Combipres: Effective Hypertension and ADHD Symptom Control
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Synonyms | |||
Combipres, a fixed-dose combination medication containing clonidine hydrochloride and chlorthalidone, represents a significant therapeutic option for clinicians managing complex cases of hypertension. This dual-action antihypertensive agent leverages complementary mechanisms to achieve robust blood pressure control while potentially mitigating dose-dependent side effects associated with monotherapy. Its unique pharmacological profile makes it particularly valuable in treatment-resistant hypertension and select off-label applications, offering a streamlined approach to polypharmacy challenges. The following comprehensive product card provides detailed information for healthcare professionals considering Combipres for appropriate patient populations.
Features
- Contains 0.1 mg, 0.2 mg, or 0.3 mg of clonidine hydrochloride per tablet
- Contains 15 mg of chlorthalidone per tablet across all strengths
- Fixed-dose combination therapy in a single oral formulation
- White, round, scored tablets with strength-specific imprints
- Available in bottles of 100 and 1000 tablets
- Typical dosing regimen of twice daily administration
- Chemical stability under proper storage conditions for 24 months
Benefits
- Synergistic blood pressure reduction through complementary mechanisms: central alpha-2 adrenergic agonism and diuresis
- Simplified dosing regimen compared to separate prescriptions, potentially improving adherence
- Reduced pill burden for patients requiring multiple antihypertensive agents
- Potential for lower individual component dosing while maintaining efficacy, possibly minimizing side effects
- Comprehensive cardiovascular risk management through blood pressure control and volume reduction
- Established safety profile with decades of clinical use and documentation
Common use
Combipres is primarily indicated for the management of hypertension in patients where combination therapy is appropriate. It is typically considered when monotherapy provides insufficient blood pressure control or when the complementary actions of both components are deemed beneficial for a particular patient profile. The medication may be particularly useful in patients with salt-sensitive hypertension or those exhibiting sympathetic nervous system overactivity. Off-label, clonidine component has been utilized in management of attention deficit hyperactivity disorder (ADHD), opioid withdrawal symptoms, menopausal flushing, and certain pain syndromes, though these uses should be carefully considered within the context of the fixed combination with chlorthalidone.
Dosage and direction
The dosage of Combipres must be individualized based on patient response and tolerance. The usual starting dose is one tablet of Combipres 0.1/15 (containing 0.1 mg clonidine hydrochloride and 15 mg chlorthalidone) twice daily. Dosage may be increased incrementally, typically at weekly intervals, to a maximum of two tablets of Combipres 0.3/15 twice daily. Doses are usually administered in the morning and at bedtime to minimize potential sedative effects during waking hours. Tablets should be swallowed whole with a full glass of water, with or without food, though consistent administration with regard to meals is recommended. Dose adjustments should be made cautiously in elderly patients or those with renal impairment. Abrupt discontinuation should be avoided due to risk of rebound hypertension.
Precautions
Patients should be monitored regularly for blood pressure response and potential adverse effects. Renal function and electrolytes, particularly potassium and sodium, should be assessed periodically during therapy due to the thiazide-like diuretic component. Hepatic function should be monitored in patients with pre-existing liver disease. Caution is advised in patients with history of depression, as clonidine may exacerbate depressive symptoms. The sedative effects of clonidine may impair mental and physical abilities required for hazardous tasks; patients should be cautioned about operating machinery or driving until they know how the medication affects them. Photosensitivity reactions may occur due to chlorthalidone; sun protection measures are recommended. Regular eye examinations are advised for patients on long-term therapy.
Contraindications
Combipres is contraindicated in patients with known hypersensitivity to clonidine, chlorthalidone, or other sulfonamide-derived drugs. It should not be used in patients with anuria or severe renal impairment (creatinine clearance <30 mL/min). The medication is contraindicated in patients with severe hepatic disease. It should not be administered to patients with sinus node dysfunction or sick sinus syndrome, except with functioning ventricular pacemaker. Combipres is contraindicated in patients with history of angioedema related to previous thiazide therapy.
