Adult Dosing

Hypertension

• Initially 50 mg/25 mg PO daily; may increase to 100 mg/25 mg PO daily

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Treatment of hypertension

• Hypersensitivity to any of the ingredients of the product or to sulfonamide-derived drugs
• Sinus bradycardia
• AV block, 2nd or 3rd degree
• Heart failure, uncompensated
• Cardiogenic shock
• Sick sinus syndrome without pacemaker
• Pheochromocytoma, untreated
• Anuria
• Use with dofetilide
• Use with verapamil

• N/A

Renal Dose Adjustment (Based on CrCl)

• 15–35 mL/minute: Max 50 mg atenolol/day
• <15 mL/minute: Max 50 mg atenolol every other day

Hepatic Dose Adjustment

• Hepatic impairment: Use with caution; dose adjustments not defined

• Concomitant use of calcium channel blockers may cause bradycardia and heart block and increased left ventricular end diastolic pressure. Patients with pre-existing conduction abnormalities or left ventricular dysfunction are particularly susceptible
• It should not be used in patients with bronchospastic disease unless patients do not respond to or cannot tolerate other antihypertensive therapy. Administer beta-2 stimulating agent concomitantly and use lowest possible dose; start smaller doses tid to avoid higher plasma levels
• Do not withdraw therapy prior to surgery in the majority of patients. Take care when using anesthetic agents which may depress the myocardium
• Therapy should be used with caution in diabetic patients if a betablocking agent is required; as it may mask tachycardia occurring with hypoglycemia
• Do not administer in patients with untreated pheochromocytoma
• It may mask signs of hyperthyroidism; avoid abrupt withdrawal due to the risk of precipitating a thyroid storm. Patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of therapy, which might precipitate a thyroid storm
• Hypokalemia may develop with brisk diuresis, when severe cirrhosis is present, or during concomitant use of corticosteroids or ACTH
• Sensitivity reactions may occour w/ or w/out history of allergy/bronchial asthama in patients receving thiazides; possible exacerbation/activation of systemic lupus erythematosus has occurred. Antihypertensive effects of thiazides may be enhanced in postsympathectomy patient
• Monitor for signs of fluid or electrolyte imbalance viz hypokalemia, hyponatremia and hypochloremic alkalosis. Use lowest possible dose to achieve desired response

Cautions: Use cautiously in

• Renal impairment
• Hepatic impairment
• Progressive hepatic disease
• Peripheral vascular disease
• Bronchospastic disease
• Major surgery
• Diabetes mellitus
• Thyroid disorder
• Seizure disorder
• Pancreatitis history
• Gout
• Post-sympathectomy
• Arrhythmias
• Breastfeeding
• Electrolyte abnormalities
• Volume depletion
• SLE
• WPW syndrome
• Elderly patients

Pregnancy Category:D

Breastfeeding: Possibly unsafe. Atenolol is extensively excreted in breastmilk. Therefore other agents may be preferred while nursing a newborn or preterm infant or with high maternal dosages. Chlorthalidone is excreted in breast milk; due to slow clearance, accumulation may occur in the infant, alternate drugs may be preffered. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 23 February 2011). According to manufacturer data atenolol is excreted in breast milk in a ratio of 1.5-6.8 when compared to the concentration in plasma. Clinically significant bradycardia has been reported in breast fed infants. Therefore caution should be exercised when administered to a nursing woman.

• CV: Bradycardia, cold extremities, postural hypotension, leg pain, orthostatic hypotension
• CNS: Dizziness, vertigo, light-headedness, tiredness, fatigue, lethargy, drowsiness, depression, dreaming, paresthesia, xanthopsia
• GI: Diarrhea, nausea, anorexia, gastric irritation, vomiting, cramping, constipation, jaundice (intrahepatic cholestatic jaundice), pancreatitis
• RESP: Wheeziness, dyspnea, bronchospasm
• HEMA: Leukopenia, Agranulocytosis, thrombocytopenia, aplastic anemia
• HYPERSENSITIVITY: Purpura, photosensitivity, rash, urticaria, necrotizing angiitis (vasculitis) (cutaneous vasculitis), Lyell's syndrome (toxic epidermal necrolysis)
• LABTESTS: Electrolyte imbalance
• METABOLIC: Hypokalemia
• MISC: Hyperglycemia, glycosuria, hyperuricemia, muscle spasm, weakness, restlessness

atenolol

• Beta blocker; primarily affects heart, vascular system and to lesser extent, lungs by blocking beta receptors
• 50% of an oral dose is absorbed from the GI tract
• Little or no metabolism by the liver; CYP450: None
• Renally excreted: 40-50%; feces 50%
• Half-life: 6-7 hrs

chlorthalidone

• Thiazide diuretic; inhibits reabsorption of sodium and chloride in proximal portion of distal convoluted tubules
• Rapidly absorbed after administration
• Not metabolized
• Excreted unchanged by the kidneys (50-75%)
• Half-life: 40-60 hrs

US Trade Name(s)

• Tenoretic 50
• Tenoretic 100

US Availability

atenolol/chlorthalidone (generic)

• TABS:
• 50 mg/25 mg
• 100 mg/25 mg

Tenoretic 100 (atenolol/chlorthalidone)

• TABS: 100 mg/25 mg

Tenoretic 50 (atenolol/chlorthalidone)

• TABS: 50 mg/25 mg

Canadian Trade Name(s)

• Tenoretic

Canadian Availability

atenolol/chlorthalidone (generic)

• TABS:
• 50 mg/25 mg
• 100 mg/25 mg

Tenoretic (atenolol/chlorthalidone)

• TABS:
• 50 mg/25 mg
• 100 mg/25 mg

UK Trade Name(s)

• Co-Tenidone
• Tenoretic
• Tenoret 50

UK Availability

Co-Tenidone (atenolol/chlorthalidone)

• TABS:
• 50 mg/25 mg
• 100 mg/25 mg

Tenoretic (atenolol/chlorthalidone)

• TABS: 100 mg/25 mg

Tenoret 50 (atenolol/chlorthalidone)

• TABS: 50 mg/25 mg

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

[Outline]

Cardiovascular

Antihypertensive Combinations

Pricing data from www.DrugStore.com in U.S.A.

• Tenoretic 100 100-25 MG TABS [Bottle] (ASTRAZENECA)
  30 mg = $86.99
  90 mg = $240.98
• Atenolol-Chlorthalidone 50-25 MG TABS [Bottle] (MYLAN)
  30 mg = $13.99
  90 mg = $32.97
• Tenoretic 50 50-25 MG TABS [Bottle] (ASTRAZENECA)
  30 mg = $61.99
  90 mg = $170.96

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.

• Atenolol 100 MG / Chlorthalidone 25 MG Oral Tablet (Mutual Pharmaceutical)
• Atenolol 100 MG / Chlorthalidone 25 MG Oral Tablet (Mylan Pharmaceuticals Inc.)
• Atenolol 100 MG / Chlorthalidone 25 MG Oral Tablet (Watson Laboratories, Inc.)
• Atenolol 50 MG / Chlorthalidone 25 MG Oral Tablet (Mutual Pharmaceutical)
• Atenolol 50 MG / Chlorthalidone 25 MG Oral Tablet (Mylan Pharmaceuticals Inc.)
• Atenolol 50 MG / Chlorthalidone 25 MG Oral Tablet (Watson Laboratories, Inc.)
• Tenoretic 100 Oral Tablet (AstraZeneca Pharmaceuticals LP)
• Tenoretic 50 Oral Tablet (AstraZeneca Pharmaceuticals LP)