Propranolol/hydrochlorothiazide | Side Effects, Dosage & More
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Generic Name:

hydrochlorothiazide-propranolol, Oral tablet

All Brands

  • Inderide (Discontinued)
A discontinued drug is a drug that has been taken off the market due to safety issues, shortage of raw materials, or low market demand.
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Highlights for hydrochlorothiazide-propranolol

Oral tablet
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Propranolol/hydrochlorothiazide is a combination of two drugs in a single form. These drugs work in different ways to treat high blood pressure. This medication is given when one of these drugs alone (or a similar one) isn’t enough to lower your blood pressure.

2

Don’t stop taking this drug suddenly. Doing so may cause worse chest pain (angina) or a heart attack. If you need to stop taking this drug, your doctor will slowly decrease your dose.

3

Common side effects include tiredness, a slow heart rate, dizziness, or headache. They also include nausea, vomiting, diarrhea, constipation, or upset stomach.

4

Propranolol/hydrochlorothiazide is only available as a generic drug. It doesn’t have a brand-name version.

5

You shouldn’t take this drug if you have a very slow heart rate, congestive heart failure, or asthma. You also shouldn’t take it if you don’t make any urine (anuria). 

IMPORTANT INFORMATION

FDA warning

This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to effects that may be dangerous.

Stopping the drug warning. Don’t stop taking this drug without talking to your doctor first. Suddenly stopping this drug may cause worse chest pain (angina) or a heart attack. This risk is higher in people with a history of heart disease. If you need to stop taking this drug, your doctor will slowly decrease your dose.

Diabetes

This medication can mask some of the signs of low blood sugar, especially a fast heart rate. If you’re on insulin or other diabetes drugs, you may need to monitor your blood sugar more closely.

Breathing problems

You shouldn’t take this drug if you have asthma or other respiratory diseases without talking to your doctor. It can make it harder for you to breathe.

Major surgery

Propranolol/hydrochlorothiazide may increase your risk of complications from anesthesia and surgery. Be sure your doctor knows that you’re taking this drug. You shouldn’t stop taking it before your surgery unless your doctor says to do so.

What is propranolol/hydrochlorothiazide?

Propranolol/hydrochlorothiazide is a prescription drug. It comes in the form of a tablet you take by mouth.

Propranolol/hydrochlorothiazide is only available as a generic drug. It’s not available in a brand-name version. Generic drugs usually cost less than brand-name drugs.

This medication is a combination of two drugs in a single form. It’s important to know about both drugs in the combination because each drug may affect you in a different way.

Propranolol/hydrochlorothiazide may be used as part of a combination therapy. This means you may need to take it with other medications to lower your blood pressure.

Why it's used

Propranolol/hydrochlorothiazide is used to treat high blood pressure. It’s given when one of these medications alone (or a similar one) isn’t enough to lower your blood pressure. Propranolol/hydrochlorothiazide may be used as the first medication to treat high blood pressure if your doctor decides that you’ll likely need more than one drug.

How it works

Propranolol/hydrochlorothiazide is a combination of two drugs. Propranolol belongs to a class of drugs called beta-blockers. Hydrochlorothiazide belongs to a class of drugs called thiazide diuretics. A class of drugs is a group of medications that work in a similar way. They are often used to treat similar conditions.

More Details

How it works

Propranolol/hydrochlorothiazide is a combination of two drugs. Propranolol belongs to a class of drugs called beta-blockers. Hydrochlorothiazide belongs to a class of drugs called thiazide diuretics. A class of drugs is a group of medications that work in a similar way. They are often used to treat similar conditions.

Propranolol works by relaxing your blood vessels and slowing down your heart rate. This allows blood to flow more easily through your body and decreases the amount of work your heart needs to do. These effects lower your blood pressure.

Hydrochlorothiazide works by helping your kidneys get rid of sodium (a salt) and water through your urine. This also helps reduce your blood pressure.

