Comparative Pharmacology
Head-to-head clinical analysis: INDERIDE LA 80 50 versus INDERIDE 80 25.
Peer-Reviewed Evidence
Head-to-head clinical analysis: INDERIDE LA 80 50 versus INDERIDE 80 25.
INDERIDE LA 80/50 vs INDERIDE-80/25
Head-to-head clinical comparison of therapeutic indices and safety profiles.
Combination of propranolol (non-selective beta-blocker) and hydrochlorothiazide (thiazide diuretic). Propranolol blocks beta-1 and beta-2 adrenergic receptors, reducing heart rate, myocardial contractility, and blood pressure. Hydrochlorothiazide inhibits sodium-chloride symporter in distal convoluted tubule, increasing excretion of sodium, chloride, and water, reducing plasma volume.
INDERIDE-80/25 is a combination of propranolol (a non-selective beta-adrenergic receptor antagonist) and hydrochlorothiazide (a thiazide diuretic). Propranolol blocks beta-1 and beta-2 adrenergic receptors, reducing heart rate, myocardial contractility, and renin release, thereby lowering blood pressure. Hydrochlorothiazide inhibits the sodium-chloride symporter in the distal convoluted tubule of the kidney, increasing excretion of sodium, chloride, and water, reducing plasma volume.
HypertensionAngina pectoris (propranolol component)Migraine prophylaxis (propranolol component)Essential tremor (propranolol component)
Management of hypertension (FDA-approved)Off-label: prevention of migraine, essential tremor, angina pectoris
One capsule orally once daily, containing propranolol hydrochloride 80 mg (immediate release) and hydrochlorothiazide 50 mg. May be titrated based on response, with maximum propranolol dose 640 mg/day and maximum hydrochlorothiazide dose 50 mg/day.
One tablet (80 mg propranolol/25 mg hydrochlorothiazide) orally twice daily.
None Documented
None Documented
Propranolol: 3-6 hours (poor metabolizers up to 10 hours). Hydrochlorthiazide: 6-15 hours (prolonged in renal impairment).
Propranolol: 3-6 hours (single dose), prolonged with chronic dosing (up to 12 hours). Hydrochlorothiazide: 6-15 hours; prolonged in renal impairment.
Propranolol: extensive hepatic metabolism via CYP2D6 and CYP1A2 to active metabolite 4-hydroxypropranolol and other inactive metabolites; hydrochlorothiazide: not metabolized, excreted unchanged by kidneys.
Propranolol is extensively metabolized in the liver via cytochrome P450 enzymes, primarily CYP2D6 and CYP1A2, forming active metabolites (e.g., 4-hydroxypropranolol). Hydrochlorothiazide is not metabolized and is excreted unchanged in urine.
Renal elimination of propranolol and hydrochlorthiazide: propranolol is extensively metabolized in the liver, <1% excreted unchanged in urine; hydrochlorthiazide is excreted unchanged in urine (≥95% renal).
Renal: 40% unchanged propranolol; 60% as metabolites. Biliary/fecal: minimal (less than 1%). Hydrochlorothiazide: renal 95% unchanged.
Propranolol: >90% bound primarily to albumin; hydrochlorthiazide: 40-68% bound to albumin.
Propranolol: 90-95% bound to albumin; hydrochlorothiazide: 68% bound to albumin.
Propranolol: 3-5 L/kg (large Vd indicates extensive tissue distribution); hydrochlorthiazide: 0.8-1.2 L/kg (distributes into extracellular fluid).
Propranolol: 4 L/kg (large Vd due to lipophilicity); hydrochlorothiazide: 0.8 L/kg (restricted to extracellular fluid).
Propranolol: 25-30% (first-pass metabolism); hydrochlorthiazide: 65-75% (oral).
Propranolol: 30% (oral) due to extensive first-pass metabolism; bioavailability increased with food or chronic dosing. Hydrochlorothiazide: 65-70% (oral).
