Atenolol-Chlorthalidone (atenolol/chlorthalidone)

It isessential that the manufacturer's labeling be consulted for more detailed information on dosage and administration of this drug. Dosage summary:

Dosage of atenolol/chlorthalidone must be individualized. Chlorthalidone is usually given at a dosage of 25 mg daily and atenolol is usually given at an initial dosage of 50 mg daily. Therefore, the manufacturer recommends an initial adult dosage with the fixed-combination atenolol/chlorthalidone preparation of 50 mg/25 mg once daily. If an optimal response is not achieved, the dosage should be increased to 100 mg/25 mg once daily. When necessary, another antihypertensive agent may be added gradually beginning with 50% of the usual recommended starting dose to avoid an excessive fall in blood pressure.

Since atenolol is excreted by the kidneys, dosage should be adjusted in patients with severe renal impairment. No significant accumulation of atenolol occurs until creatinine clearance falls below 35 mL/min/1.73 m2(normal range is 100 mL/min/1.73 m2 to 150 mL/min/1.73 m2); therefore, the following maximum dosages are recommended for patients with renal impairment (see Table 1).

Table 1. Atenolol/Chlorthalidone Dosage Information in Renal Impairment.

Creatinine Clearance Atenolol Elimination Maximum Dosage (mL/min/1.73 m) Half-Life (hrs.) 15 to 35 16 to 27 50 mg daily <15 >27 50 mg every other day

See Full Prescribing Information for additional details on dosage and administration.

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There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

*Patients with sinus bradycardia.

*Patients with heart block greater than first degree.

*Patients with cardiogenic shock.

*Patients with overt cardiac failure.

*Patients with anuria.

*Patients with hypersensitivity to this product or to sulfonamide-derived drugs.

There are no contraindication contraindications for this drug.

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

Atenolol/chlorthalidone is usually well tolerated in properly selected patients. Most adverse effects have been mild and transient. The adverse effects observed for the fixed combination atenolol/chlorthalidone preparation are essentially the same as those seen with the individual components.

There are no severe adverse reactions for this drug.

There are no less severe adverse reactions for this drug.

No enhanced messaging available.

Safety and effectiveness in pediatric patients have not been established.

Atenolol can cause fetal harm when administered to a pregnant woman. Atenolol crosses the placental barrier and appears in cord blood. Administration of atenolol, starting in the second trimester of pregnancy, has been associated with the birth of infants that are small for gestational age. No studies have been performed on the use of atenolol in the first trimester and the possibility of fetal injury cannot be excluded. If atenolol is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Neonates born to mothers who are receiving atenolol at parturition may be at risk for hypoglycemia and bradycardia. Caution should be exercised when atenolol/chlorthalidone is administered during pregnancy.

In animal reproductive studies with atenolol/chlorthalidone tablets, there was no evidence of teratogenic effects, but embryonic resorptions were observed.

Atenolol is excreted in human breast milk at a ratio of 1.5 to 6.8 when compared to the concentration in plasma. Nursing infants may be at risk for hypoglycemia and bradycardia. Premature infants, or infants with impaired renal function, may be more likely to develop adverse effects. Caution should be exercised when atenolol/chlorthalidone is administered to a woman who is breastfeeding.

Clinical studies of atenolol/chlorthalidone did not include sufficient numbers of patients 65 years of age and older to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant disease or other drug therapy.