clonidine/chlorthalidone (Rx)

Brand and Other Names:Clorpres
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

clonidine/chlorthalidone

tablet

  • 0.1mg/15mg
  • 0.2mg/15mg
  • 0.3mg/15mg
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Hypertension

Not indicated for initial therapy

If the fixed dose combination represents the dose appropriate to the individual patient's needs, it may be more convenient than the separate components

Usual dose: 0.1-0.3 mg/15 mg PO qDay or q12hr

Maximum: 0.6 mg/30 mg PO qDay

Renal Impairment

Use caution in dosing/titrating patients with renal dysfunction

Cumulative effects of thiazides may develop with impaired renal function; dose adjustment may be necessary; azotemia may be precipitated

Hepatic Impairment

Use caution; not studied

Administration

Combination may be substituted for the titrated individual components

Withdraw gradually over a period of 2-4 days

Safety/efficacy not established

May benefit from lower initial dose

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Interactions

Interaction Checker

and clonidine/chlorthalidone

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     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            No adverse effects specific to the combination have been observed; adverse effects limited to those previously reported with clonidine and chlorthalidone

            Clonidine

            • Orthostatic hypotension
            • Bradycardia
            • Syncope
            • Arrhythmia
            • Chest pain
            • Atrioventricular block
            • Flushing
            • Drowsiness
            • Fatigue
            • Malaise
            • Rash
            • Anorexia, weight gain
            • Dry mouth
            • Nausea/vomiting
            • Abnormal LFTs

            Chlorthalidone

            • Blurred vision, xanthopsia
            • Constipation
            • Diarrhea
            • Dizziness
            • Electrolyte abnormalities
            • Headache, vasculitis
            • Hyperglycemia
            • Hyperuricemia
            • Hypotension
            • Impotence
            • Loss of appetite
            • Muscular spasticity, restlessness
            • Nausea/vomiting
            • Paresthesia
            • Photosensitivity, phototoxicity
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            Warnings

            Contraindications

            Hypersensitivity to either component or sulfonamide derivatives

            Cautions

            Bronchospastic disease

            DM, hyperuricemia or gout, hypotension, SLE

            Chlorthalidone may cause fluid or electrolyte imbalance including hyponatremia, hypochloremic alkalosis, or hypokalemia

            History of depression

            Liver disease

            May aggravate digitalis toxicity

            Patients allergic to sulfa may show cross-sensitivity

            May impair ability to perform hazarous tasks

            Risk of male sexual dysfunction

            Renal impairment

            Severe coronary insufficiency, recent MI, conduction disturbances, cerebrovascular disease, chronic renal failure, Raynaud's disease, thromboangiitis obliteran

            Sudden cessation of clonidine treatment has resulted in subjective symptoms such as nervousness, agitation and headache, accompanied or followed by a rapid rise in blood pressure and elevated catecholamine concentrations in the plasma

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: excreted in breast milk, use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Clonidine/chlorthalidone is a fixed-combination tablet that combines a central alpha-2 stimulator, clonidine and a diuretic, chlorthalidone

            Clonidine produces central alpha 2-adrenergic stimulation, which results in a decreased sympathetic outflow to the heart, kidneys, and peripheral vasculature; this results in decreased peripheral vascular resistance, decreased systolic and diastolic blood pressure, and decreased heart rate

            Chlorthalidone, a monosulfonamyl diuretic, inhibits Na & Cl reabsorption in cortical-diluting segment of ascending loop of Henle

            Pharmacokinetics

            Clonidine

            • Half-Life: 12-16 hr (normal renal function); 41 hr (impaired renal function)
            • Onset: 0.51 hr
            • Metabolism: Liver
            • Excretion: Urine (40-60%)
            • Duration: 6-10 hr
            • Peak plasma time: 3-5 hr (immediate release); 7-8 hr (extended release)
            • Vd: 2.1 L/kg
            • Protein binding: 20-40%
            • Bioavailability: 75-85% (immediate release); 89% (extended release)

            Chlorthalidone

            • Duration: 24-72 hr
            • Onset: 2-6 hr (peak effect)
            • Metabolism: Liver
            • Protein binding: 75%
            • Bioavailability: 60-65%
            • Excretion: Urine (50-65%)
            • Half-life: 40-60 hr (normal renal function); prolonged in renal impairment; 81 hr (anuria)
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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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