Combination Products as First-Line Pharmacotherapy

Robert R. Fenichel, PhD, MD; Raymond J. Lipicky, MD
Arch Intern Med. 1995;155(1):117. doi:10.1001/archinte.1995.00430010125024.
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Our editorial1 in the July 11, 1994, issue of the Archives stated that betaxolol-chlorthalidone and bisoprolol-hydrochlorothiazide are the only fixed-dose combination products approved in the United States as first-line pharmacotherapy for hypertension. This is incorrect.

We inadvertently neglected to discuss the fixed-dose combination of captopril and hydrochlorothiazide. This combination was approved in 1984, and it was approved as first-line therapy in 1991. The latter approval was a consequence of the marked improvement in the regimen that the combination allows, ie, the combination can be effectively administered once a day, while captopril monotherapy must be given twice or three times a day. The approval of captopril-hydrochlorothiazide as first-line therapy was, thus, an exception to the generalization overbroadly stated in our editorial that no combination of an angiotensin-converting enzyme inhibitor and hydrochlorothiazide could ever be approved as first-line therapy. Captopril-hydrochlorothiazide was approved—and similar decisions might be made in the future—because the


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