Atenolol compositum Sandoz табл.п.о. 50+12,5 mg

General characteristics. Structure:

Active ingredients: Atenolol of 50 mg. Chlortalidonum of 12,5 mg.
 
Excipients: Corn starch, magnesium a carbonate, sodium додецилсульфат, hydroxypropyl cellulose, glikolit sodium starch, magnesium stearate, lactose, methylhydroxypropyl cellulose, dioxide of titanium, PEG 4000.

Pharmacological properties:

Pharmacokinetics. Data on drug pharmacokinetics Atenolol a compositum Sandoz are not provided.
The combined anti-hypertensive drug, has long hypotensive effect. The effect is caused by action of two components - beta adrenoblocker (атенолол) and diuretic (Chlortalidonum).
Atenolol
Cardioselective hydrophilic beta 1 - adrenoblocker.

Has no internal sympathomimetic activity, has no membrane stabilizing activity.

Main pharmacological actions: anti-adrenergic, anti-anginal, antiarrhytmic, anti-hypertensive, cardioprotective.

Urezhayet the heart rate (negative chronotropic), slows down atrioventricular conductivity (negative dromotropic effect), reduces excitability of a myocardium (negative bathmotropic effect), reduces sokratitelny ability of a myocardium (negative inotropic effect), reduces arterial pressure at the expense of the listed mechanisms, and also due to suppression of secretion of a renin, reduces pressure in system of a portal vein due to reduction of a hepatic and mezenterialny blood-groove.
 
Hlortalidol
Not thiazide sulfanamide diuretic drug of long action (48-72 hours after a single dose inside).

Chlortalidonum breaks a reabsorption of sodium , chlorine and equivalent amounts of water in distal tubules of nephron, increases removal from an organism of potassium ions , magnesium , bicarbonate, з gains removal of uric acid and calcium ions, reduces sensitivity of a vascular wall to vasoconstrictive influences.

Treats diuretics of average efficiency and it is characterized extremely by a hypotoxicity.

Main therapeutic action: diuretic and anti-hypertensive.

Indications to use:

Essential hypertensia.
The combined drug Atenolol a compositum Sandoz is appointed in that case when therapy by separate active agent for the purpose of normalization of arterial pressure is insufficient or for more convenient purpose of drugs which doses were picked up during separate therapy.

Route of administration and doses:

Atenolol the compositum Sandoz should be accepted before a breakfast, without chewing and washing down with enough liquid.

Appoint on 1 tablet containing 50 mg of an atenolol and 12,5 mg of Chlortalidonum, once a day.

If necessary, and depending on a condition of the patient, the dose can be increased before reception 2 times a day on 1 tablet.

Drug withdrawal after long treatment should be carried out, whenever possible, gradually.
Use in special clinical cases
At patients with a renal failure the dose of drug should be reduced.

Features of use:

To patients with psoriasis in the family anamnesis, administration of drugs, the beta adrenoceptors containing blockers (Atenolol a compositum Sandoz), is possible only at careful weighing of a ratio of risk and advantage.

Blockers of beta adrenoceptors can increase sensitivity in relation to allergens and cause heavy anaphylactic reactions in this connection, the patients who are on the desensibilizing therapy have to accept drug carefully.

Against the background of treatment by drug systematic control of level of potassium in blood, especially at elderly patients, at the patients accepting cardiac glycosides at patients with dysfunction of digestive tract is necessary.
At an abnormal liver function and kidneys
With care to appoint at the expressed abnormal liver function and/or kidneys (glomerular filtering is lower than 30 ml/min. and/or the clearance of creatinine is higher than 1,8 mg / 100 ml).
 
Influence on ability of control of vehicles and mechanisms
Due to a possibility of development of individual reactions to administration of drug, ability of adequate participation in the road and transport movement can be broken, or at service of the cars demanding speed of reaction. Similar influence amplifies at a concomitant use of alcohol.

Side effects:

Atenolol a compositum Sandoz is usually well had.

Manifestation of the following side effects is possible:
From outside warmly - vascular system
 Bradycardia , development of heart failure, cold snap of extremities. Emergence of AV of blockade, strengthening of manifestations of a Charcot's syndrome, emergence of a syndrome of Reynaud is possible.
 
From TsNS
Dizziness, sleep disorder, increased fatigue.
 
From a GIT
 Dispepsichesky frustration. 
 
From system of a hemopoiesis
In rare instances - thrombocytopenia, a leukopenia.
 
Dermatological reactions
Skin rash, exacerbation of psoriasis.
 
From water and electrolytic balance
The hyponatremia (connected with Chlortalidonum), hypopotassemia.
 