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hydrochlorothiazide-propranolol Side Effects

Oral tablet

More Common Side Effects

The more common side effects that can occur with propranolol/hydrochlorothiazide include:

  • tiredness

  • a slower than normal heart rate

  • dizziness

  • headache

  • dry mouth or thirst

  • nausea

  • vomiting

  • diarrhea

  • constipation

  • upset stomach

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Heart failure. Symptoms can include:

    • shortness of breath
    • chronic coughing or wheezing
    • swelling in the ankles or legs
    • tiredness
    • lightheadedness
    • nausea or loss of appetite
    • confusion or trouble thinking
    • fast heart rate
  • Breathing problems. Symptoms can include:

    • shortness of breath
    • trouble breathing or swallowing
  • Severe allergic reaction. Symptoms can include:

    • trouble breathing
    • swelling of your throat, tongue, hands, feet, ankles, or lower legs
    • hives
  • Skin problems. Symptoms can include:

    • severe rash with peeling skin
    • sores in your mouth or nose, or around your eyes
  • Vision problems, including glaucoma or nearsightedness (your risk of glaucoma may be higher if you have a sulfonamide or penicillin allergy). Symptoms can include:

    • eye pain
    • blurred vision
    • trouble seeing far away
    • seeing halos around objects
  • Electrolyte imbalances. Symptoms can include:

    • dry mouth
    • increased thirst
    • weakness
    • tiredness
    • restlessness
    • muscle pain or cramps
    • muscle weakness
    • urinating smaller amounts
    • faster heart rate
    • nausea
    • vomiting
  • Systemic lupus erythematosus (SLE). Symptoms can include:

    • severe skin rash (may present as a butterfly-shaped rash across the nose)
    • mouth sores
    • tiredness
    • joint pain
    • hair loss
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Propranolol/hydrochlorothiazide may cause drowsiness.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
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hydrochlorothiazide-propranolol May Interact with Other Medications

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Propranolol/hydrochlorothiazide can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Alcohol interaction

If you drink alcohol with this drug, propranolol/hydrochlorothiazide might take longer to leave your body. This means you may have an increased level of this drug in your body. This can cause worse side effects, such as slowed reflexes, poor judgment, or sleepiness. It also raises your risk of dangerously low blood pressure.

Medications that might interact with this drug

Asthma drugs

Taking certain asthma drugs with propranolol/hydrochlorothiazide can increase the amount of asthma medication in your body. This means you may have more side effects. These drugs include:

  • theophylline

Blood pressure drugs

These drugs may increase the effects of propranolol/hydrochlorothiazide on your heart. This can greatly slow down your heart rate. These drugs include:

  • reserpine

Diabetes drugs

Propranolol/hydrochlorothiazide can mask some of the signs of low blood sugar, especially fast heart rate. If you’re taking diabetes medications, you may need to monitor your blood sugar more closely. Your doctor may adjust the dose of your diabetes drugs, especially if you’re at a higher risk for hypoglycemia (low blood sugar). Diabetes drugs include:

  • chlorpropamide
  • glimepiride
  • glipizide
  • glyburide
  • tolazamide
  • tolbutamide
  • nateglinide
  • repaglinide
  • insulin

Heart drugs

Using these drugs with propranolol/hydrochlorothiazide can greatly slow down your heart rate. If you’re taking these drugs, ask your doctor if taking propranolol/hydrochlorothiazide is safe for you. These drugs include:

  • digoxin
  • verapamil
  • diltiazem

Heartburn drugs

Taking certain heartburn drugs with propranolol/hydrochlorothiazide can increase the amount of this drug in your body. This means that you may have more side effects. These heartburn drugs include:

  • cimetidine

Pain drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) can affect the way propranolol/hydrochlorothiazide works in your kidneys. This means it may not work as well to lower your blood pressure. NSAIDs include:

  • diclofenac
  • etodolac
  • ibuprofen
  • indomethacin
  • ketorolac
  • meloxicam
  • nabumetone
  • naproxen

Psychiatric drugs

Taking certain psychiatric drugs with propranolol/hydrochlorothiazide can cause your blood pressure to drop to dangerously low levels. It also raises your risk of heart attack. These drugs include:

  • haloperidol

Lithium is used to treat certain mood disorders. When it’s taken with propranolol/hydrochlorothiazide, the amount of lithium in your body may be increased. This raises your risk of lithium side effects. These include trouble with coordination, slurred speech, or shakiness.

