Individualize. Take once daily. Replacement therapy: may be substituted for individual components. Titrate, if necessary, every 2 weeks up to max 200/25mg. Severe renal impairment: not recommended. Moderate hepatic impairment: consider initiating with lower HCTZ component.
Cardioselective beta-1 blocker + diuretic.
Cardiogenic shock. Overt heart failure. 2nd- or 3rd-degree AV block. Sinus bradycardia. Anuria. Sulfonamide allergy.
Ischemic heart disease. Bronchospastic disease. Pheochromocytoma. Major surgery. Renal or hepatic disease. Diabetes and hypoglycemia. Thyrotoxicosis (hyperthyroidism). Peripheral vascular disease. CHF. SLE. Acute myopia. Secondary angle-closure glaucoma. Gout. Post-sympathectomy. Avoid abrupt cessation. Monitor electrolytes. Pregnancy (Cat.C). Nursing mothers.
Additive effects with catecholamine-depleting drugs (eg, reserpine, MAOIs). Potentiated by CYP2D6 inhibitors (eg, quinidine, fluoxetine, paroxetine, propafenone). Risk of bradycardia with digitalis, clonidine, diltiazem, verapamil. Potentiated by alcohol, barbituates, narcotics, other antihypertensives. Hypokalemia with corticosteroids, ACTH. May increase lithium toxicity. Antagonized by NSAIDs (monitor). Adjust antidiabetic drugs. Decreased absorption with cholestyramine and colestipol resins. Antagonizes norepinephrine. Possible increased response to muscle relaxants (eg, tubocurarine). May interfere with parathyroid tests.
Nasopharyngitis, fatigue, dizziness, back pain, nausea; bronchospasm, bradycardia, CHF, heart block.