Indications for DUTOPROL:
Individualize. Initially 25/12.5mg once daily; may titrate at 2-week intervals to max 200mg/25mg once daily. May substitute for individual titrated components. Severe renal impairment (CrCl ≤30mL/min): not established.
Cardiogenic shock. Decompensated heart failure. Sinus bradycardia. Sick sinus syndrome. 2nd- or 3rd-degree AV block unless paced. Anuria. Sulfonamide allergy.
Cardiac ischemia after abrupt discontinuation.
Ischemic heart disease. Worsening cardiac failure (reduce or interrupt dose if necessary). Bronchospastic disease. Monitor HR and rhythm; reduce dose or discontinue if severe bradycardia occurs. Pheochromocytoma. Major surgery. Renal or hepatic impairment. Volume depletion. Monitor serum electrolytes periodically. Diabetes and hypoglycemia. Thyrotoxicosis (hyperthyroidism). Peripheral vascular disease. Acute myopia. Secondary angle-closure glaucoma. SLE. Gout. Post-sympathectomy. Avoid abrupt cessation (reduce dose over 1–2 weeks and monitor). Monitor electrolytes. Pregnancy (Cat.C). Nursing mothers.
Cardioselective beta-blocker + diuretic.
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 epinephrine. Possible increased response to muscle relaxants (eg, tubocurarine). Beta-blockers may mask signs of hypoglycemia. May interfere with parathyroid tests.
Nasopharyngitis, fatigue, dizziness, back pain, nausea; bronchospasm, bradycardia, CHF, heart block, vision disorders; HCTZ: increased risk for non-melanoma skin cancer.