DRUG INTERACTIONS Drug Interactions
When administered concurrently, the following drugs may interact with bendroflumethiazide:
Alcohol, barbiturates, or narcotics –potentiation of orthostatic hypotension may occur.
Amphotericin B, corticosteroids, or corticotropin (ACTH) –may intensify electrolyte imbalance, particularly hypokalemia. Monitor potassium levels; use potassium replacements if necessary.
Anticoagulants (oral) –dosage adjustments of anticoagulant medication may be necessary since bendroflumethiazide may decrease their effects.
Antigout medications –dosage adjustments of antigout medication may be necessary since bendroflumethiazide may raise the level of blood uric acid.
Other antihypertensive medications (e.g., ganglionic or peripheral adrenergic blocking agents) –dosage adjustments may be necessary since bendroflumethiazide may potentiate their effects.
Antidiabetic drugs (oral agents and insulin) –since thiazides may elevate blood glucose levels, dosage adjustments may be necessary.
Calcium salts –increased serum calcium levels due to decreased excretion may occur. If calcium must be prescribed monitor serum calcium levels and adjust calcium dosage accordingly.
Cardiac glycosides –enhanced possibility of digitalis toxicity associated with hypokalemia. Monitor potassium levels; use potassium replacement if necessary.
Cholestyramine resin and colestipol HCL –may delay or decrease absorption of bendroflumethiazide. Sulfonamide diuretics should be taken at least one hour before or four to six hours after these medications.
Diazoxide –enhanced hyperglycemic, hyperuricemic, and antihypertensive effects. Be cognizant of possible interaction; monitor blood glucose and serum uric acid levels.
Lithium salts –may enhance lithium toxicity due to reduced renal clearance. Avoid concurrent use; if lithium must be prescribed monitor serum lithium levels and adjust lithium dosage accordingly. (See WARNINGS.)
MAO inhibitors –dosage adjustments of one or both agents may be necessary since hypotensive effects are enhanced.
Nondepolarizing muscle relaxants, preanesthetics and anesthetics used in surgery (e.g., tubocurarine chloride and galamine triethiodide) –effects of these agents may be potentiated; dosage adjustments may be required. Monitor and correct any fluid and electrolyte imbalances prior to surgery if feasible.
Nonsteroidal anti-inflammatory agents –in some patients, the administration of a nonsteroidal anti-inflammatory agent can reduce the diuretic, natriuretic, and antihypertensive effect of loop, potassium-sparing or thiazide diuretics. Therefore, when bendroflumethiazide and nonsteroidal anti-inflammatory agents are used concomitantly, the patient should be observed closely to determine if the desired effect of the diuretic is obtained.
Methenamine –possible decreased effectiveness due to alkalinization of the urine.
Pressor amines (e.g., norepinephrine) –decreased arterial responsiveness, but not sufficient to preclude effectiveness of the pressor agent for therapeutic use. Use caution in patients taking both medications who undergo surgery. Administer preanesthetic and anesthetic agents in reduced dosage, and if possible, discontinue bendroflumethiazide one week prior to surgery.
Probenecid or sulfinpyrazone –increased dosage of these agents may be necessary since bendroflumethiazide may have hyperuricemic effects.
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