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The following safety information is crucial for understanding the potential risks and necessary precautions when using this medication. Please read carefully and discuss with your healthcare provider if you have any questions or concerns.

• Not for Initial Therapy: This medication is not intended for starting treatment to lower blood pressure. Initially, your healthcare provider should prescribe methyldopa and hydrochlorothiazide separately, adjusting the dosage based on your response and blood pressure levels.

• Electrolyte Imbalance: This medication may disrupt your body's electrolyte balance, involving sodium, chloride, potassium, and magnesium levels. This imbalance can be dangerous, particularly if you are dehydrated, vomiting, or using other medications that affect electrolytes. Consult your healthcare provider if you are uncertain about the impact of other medications, supplements, or foods on your electrolyte levels. Seek immediate medical attention if you experience symptoms such as dry mouth, extreme thirst, weakness, fatigue, restlessness, confusion, seizures, muscle pain or cramps, low blood pressure, difficulty urinating, irregular heartbeat, nausea, or vomiting.

• Hemolytic Anemia: Long-term use can lead to a positive Coombs test, indicating your body is attacking its red blood cells. This may result in a serious condition called hemolytic anemia, where red blood cells are destroyed faster than they are produced. If you are on long-term treatment, your healthcare provider will conduct blood tests before and during treatment.

• Liver Issues: Although rare, this medication can cause severe liver problems. If you have a history of liver issues, discuss alternative treatments with your provider. Report symptoms such as fever, unusual vomiting, pale stools, dark urine, abdominal pain, or yellowing of the skin and eyes immediately.

• Low White Blood Cell Count: Rarely, this medication can reduce white blood cell counts, impairing your immune response and increasing infection risk. This condition is temporary and resolves after discontinuing the medication.

• Gout: The medication can elevate uric acid levels, potentially triggering or worsening gout, especially if you have a history of gout or current kidney issues.

• High Blood Sugar Levels: The medication may increase blood sugar levels. If you have diabetes, monitor your blood sugar more frequently and inform your provider to adjust your diabetes medications if necessary.

Contraindications: This medication should be avoided under the following conditions due to potential health risks:

• Current liver problems
• Liver issues related to previous methyldopa use
• Inability to produce urine (anuria)
• Use of monoamine oxidase (MAO) inhibitors
• Allergy to sulfonamide medications

If any of these conditions apply to you, consult your healthcare provider before using this medication.

Common side effects:

• dizziness
• lightheadedness
• drowsiness
• headaches
• stuffy nose
• feeling of weakness

Less common but important to monitor:

• swelling
• weight gain
• slow heart rate
• nausea
• vomiting
• diarrhea
• dry mouth
• joint or muscle pain
• feeling of pins and needles
• rash
• changes in menstrual cycles
• breast enlargement
• decreased sexual drive

Serious side effects:

• extreme thirst
• muscle cramps
• irregular heartbeat
• confusion
• dark urine
• yellowing of the skin and eyes
• unusual vomiting
• stomach pain
• severe dizziness
• trouble breathing

Interactions with high risk of serious adverse effects and should be avoided:

• MAO inhibitors (isocarboxazid, linezolid, phenelzine, etc.)

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Dofetilide
• Lithium
• Alcohol, marijuana, antihistamines, sleep aids, anti-anxiety medications, muscle relaxants, and opioids