From respiratory system
At the patients with bronchial asthma or having in the anamnesis of the instruction on a bronchospasm emergence of a bronchospasm is possible.
 
Others
Hyperuricemia, disturbance of tolerance to glucose, decrease in a potentiality (at prolonged use).

Interaction with other medicines:

Interaction with other medicines:
Insulin and peroral anti-diabetic means
Action of the last can amplify. It is regularly necessary to control sugar level in blood. Hypoglycemia signs: tachycardia and tremor.
 
Tricyclic antidepressants, barbiturates, fenotiazina, diuretics, vazodilatator and other anti-hypertensive means and alcohol
Strengthening of anti-hypertensive effect is possible.
 
APF inhibitors (captopril, enalapril)
At the beginning of therapy perhaps sharp strengthening of anti-hypertensive effect Atenolol compositum Sandoz.
 
Blockers of calcium channels like nifedipine
Strengthening of anti-hypertensive effect is possible.
 
Antiarrhytmic means
The cardiodepressive effect can be summed up.
 
Blockers of calcium channels like verapamil or diltiazem. other antiarrhytmic means (Disopyramidum)
Perhaps sharp strengthening of anti-hypertensive effect, development of bradycardia and other disturbances of a cordial rhythm . It is necessary to avoid intravenous administration of these funds for a fonepriyem of drug Atenolol a compositum Sandoz.
 
Cardiac glycosides, Reserpinum, alpha - Methyldopa, гуанфацин or a clonidine
Because of possible emergence of deficit of potassium and/or magnesium in connection with reception Atenolol a compositum Sandoz, can raise sensitivity of a cardiac muscle to cardiac glycosides, and, respectively, increases the frequency of their side effects. Sharp cancellation of a clonidine can lead to increase in arterial pressure therefore cancellation of reception of a clonidine should be made gradually and only in several days after reception cancellation Atenolol a compositum Sandoz.
 
Noradrenaline, adrenaline
Perhaps essential increase in size of arterial pressure.
 
MAO inhibitors
Increase in level of arterial pressure is possible.
 
Salicylates and other non-steroidal anti-inflammatory drugs (e.g. indometacin)
Decrease in anti-hypertensive effect is possible, and at a high dosage of salicylates strengthening of toxic effect of salicylates on the central nervous system.
 
Drugs
Strengthening of hypotensive effect and summing of a negative inotropic effect of both means.
 
Muscular relaxants (tubocurarine)
Strengthening, or easing nervously - muscular blockade is possible. The anesthesiologist has to be informed of reception Atenolol a compositum Sandoz.
 
Glucocorticoids, карбеноксолон, Amphotericinum In, furosemide
 Potassium removal strengthening is possible .
 
Lithium
 Reduction of removal of lithium and strengthening cardio-and neuro - toxic effect of lithium.

Contraindications:

- Hypersensitivity to any of drug components.
- Acute heart failure.
- Chronic heart failure .
- Sick sinus syndrome. 
- The expressed bradycardia .
- AV blockade of II and III degrees.
- The expressed arterial hypotension.
- Disturbances of peripheral blood supply.
- A concomitant use of MAO inhibitors (except for reception of MAO inhibitors of V type).
- Bronchial asthma.
- Severe forms of chronic obstructive bronchitis.
- Hypopotassemia.
- Hyponatremia.
- Hypercalcemia.
- Gout.
- Pregnancy.
- Feeding period breast.
- Children's age.

With care to appoint at:
- The expressed abnormal liver function and/or kidneys.
- Labile diabetes mellitus of the I type.
- existence at patients of a gormonprodutsirovanny tumor of adrenal glands.
- Performing therapy by foxglove glycosides, glucocorticoids or reception of purgatives.
- To an atrioventricular block of the I degree.

Use at pregnancy and feeding by a breast

Use Atenolol a compositum Sandoz is contraindicated during pregnancy and during feeding by a breast.

Overdose:

Symptoms: nausea, vomiting, appetite loss, tremor, feeling of alarm, tachycardia, headache, stethalgia.

Treatment: at development of the expressed bradycardia it is necessary to enter into 1-2 mg of atropine , if necessary - 10 mg of a glucagon in a look in/in a bolus. At absence or inefficiency of a glucagon, it is possible in/in introduction of Dobutaminum (2,5 mkg/min. of body weight) or 10 - 25 mkg of an izoprenalin in/in kapelno with a speed which is not exceeding 5 mkg/min.

Storage conditions:

To store at a temperature not above 25 °C. Period of validity of 5 years. To store in places unavailable to children. Not to use after expiry date.

Issue conditions:

According to the recipe

Packaging:

In the blister of 10 tablets. In packaging 3 blisters.