Tenoric, 100 mg+25 mg 28 pcs

Tenoric is a combined antihypertensive drug with a prolonged hypotensive effect. The effect is due to the action of two components: a beta1-adrenoblocker (atenolol) and a diuretic (chlorthalidone).

Atenolol is a cardioselective beta1-adrenoblocker. Selectivity decreases with increasing dose. Atenolol has no intrinsic sympathomimetic and membrane stabilizing effects. Like other beta-adrenoblockers, it has a negative inotropic effect and decreases HR.

Chlorthalidone is a nonthiazide sulfonamide diuretic, increases sodium and chlorine excretion. Increases the excretion of potassium, magnesium and bicarbonate.

The mechanism of antihypertensive action is probably related to sodium excretion. The combination of atenolol with diuretics is more effective than the use of each component alone.

The action of Tenoric lasts for 24 hours after a single oral daily dose.

Indications

Arterial hypertension.

Active ingredient

Composition

1 tablet contains:

Active ingredients:

atenolol 100 mg;

Chlorthalidone 25 mg.

Auxiliary substances:

corn starch,

lactose,

polyvinylpyrrolidone,

sodium lauryl sulfate,

talc,

isopropanol,

colloidal silicon dioxide,

magnesium stearate.

Composition of the film coating:

Isopropanol, methylene chloride, hypromellose, talc, titanium dioxide, vaseline oil, macrogol.

How to take, the dosage

The dosing regimen is given in terms of atenolol.

The average dose of Tenoric for adults is 100 mg; the starting dose is 50 mg once daily.

In general, the use of the drug in a dose corresponding to 100 mg of atenolol produces a good clinical effect. Subsequent increase in dose either does not lead to further BP reduction, or reduces it very insignificantly. If necessary, an additional antihypertensive agent may be prescribed.

The drug should be prescribed in lower doses in elderly persons.

Interaction

Simultaneous use of Tenoric with dihydropyridine derivatives (nifedipine) may increase the risk of arterial hypotension, in patients with latent heart failure may appear signs of circulatory disorders.

The cardiac glycosides in combination with beta-adrenoblockers may increase AV conduction time.

Beta-adrenoblockers can exacerbate ricochet hypertension, which can occur after clonidine withdrawal. If both medications are prescribed, the beta-adrenoblocker should be discontinued several days before discontinuing clonidine. If clonidine needs to be replaced by a beta-adrenoblocker, the latter should be prescribed a few days after clonidine has been discontinued.

The beta-adrenoblocker should be used with caution in combination with class I antiarrhythmic agents (disopyramide) because the cardiodepressant effect may be summed up.

The concomitant use of sympathomimetic agents, e.g., epinephrine (adrenaline), norepinephrine (noradrenaline) may neutralize the effect of beta-adrenoblockers and lead to a significant increase in BP.

Salicylates and NSAIDs (ibuprofen, indomethacin), estrogens may decrease the hypotensive effect of beta-adrenoblockers, and when using salicylates in high doses may increase the toxic effect of salicylates on the CNS.

Lithium-containing drugs should not be used with diuretics because they may decrease renal clearance of lithium.

The use of beta-adrenoblockers in combination with general anesthetics may increase the risk of arterial hypotension and the net negative inotropic effect of both agents (anesthetic agents with minimal negative inotropic effects should be used). The effect of curare-like myorelaxants may also be enhanced.
When Tenoric is used with MAO inhibitors an increase in BP may occur (this combination should be avoided).

In concomitant use of Tenoric with ACE inhibitors (captopril, enalapril) at the beginning of therapy a sharp increase in antihypertensive effect is possible.

In co-administration of Tenoric with GCS, amphotericin B, furosemide potassium excretion may be increased.

In co-administration with Tenoric the effect of insulin and oral hypoglycemic agents may decrease (blood glucose levels should be monitored).

Tricyclic antidepressants, barbiturates, phenothiazines, diuretics, vasodilators and other antihypertensive agents may increase the antihypertensive effect of Tenoric.

. The use of beta-adrenoblockers in combination with calcium channel blockers with negative inotropic effect, such as verapamil, diltiazem, may increase this effect, especially in patients with reduced myocardial contractility and/or with impaired sinoatrial or AV conduction, which can cause severe arterial hypotension, marked bradycardia and heart failure (a calcium channel blocker should not be used by IV for 48 h after beta-adrenoblocker withdrawal).

The simultaneous administration of Tenoric with reserpine, clonidine, guanfacine may cause marked bradycardia.

Special Instructions

Atenolol, a beta-adrenoblocker in Tenoric

Patients with grade I AV blockade should be used with caution.

Please note that use of the drug may mask the effects of thyrotoxicosis and hypoglycemia.

If bradycardia (heart rate less than 50 beats/min) with clinical symptoms develops with the use of the drug, the dose should be reduced or the drug should be stopped.

Tenoric should not be abruptly withdrawn in patients with CHD.

In smokers, a decrease in the therapeutic effect of the drug may be noted.

Particular attention should be paid in cases where surgery with general anesthesia is required. The drug administration should be discontinued 48 h before the surgical intervention, and the drug with the lowest possible negative inotropic effect should be chosen as an anesthetic.

The drug administration may cause hypersensitivity to allergens and development of severe anaphylactic reactions; therefore, patients receiving desensitization therapy should use the drug with great caution. Such patients may not respond to medium doses of epinephrine (adrenaline) used to treat allergic reactions.
Patients with bronchoobstructive syndrome should be prescribed with caution and therapy with beta-adrenomimetics in case of worsening of bronchial conduction.

The use of atenolol may decrease tear fluid production, which is important for patients who use contact lenses.

Directed by the diruetide chlorthalidone in Tenoric

Hypokalemia may occur with the use of the drug. Serum potassium levels should be monitored especially in patients receiving cardiac glycosides for treatment of heart failure, in patients with an unbalanced diet (low potassium content) or in patients with complaints about gastrointestinal disorders. The development of hypokalemia in patients receiving cardiac glycosides may lead to arrhythmias.

The drug is used with caution in patients with impaired renal function.

An impairment of glucose tolerance may occur with the use of the drug. Caution should be exercised when prescribing the drug in patients with predisposition to diabetes mellitus.

Hyperuricemia may occur with the use of the drug; however, in some cases, it may be necessary to use uric acid elimination products.

Pediatric use

The efficacy and safety of Tenoric in children and adolescents less than 18 years of age has not been established; therefore, the drug should not be prescribed in patients in this age group.

Impact on driving and operating machinery

The use of Tenoric generally does not affect the ability to drive and operate machinery. Nevertheless, the question about the ability to drive vehicles should be decided after assessing the individual tolerability of the drug.

Contraindications

Side effects

Hyperuricemia, hypokalemia, impaired glucose tolerance, bradycardia, heart block, orthostatic hypotension, heart failure, cold extremities, intermittent claudication, Raynaud’s syndrome, confusion, mood swings, hallucinations, insomnia, nightmares, dry eyes, dyspeptic and visual disturbances, leukopenia, thrombocytopenia, purpura, alopecia, psoriasis, paresthesia, bronchospasm.

Overdose

Symptoms: marked bradycardia, arterial hypotension, acute heart failure, bronchospasm, convulsions, increased somnolence.

The treatment: close monitoring of the patient’s condition, if necessary – hospitalization in the ICU, gastric lavage, use of activated charcoal and laxatives; in arterial hypotension and shock – administration of plasma or plasma substitutes; in bronchospasm – bronchodilators, in significant diuresis – fluid and electrolytes administration. Hemodialysis or hemoperfusion may be performed.