methyldopa / HCTZ
Methyldopa/hydrochlorothiazide is a combination of two medications to help treat high blood pressure, but it shouldn't be used as an initial treatment option. Your provider must start you on the individual medications, methyldopa and hydrochlorothiazide first before you can take this combination. Methyldopa/hydrochlorothiazide is a convenient option for people who tolerate the two separate medications and prefer to take one pill, but it was discontinued in the U.S. and is no longer available.
What is Methyldopa/hydrochlorothiazide?
What is Methyldopa/hydrochlorothiazide used for?
- High blood pressure (hypertension)
How Methyldopa/hydrochlorothiazide works
Methyldopa/hydrochlorothiazide is a combination of two medications that work together to lower blood pressure:
- Methyldopa is an alpha-2 adrenergic receptor agonist. It tells the brain to lower the activity of stress hormones so your blood vessels can relax.
- Hydrochlorothiazide is a thiazide diuretic (water pill). It works in your kidneys to help get rid of extra water and electrolytes, like sodium, chloride, and potassium, in order to lower your blood pressure.
Drug facts
| Common Brands | Aldoril |
|---|---|
| Drug Class | Alpha-2 adrenergic receptor agonist / Diuretic (water pill) |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Discontinued |
Side effects of Methyldopa/hydrochlorothiazide
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Temporary sleepiness
- Temporary headache
- Temporary weakness
- Low blood pressure
- Dizziness
- Sensitivity to light
Less Common Side Effects
- Swelling
- Weight gain
- Slow heart rate
- Nausea
- Vomiting
- Diarrhea
- Dry mouth
- Lightheadedness
- Pins and needles feeling
- Joint or muscle pain
- Stuffy nose
- Rash
- Absent period
- Breast enlargement
- Lower sex drive
Methyldopa/hydrochlorothiazide serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Electrolyte imbalance: dry mouth, extreme thirst, weakness, tiredness, sleepiness, restlessness, confusion, seizures, muscle pain or cramps, low blood pressure, trouble urinating, irregular heart beat, nausea, or vomiting
- Hemolytic anemia: paleness of skin, dark urine, fever, weakness, confusion, or yellowing of eyes and skin
- Liver damage: unsual vomiting, pale stools, dark urine, stomach pain, or yellowing of the eyes and skin
The following Methyldopa/hydrochlorothiazide side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Rare
Unexplained fever shortly after starting to take this medicine
Check with your doctor as soon as possible if any of the following side effects occur:
Signs and symptoms of too much potassium loss
increased thirst
irregular heartbeats
muscle cramps or pain
nausea or vomiting
unusual tiredness or weakness
weak pulse
Rare
Cough or hoarseness
dark or amber urine
diarrhea or stomach cramps (severe or continuing)
fever, chills, troubled breathing, and fast heartbeat
general feeling of discomfort or illness or weakness
joint pain
lower back or side pain
painful or difficult urination
pale stools
stomach pain (severe) with nausea and vomiting
tiredness or weakness after having taken this medicine for several weeks (continuing)
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Dizziness or light-headedness when getting up from a lying or sitting position
drowsiness
dryness of mouth
headache
Less common
Decreased sexual ability or interest in sex
increased sensitivity of skin to sunlight (skin rash, itching, redness or other discoloration of skin or severe sunburn after exposure to sunlight)
loss of appetite
numbness, tingling, pain, or weakness in hands or feet
slow heartbeat
swelling of breasts or unusual milk production
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Methyldopa/hydrochlorothiazide
Pros
- Two medications combined into one pill
- Two different strengths available
- Hydrochlorothiazide can help offset the swelling and weight gain side effects from methyldopa
Cons
- Generally needs to be taken multiple times a day
- Not for initial treatment of high blood pressure
- Raise the risk of sunburn and skin cancer
- Not a good option for people with liver problems
Pharmacist tips for Methyldopa/hydrochlorothiazide
- Wear sunscreen and protective clothing when going outside because methyldopa/hydrochlorothiazide can make your skin more sensitive to sunlight and raise your risk of sunburns and skin cancer.
- Methyldopa/hydrochlorothiazide can cause swelling or weight gain. This can be dangerous if you have heart failure. Let your provider know if you develop this side effect.
- Although rare, methyldopa/hydrochlorothiazide can cause uncontrollable figeting or movement in certain people. Speak to your provider about stopping this medication if that happens.
- Your provider might order labs before starting methyldopa/hydrochlorothiazide and periodically throughout your treatment to check your liver function and electrolyte levels.
- Let your provider know if you are getting dialysis because methyldopa/hydrochlorothiazide might be removed during the process and not work as well in controlling your blood pressure.
- Before going for parathyroid function tests, let your provider know that you are taking methyldopa/hydrochlorothiazide because this medication needs to be stopped before your test.
- Let your provider know if you are pregnant, planning to become pregnant, or if you're breastfeeding. It's not known if methyldopa/hydrochlorothiazide can harm your unborn baby, but this medication can pass into the placenta and your breastmilk.
Risks and warnings for Methyldopa/hydrochlorothiazide
Methyldopa/hydrochlorothiazide can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Not for initial therapy
Methyldopa/hydrochlorothiazide is not for initial therapy to lower your blood pressure. Your provider must start you on the two medications, methyldopa and hydrochlorothiazide, separately and adjust your dose according to your response to the medications and your blood pressure levels.
