Tenoric coated pills 50mg N28
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Active ingredients
Atenolol + Hlortalidone
Release form
Pills
Composition
Atenolol (atenolol) 50 mg; Chlorthalidone (chlorthalidone) 12.5 mg
Pharmacological effect
Combined antihypertensive drug, has a prolonged hypotensive effect. The effect is due to the action of two components: beta1-adrenoblocker (atenolol) and diuretic (chlorthalidone). Atenolol is a cardioselective beta1-adrenergic blocker. Selectivity decreases with increasing doses. Atenol does not have internal sympathomimetic and membrane stabilizing effects. Like other beta-adrenergic blockers, it has a negative inotropic effect, slows heart rate. Chloridalidone is a non-thiazide sulfonamide diuretic, increases the excretion of sodium and chlorine. Increases the excretion of potassium, magnesium and bicarbonate. The mechanism of antihypertensive action is probably related to the excretion of sodium. The combination of atenolol with diuretics is more effective than the use of each of the components separately. The effect of the drug Tenoric persists for 24 hours after a single oral administration in a daily dose.
Pharmacokinetics
The simultaneous use of atenolol and chlorthalidone has little effect on the pharmacokinetics of each of the active substances. Atenolol Absorption and distribution After taking the drug inside, atenolol is absorbed from the gastrointestinal tract by 40-50%. Cmax in plasma is achieved 2-4 hours after administration. Plasma protein binding is approximately 6-16%. Metabolism and eliminationAtenolol does not undergo a pronounced hepatic metabolism, more than 90% (absorbed into the systemic circulation) is excreted unchanged. T1 / 2 is 6-9 hours, but may increase in cases of severe renal failure, since atenolol is eliminated mainly by the kidneys. Chlorthalidone Absorption and distribution After administration of the drug, chlorthalidone is absorbed from the gastrointestinal tract by 60%. Cmax in plasma is noted after about 12 hours. Chlorthalidone binds to plasma proteins by about 75%. Excretion is excreted by the kidneys, T1 / 2 is approximately 50 hours.
Indications
Arterial hypertension.
Contraindications
- hypersensitivity to any of the components of the drug; - cardiogenic shock, collapse; - severe hypotension (systolic pressure below 90 mm Hg).Art.); - metabolic acidosis; - pronounced disorders of the peripheral circulation; - atrioventricular block II and III; - sick sinus syndrome; - pheochromocytoma (without simultaneous use of alpha-adrenergic blockers); - acute heart failure and chronic heart failure - refractory hypokalemia; - gout; - myasthenia; - acute hepatitis; - renal failure (creatinine clearance less than 35 ml / min); - age up to 18 years (efficacy and safety not established); - hereditary n lactose intolerance, lactase deficiency and glucose / galactose malabsorption syndrome.
Precautionary measures
When prescribing the drug to patients with impaired renal function, reduce the frequency of taking the drug.
Use during pregnancy and lactation
The drug Tenoric is contraindicated for use during pregnancy and lactation (breastfeeding).
Dosage and administration
The drug should be taken orally, in the morning, before eating, without chewing and drinking plenty of water. In hypertension, the initial dose is 1 tablet of the drug containing 50 mg of atenolol and 12.5 mg of chlorthalidone per day. The maximum daily dose is 100 mg of atenolol and 25 mg of chlorthalidone per day. With increasing doses, a further reduction in blood pressure either does not occur, or it is insignificant, but if necessary, another antihypertensive agent can be used. Elderly patients. For this age group, a lower dose of the drug (for atenolol) is often required, which is determined by the doctor. in the treatment of patients with impaired renal function. In patients with creatinine clearance less than 35 ml / min, the drug can only be used after titration of the dose of certain components of the preparation ata.Clirence of creatinineMaximal dose of atenolol (ml / min / 1.73 m2) 15-3550 mg per dayLess than 1550 mg every other day The dose of the drug should be reduced by reducing the frequency of intake (see section Precautions when using). when it is canceled, no special actions are required when you first take Tenoric. The abolition of the drug after prolonged treatment should be carried out, if possible, gradually. The actions of the doctor (paramedic), the patient when skipping taking one or several doses of the drug Tenoric. When skipping taking the drug should not double the dose.Skipping taking the next dose of the drug may be accompanied by a decrease in the effectiveness of treatment.
Side effects
Laboratory indicators: hyperuricemia, hyponatremia (associated with chlorthalidone), hypokalemia, impaired glucose tolerance. On the cardiovascular system: bradycardia, increased symptoms of chronic heart failure; orthostatic hypotension, which may be accompanied by syncope. Arrhythmias may occur, including atrioventricular block; intermittent claudication, cold extremity, development of Raynaud's syndrome. From the side of the central nervous system: confusion, dizziness, headache, mood lability, acute psychosis, hallucinations, paresthesias, sleep disorders, increased fatigue, apathy, disorientation. From the digestive tract: dryness oral mucosa, gastrointestinal disorders (nausea, constipation, anorexia), increased serum hepatic transaminase activity; abnormal liver function with symptoms of intrahepatic cholestasis; From the hemopoietic system: leukopenia, purpura, thrombocytopenia, agranulocytosis, eosinophilia. or with a history of indications of bronchospasm. On the part of the organ of vision: visual impairment, dryness of the mucous membrane of the eyes. Others: an increase in the titer of antinuclear antibodies, although the clinical significance of this the fact is not clear; decrease in potency.
