$Unique_ID{BRK01839}
$Pretitle{}
$Title{ATENOLOL AND CHLORTHALIDONE COMBINATION}
$Subject{Tenoretic (ICI Pharma)}
$Volume{}
$Log{}

Copyright (C) 1991 Publications International, Ltd.


ATENOLOL AND CHLORTHALIDONE COMBINATION
------------------------------------------------------------------------------

BRAND NAME (Manufacturer):
     Tenoretic (ICI Pharma)
TYPE OF DRUG:
     Beta-adrenergic blocking agent and diuretic
INGREDIENT:
     Satenolol and chlorthalidone
DOSAGE FORM:
     Tablets (50 mg atenolol and 25 mg chlorthalidone; 100 mg atenolol and 25
       mg chlorthalidone)
STORAGE:
     Atenolol and chlorthalidone combination tablets should be stored at room
       temperature in a tightly closed, light-resistant container.  The
       tablets should be protected from moisture during storage.

USES

     Atenolol and chlorthalidone combination is prescribed to treat high blood
pressure.  Chlorthalidone is a diuretic, which reduces fluid accumulation in
the body by increasing the elimination of salt and water through the kidneys.
Atenolol belongs to a group of medicines known as beta-adrenergic blocking
agents or, more commonly, beta blockers.  They work by controlling impulses
along certain nerve pathways.

TREATMENT

     This medication can be taken with a glass of water, with meals,
immediately following meals, or on an empty stomach, depending on your
doctor's instructions.
     Try to take the medication at the same times(s) each day.  Avoid taking a
dose after 6:00 P.M.; otherwise, you may have to get up during the night to
urinate.
     If you miss a dose of this medication, take the missed dose as soon as
possible, unless it is almost time for your next dose.  In that case, do not
take the missed dose at all; just wait until the next scheduled dose.  Do not
double the dose.
     Atenolol and chlorthalidone combination does not cure high blood
pressure, but it will help to control the condition as long as you continue to
take it.

SIDE EFFECTS

     Minor.

     Anxiety, constipation, cramps, decreased sexual ability, diarrhea,
difficulty in sleeping, dizziness, drowsiness, dryness of the eyes and skin,
gas, headache, heartburn, loss of appetite, nervousness, restlessness, stomach
discomfort, sweating, or tiredness.  These side effects should disappear as
your body adjusts to the medication.
     Chlorthalidone can cause increased sensitivity to sunlight.  It is
important, therefore, to avoid prolonged exposure to sunlight and sunlamps.
Wear protective clothing and sunglasses, and use an effective sunscreen.
     If you become extra-sensitive to the cold, be sure to dress warmly during
cold weather.
     Plain, nonmedicated eye drops (artificial tears) may help to relieve eye
dryness.
     To relieve constipation, increase the amount of fiber in your diet (fresh
fruits and vegetables, salads, bran, and whole-grain breads) unless your
doctor directs you to do otherwise.
     Sucking on ice chips or chewing sugarless gum helps to relieve mouth and
throat dryness.
     To avoid dizziness or light-headedness when you stand, contract and relax
the muscles of your legs for a few moments before rising.  Do this by
alternately pushing one foot against the floor while raising the other foot
slightly, so that you are "pumping" your legs in a pedaling motion.

     Major.

     Tell your doctor about any side effects that are persistent or
particularly bothersome.  IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about
blurred vision, cold hands and feet (due to decreased blood circulation to
skin, fingers, and toes), confusion, depression, difficulty in breathing, dry
mouth, excessive thirst, excessive weakness, fever, hair loss, hallucinations,
itching, joint pain, mood changes, muscle pain or spasms, nausea, nightmares,
numbness or tingling in the fingers or toes, palpitations, rapid weight gain
(three to five pounds within a week), reduced alertness, ringing in the ears,
skin rash, sore throat, swelling, unusual bleeding or bruising, vomiting, or
yellowing of the eyes or skin.

INTERACTIONS

     Atenolol and chlorthalidone combination can interact with other types of
medications:
     1. Indomethacin, aspirin, and other salicylates may decrease the
blood-pressure-lowering effects of beta blockers.
     2. Concurrent use of atenolol and calcium channel blockers (diltiazem,
nifedipine, verapamil) or disopyramide can lead to heart failure or very low
blood pressure.
     3. Cimetidine can increase blood levels of atenolol, resulting in greater
side effects.  Side effects may also be increased when atenolol is taken with
clonidine, digoxin, epinephrine, phenylephrine, phenylpropanolamine,
phenothiazine tranquilizers, prazosin, reserpine, oral contraceptives (birth
control pills), or monoamine oxidase (MAO) inhibitors.  At least 14 days
should separate the use of atenolol and the use of an MAO inhibitor.
     4. Atenolol can antagonize (act against) the effects of theophylline,
aminophylline, albuterol, isoproterenol, metaproterenol, and terbutaline.
     5. Alcohol, barbiturates, and rifampin can decrease blood levels of beta
blockers, resulting in decreased effectiveness.
     6. The action of beta blockers may be increased if they are used with
chlorpromazine, furosemide, or hydralazine, which may have a negative effect.
     7. Atenolol and chlorthalidone can interact with insulin and oral
antidiabetic agents--raising or lowering blood sugar levels and masking the
symptoms of low blood sugar.
     8. Chlorthalidone can decrease the effectiveness of oral anticoagulants
(blood thinners, such as warfarin), antigout medications, and methenamine.
     9. Fenfluramine may increase the blood-pressure-lowering effects of this
drug, which can be dangerous.
     10. Cholestyramine and colestipol can decrease the absorption of
chlorthalidone from the gastrointestinal tract.  Chlorthalidone should,
therefore, be taken one hour before or four hours after a dose of
cholestyramine or colestipol (if you have also been prescribed one of these
medications).
     11. Chlorthalidone may increase the side effects of amphotericin B,
calcium supplements, cortisone-like steroids (such as cortisone,
dexamethasone, hydrocortisone, prednisone, and prednisolone), digoxin,
digitalis, lithium, quinidine, sulfonamide antibiotics, and vitamin D.
     Before starting atenolol and chlorthalidone combination, BE SURE TO TELL
YOUR DOCTOR about all of the medications you are currently taking, especially
any of the ones listed above.