Contraindicated in anuria. For GFR 30-50 mL/min: reduce dose or extend interval; monitor electrolyte levels. For GFR <30 mL/min: avoid use or administer with extreme caution; thiazides are ineffective at GFR <30 mL/min.
GFR 30-60 mL/min: reduce dose or extend interval; GFR <30 mL/min: contraindicated due to hydrochlorothiazide component.
Child-Pugh Class A: no adjustment required. Child-Pugh Class B: reduce propranolol dose by 50% and monitor heart rate. Child-Pugh Class C: avoid use due to risk of hepatic encephalopathy and reduced clearance of propranolol.
Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: contraindicated.
Not recommended for use in pediatric patients due to fixed combination and lack of safety/efficacy data.
Not recommended for children; safety and efficacy not established.
Initiate at lowest effective dose (e.g., one capsule of INDERIDE LA 40/25 daily). Monitor renal function, electrolytes, and orthostatic hypotension. Avoid in elderly with gout or hyperuricemia.
Initiate at lowest dose; monitor renal function and orthostatic hypotension; adjust based on response and tolerability.
Exacerbation of angina and myocardial infarction upon abrupt withdrawal of beta-blockers; taper dose over 1-2 weeks.
Exacerbation of angina pectoris and myocardial infarction upon abrupt discontinuation of beta-blockade; taper dose gradually.
May mask signs of thyrotoxicosis and hypoglycemia; exacerbation of peripheral vascular disease; bronchospasm in patients with asthma/COPD; cardiac failure; electrolyte imbalances (hypokalemia, hyponatremia) with thiazide; acute angle-closure glaucoma; systemic lupus erythematosus exacerbation; non-melanoma skin cancer risk with thiazides.
May exacerbate heart failure, bronchospasm, and mask hypoglycemia in diabetic patients. Use caution in patients with renal impairment (monitor electrolytes and renal function). Hydrochlorothiazide can cause electrolyte imbalances, hyperglycemia, and hyperuricemia.
Hypersensitivity to propranolol, hydrochlorothiazide, or sulfonamide-derived drugs; bronchial asthma; sinus bradycardia; heart block greater than first degree; cardiogenic shock; overt cardiac failure; anuria; concomitant use with verapamil (for propranolol).
Bronchial asthma, sinus bradycardia, heart block (greater than first degree), cardiogenic shock, decompensated heart failure, anuria (for hydrochlorothiazide component), hypersensitivity to any component.
Data Pending Review
Data Pending Review
Avoid grapefruit juice which may alter propranolol metabolism. Avoid licorice (glycyrrhizin) as it can worsen hypokalemia from hydrochlorothiazide. Limit sodium intake to reduce edema and hypertension. Maintain adequate potassium intake (bananas, oranges) unless specified otherwise by physician.
Avoid high-sodium foods to prevent blunting of antihypertensive effect. Limit potassium-rich foods (bananas, oranges) due to hyperkalemia risk from HCTZ. Grapefruit juice may increase propranolol levels. Alcohol may potentiate hypotension.
First trimester: Propranolol (beta-blocker) crosses placenta, associated with intrauterine growth restriction (IUGR) and small placental weight. Second/third trimester: Increased risk of fetal bradycardia, hypoglycemia, respiratory depression, and low Apgar scores. Avoid in pregnancy unless benefit outweighs risk; consider alternative agents.
INDERIDE-80/25 contains propranolol (a beta-blocker) and hydrochlorothiazide (a thiazide diuretic). Propranolol: First trimester: limited human data, no clear increased risk of major malformations, but possible fetal bradycardia and growth restriction; Second and third trimesters: risk of intrauterine growth restriction, neonatal hypoglycemia, bradycardia, and respiratory depression at delivery. Hydrochlorothiazide: First trimester: based on limited data, no major teratogenic risk; Second and third trimesters: may cause fetal or neonatal jaundice, thrombocytopenia, electrolyte disturbances, and potential placental hypoperfusion.
