 32, p. 660-4
  36. (2001) "Product Information. Coreg (carvedilol)." SmithKline Beecham
  37. Lithell H, Andersson PE (1997) "Metabolic effects of carvedilol in hypertensive patients." Eur J Clin Pharmacol, 52, p. 13-7
  38. Gordon NF, Scott CB, Duncan JJ (1997) "Effects of atenolol versus enalapril on cardiovascular fitness and serum lipids in physically active hypertensive men." Am J Cardiol, 79, p. 1065-9
  39. (2007) "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals
Moderate

Hydrochlorothiazide High Cholesterol (Hyperlipoproteinemia, Hypertriglyceridemia, Sitosterolemia)

Moderate Potential Hazard, Moderate plausibility

thiazides - hyperlipidemia

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 (22)
  1. Pollare T, Lithell H, Berne C (1989) "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." N Engl J Med, 321, p. 868-73
  2. Ames RP, Hill P (1976) "Increase in serum-lipids during treatment of hypertension with chlorthalidone." Lancet, 1, p. 721-3
  3. Fager G, Berglund G, Bondjers G, Elmfeldt D, Lager I, Olofsson SO, Smith U, Wiklund O (1983) "Effects of anti-hypertensive therapy on serum lipoproteins. Treatment with metoprolol, propranolol and hydrochlorothiazide." Artery, 11, p. 283-96
  4. Beling S, Vukovich RA, Neiss ES, Zisblatt M, Webb E, Losi M (1983) "Long-term experience with indapamide." Am Heart J, 106, p. 258-62
  5. Slotkoff L (1983) "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J, 106, p. 233-7
  6. (2002) "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Co., Inc
  7. (2002) "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer
  8. Luther RR, Glassman HN, Estep CB, Maurath CJ, Jordan DC (1989) "The effects of terazosin and methyclothiazide on blood pressure and serum lipids." Am Heart J, 117, p. 842-7
  9. (2001) "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer
  10. (2001) "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc
  11. (2001) "Product Information. Diuril (chlorothiazide)." Merck & Co., Inc
  12. Smith WM (1979) "Diuretics and cholesterol elevation." JAMA, 242, p. 1612
  13. (2001) "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical
  14. (2001) "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel
  15. (2001) "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories
  16. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L (1983) "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl, 672, p. 79-83
  17. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC (1980) "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther, 28, p. 611-8
  18. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H (1986) "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing, 15, p. 151-5
  19. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  20. Kasiske BL, Ma JZ, Kalil RS, Louis TA (1995) "Effects of antihypertensive therapy on serum lipids." Ann Intern Med, 122, p. 133-41
  21. Freis ED (1995) "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med, 122, p. 223-6
  22. Ames RP (1996) "A comparison of blood lipid and blood pressure responses during the treatment of systemic hypertension with indapamide and with thiazides." Am J Cardiol, 77, b12-6

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Hydrochlorothiazide/timolol drug interactions

There are 654 drug interactions with hydrochlorothiazide / timolol.

Hydrochlorothiazide/timolol disease interactions

There are 30 disease interactions with hydrochlorothiazide / timolol which include:

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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.

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

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