Anti-Hypertensive Combinations

Angiotensin-ii receptor antagonists & diuretics

Calcium channel blockers & ace inhibitors

Ace inhibitors & diuretics

Benazepril & HCTZ (Lotensin HCT ®)	Benazepril (HTN) range: 10-80 mg qd (Initial: 10mg po qd). HCTZ (Range): 12.5-50 mg per day. Lotensin HCT 10/12.5 or Lotensin HCT 20/12.5. The HCTZ dose should generally not be increased until 2-3 weeks have elapsed. Patients whose blood pressures are adequately controlled with 25 mg of daily HCTZ, but who experience significant potassium loss with this regimen, may achieve similar blood-pressure control without electrolyte disturbance if they are switched to Lotensin HCT 5/6.25. Supplied: (5 mg/6.25 mg, 10 mg/12.5 mg, 20 mg/12.5 mg, 20 mg/25 mg)
Captopril & HCTZ (Capozide ®)	Adult (usual) Hypertension (HTN): initial, 1 tab (captopril 25 mg/HCTZ 15 mg) orally once daily. HTN: titration, allow 6-8 wk to achieve optimum antihypertensive effect - may administer daily dose in divided doses. HTN: maximum dose: 150 mg captopril and 50 mg HCTZ per day. Supplied: (25 mg/15 mg, 25 mg/25 mg, 50 mg/15 mg, 50 mg/25 mg)
Enalapril & HCTZ (Vaseretic ®)	Enalapril (Usual range): 10 to 40 mg per day administered in a single or two divided dose. HCTZ (range): 12.5 to 50 mg daily. A patient whose blood pressure is not adequately controlled with either enalapril or HCTZ monotherapy may be given Vaseretic 5-12.5 or Vaseretic 10-25. The HCTZ dose should generally not be increased until 2-3 weeks have elapsed. In general, patients do not require doses in excess of 20 mg of enalapril or 50 mg of HCTZ. The daily dosage should not exceed four tablets of Vaseretic 5-12.5 or two tablets of Vaseretic 10-25. Supplied: (5 mg/12.5 mg, 10 mg/25 mg)
Lisinopril & HCTZ (Prinzide ®) (Zestoretic ®)	Hypertension - Initial dose: 10/12.5 or 20/12.5. Further increases of either or both components could depend on clinical response. The HCTZ dose should generally not be increased until 2-3 weeks have elapsed. Maximum dose: 80/50 mg orally once daily. Patients whose blood pressures are adequately controlled with 25 mg of daily HCTZ, but who experience significant potassium loss with this regimen, may achieve similar or greater blood pressure control with less potassium loss if they are switched to 10/12.5. Dosage higher than lisinopril 80 mg and HCTZ 50 mg should not be used. Supplied: (10 mg/12.5 mg, 20 mg/12.5 mg, 20 mg/25 mg)
Moexipril & HCTZ (Uniretic ®)	Moexipril (range) 7.5 to 30 mg daily- administered in a single or two divided doses. HCTZ (range): 12.5 to 50 mg daily. Initial dose: (7.5 mg /12.5 mg) or (15 mg /12.5 mg) or (15 mg /25 mg) one hour before a meal. Titrate: q2-3 weeks. Total daily doses above 30 mg /50 mg a day have not been studied in hypertensive patients. Patients whose blood pressures are adequately controlled with 25 mg of HCTZ daily, but who experience significant potassium loss with this regimen, may achieve blood pressure control without electrolyte disturbance if they are switched to moexipril 3.75 mg/HCTZ 6.25 mg (one-half 7.5 mg /12.5 mg tablet). For patients who experience an excessive reduction in blood pressure with 7.5 mg /12.5 mg, the physician may consider prescribing moexipril 3.75 mg/HCTZ 6.25 mg. Supplied: (7.5 mg/12.5 mg, 15mg/12.5 mg, 15 mg/25 mg)

Angiotensin-ii receptor antagonists & diuretics

(azilsartan medoxomil and chlorthalidone)

(EDARBYCLOR ®)

Drug UPDATE:
[Drug information / PDF]
Dosing: Click (+) next to Dosage and Administration section (drug info link)
ABBREVIATED MONOGRAPH - SEE PACKAGE INSERT.

Initial U.S. Approval: 2011

BOXED WARNING:
WARNING: FETAL TOXICITY See full prescribing information for complete boxed warning.

When pregnancy is detected, discontinue EDARBYCLOR as soon as possible (5.1)
Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus (5.1)

INDICATIONS AND USAGE
Edarbyclor is an angiotensin II receptor blocker (ARB) and a thiazide-like diuretic combination product indicated for the treatment of hypertension, to lower blood pressure:

In patients not adequately controlled with monotherapy (1)
As initial therapy in patients likely to need multiple drugs to help achieve blood pressure goals (1)

Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions (1)
DOSAGE AND ADMINISTRATION
ABBREVIATED MONOGRAPH - SEE PACKAGE INSERT.

