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Generic Name: guanethidine and hydrochlorothiazide (gwhan ETH i deen and hye droe klor oh THYE a zide)
Brand Names: Esimil

What is Esimil (guanethidine and hydrochlorothiazide)?

Guanethidine lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels (veins and arteries) to relax and your heart to beat more slowly and easily.

Hydrochlorothiazide is a thiazide diuretic (water pill). It helps to lower your blood pressure and decrease edema (swelling) by increasing the amount of salt and water you lose in your urine.

Guanethidine and hydrochlorothiazide is used to treat high blood pressure.

Guanethidine and hydrochlorothiazide may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Esimil (guanethidine and hydrochlorothiazide)?

Tell your doctor and dentist that you are taking this medication before having surgery.

Who should not take Esimil (guanethidine and hydrochlorothiazide)?

You must not take guanethidine and hydrochlorothiazide if you

• have pheochromocytoma;

• have congestive heart failure; or

• are taking a monoamine oxidase inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate).

Before taking this medication, tell your doctor if you have

• peptic ulcer disease (stomach ulcers) or other stomach problems,

• ulcerative colitis,

• gallstones,

• kidney or liver disease,

• diabetes,

• gout,

• a collagen vascular disease such as systemic lupus erythematosus,

• high levels of cholesterol or triglyceride (types of fat) in your blood,

• pancreatitis,

• asthma, or

• any type of heart disease.

You may require a lower dose or special monitoring during therapy with guanethidine and hydrochlorothiazide if you have any of these conditions.

How should I take Esimil (guanethidine and hydrochlorothiazide)?

Take guanethidine and hydrochlorothiazide exactly as directed. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Do not stop taking guanethidine and hydrochlorothiazide. Stopping suddenly could make your condition much worse or cause very serious side effects.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the dose you missed and take only your next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose?

Symptoms of a guanethidine and hydrochlorothiazide overdose include low blood pressure (fainting, dizziness, weakness); sleepiness; uncontrollable hand, leg, or arm movements; a slow pulse; low body temperature; diarrhea; increased urination; vomiting, and slow breathing.

What should I avoid while taking Esimil (guanethidine and hydrochlorothiazide)?

Do not let yourself become overheated in hot weather or during exercise, and use caution if you have a fever. These situations increase the effects of guanethidine and hydrochlorothiazide, and you may become very dizzy.

Avoid a diet high in salt. Too much salt will cause your body to retain water and will decrease the effects of hydrochlorothiazide.

Do not take any over-the-counter cough, cold, allergy, sleep, or diet medications without first asking your doctor or pharmacist. These products will interfere with your guanethidine and hydrochlorothiazide therapy.

Use caution when you are driving, climbing ladders, or performing other hazardous activities until you know how guanethidine and hydrochlorothiazide affects you. If it makes you dizzy or drowsy, avoid these activities.

Tell your doctor and dentist that you are taking this medication before having surgery.

Esimil (guanethidine and hydrochlorothiazide) side effects

• an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

• a very irregular heartbeat;

• heart failure (shortness of breath, swelling of ankles or legs, sudden weight gain of 5 pounds or more);

• chest pain;

• little or no urine;

• unusual fatigue;

• abnormal bleeding or bruising;

• yellow skin or eyes;

• confusion;

• fainting; or

• uncontrollable hand, arm, or leg movements.

Other, less serious side effects are more likely to occur. Continue to take guanethidine and hydrochlorothiazide and talk to your doctor if you experience

• fatigue or drowsiness;

• dizziness (avoid standing up too quickly and use caution when performing hazardous activities);

• anxiety, depression or nightmares;

• diarrhea, nausea, vomiting, or an acid stomach (take guanethidine and hydrochlorothiazide with food or milk if it upsets your stomach);

• abdominal pain;

• a stuffy nose or a dry mouth (sucking on ice chips or sugarless hard candy may relieve a dry mouth);

• blurred vision;

• tingling or numbness in your arms, legs, hands, or feet;

• excessive urination;

• muscle weakness or cramps;

• increased hunger or thirst;

• weight gain;

• sensitivity to sunlight; or

• impotence or difficulty ejaculating.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Esimil (guanethidine and hydrochlorothiazide)?

