Universal reference book for medicines
Product name: TENORIK В® (TENORIC)

Active substance: atenolol, chlorthalidone

Type: Antihypertensive drug

Producer: IPKA LABORATORIS LIMITED REPRESENTATIVE OFFICE (Russia) manufactured by IPCA LABORATORIES (India)
Composition, form of production and packaging
The tablets covered with a film membrane of
white or almost white color, round, biconcave, with dividing risk from one side.

1 tab.

atenolol 50 mg

Chlorthalidone 12.5 mg

[PRING] corn starch, lactose, polyvinylpyrrolidone, sodium lauryl sulfate, talc, isopropanol, silicon dioxide colloid, magnesium stearate.

Composition of the film shell: isopropanol, methylene chloride, hypromellose, talc, titanium dioxide, vaseline oil, macrogol.

10 pieces.
- Strips (10) - packs of cardboard.
14 pcs.
- Strips (2) - packs of cardboard.
14 pcs.
- blisters (2) - packs of cardboard.
Forte tablets coated with a film coat of white or almost white color, round, biconcave, with a dividing risk on one side.

1 tab.

atenolol 100 mg

chlorthalidone 25 mg

[PRING] corn starch, lactose, polyvinylpyrrolidone, sodium lauryl sulfate, talc, isopropanol, silicon dioxide colloid, magnesium stearate.

Composition of the film shell: isopropanol, methylene chloride, hypromellose, talc, titanium dioxide, vaseline oil, macrogol.

10 pieces.
- Strips (10) - packs of cardboard.
14 pcs.
- Strips (2) - packs of cardboard.
14 pcs.
- blisters (2) - packs of cardboard.
INSTRUCTION FOR THE SPECIALIST.

Description of the drug approved by the manufacturer for the print edition of 2007.

PHARMACHOLOGIC EFFECT

Combined antihypertensive drug, has a prolonged hypotensive effect.
The effect is due to the action of two components: beta 1 -adrenoconvertor (atenolol) and diuretic (chlorthalidone).
Atenolol is a cardioselective beta 1- adrenoblocker.
Selectivity decreases with increasing dose. Atenol does not have internal sympathomimetic and membrane-stabilizing effects. Like other beta-adrenoblockers it has a negative inotropic effect, it reduces the heart rate.
Chlortalidone is a non-iodide sulfonamide diuretic, enhances the release of sodium and chlorine.
Increases the secretion of potassium, magnesium and bicarbonate. The mechanism of antihypertensive action is probably associated with sodium excretion. The combination of atenolol with diuretics is more effective than using each of the components separately.
The effect of the drug Tenorik persists for 24 hours after a single oral intake 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

Suction and distribution

After taking the drug inside, atenolol is absorbed from the digestive tract by 40-50%.
C max in blood plasma is achieved in 2-4 hours after administration. Binding to plasma proteins is approximately 6-16%.
Metabolism and excretion

Atenolol is not exposed to pronounced hepatic metabolism, more than 90% (absorbed into the systemic bloodstream) is excreted unchanged.
T 1/2 is 6-9 hours, but may increase in cases of severe renal failure, since atenolol is excreted mainly by the kidneys.
Chlorthalidone

Suction and distribution

After taking the drug inside chlortalidone is absorbed from the digestive tract by 60%.
C max in the blood plasma is observed after about 12 hours. Chlortalidone binds to plasma proteins by approximately 75%.
Excretion

It is excreted by the kidneys, T 1/2 is approximately 50 hours.

INDICATIONS

- arterial hypertension.

DOSING MODE

Dosing regimen is given in terms of atenolol.

The average dose of the drug Tenorik for adults is 100 mg;
the initial dose is 50 mg 1 time / day.
As a rule, the use of the drug in a dose corresponding to 100 mg of atenolol, gives a good clinical effect.
The subsequent increase in the dose or does not lead to a further decrease in blood pressure, or reduces it very slightly. If necessary, an additional antihypertensive agent may be prescribed.
For the elderly, the drug should be given in lower doses.

When prescribing the drug, patients with impaired renal function should reduce the frequency of taking the drug.

After prolonged use of Tenoric, the drug should be discontinued gradually.

