Propranolol with Hydrochlorothiazide Interaction Details

Brand Names Associated with Propranolol

Brand Names Associated with Hydrochlorothiazide

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 15, 2023

Interaction Effect

Hyperglycemia, hypertriglyceridemia

Interaction Summary

Propranolol has been reported to potentiate the hyperglycemic effect of hydrochlorothiazide. Three studies have demonstrated increased levels of blood glucose, triglycerides, and uric acid.

Severity

Moderate

Onset

Delayed

Evidence

Theoretical

How To Manage Interaction

Avoid concomitant therapy in patients with diabetes or hypertriglyceridemia. However, if concurrent therapy is required, the physician may consider monitoring the patient's glucose and serum lipid levels.

Mechanism Of Interaction

Unknown

Literature Reports

A) Oral hydrochlorothiazide 50 mg was administered twice daily to 14 men with hypertension and type II diabetes for three weeks, resulting in increases of fasting blood glucose by 31% and glycosylated hemoglobin by 6%. A subsequent 3-week period of oral propranolol therapy (80 mg twice daily) produced no significant increases in either parameter. However, in a third 3-week treatment period with combination propranolol and hydrochlorothiazide, fasting glucose rose by 56% with glycosylated hemoglobin increasing by 15%. It is suggested that propranolol augments hydrochlorothiazide-induced hyperglycemia by a mechanism independent of insulin secretion. Hydrochlorothiazide may act through direct effect on hepatic glucose production whereas propranolol may act via indirect inhibition of glucose uptake. The hyperglycemic responses of hydrochlorothiazide and its potentiation by propranolol were independent of serum potassium levels and of endogenous insulin secretion, determined by urine C-peptide excretion .

B) One study described the additive effect of propranolol on the thiazide-induced increase in triglyceride and urate concentrations. Seven hundred eighty-five hypertensive males, aged 40 to 49 years, were treated with hydrochlorothiazide alone and in combination with either methyldopa or propranolol. At the end of three years of therapy, those treated with hydrochlorothiazide plus propranolol had a statistically significant increase in their triglycerides and urate concentration. The triglyceride increase was most pronounced in patients who gained weight. The increase in the hydrochlorothiazide plus methyldopa group was insignificant. Until more data are available, closer monitoring of fasting blood sugar is indicated with combined propranolol and thiazide therapy in patients with diabetes .

Propranolol Overview

• Propranolol is used to treat high blood pressure, irregular heart rhythms, pheochromocytoma (tumor on a small gland near the kidneys), certain types of tremor, and hypertrophic subaortic stenosis (a heart muscle disease). It is also used to prevent angina (chest pain), migraine headaches, and to improve survival after a heart attack. Propranolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.

• High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Hydrochlorothiazide Overview

• Hydrochlorothiazide is used alone or in combination with other medications to treat high blood pressure. Hydrochlorothiazide is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, and liver disease and to treat edema caused by using certain medications including estrogen and corticosteroids. Hydrochlorothiazide is in a class of medications called diuretics ('water pills'). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.

• High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.