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Specific Concerns With Propranolol/HCTZ

Specific Propranolol/HCTZ Precautions and Warnings

Some warnings and precautions to be aware of prior to taking this blood pressure medication include the following:
  • There have been reports of chest pain (angina) and heart attacks in people who suddenly stopped taking propranolol, one of the medications in propranolol/HCTZ. Therefore, if you no longer need this medication, your healthcare provider will likely gradually reduce your dose. Follow your healthcare provider's instructions for stopping this medication.
  • Propranolol/HCTZ may cause extremely low blood pressure or a slow heart rate, especially when you first start taking it. Extremely low blood pressure is more likely to occur in people who are taking high doses of diuretics ("water pills"), dehydrated (which can happen when you are sick with nausea and vomiting), or on kidney dialysis. If you become dizzy, lightheaded, or faint while taking propranolol/HCTZ, lie down and contact your healthcare provider.
  • This medication can alter blood electrolyte levels, including sodium, potassium, and chloride levels. Your healthcare provider may regularly check your electrolyte levels with a blood test during treatment. If you notice any symptoms of an electrolyte imbalance, contact your healthcare provider. Such symptoms may include:
    • Dry mouth
    • Thirst
    • Weakness
    • Extreme tiredness
    • Restlessness
    • Confusion
    • Low blood pressure, which may cause dizziness and lightheadedness
    • Muscle tiredness, pains, or cramps
    • Nausea and vomiting
    • Decreased urination
    • Increased heart rate (tachycardia).
  • Propranolol/HCTZ should be used with caution in people with liver or kidney disease. Your healthcare provider may monitor you more closely if you have one of these conditions.
  • This medicine may worsen systemic lupus erythematosus (lupus or SLE for short) or, in some cases, may even cause the condition. It may also cause or worsen gout, a form of arthritis characterized by high uric acid levels.
  • Propranolol/HCTZ is more likely than other drugs to cause allergic reactions, including dangerous skin rashes. Seek immediate medical attention if you develop signs of an allergic reaction, including:


    • Hives
    • An unexplained rash
    • Difficulty breathing
    • Swelling of the face or throat.
    • Unexplained weight gain
    • Swelling in your arms, hands, legs, or ankles
    • Shortness of breath.
  • Propranolol/HCTZ should be used with extreme caution in people with certain lung diseases, such as asthma, emphysema, and chronic bronchitis. This is because such medications may cause narrowing (constriction) of the airways.
  • Make sure your healthcare provider knows you are taking propranolol/HCTZ before you have major surgery or dental procedures.


  • Drugs that contain hydrochlorothiazide, including this medication, can sometimes cause a potentially dangerous eye reaction (a particularly dangerous type of glaucoma). This reaction usually occurs within days to weeks of starting the drug. Because this reaction can permanently damage vision, let your healthcare provider know right away if you develop vision changes and/or eye pain. The main treatment for this reaction is to stop taking this medication, although other treatment, including surgery, may sometimes be necessary. 
  • Because it contains propranolol, a beta blocker, this product may mask certain symptoms of hypoglycemia, such as a fast heart rate. Also, propranolol/HCTZ may cause changes in blood sugar levels, even in people who do not have diabetes. If you have diabetes, contact your healthcare provider if you notice changes in the results of your blood sugar tests.
  • People with severe allergies may be more sensitive to allergens while taking propranolol/HCTZ. They may also not respond to the usual doses of epinephrine used to treat allergic reactions.
  • This medication can interfere with glaucoma screening tests by lowering the pressure within the eye (intraocular pressure). The pressure within the eye normally increases again once propranolol/HCTZ is stopped.
  • Propranolol/HCTZ is a pregnancy Category C medication. This means that it may not be safe for use during pregnancy (see Inderide and Pregnancy).
  • Propranolol/HCTZ passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to taking this medication (see Inderide and Breastfeeding).
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