SIDE EFFECT

From the cardiovascular system: bradycardia, increased symptoms of heart failure, orthostatic hypotension (may be accompanied by syncope), cold extremities.
There may be arrhythmias, AV blockade, a symptom of intermittent claudication, Raynaud's syndrome.
From the central nervous system and the peripheral nervous system: confusion, dizziness, headache, mood swings, acute psychosis, hallucinations, paresthesia, sleep disturbance, fatigue, apathy, disorientation, visual impairment.

On the part of the digestive system: dry mouth, gastrointestinal disorders;
in rare cases - an increase in the level of hepatic transaminases in the serum, hepatotoxicity with intrahepatic cholestasis, nausea (associated with the intake of chlorthalidone), constipation, pancreatitis, anorexia.
On the part of the hematopoiesis system: leukopenia, purpura, thrombocytopenia, agranulocytosis, eosinophilia.

Dermatological reactions: alopecia, dry eyes, psoriasis-like reactions, exacerbation of psoriasis, skin rash, photosensitization.

On the part of the respiratory system: bronchospasm (in patients with bronchial asthma or with instructions for bronchospasm in the anamnesis).

On the part of laboratory indicators: hyperuricemia, hyponatremia (associated with the administration of chlorthalidone), hypokalemia.

Other: an increase in the number of antinuclear antibodies (the clinical significance is unclear), a decrease in potency, a violation of glucose tolerance.

The preparation of Tenoric is usually well tolerated.
Side effects are rare, mild and transient in nature.
CONTRAINDICATIONS

- pronounced bradycardia;

- cardiogenic shock;

- severe arterial hypotension;

metabolic acidosis;

- severe peripheral circulatory disturbances;

- AV blockade II and III degree;

- SSSU;

- untreated pheochromocytoma;

- acute heart failure;

- Chronic heart failure;

- Vasospastic angina (Prinzmetal angina);

- bronchial asthma;

- obstructive bronchitis;

- diabetes;

- hypoglycemia;

- gout;

- Myasthenia gravis;

acute hepatitis;

acute renal failure;

- children and adolescence under 18;

- Hypersensitivity to the components of the drug.

PREGNANCY AND LACTATION

The drug Tenorik is contraindicated for use in pregnancy and lactation (breastfeeding).

APPLICATION FOR FUNCTIONS OF THE LIVER

When prescribing the drug, patients with impaired renal function should reduce the frequency of taking the drug.

Contraindicated in acute kidney deficiency.

APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS

The drug is contraindicated in acute hepatitis.

APPLICATION FOR CHILDREN

The effectiveness and safety of the use of Tenoric in children and adolescents under 18 years have not been established, so do not prescribe the drug to patients of this age group.

APPLICATION IN ELDERLY PATIENTS

For the elderly, the drug should be given in lower doses.

SPECIAL INSTRUCTIONS

Conditioned beta-adrenoblocker atenolol, which is part of Tenorik

Be wary appoint patients with AV-blockade I degree.

It should be borne in mind that the use of the drug can mask the phenomena of thyrotoxicosis and hypoglycemia.

With the development of bradycardia (heart rate to 50 beats per minute) with clinical symptoms, the dose should be reduced or the drug should be withdrawn.

Do not abruptly cancel Tenoric in patients with ischemic heart disease.

Smokers may experience a decrease in the therapeutic effect of the drug.

Special care should be taken in cases where surgical intervention is required with general anesthesia.
The drug should be discontinued 48 hours before surgery, and as an anesthetic should choose the drug with the possible minimum negative inotropic effect.
Against the background of taking the drug may increase sensitivity to allergens and the development of severe anaphylactic reactions, 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.
Caution should be given to patients with bronchoobstructive syndrome, and in case of worsening of bronchial conductivity, beta-adrenomimetic therapy should be administered.

With the use of atenolol, tear production can be reduced, which is important for patients using contact lenses.

The dicritic chlorthalidone, which is part of the Tenoric

Against the background of the drug may occur hypokalemia.
Serum potassium should be monitored, especially in patients receiving cardiac glycosides for the treatment of 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 arrhythmia.
With caution apply the drug in patients with impaired renal function.