Do not take guanethidine and hydrochlorothiazide if you are taking a monoamine oxidase inhibitor (MAOI), or if you have taken one in the last 14 days. MAOIs, used to treat depression, include isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate).

Before taking this medication, tell your doctor if you are taking any of the following medicines:

• tricyclic antidepressants such as amitriptyline (Elavil, Endep) or doxepin (Sinequan), which may decrease the effects of guanethidine and hydrochlorothiazide;
• other commonly used tricyclic antidepressants, including amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), and protriptyline (Vivactil);

• digoxin (Lanoxin) or quinidine (Cardioquin, Quinidex, Quinora, Quinaglute), which will increase the risk of experiencing an irregular heartbeat when taken with guanethidine and hydrochlorothiazide;

• barbiturates such as phenobarbital (Luminal, Solfoton), amobarbital (Amytal), and secobarbital (Seconal), which may cause extreme sleepiness or dizziness if taken with guanethidine and hydrochlorothiazide;

• narcotic pain relievers such as codeine (Tylenol #3, Tylenol #4, others), propoxyphene (Darvon, Darvocet, Wygesic), oxycodone (Percodan, Percocet, Tylox), meperidine (Demerol), morphine (MS Contin, Duramorph, others), and others, which also may cause extreme sleepiness or dizziness if taken with guanethidine and hydrochlorothiazide;

• steroid medications such as hydrocortisone (Hydrocortone, Cortef), prednisone (Deltasone, Orasone), prednisolone (Delta Cortef, Prelone), methylprednisolone (Medrol), betamethasone (Celestone), dexamethasone (Decadron, Hexadrol), and others, which may increase the side effects of hydrochlorothiazide;

• prescription and over-the-counter cough, cold, allergy, diet, and sleeping pills, any of which may contain drugs that increase your blood pressure and heart rate and thus decrease the effects of guanethidine;

• the cholesterol-lowering drugs cholestyramine (Questran) and colestipol (Colestid), which may decrease the effects of hydrochlorothiazide if they are used together;

• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil), ketoprofen (Orudis, Orudis, KT, Oruvail), and naproxen (Naprosyn, Anaprox, Aleve), which may also decrease the effects of hydrochlorothiazide;

• other commonly used NSAIDs, including diclofenac (Cataflam, Voltaren), etodolac (Lodine), fenoprofen (Nalfon), flurbiprofen (Ansaid), indomethacin (Indocin), ketorolac (Toradol), mefenamic acid (Ponstel), nabumetone (Relafen), oxaprozin (Daypro), piroxicam (Feldene), sulindac (Clinoril), and tolmetin (Tolectin);

• oral antidiabetic drugs such as Glipizide (Glucotrol), glyburide (Micronase, Glynase, Diabeta), chlorpropamide (Diabinese), tolazamide (Tolinase) and tolbutamide (Orinase), which may not lower your blood sugar as well during therapy with guanethidine and hydrochlorothiazide (your diabetes therapy may have to be adjusted);

• lithium (Lithobid, Eskalith), which should not be taken with hydrochlorothiazide because serious side effects may result; or

• other drugs that also lower blood pressure, including acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), carteolol (Cartrol), labetalol (Trandate, Normodyne), propranolol (Inderal), pindolol (Visken), timolol (Blocadren), benazepril (Lotensin), enalapril (Vasotec), captopril (Capoten), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), quinapril (Accupril), ramipril (Altace), amlodipine (Norvasc), bepridil (Vascor), diltiazem (Cardizem, Dilacor), felodipine (Plendil), isradipine (Dynacirc), nicardipine (Cardene), nifedipine (Adalat, Procardia), nimodipine (Nimotop), and verapamil (Calan, Verelan, Isoptin).

Drugs other than those listed here may also interact with guanethidine and hydrochlorothiazide or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

Where can I get more information?

• Your pharmacist has additional information about guanethidine and hydrochlorothiazide written for health professionals that you may read.

What does my medication look like?

Guanethidine and hydrochlorothiazide is available with a prescription under the brand name Esimil. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

guanethidine/hydrochlorothiazide strengths are as follows:

• Esimil 10 mg/25 mg--round, white scored tablets

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.