Possible side effect
- Common: Dry mouth, drowsiness, dizziness, constipation, sedation, fatigue
- Cardiovascular: Orthostatic hypotension, bradycardia, syncope, ECG abnormalities
- Gastrointestinal: Nausea, vomiting, abdominal pain, anorexia, parotid pain
- Metabolic: Hypokalemia, hyponatremia, hypochloremia, hypercalcemia, hyperglycemia, hyperuricemia
- Neurological: Headache, insomnia, nightmares, nervousness, restlessness, anxiety
- Dermatological: Rash, pruritus, urticaria, photosensitivity
- Genitourinary: Impotence, urinary frequency, nocturia
- Other: Weight gain, nasal dryness, weakly positive Coombs test
Drug interaction
Combipres has numerous potential drug interactions requiring careful consideration. Concomitant use with other central nervous system depressants (alcohol, barbiturates, benzodiazepines) may potentiate sedative effects. Tricyclic antidepressants may reduce the antihypertensive efficacy of clonidine. Beta-blockers may potentiate bradycardia and enhance rebound hypertension upon abrupt withdrawal. Concurrent use with other antihypertensive agents may result in additive hypotensive effects. Nonsteroidal anti-inflammatory drugs may reduce the diuretic and antihypertensive effects of chlorthalidone. Digoxin toxicity may be potentiated by hypokalemia. Lithium clearance may be reduced, increasing risk of lithium toxicity. The hypoglycemic effect of insulin and oral antidiabetic agents may be diminished.
Missed dose
If a dose of Combipres is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed one. If multiple doses are missed, blood pressure should be monitored closely and healthcare provider consulted before resuming therapy, as rebound hypertension may occur with clonidine withdrawal.
Overdose
Overdose of Combipres may manifest as profound hypotension, bradycardia, respiratory depression, hypothermia, drowsiness, diminished reflexes, and weakness. Hypokalemia or other electrolyte disturbances may occur due to chlorthalidone component. Gastric lavage may be considered if presentation is early after ingestion. Activated charcoal may be administered. Primary treatment involves supportive care with attention to respiratory and cardiovascular status. Atropine may be used for bradycardia. Vasopressors may be required for hypotension, though their use should be cautious due to potential paradoxical response. Dialysis is not likely to be effective for clonidine removal but may help correct electrolyte imbalances. Tolazoline has been used as an antidote for clonidine overdose in some cases.
Storage
Combipres tablets should be stored at controlled room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F). The medication should be kept in its original container, tightly closed, and protected from light and moisture. Tablets should be kept out of reach of children and pets. Unused medication should be properly disposed of according to local regulations and should not be flushed down the toilet or drain unless specifically instructed.
Disclaimer
This information is intended for healthcare professionals and should not replace professional medical advice, diagnosis, or treatment. The content provided is based on current pharmacological knowledge but may not encompass all possible information about this medication. Healthcare providers should consult full prescribing information and consider individual patient factors before prescribing Combipres. Patients should be instructed to read the patient information leaflet and discuss any questions with their healthcare provider. The safety and efficacy of Combipres in pediatric patients have not been established.
Reviews
Clinical experience with Combipres demonstrates effective blood pressure control in appropriate patient populations. Many clinicians appreciate the convenience of the fixed-dose combination for improving adherence in patients requiring multiple antihypertensive agents. The complementary mechanisms of action are frequently noted as advantageous, particularly in patients with volume overload and sympathetic overactivity. Some practitioners report satisfactory efficacy in treatment-resistant hypertension when used as part of a comprehensive regimen. Concerns occasionally noted include the need for careful monitoring of metabolic parameters and the potential for withdrawal phenomena with missed doses. Overall, Combipres remains a valuable option in the antihypertensive arsenal when used judiciously in appropriately selected patients.