Against the background of the use of the drug, there may be a violation of glucose tolerance.
Caution is necessary to prescribe the drug to patients with a predisposition to diabetes mellitus.
Against the background of the drug may develop hyperuricemia, usually minor, but in some cases, it may be necessary to use funds that promote the excretion of uric acid.

Use in Pediatrics

The effectiveness and safety of the use of Tenoric in children and adolescents under 18 years have not been established, so do not prescribe the drug to patients of this age group.

Impact on the ability to drive vehicles and manage mechanisms

The use of Tenorics, as a rule, does not affect the ability to drive vehicles and control mechanisms.
Nevertheless, the question of the possibility of driving a vehicle should be addressed after assessing the individual tolerability of the drug.
OVERDOSE

Symptoms: severe bradycardia, arterial hypotension, acute heart failure, bronchospasm, convulsions, increased drowsiness.

Treatment: careful monitoring of the patient's condition, if necessary - hospitalization in the ICU, gastric lavage, the use of activated carbon and laxatives;
with arterial hypotension and shock - the introduction of plasma or plasma substitutes; with bronchospasm - the use of bronchodilators, with significant diuresis - the introduction of fluid and electrolytes. It is possible to conduct hemodialysis or hemoperfusion.
DRUG INTERACTION

The simultaneous use of Tenoric with derivatives of dihydropyridine (nifedipine) may increase the risk of developing arterial hypotension, in patients with latent cardiac insufficiency, signs of circulatory disturbance may appear.

Cardiac glycosides in combination with beta-blockers can increase the AV-conduction time.

Beta-adrenoblockers can aggravate the ricochet hypertension, which can occur after the withdrawal of clonidine.
If both drugs are prescribed, the beta-blocker should be discontinued a few days before cessation of clonidine. If you need to replace clonidine with a beta-blocker, the latter should be administered a few days after cessation of clonidine therapy.
It is necessary to use caution in prescribing a beta-blocker in combination with antiarrhythmic drugs of the first class (disopyramide),
cardiodepressive effect can be summarized.
The concomitant use of sympathomimetic drugs, for example, epinephrine (adrenaline), norepinephrine (noradrenaline) can neutralize the effect of beta-blockers and lead to a significant increase in blood pressure.

Salicylates and NSAIDs (ibuprofen, indomethacin), estrogens can reduce the hypotensive effect of beta-blockers, and when salicylates are used in high doses, the toxic effect of salicylates on the central nervous system may increase.

Preparations containing lithium should not be used with diuretics.
they can reduce renal clearance of lithium.
The use of beta-blockers along with the means for general anesthesia can lead to an increased risk of developing arterial hypotension and a summation of the negative inotropic effect of both drugs (an anesthetic with a minimal negative inotropic effect should be used).
It is also possible to intensify the action of curare-like muscle relaxants.
When using the drug Tenorik with MAO inhibitors, it is possible to increase blood pressure (this combination should be avoided).

With the simultaneous use of the preparation Tenorik with ACE inhibitors (captopril, enalapril) at the beginning of therapy, a sharp increase in the antihypertensive effect is possible.

With the combined use of Tenoric with GCS, amphotericin B, furosemide, potassium excretion is possible.

When combined with Tenorik, the action of insulin and oral hypoglycemic agents may decrease (blood glucose levels should be monitored).

Tricyclic antidepressants, barbiturates, phenothiazines, diuretics, vasodilators and other antihypertensives can enhance the antihypertensive effect of Tenoric.

The use of beta-blockers in combination with calcium channel blockers, which have a negative inotropic effect, such as verapamil, diltiazem, may lead to an increase in this effect, especially in patients with reduced contractility of the myocardium and / or with a violation of sinoatrial or AV-conduction, which can become the cause of severe arterial hypotension, severe bradycardia and heart failure (the calcium channel blocker should not be used IV for 48 hours after the abolition of the beta-blocker)
.
With the simultaneous appointment of Tenoric with reserpine, clonidine, guanfacin, there may be a pronounced bradycardia.

TERMS OF RELEASE FROM PHARMACY

The drug is released by prescription.

TERMS AND CONDITIONS OF STORAGE

The drug should be stored in a dry, cool, protected from light, out of reach of children, at a temperature of no higher than 25 В° C.
Shelf life - 3 years.
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