atenolol/chlorthalidone (Rx)

Brand and Other Names:Tenoretic
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

atenolol/chlorthalidone

tablet

  • 50mg/25mg
  • 100mg/25mg
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Hypertension

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

Renal Impairment

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

Anuria: Contraindicated

Hepatic Impairment

Not studied; use caution

Administration

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

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Interactions

Interaction Checker

and atenolol/chlorthalidone

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            No adverse effects specific to the combination have been observed; adverse effects limited to those previously reported with atenolol and chlorthalidone

            Frequency Not Defined

            Atenolol

            • 2/3° AV block
            • Bradycardia
            • Cold extremities
            • Diarrhea
            • Drowsiness
            • Hypotension
            • Leg pain
            • Lethargy
            • Lightheadedness
            • Nausea
            • Postural hypotension
            • Unusual dreams
            • Vertigo

            Chlorthalidone

            • Blurred vision, xanthopsia
            • Constipation
            • Diarrhea
            • Dizziness
            • Electrolyte abnormalities
            • Headache, vasculitis
            • Hyperglycemia
            • Hyperuricemia
            • Hypotension
            • Impotence
            • Loss of appetite
            • Muscular spasticity, restlessness
            • Nausea/vomiting
            • Paresthesia
            • Photosensitivity, phototoxicity

            < 1%

            Atenolol

            • 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

            Chlorthalidone

            • 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)
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            Warnings

            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

            Contraindications

            Anuria

            Cardiogenic shock

            Heart block 2°/3°

            Hypersensitivity to either component or sulfonamides

            Overt cardiac failure

            Sinus bradycardia

            Untreated pheochromocytoma

            Cautions

            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

            Bronchospastic disease

            Cerebrovascular insufficiency

            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

            Renal impairment

            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

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            Pregnancy & Lactation

            Pregnancy Category: D

            Lactation: excreted in breast milk, use caution

            Pregnancy Categories

            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.

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            Pharmacology

            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

            Pharmacokinetics

            Atenolol

            • 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%)

            Chlorthalidone

            • 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)
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            Formulary

            FormularyPatient Discounts

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            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.

            Tier Description
            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.
            Code Definition
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