Drug Profile

Do Not Use:

These products are fixed combinations of a calcium channel blocker with an angiotensin-converting enzyme (ACE) inhibitor. 

There are good reasons not to use any fixed-combination drug for high blood pressure. A single drug is often enough to control high blood pressure. There is no reason to put yourself at extra risk by taking drugs you do not need.

First-line treatment for high blood pressure 

If you have high blood pressure, the best way to reduce or eliminate your need for medication is by improving your diet, losing weight, exercising and decreasing your salt and alcohol intake. Mild hypertension can be controlled by proper nutrition and exercise. If these measures do not lower your blood pressure enough and you need medication, hydrochlorothiazide (ESIDRIX, HYDRODIURIL, MICROZIDE), a water pill, is the drug of choice, starting with a low dose of 12.5 milligrams daily. It also costs less than other blood-pressure drugs.

There is growing evidence that thiazide diuretics, such as hydrochlorothiazide, significantly decrease the rate of bone mineral loss in both men and women because they reduce the amount of calcium lost in the urine.[1] Research now suggests that thiazide diuretics may protect against hip fracture.[2]

If your high blood pressure is more severe, and hydrochlorothiazide alone does not control it, another family of high-blood-pressure-lowering drugs may be added to your treatment. In this case, your doctor would prescribe the hydrochlorothiazide and the second drug separately, with the dose of each drug adjusted to meet your needs, rather than using a product that combines the drug in a fixed combination.

Whatever drugs you take for high blood pressure, once your blood pressure has been normal for a year or more, a cautious decrease in dose and renewed attention to nondrug treatment may be worth trying, according to The Medical Letter on Drugs and Therapeutics.[3]

An editorial in the British Medical Journal (BMJ) stated:

Treatment of hypertension is part of preventive medicine and like all preventive strategies, its progress should be regularly reviewed by whoever initiates it. Many problems could be avoided by not starting antihypertensive treatment until after prolonged observation. ... Patients should no longer be told that treatment is necessarily for life: the possibility of reducing or stopping treatment should be mentioned at the outset.[4]

The May 2012 issue of Worst Pills, Best Pills News highlighted a recent BMJ study indicating that patients taking several types of commonly used antihypertensive medications are at increased risk of developing gout, a type of arthritis.

The BMJ study also showed that a small number of other antihypertensive drugs appear to have the opposite effect, decreasing the risk of gout.

All patients should be informed of the risk of gout with diuretics, beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors) and non-lorsartan angiotensin II receptor blockers (ARBs) when starting these medications or increasing their dosages.[5]

In 2011, the Canadian Medical Association Journal published results from a Canadian study on the use of macrolide antibiotics and calcium channel blocker drugs in elderly patients. The study found that patients using this drug combination therapy experienced an increased risk of being hospitalized for hypotension or low blood pressure. According to the article, the risk of hypotension occurred with both erythromycin (E.E.S., E.E.S. 200, E.E.S. 400, ERYC, ERYPED, ERY-TAB, ERYTHROCIN, PCE, PEDIAMYCIN, PEDIAMYCIN 400) and clarithromycin (BIAXIN, BIAXIN XL, PREVPAC [a drug combination used to treat peptic ulcer disease that also contains the antibiotic amoxicil¬lin and the stomach acid-suppressing drug lansoprazole]).[6]

In 2013, the Journal of the American Medical Association published data from another Canadian study on the use of macrolide antibiotics and calcium channel blocker drugs. This study looked at the use of clarithromycin versus azithromycin (ZITHRO¬MAX, ZMAX) in elderly patients taking calcium channel blockers. The purpose of the study was to evaluate patients for the risk of hospitalization for acute kidney injury or hypotension, as well as all-cause mortality. The study showed that there were small but statistically significant greater risks of hospitalization for acute kidney injury or hypotension and of death in patients taking clarithromycin with a calcium channel blocker drug compared to those taking azithromycin with a calcium channel blocker.[7]