Seizure drugs

Taking certain seizure drugs with propranolol/hydrochlorothiazide can make this drug less effective. This means it may not work as well to lower your blood pressure. These seizure drugs include:

  • phenytoin
  • phenobarbital

Thyroid drugs

Taking certain thyroid drugs with propranolol/hydrochlorothiazide can make the thyroid medication less effective. These drugs include: 

  • levothyroxine

Tuberculosis drugs

Taking certain tuberculosis drugs with propranolol/hydrochlorothiazide can make this drug less effective. This means it may not work as well to lower your blood pressure. These tuberculosis drugs include:

  • rifampin

Other drugs

Chlopromazine is used to treat several conditions, including schizophrenia. When it’s taken with propranolol/hydrochlorothiazide, the levels of both drugs in your body can be increased. This can cause more side effects from both drugs.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Propranolol/hydrochlorothiazide warnings
heart failure
People with heart failure or heart disease

This drug may worsen your heart failure. Don’t stop taking this drug without talking to your doctor first. Suddenly stopping this drug may cause worse chest pain (angina) or a heart attack. This risk is higher in people with a history of heart disease. If you need to stop taking this drug, your doctor will slowly decrease your dose. If you have a slow heart rate (bradycardia) or second- or third-degree heart block, you shouldn’t take this medication. It could slow your heart rate even more.

breathing problems
People with breathing problems

You shouldn’t use this drug if you have asthma. If you have COPD, ask your doctor if this drug is safe for you. This drug could make it harder to breathe, or it may stop some breathing medications from working well.

diabetes
People with diabetes

This medication can block symptoms of low blood sugar, such as a fast heart rate. If you have excessive sweating and dizziness without an increased heart rate while taking this drug, you may have low blood sugar.

thyroid problems
People with thyroid problems

This drug may mask the symptoms of hyperthyroidism, such as a fast heart rate. If you stop taking this drug suddenly, it may cause your hyperthyroidism symptoms to get much worse. You may need urgent medical care. Tell your doctor if you have any thyroid problems before starting this medication.

kidney problems
People with kidney problems

Propranolol/hydrochlorothiazide is removed from your body by your kidneys. If your kidneys don’t work well, it may take longer for this drug to clear your body. It may build up, which may increase your risk of serious side effects. If your kidney disease gets worse while you’re on this drug, your doctor should stop this medication.

liver problems
People with liver problems

Propranolol/hydrochlorothiazide works by removing extra water and salt from your body. If you have liver disease, these changes can cause complications, including coma. Talk to your doctor about whether this drug is safe for you.

gout
People with gout

This drug may increase the level of uric acid in your body. This can make your gout worse.

pregnant women
Pregnant women

Propranolol/hydrochlorothiazide is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should only be used if the potential benefit justifies the potential risk to the fetus.

breastfeeding
Women who are breast-feeding

Propranolol/hydrochlorothiazide may pass into breast milk and cause serious effects in a breast-fed child.

Talk to your doctor if you breast-feed your baby. You may need to decide whether to stop breast-feeding or stop taking this medication.

for seniors
For seniors

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

for children
For children

This medication hasn’t been studied in children. It shouldn’t be used in children younger than 18 years.

call doctor
When to call the doctor

Call your doctor if you plan to have surgery. You may need to temporarily stop taking this medication.