Propranolol is excreted into breast milk in low amounts (M/P ratio approximately 0.5). Infant dose estimated at <1% of maternal weight-adjusted dose. Not known to cause adverse effects in term infants; monitor for bradycardia, hypotension, hypoglycemia. Hydrochlorothiazide: Minimal excretion; may suppress lactation. Use caution, especially in preterm infants.
Propranolol is excreted into breast milk in small amounts; the M/P ratio is approximately 0.3-0.5. Infant dose is less than 1% of maternal weight-adjusted dose, considered compatible with breastfeeding. Hydrochlorothiazide is also excreted into breast milk, but levels are low; M/P ratio unknown. However, thiazides may suppress lactation and cause neonatal electrolyte disturbances. Use with caution, especially in newborns with impaired renal function.
No specific dose adjustment is routinely recommended for propranolol in pregnancy, but increased clearance may require dose increment; monitor efficacy. Hydrochlorothiazide is generally avoided in pregnancy due to risk of volume depletion and uteroplacental hypoperfusion; if used, monitor for electrolyte imbalances. Individualize dosing based on maternal response and fetal tolerability.
Propranolol: Pregnancy may increase clearance, potentially requiring dose increase; however, beta-blockers generally require careful titration to avoid fetal bradycardia. Hydrochlorothiazide: Pregnancy may decrease efficacy due to increased volume of distribution; avoid in preeclampsia due to potential placental hypoperfusion. In general, use the lowest effective dose, monitor maternal response, and consider pregnancy-induced pharmacokinetic changes.
Category C
Category C
INDERIDE LA 80/50 is a fixed-dose combination of propranolol (80 mg long-acting) and hydrochlorothiazide (50 mg). Propranolol is a non-selective beta-blocker that can mask tachycardia in hypoglycemia and thyrotoxicosis; use caution in diabetes and hyperthyroidism. Hydrochlorothiazide may exacerbate gout, hypercalcemia, and hypokalemia. Avoid in patients with asthma, COPD, bradycardia, heart block, or anuria. Monitor electrolytes, renal function, and blood glucose.
Combination product of propranolol (80 mg) and hydrochlorothiazide (25 mg). Propranolol is a non-selective beta-blocker; contraindicated in asthma, bradycardia, and heart block. Monitor for bronchospasm, hypoglycemia (masks symptoms), and bradycardia. Hydrochlorothiazide (HCTZ) is a thiazide diuretic; check electrolytes, renal function, and for gout/hyperuricemia. Titrate doses separately before switching to combination. Avoid abrupt withdrawal of beta-blocker (risk of myocardial ischemia).
Do not crush or chew the capsule; swallow whole.Take at the same time each day, usually in the morning to avoid nocturia from diuretic.Do not stop abruptly; withdrawal can cause chest pain or heart attack.Report slow heartbeat, dizziness, swelling, weight gain, or shortness of breath.May cause dizziness or drowsiness; avoid driving until effects known.Avoid alcohol and NSAIDs (e.g., ibuprofen) which can reduce effectiveness and increase side effects.Use sunscreen; may increase sun sensitivity (photosensitivity).Monitor for signs of low potassium (muscle cramps, weakness) or high uric acid (joint pain).
Take exactly as prescribed, usually once daily in the morning to avoid nocturia.Do not stop abruptly; consult doctor before discontinuing (risk of chest pain or heart attack).May cause dizziness or lightheadedness; avoid driving if affected.Report slow heartbeat, fainting, difficulty breathing, or swelling.Monitor for increased blood sugar if diabetic; beta-blockers may hide signs of low blood sugar.Avoid excessive sweating or dehydration; stay well-hydrated.Limit alcohol and caffeine intake as they may affect blood pressure.Use sunscreen; medication may increase sensitivity to sunlight.