Indicated in the treatment of hypertension.
Beta-blocker + Calcium-channel blocker;
Atenolol and chlorthalidone have been used singly and concomitantly for the treatment of hypertension. Studies have shown that there is no interference with bioavailability when these agents are given together in the single combination tablet. Therefore, this combination provides a convenient formulation for the concomitant administration of these two drugs.
Atenolol is a beta1-selective (cardioselective) beta-adrenergic receptor blocking agent that provides-
reduction in resting and exercise heart rates and cardiac output
reduction of systolic and diastolic blood pressure at rest and on exercise
reduction in reflex orthostatic tachycardia.
Chlorthalidone is a monosulfonamyl diuretic with prolonged action and low toxicity. It produces diuresis with greatly increased excretion of sodium and chloride at distal convoluted tubule of the nephron.
Adult: Per tab contains Atenolol (mg)/Chorthalidone (mg): 50/25 or 100/25. Initially one tab of 50/25 once daily; may increase to one tab of 100/25 once daily according to response
This combination may potentiate the action of other antihypertensive agents used concominantly. Concominant use with catecholamine depletor (eg, reserpine) may cause hypotension and/or marked bradycardia
Calcium channel blockers, Amiodarone may have an additive effect when given with this combination.
Concomitant use of prostaglandin synthase inhibiting drugs, eg, indomethacin, may decrease the hypotensive effects of beta blockers.
Both digitalis glycosides and beta-blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.
Sinus bradycardia, 2nd or 3rd degree heart block, cardiogenic shock, anuria, hypersentivity to either product or sulphonamide derivatives.Bronchospastic disease, renal or hepatic impairment, elderly. May aggravate peripheral arterial circulatory disorder. Beta-blocker can depress myocardial contractility; continued use in patients w/o history of cardiac failure may in some cases, lead to cardiac failure. Caution in patients receiving anesth agents that may depress myocardium. In patients w/ coronary artery disease, abrupt withdrawal may cause angina pectoris exacerbation, Ml. Atenolol may mask signs (tachycardia) of hypoglycaemia & thyrotoxicosis. Latent DM may manifest w/ Chlorthalidone therapy. Chlorthalidone can cause hyperuricaemia & precipitate gout. Monitor renal functions, K levels, & signs of fluid & electrolytes imbalance. Discontinue if progressive renal impairment is evident. Not recommended in pregnancy & lactation. Safety & efficacy in paed patients have not been established.
Atenolol: Dyspnoea, wheeziness, bradycardia, hypotension, cold extremities, fatigue, dizziness, insomnia, lethargy, confusion, headache, depression, nightmares, nausea, diarrhoea, constipation, impotence, paraesthesia, rash, Raynaud’s phenomenon. Chlorthalidone: Orthostatic hypotension, GI disturbances, jaundice, pancreatitis. vertigo, lethargy, paraesthesia, photosensitivity, rash, muscle cramps, hypokalaemia, hyponatraemia, hyperglycaemia, hyperuricaemia or gout, leucopenia, agranulocytosis, aplastic anaemia, thrombocytopenia. Atenolol: Heart failure, 2 or 3rd degree AV block. Chlorthalidone: Hypersensitivity reaction including toxic epidermal necrolysis.
Pregnancy atenolol: weigh risk/benefit during pregnancy, esp. in 2nd and 3rd trimesters; possible risk of teratogenicity based on limited or conflicting human data; risk of intrauterine growth restriction and neonatal adverse effects, incl. bradycardia and hypoglycemia, based on limited human data chlorthalidone: may use during pregnancy if on chronic tx before conception, otherwise caution advised; no known risk of teratogenicity based on human data; possible risk of decr. placental perfusion and neonatal adverse effects, incl. hypoglycemia, thrombocytopenia, and electrolyte abnormalities, based on limited or conflicting human data; risks not observed if chronic use before conception Lactation atenolol: consider alternative while breastfeeding, esp. in high-risk infants; possible risk of infant bradycardia, cyanosis, and hypothermia based on conflicting human data; inadequate human data available to assess effects on milk production chlorthalidone: consider alternative while breastfeeding; possible risk of infant harm based on limited human data and drug properties; possible decr. milk production based on conflicting human data
No specific information is available with regard to overdosage of this combination in humans. Treatment should be symptomatic and supportive and directed to the removal of any unabsorbed drug by induced emesis, or administration of activated charcoal. Atenolol can be removed from the general circulation by hemodialysis. Further consideration should be given to dehydration, electrolyte imbalance and hypotension by established procedures.
Store in cool and dry place, protected from light.
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