Electrolyte imbalance
- Risk factors: Dehydration | Vomiting | Taking other medications that affect your electrolytes
Methyldopa/hydrochlorothiazide can cause your electrolytes, such as sodium, chloride, potassium, and magnesium, to be out of balance. Sometimes, this can be dangerous. You're at a higher risk for this problem if you're dehydrated, vomiting, or also taking other medications that affect your electrolytes. If you're not sure whether your other medications, supplements, or food products can change your electrolyte levels, ask your provider. Get medical help if you experience symptoms of electrolyte imbalance such as dry mouth, extreme thirst, weakness, tiredness, sleepiness, restlessness, confusion, seizures, muscle pain or cramps, low blood pressure, trouble urinating, irregular heart beat, nausea, or vomiting.
Breakdown of red blood cells (hemolytic anemia)
- Risk factors: Taking methyldopa/hydrochlorothiazide for a long time | Positive Coombs test
Taking methyldopa/hydrochlorothiazide for a long time can cause people to get a positive Coombs test, which means that your body is attacking your red blood cells. This usually happens between 6 and 12 months after you start taking methyldopa/hydrochlorothiazide. Although very rare, this can lead to a serious and life-threatening condition called hemolytic anemia, where your red blood cells are destroyed faster than they are made. If you're going to be taking methyldopa/hydrochlorothiazide for a long time, your provider will have you get a blood test before and regularly throughout your treatment.
Liver problems
- Risk factors: History of or current liver problems
Although rare, methyldopa/hydrochlorothiazide can cause liver problems, which can be life-threatening in some cases. If you have a history of or current liver problems, talk to your provider for an alternative medication. Let your provider know right away if you get a fever or experience any symptoms of liver damage, such as unsual vomiting, pale stools, dark urine, stomach pain, or yellowing of the eyes and skin while taking methyldopa/hydrochlorothiazide.
Low white blood cell count
In some rare cases, methyldopa/hydrochlorothiazide can lower the number of white blood cells in your body. White blood cells are needed for your immune system to fight off infections. With a lower level of white blood cells, you can get sick easier or have a harder time recovering from an infection. This problem is temporary and will go away once you stop taking methyldopa/hydrochlorothiazide.
Gout
- Risk factors: History of gout | Current kidney problems
Methyldopa/hydrochlorothiazide can raise uric acid levels in your body, which might cause or worsen gout.
High blood sugar levels
- Risk factors: Diabetes
Methyldopa/hydrochlorothiazide might raise your blood sugar levels. If you have diabetes, check your blood sugar more regularly and let your provider know you're taking methyldopa/hydrochlorothiazide in case they need to adjust your diabetes medications.
Methyldopa/hydrochlorothiazide dosage
Typical dosage for Methyldopa/hydrochlorothiazide
The typical starting dose is 250 mg/15 mg (methyldopa/hydrochlorothiazide) by mouth two to three times a day, or 250 mg/25 mg (methyldopa/hydrochlorothiazide) two times a day. The dose can vary greatly depending on your previous dose and your response to the two separate medications, methyldopa and hydrochlorothiazide.
Interactions between Methyldopa/hydrochlorothiazide and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Brofaromine
- Clorgyline
- Dofetilide
- Furazolidone
- Iproniazid
- Isocarboxazid
- Lazabemide
- Linezolid
- Moclobemide
- Nialamide
- Pargyline
- Phenelzine
- Procarbazine
- Rasagiline
- Selegiline
- Toloxatone
- Tranylcypromine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aceclofenac
- Acemetacin
- Acetyldigoxin
- Amphetamine
- Amtolmetin Guacil
- Arsenic Trioxide
- Aspirin
- Benzphetamine
- Bromfenac
- Bufexamac
- Celecoxib
- Choline Salicylate
- Clonixin
- Deslanoside
- Desmopressin
- Dexibuprofen
- Dexketoprofen
- Dextroamphetamine
- Diclofenac
- Diflunisal
- Digitalis
- Digitoxin
- Digoxin
- Dipyrone
- Droperidol
- Droxicam
- Entacapone
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Flecainide
- Floctafenine
- Flufenamic Acid
- Flurbiprofen
- Ibuprofen
- Indomethacin
- Iobenguane I 131
- Ketanserin
- Ketoprofen
- Ketorolac
- Levomethadyl
- Lisdexamfetamine
- Lithium
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Methamphetamine
- Methotrexate
- Metildigoxin
- Morniflumate
- Nabumetone
- Naproxen
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Ouabain
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Phenylbutazone
- Piketoprofen
- Piroxicam
- Porfimer
- Proglumetacin
- Propyphenazone
- Proquazone
- Proscillaridin
- Pseudoephedrine
- Rofecoxib
- Salicylic Acid
- Salsalate
- Sodium Salicylate
- Sotalol
- Sulindac
- Tenoxicam
- Tiaprofenic Acid
- Tolfenamic Acid
- Tolmetin
- Valdecoxib
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alprenolol
- Aminolevulinic Acid
- Bepridil
- Bisoprolol
- Carbamazepine
- Cholestyramine
- Ferric Ammonium Citrate
- Ginkgo
- Gossypol
- Haloperidol
- Iron
- Licorice
- Phenylpropanolamine
- Sotalol
- Timolol
- Topiramate
Methyldopa/hydrochlorothiazide contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Methyldopa/hydrochlorothiazide will not be safe for you to take.
- Current liver problems
- Liver problems related to previous use of methyldopa
- Unable to produce urine (anuria)
- Take medications called monoamine oxidase (MAO) inhibitors
- Allergy to sulfonamide medications