Starting dose is 40/12.5 mg once daily.
Edarbyclor may be used to provide additional blood pressure lowering for patients not adequately controlled on azilsartan medoxomil 80 mg or chlorthalidone 25 mg.

Dose may be increased to 40/25 mg after 2 to 4 weeks as needed to achieve blood pressure goals.

Maximal dose is 40/25 mg.

May be administered with other antihypertensive agents.
Edarbyclor may be administered with or without food.
Replace volume in volume-depleted patients prior to use.

DOSAGE FORMS AND STRENGTHS
Tablets (azilsartan/chlorthalidone): 40/12.5 mg and 40/25 mg
CONTRAINDICATIONS
Anuria
Do not coadminister aliskiren with Edarbyclor in patients with diabetes

WARNINGS AND PRECAUTIONS
In patients with an activated renin-angiotensin-aldosterone system (RAAS), such as volume- and/or salt-depleted patients, Edarbyclor can cause excessive hypotension. Correct volume or salt depletion prior to administration of Edarbyclor (5.2)
In patients with renal artery stenosis, Edarbyclor may cause renal failure (5.3)
Monitor renal function in patients with renal impairment. Consider discontinuing Edarbyclor with progressive renal impairment (5.3)
Monitor serum electrolytes periodically (5.4)

Losartan &
HCTZ
(Hyzaar ®)

Adult (usual) Hypertension (HTN): initial, 1 tab (50 mg losartan/12.5 mg HCTZ) po qd. HTN: titration, allow 3 wk to achieve optimum antihypertensive effect. HTN: titrate to maintenance, may increase to MAX dose of 100/50 mg orally once daily.
Supplied: (50 mg/12.5 mg, 100 mg/25 mg)

Valsartan &
HCTZ
(Diovan HCT ®)

Adult (usual) Hypertension: initial, 12.5 HCTZ/80 mg valsartan orally once daily. Hypertension: maintenance 12.5/80 mg to 25/160 mg po qd. Titrate at intervals of 3-4 wekks. MAX 25/160 mg daily.
Supplied: (80 mg/12.5 mg, 160 mg/12.5 mg, 160mg/25 mg)

Beta blockers & diuretics

Atenolol & chlorthalidone (Tenoretic®)	Dosage, Adult (usual): Hypertension (HTN): initial, 1 tab (50/25 mg) po qd. HTN: titration, allow 1-2 wk to achieve optimum antihypertensive effect. HTN: maintenance, may increase to 1 tab (100/25 mg) orally once daily. Supplied: (50 mg/25 mg, 100 mg/25 mg)
Bisoprolol & HCTZ (Ziac®)	Hypertension: initial, 1 tab (2.5/6.25 mg) orally once daily. Titration - allow 1-2 wk to achieve optimum antihypertensive effect. May increase to MAX dose of 20/12.5 mg orally once daily. Supplied: (2.5 mg/6.25 mg, 5 mg/6.25 mg, 10 mg/6.5 mg)
Metoprolol & HCTZ (Lopressor HCT®)	[ HCTZ (range): 12.5 to 50 mg per day. The usual initial dosage of Lopressor is 100 mg daily in single or divided doses. The effective dosage range is 100 to 450 mg per day. ] The following dosage schedule may be used to administer from 100 to 200 mg of Lopressor per day and from 25 to 50 mg of HCTZ per day: Lopressor HCT Dosage Tablets of 50/25 - 2 tablets per day in single or divided doses. Tablets of 100/25 - 1 to 2 tablets per day in single or divided doses. Tablets of 100/50 - 1 tablet per day in single or divided doses. Dosing regimens that exceed 50 mg of HCTZ per day are not recommended. Supplied: (50 mg/25 mg, 100 mg/25 mg, 100 mg/50 mg)
Nadolol & bendroflumethazide (Corzide ®)	Initial dose: 40 mg/5 mg tablet once daily. When the antihypertensive response is not satisfactory, the dose may be increased by administering the 80 mg/5 mg tablet once daily. When necessary, another antihypertensive agent may be added gradually beginning with 50 percent of the usual recommended starting dose to avoid an excessive fall in blood pressure. Supplied: (40 mg/5 mg, 80 mg/5 mg)
Propranolol & HCTZ (Inderide ®)	HCTZ (range): 12.5 to 50 mg per day. The initial dose of propranolol is 80 mg daily. The usual effective dose when used alone is 160 to 480 mg per day. One Inderide tablet twice daily can be used to administer up to 160 mg of propranolol and 50 mg of HCTZ. For doses of propranolol greater than 160 mg the combination products are not appropriate, because their use would lead to an excessive dose of the thiazide component. Supplied: (40 mg/25 mg, 80 mg/25 mg). (Inderide LA ®) : (80 mg/50 mg, 120 mg/50 mg, 160 mg/50 mg)
Timolol & HCTZ (Timolide ®)	Initial dose (HTN): 1 tablet twice a day or 2 tablets once a day. HCTZ (range): 12.5 to 50 mg per day when used alone. If the antihypertensive response is not satisfactory, another nondiuretic antihypertensive agent may be added. Supplied: (10 mg/25 mg)

