Dosing & Uses
Dosage Forms & Strengths
Not indicated for initial therapy
If the fixed dose combination represents the dose appropriate to the individual patient's needs, it may be more convenient than the separate components
Initial dose: 50 mg atenolol/25 mg chlorthalidone PO qDay
May increase to 100 mg atenolol/25 mg chlorthalidone PO qDay if needed
When necessary, another antihypertensive agent may be added gradually beginning with 50 percent of the usual recommended starting dose to avoid an excessive fall in blood pressure
Use caution in dosing/titrating patients with renal dysfunction
Cumulative effects of thiazides may develop with impaired renal function
CrCl > 35 mL/min/1.73 m²: Dose adjustment not necessary
CrCl 15-35 mL/min/1.73 m²: Maximum 50 mg PO qDay
CrCl <15 mL/min/1.73 m²: Maximum 25 mg PO qDay or 50 mg PO every other day
Not studied; use caution
Combination may be substituted for the titrated individual components
Withdraw gradually over a period of about 2 weeks
May need dosage reduction for geriatric patients
<18 years: Safety/efficacy not established
Serious - Use Alternative
Significant - Monitor Closely
No adverse effects specific to the combination have been observed; adverse effects limited to those previously reported with atenolol and chlorthalidone
Frequency Not Defined
- 2/3° AV block
- Cold extremities
- Leg pain
- Postural hypotension
- Unusual dreams
- Blurred vision, xanthopsia
- Electrolyte abnormalities
- Headache, vasculitis
- Loss of appetite
- Muscular spasticity, restlessness
- Photosensitivity, phototoxicity
- Antinuclear antibodies (ANA), catatonia, disorientation, elevated serum hepatic enzymes & bilirubin, emotional lability, fatigue, hallucinations, headache, hypotension, impaired performance on neuropsychometric tests, impotence, lupus syndrome, mental depression, nausea, Peyronie's disease, psychoses, purpura, rashes, severe CHF, short-term memory impairment, sick sinus syndrome, thrombocytopenia, visual disturbances, wheezing & dyspnea more likely if dose >100 mg qD, xerophthalmia, xerostomia
- Cardiac dysrhythmia (rare), disorder of hematopoietic structure (rare), hepatotoxicity (rare), pancreatitis (rare), pulmonary edema (rare), scaling eczema (ra re), stevens-Johnson syndrome (rare), systemic lupus erythematosus (rare), toxic epidermal necrolysis (rare)
Black Box Warning
Exacerbation of angina and, in some cases, myocardial infarction reported, after abrupt discontinuation
When discontinuing chronically administered beta-blockers (particularly with ischemic heart disease) gradually reduce dose over 1-2 weeks and carefully monitor
If angina markedly worsens or acute coronary insufficiency develops, reinstate beta-blocker administration promptly, at least temporarily (in addition to other measures appropriate for unstable angina)
Warn patients against interruption or discontinuation of beta-blocker without physician advice
Heart block 2°/3°
Hypersensitivity to either component or sulfonamides
Overt cardiac failure
Surgery/Anesthesia: Chronically administered beta-blockers should not be routinely withdrawn prior to major surgery; however, impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures
Correct hypokalemia before initiating therapy
CHF, beta blockade carries the potential hazard of further depressing myocardial contractility and precipitating more severe failure
Use caution in diabetes mellitus, fluid or electrolyte imbalance (hypochloremic alkalosis, hypercalcemia, hyponatremia), moderate or high cholesterol concentrations, history of asthma, hyperuricemia or gout, hypotension, SLE
Hyperthyroidism/thyrotoxicosis, liver disease
May aggravate digitalis toxicity
Peripheral vascular disease
Risk of male sexual dysfunction
Sensitivity reactions may occur with or without history of allergy or asthma
Compromised left ventricular function
Patients receiving clonidine - discontinue atenolol several days prior to withdrawal of clonidine
Pregnancy & Lactation
Pregnancy Category: D
Lactation: excreted in breast milk, use caution
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Atenolol/chlorthalidone is a fixed-combination tablet that combines a beta adrenergic receptor blocker atenolol, and a diuretic, chlorthalidone
Atenolol: Cardioselective inhibitor of beta(1)-adrenoceptor, has no significant intrinsic sympathomimetic activity or membrane stabilizing activity in its therapeutic dosage; exhibits beta(2)-adrenoceptors inhibition and negative chronotropic effect
Chlorthalidone: Monosulfonamyl diuretic inhibits Na and Cl reabsorption in cortical-diluting segment of ascending loop of Henle
- Onset: 2-4 hr (peak effect)
- Protein binding: 6-16%
- Metabolism: Liver
- Duration: 12-24 hr (normal renal function)
- Absorption: 50%
- Half-life: 6-7 hr (normal renal function); 15-35 hr (end stage renal disease); >5 hr (children >10 years of age); < 5 hr (children 5-10 year of age)
- Peak plasma time: 2-4 hr (PO)
- Excretion: Feces (50%); urine (40%)
- Duration: 24-72 hr
- Onset: 2-6 hr (peak effect)
- Metabolism: Liver
- Protein binding: 75%
- Bioavailability: 60-65%
- Excretion: Urine (50-65%)
- Half-life: 40-60 hr (normal renal function); prolonged in renal impairment; 81 hr (anuria)
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.