Call your doctor if you become pregnant while taking this drug.

allergies
Allergies

Propranolol/hydrochlorothiazide can cause a severe allergic reaction. Symptoms can include: 

  • trouble breathing
  • swelling of your throat or tongue
  • hives
  • rash

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room.

Hydrochlorothiazide is a sulfonamide drug. If you’re allergic to sulfonamide (sulfa drugs), don’t take this drug. Also, if you’re allergic to penicillin, your risk of glaucoma is increased when taking propranolol/hydrochlorothiazide.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it a second time after an allergic reaction could be fatal.

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How to Take hydrochlorothiazide-propranolol (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your doctor will tell you what dosage is right for you. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Important considerations for propranolol/hydrochlorothiazide

High blood pressure (hypertension)

Generic: propranolol/hydrochlorothiazide

Form: Oral tablet
Strengths: 
  • 40 mg propranolol/25 mg hydrochlorothiazide
  • 80 mg propranolol/25 mg hydrochlorothiazide
Adult dosage (ages 18–64 years)
  • Typical starting dose: 1 tablet of 40 mg propranolol/25 mg hydrochlorothiazide taken by mouth twice per day
  • Maximum dose: 1 tablet of 80 mg propranolol/25 mg hydrochlorothiazide taken by mouth twice per day
Child dosage (ages 0–17 years)

This medication hasn’t been studied in children. It shouldn’t be used in people younger than 18 years.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Propranolol/hydrochlorothiazide comes with serious risks if you don't take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all

If you don’t take this medication, your blood pressure may get worse. You’ll have a higher risk of chest pain (angina) or heart attack. If you stop this drug suddenly, your blood pressure may spike. This can cause chest pain or a heart attack. Don’t stop taking propranolol/hydrochlorothiazide without talking to your doctor.

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much

You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • slow heart rate
  • low blood pressure
  • fainting
  • trouble breathing

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room right away.

What to do if you miss a dose

If you forget to take your dose, take it as soon as you remember. If it’s just a few hours until the time for your next dose, then wait and only take one dose at that time. Never try to catch up by taking two doses at once. This could cause dangerous side effects.

How to tell if the drug is working

Your blood pressure should go down. Your doctor will monitor your blood pressure regularly. Your doctor may also suggest that you buy a home blood pressure monitor and check your blood pressure at home.

Propranolol/hydrochlorothiazide is used for long-term treatment.

Important considerations for taking propranolol/hdyrochlorothiazide

Take your medication at the same time every day

Hydrochlorothiazide, one of the drugs in this medication, is a diuretic. This means it may make you urinate more often. Taking your second dose with the evening meal instead of at bedtime may be helpful. It may decrease the number of times you get up at night to use the bathroom.

Store this drug carefully

  • Keep propranolol/hydrochlorothiazide at room temperature between 68°F (20°C) and 77°F (25°C).
  • Don’t freeze this drug.
  • Keep this drug away from light.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Travel

When traveling with your medication:

  • Always carry it with you or in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.

Self-management

You may need to check your blood pressure at home. You should keep a log with the date, time of day, and your blood pressure readings. Bring this log with you to your doctor appointments.

Your doctor may suggest that you buy a home blood pressure monitor. This will allow you to check your blood pressure at home.

Clinical monitoring

During treatment with this drug, your doctor will check your:

  • kidney function
  • liver function
  • electrolyte levels (the salts in your body, such as potassium)
  • blood pressure
  • heart rate

Sun sensitivity

Propranolol/hydrochlorothiazide can make your skin more sensitive to the sun. This increases your risk of sunburn. Avoid the sun if you can. If you can’t, be sure to wear protective clothing and apply sunscreen.

Hidden costs

If your doctor asks you to check your blood pressure at home, you’ll need a blood pressure monitor. These are available at most pharmacies.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other options that may work for you.

What does the pill look like?

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Show Sources

  • Mylan Pharmaceuticals Inc. (2015, June). Propranolol hydrochloride and hydrochlorothiazide [package insert]. Morgantown, WV.

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on September 18, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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