Calcium channel blockers & ace inhibitors

Amlodipine & benazepril (Lotrel ®)	Adult (usual)- Hypertension: initial 2.5/10 mg orally once daily - may increase to 5/10 mg or 5/20 mg orally once daily. Amlodipine is an effective treatment of hypertension in once-daily doses of 2.5-10 mg while benazepril is effective in doses of 10-80 mg. In clinical trials of amlodipine/benazepril combination therapy using amlodipine doses of 2.5-10 mg and benazepril doses of 10-20 mg, the antihypertensive effects increased with increasing dose of amlodipine in all patient groups, and the effects increased with increasing dose of benazepril in nonblack groups. Supplied: (2.5 mg/10 mg, 5 mg/10 mg, 5 mg/20 mg)
Felodipine & enalapril (Lexxel ®)	Adult (usual) Hypertension: initial, 5mg/5mg tab po qd, may titrate to two 5mg/5mg tab po qd, then four 5mg/2.5 mg tab po qd. Supplied: (5mg/2.5 mg, 5 mg/5 mg)
Verapamil & trandolapril (Tarka ®)	Adult (usual) - 1 tablet po qd. Hypertension: 1-4 mg trandolapril/120-480 mg verapamil po qd or in 2 divided doses. The recommended usual dosage range of trandolapril for hypertension is 1 to 4 mg per day administered in a single dose or two divided doses. The recommended usual dosage range of Isoptin-SR for hypertension is 120 to 480 mg per day administered in a single dose or two divided doses. Supplied: (180 mg/2 mg, 240 mg/1 mg, 240 mg/2 mg, 240 mg/4 mg).

Diuretic combinations / other

Amiloride & HCTZ (Moduretic ®)	Give with food. The usual starting dosage is 1 tablet a day. The dosage may be increased to 2 tablets a day, if necessary. More than 2 tablets of Moduretic daily usually are not needed and there is no controlled experience with such doses. HCTZ (range): 12.5 to 50 mg per day. Supplied: (5 mg/50 mg)
Spironolactone & HCTZ (Aldactazide ®)	CHF, hepatic cirrhosis, or nephrotic syndrome: The usual maintenance dose of Aldactazide is 100 mg each of spironolactone and HCTZ daily, administered in a single dose or in divided doses, but may range from 25 mg to 200 mg of each component daily depending on the response to the initial titration. Hypertension: many patients will be found to have an optimal response to 50 mg to 100 mg each of spironolactone and HCTZ daily, given in a single dose or in divided doses. Supplied: (25 mg/50 mg, 50 mg/50 mg)
Triamterene & HCTZ (Dyazide ®, Maxzide ®)	Adult (usual) Hypertension (HTN): initial, 1 tab/cap (25 mg HCTZ/37.5 mg triamterene) po qd. HTN: titration, allow 2-3 wk to achieve optimum antihypertensive effect. HTN: titrate to maintenance, may increase to maximum dose of 50/75 mg po qd. Supplied: (37.5 mg/25 mg capsule and tablet, 75 mg/50 mg tablet)
Clonidine & chlorthalidone (Combipres ®)	Adult (usual) Hypertension: 15 mg/0.1 mg, 15 mg/0.2 mg, or 15 mg/0.3 mg po qd - bid. maximum dose of 30 mg/0.6 mg per day. Supplied: (0.1 mg/15 mg, 0.2 mg/15 mg, 0.3 mg/15 mg)
Hydralazine & HCTZ (Apresazide ®)	Usual Dosage: One capsule twice daily. Supplied: (25 mg/25 mg, 50 mg/50 mg, 100 mg/50 mg)
Methyldopa & HCTZ (Aldoril ®)	Usual starting dose: (250 mg/15 mg) two or three times a day or one tablet of (250 mg/25 mg) - two times a day. Alternatively, one tablet of 500 mg/30 mg or 500 mg/50 mg once daily may be used. HCTZ (range): 12.5 to 50 mg per day. methyldopa daily range: 500 mg to 2 g. The maximum recommended daily dose of methyldopa is 3 g. Supplied: (250 mg/15 mg, 250 mg/25 mg, 500 mg/30 mg, 500 mg/50 mg)
Prazosin & polythiazide (Minizide ®)	Usual - Adults: Oral: 1 capsule 2-3 times/day. Supplied: (1 mg/0.5 mg, 2 mg/0.5 mg, 5 mg/0.5 mg)

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates. A local search option of this data can be found here.