nadolol/bendroflumethiazide (Rx)

Brand and Other Names:Corzide
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Dosing & Uses


Dosage Forms & Strengths



  • 40mg/5mg
  • 80mg/5mg


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

Initial dose: Nadolol 40 mg/bendroflumethiazide 5 mg PO qDay

Increase to Nadolol 80 mg/bendroflumethiazide 5 mg PO qDay if needed

Bendroflumethiazide 5 mg in combination product is 30% more bioavailable than that of 5 mg in single entity tablets

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

Renal Impairment

Use caution in dosing/titrating patients with renal dysfunction

Cumulative effects of thiazides may develop with impaired renal function

CrCl >50 mL/min/1.73 m²: Administer qDay

CrCl 31-50 mL/min/1.73 m²: Administer q24-36 hr

CrCl 10-30 mL/min/1.73 m²: Administer q24-48 hr

CrCl <10 mL/min/1.73 m²: Administer q40-60 hr


Combination may be substituted for the titrated individual components, though conversion from 5 mg bendroflumethiazide in single entity tablets to combination product represents a 30 percent increase in dose of bendroflumethiazide

Withdraw gradually over a period of about 2 weeks

<18 years: Safety/efficacy not established

Dose reduction may be necessary depending on patient's renal function



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            Adverse Effects

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

            Frequency Not Defined


            • Abdominal discomfort
            • Constipation
            • Diarrhea
            • CHF
            • Nausea
            • Cough
            • Nasal congestion
            • Drowsiness
            • Insomnia
            • Palpitaion
            • Decreased sexual ability
            • Bradycardia
            • Dizziness
            • Fatigue
            • Hypotension


            • Hypotension
            • Anorexia, epigastric distress
            • Phototoxicity
            • Hypercalcemia
            • Hyperuricemia
            • Hyperlipidemia
            • Hypercholesterolemia
            • Hypochloremia
            • Hypokalemia (common)
            • Hypomagnesemia
            • Hyponatremia
            • Glucose intolerance


            Black Box Warnings

            Hypersensitivity to catecholamines has been observed during withdrawal

            Exacerbation of angina and, in some cases, myocardial infarction occurrence after abrupt discontinuation

            When discontinuing chronically administered beta-blockers (particularly with ischemic heart disease) gradually reduce dose over 1-2 wk and carefully monitor

            If angina markedly worsens or acute coronary insufficiency develops, reinstate beta-blocker administration promptly, at least temporarily (in addition to other measures appropriate for unstable angina)

            Warn patients against interruption or discontinuation of beta-blocker without physician advice

            Because coronary artery disease is common and may be unrecognized, slowly discontinue beta-blocker therapy, even in patients treated only for hypertension



            Cardiogenic shock

            Heart block 2°/3°

            Hypersensitivity to either component or sulfonamides

            Overt cardiac failure

            Sinus bradycardia

            Uncompensated cardiac failure



            Anesthesia/surgery (myocardial depression); chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery, however the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures

            Bronchospastic disease

            Cerebrovascular insufficiency

            CHF, beta blockade carries the potential hazard of further depressing myocardial contractility and precipitating more severe failure

            DM, fluid or electrolyte imbalance, hyperuricemia or gout, hypotension, SLE

            Liver disease

            May aggravate digitalis toxicity

            Peripheral vascular disease

            Renal impairment

            Risk of male sexual dysfunction

            Sensitivity reactions may occur with or without history of allergy or asthma

            May interfere with phenolsulfonphthalein test; may produce false negatives in phentolamine and tyramine tests

            Avoid abrupt withdrawal

            Acute angle-closure glaucoma

            • Thiazide diuretics can cause an idiosyncratic reaction, resulting in acute angle-closure glaucoma and elevated intraocular pressure with or without a noticeable acute myopic shift and/or choroidal effusions
            • Symptoms may include acute onset of decreased visual acuity or ocular pain and typically occur within hours to weeks of drug initiation
            • Untreated, angle-closure glaucoma may result in permanent visual field loss
            • The primary treatment is to discontinue thiazide diuretics as rapidly as possible
            • Prompt medical or surgical treatments may need to be considered if the intraocular pressure remains uncontrolled
            • Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy

            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.



            Mechanism of Action

            Nadolol/bendroflumethiazide is a fixed-combination tablet that combines a Beta adrenergic receptor blocker nadolol and a diuretic, bendroflumethiazide

            Nadolol blocks beta-1 & beta-2 adrenergic receptors

            Bendroflumethiazide, a thiazide diuretic, inhibits Na+ reabsorption in distal renal tubules resulting in increased excrertion of Na+ & water, also K+ & H+ ions



            • Half-Life: 10-24 hr; prolonged in renal impairment
            • Bioavailability: 30-40%
            • Onset: 3-4 hr
            • Duration: 17-24 hr
            • Vd: 1.9 L/kg
            • Protein binding: 30%
            • Excretion: Urine
            • Peak plasma time: 2-4 hr


            • Half-Life: 3-3.9 hr
            • Bioavailability: In combination with nadolol increases 30% compared to bendroflumethiazide alone
            • Onset: 2 hr (diuresis); 3-4 hr (hypertension)
            • Duration: 18-24 hr (diuresis); 7 days (hypertension)
            • Peak Plasma Time: 4 hr
            • Excretion: Urine
            • Dialyzable: No (HD)


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            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.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.