Overdose
Symptoms: severe bradycardia, arterial hypotension, acute heart failure, bronchospasm, convulsions, increased drowsiness. Treatment: careful monitoring of the patient, if necessary - hospitalization in the ICU, gastric lavage, the use of activated carbon and laxatives; in case of arterial hypotension and shock, administration of plasma or plasma substitutes; with brochospasm - the use of bronchodilators, with significant diuresis - the introduction of fluid and electrolytes. Hemodialysis or hemoperfusion is possible.
Interaction with other drugs
Simultaneous use of tenoric with dihydropyridine derivatives (nifedipine) may increase the risk of arterial hypotension, in patients with latent heart failure, signs of circulatory disturbances may appear. Cardiac glycosides in combination with beta-adrenergic blockers may increase the time of AV conduction. Beta-adrenergic blockers may exacerbate rykos which may occur after clonidine withdrawal. If both drugs are prescribed, the beta-blocker should be stopped a few days before discontinuing clonidine. If it is necessary to replace clonidine with a beta-blocker, the latter should be administered several days after discontinuation of therapy with clonidine. It is necessary to prescribe a beta-blocker in combination with class I antiarrhythmic drugs (disopyramide), since The cardiodepressive effect can be summed. The concomitant use of sympathomimetic drugs, such as epinephrine (adrenaline), norepinephrine (norepinephrine), can neutralize the effect of beta-adrenergic blockers and lead to a significant increase in blood pressure. adrenergic blockers, and the use of salicylates in a high dose may increase the toxic effect of salicylates on the CNS. Preparations containing lithium should not be used with diuretics, .K. they can reduce the renal clearance of lithium. The use of beta-blockers together with general anesthesia can lead to an increased risk of arterial hypotension and the summation of the negative inotropic effect of both drugs (use an anesthetic with minimal negative inotropic effect). It is also possible to increase the effect of curare-like muscle relaxants. When using the drug Tenoric with MAO inhibitors, an increase in blood pressure (this combination should be avoided) is possible. If Tenoric is used simultaneously with ACE inhibitors (captopril, enalapril), an antihypertensive effect may be dramatically increased at the beginning of therapy. with GCS, amphotericin B, furosemide, potassium excretion may be enhanced. When combined with Tenoric, the effects of insulin and oral hypoglycemic agents can is reduced (it should control the level of glucose in the blood) .Tritsiklicheskie antidepressants, barbiturates, phenothiazines, diuretics,vasodilators and other antihypertensive drugs may enhance the anti-hypertensive effect of Tenorica. The use of beta-blockers in combination with calcium channel blockers that have a negative inotropic effect, such as verapamil, diltiazem, can lead to an increase in this effect, especially in patients with reduced myocardial contractility, and can also increase myocardial contractility. with impaired sinoatrial or AV conduction, which can cause severe arterial hypotension, severe bradycardia, and cardiac failure. Spine (calcium channel blocker should not be used in / for 48 hours after discontinuation of beta-blocker). If Tenoric is given concurrently with reserpine, clonidine, guanfacine, severe bradycardia may occur.
special instructions
Conditioned with beta-adrenergic blocker by atenolol, which is part of Tenoric. Patients with AV block I degree should be cautious. It should be noted that the use of the drug can mask the effects of thyrotoxicosis and hypoglycemia. When developing against the background of the use of the drug bradycardia (HR, up to 50 beats / min) s clinical symptoms should reduce the dose or discontinue the drug. Do not abruptly discontinue Tenoric in patients with IBS. Smokers may experience a decrease in the therapeutic effect of the drug. Special attention should be paid In cases where surgical intervention is required with general anesthesia. The drug should be discontinued 48 hours before surgery, and as an anesthetic one should choose a drug with possibly minimal negative inotropic effects. On the background of the drug intake, an increase in sensitivity to allergens and the development of severe anaphylactic reactions is expected, and therefore patients receiving desensitizing therapy, should take the drug with great care. Such patients may not respond to the average dose of epinephrine (adrenaline) used to treat allergic reactions. Patients with bronchoobstructive syndrome should be prescribed with caution, and in case of worsening bronchial conduction, beta-adrenomimetic therapy can be used. When atenolol is used, there may be a decrease in tear fluid production, which It is important for patients using contact lenses. Conditioned by chloralidone diuretic, which is part of Tenoric. Cach hypokalemia.Serum potassium should be monitored, especially in patients receiving cardiac glycosides for treating heart failure, in patients with an unbalanced diet (low in potassium) or in patients with complaints of gastrointestinal disorders. The development of hypokalemia in patients receiving cardiac glycosides can lead to arrhythmias. The drug is used with caution in patients with impaired renal function. A glucose tolerance disorder may occur with the use of the drug. Patients with a predisposition to diabetes should be prescribed with caution. On the background of the use of the drug, hyperuricemia may develop, usually insignificant, but in some cases it may be necessary to use uric acid excretion remedies. 18 years old has not been established, therefore, it should not be prescribed the drug to patients of this age group. Effect on the ability to drive motor vehicles and management and mehanizmamiPrimenenie Tenorika, as a rule, does not affect the ability to drive vehicles and management mechanisms. Nevertheless, the question of the possibility of driving a vehicle should be solved after assessing the individual tolerance of the drug.