WARNINGS

     * Tell your doctor about unusual or allergic reactions you have had to
medications, especially to atenolol or any other beta blocker (acebutolol,
betaxolol, carteolol, esmolol, labetalol, metoprolol, nadolol, penbutolol,
pindolol, propranolol, timolol), to chlorthalidone or other diuretics (such as
bendroflumethiazide, benzthiazide, chlorothiazide, cyclothiazide,
hydrochlorothiazide, hydroflumethiazide, methyclothiazide, metolozone,
polythiazide, quinethazone, trichlormethiazide, and furosemide), or to any
sulfa drug, including oral antidiabetic medications and sulfonamide
antibiotics.
     * Tell your doctor if you now have or if you have ever had asthma,
diabetes mellitus, heart disease, gout, kidney disease or problems with
urination, liver disease, lung disease, pancreatitis, poor circulation in the
fingers or toes, systemic lupus erythematosus, or thyroid disease.
     * Chlorthalidone can cause potassium loss.  Signs of potassium loss
include dry mouth, thirst, weakness, muscle pain or cramps, nausea, and
vomiting.  If you experience any of these symptoms, call your doctor.  To help
prevent this problem, your doctor may have blood tests performed periodically
to monitor your potassium levels.  To help avoid potassium loss, take this
medication with a glass of fresh or frozen orange juice or cranberry juice, or
eat a banana every day.  The use of a salt substitute also helps to prevent
potassium loss.  Do not change your diet, however, until you discuss it with
your doctor.  Too much potassium may also be dangerous.
     * While taking this medication, limit your intake of alcohol in order to
prevent dizziness and light-headedness.
     * Do not take any over-the-counter (nonprescription) medication for
weight control or for allergy, asthma, cough, cold, or sinus problems unless
you first check with your doctor.  To prevent severe water loss (dehydration)
while taking this medication, check with your doctor if you have any illness
that causes severe or continuous nausea, vomiting, or diarrhea.
     * This medication can raise blood sugar levels in diabetic patients.
Blood sugar should be monitored carefully with blood or urine tests when this
medication is being taken.
     * You may want to check your pulse while taking this medication.  If your
pulse is much slower than your usual rate (or if it is less than 50 beats per
minute), check with your doctor; a pulse rate that slow may cause circulation
problems.
     * Atenolol can affect your body's response to exercise.  Make sure that
you ask your doctor what an appropriate amount of exercise would be for you,
taking into account your medical condition.  Before having surgery or any
other medical or dental treatment, tell your doctor or dentist that you are
taking this medicine.  Often, this medication will be discontinued 48 hours
prior to any major surgery.
     * This medication can cause dizziness, drowsiness, light-headedness, or
decreased alertness.  Therefore, exercise caution whenever driving a car or
operating potentially dangerous equipment.
     * A doctor does not usually prescribe a "fixed-dose" drug like this as
the first choice in the treatment of high blood pressure.  Usually the patient
first receives each ingredient singly.  If there is an adequate response to
the fixed dose contained in this product, it can then be substituted.  The
advantage of a combination product is increased convenience and (often)
decreased cost.
     * It is important that you do not stop taking this medicine unless you
first check with your doctor.  Some conditions worsen when this medicine is
stopped suddenly, and the danger of a heart attack is increased in some
patients.  Your doctor may, therefore, want you to gradually reduce the amount
of medicine you take before stopping completely.  Make sure that you have
enough medicine on hand to last through vacations, holidays, and weekends.
     * Be sure to tell your doctor if you are pregnant.  Animal studies have
shown that some beta blockers can cause problems in pregnancy when used at
very high doses.  Studies have not been conducted in humans, but there has
been some association between use of beta blockers during pregnancy and low
birth weight, as well as breathing problems and slow heart rate in newborn
infants.  However, other reports have shown no effects on newborn infants.
Also, tell your doctor if you are breast-feeding an infant.  Although problems
in humans have not been reported, small amounts of this medication may pass
into breast milk, so caution is warranted.

----------------

The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
