Metoclopramid-Akri may be available in the countries listed below.
Metoclopramide hydrochloride (a derivative of Metoclopramide) is reported as an ingredient of Metoclopramid-Akri in the following countries:
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Laimolin may be available in the countries listed below.
Dequalinium Chloride is reported as an ingredient of Laimolin in the following countries:
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Broncovanil may be available in the countries listed below.
Guaifenesin is reported as an ingredient of Broncovanil in the following countries:
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In the US, Astelin (azelastine nasal) is a member of the drug class nasal antihistamines and decongestants and is used to treat Hay Fever.
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Azelastine hydrochloride (a derivative of Azelastine) is reported as an ingredient of Astelin in the following countries:
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Bencidamina may be available in the countries listed below.
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Millact may be available in the countries listed below.
Tilactase is reported as an ingredient of Millact in the following countries:
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Tenoretic® (atenolol and chlorthalidone) is for the treatment of hypertension. It combines the antihypertensive activity of two agents: a beta1-selective (cardioselective) hydrophilic blocking agent (atenolol, TENORMIN®) and a monosulfonamyl diuretic (chlorthalidone). Atenolol is Benzeneacetamide, 4-[2'-hydroxy-3'-[(1-methylethyl) amino] propoxy]-.
Atenolol (free base) is a relatively polar hydrophilic compound with a water solubility of 26.5 mg/mL at 37° C. It is freely soluble in 1N HCl (300 mg/mL at 25°C) and less soluble in chloroform (3 mg/mL at 25°C).
Chlorthalidone is 2-Chloro-5-(1-hydroxy-3-oxo-1-isoindolinyl) benzene sulfonamide:
Chlorthalidone has a water solubility of 12 mg/100 mL at 20°C.
Each Tenoretic 100 Tablet contains:
Atenolol (TENORMIN®).......................................100 mg
Chlorthalidone........................................................ 25 mg
Each Tenoretic 50 Tablet contains:
Atenolol (TENORMIN®).........................................50 mg
Chlorthalidone..........................................................25 mg
Inactive ingredients: magnesium stearate, microcrystalline cellulose, povidone, sodium starch glycolate.
Atenolol and chlorthalidone have been used singly and concomitantly for the treatment of hypertension. The antihypertensive effects of these agents are additive, and studies have shown that there is no interference with bioavailability when these agents are given together in the single combination tablet. Therefore, this combination provides a convenient formulation for the concomitant administration of these two entities. In patients with more severe hypertension, Tenoretic may be administered with other antihypertensives such as vasodilators.
Atenolol is a beta1-selective (cardioselective) beta-adrenergic receptor blocking agent without membrane stabilizing or intrinsic sympathomimetic (partial agonist) activities. This preferential effect is not absolute, however, and at higher doses, atenolol inhibits beta2-adrenoreceptors, chiefly located in the bronchial and vascular musculature.
In standard animal or human pharmacological tests, beta-adrenoreceptor blocking activity of atenolol has been demonstrated by: (1) reduction in resting and exercise heart rates and cardiac output, (2) reduction of systolic and diastolic blood pressure at rest and on exercise, (3) inhibition of isoproterenol induced tachycardia and (4) reduction in reflex orthostatic tachycardia.
A significant beta-blocking effect of atenolol, as measured by reduction of exercise tachycardia, is apparent within one hour following oral administration of a single dose. This effect is maximal at about 2 to 4 hours and persists for at least 24 hours. The effect at 24 hours is dose related and also bears a linear relationship to the logarithm of plasma atenolol concentration. However, as has been shown for all beta blocking agents, the antihypertensive effect does not appear to be related to plasma level.
In normal subjects, the beta1-selectivity of atenolol has been shown by its reduced ability to reverse the beta2-mediated vasodilating effect of isoproterenol as compared to equivalent beta-blocking doses of propranolol. In asthmatic patients, a dose of atenolol producing a greater effect on resting heart rate than propranolol resulted in much less increase in airway resistance. In a placebo controlled comparison of approximately equipotent oral doses of several beta blockers, atenolol produced a significantly smaller decrease of FEV1 than nonselective beta blockers, such as propranolol and unlike those agents did not inhibit bronchodilation in response to isoproterenol.
Consistent with its negative chronotropic effect due to beta blockade of the SA node, atenolol increases sinus cycle length and sinus node recovery time. Conduction in the AV node is also prolonged. Atenolol is devoid of membrane stabilizing activity, and increasing the dose well beyond that producing beta blockade does not further depress myocardial contractility. Several studies have demonstrated a moderate (approximately 10%) increase in stroke volume at rest and exercise.
In controlled clinical trials, atenolol given as a single daily dose, was an effective antihypertensive agent providing 24-hour reduction of blood pressure. Atenolol has been studied in combination with thiazide-type diuretics and the blood pressure effects of the combination are approximately additive. Atenolol is also compatible with methyldopa, hydralazine and prazosin, the combination resulting in a larger fall in blood pressure than with the single agents. The dose range of atenolol is narrow, and increasing the dose beyond 100 mg once daily is not associated with increased antihypertensive effect. The mechanisms of the antihypertensive effects of beta-blocking agents have not been established. Several mechanisms have been proposed and include: (1) competitive antagonism of catecholamines at peripheral (especially cardiac) adrenergic neuron sites, leading to decreased cardiac output, (2) a central effect leading to reduced sympathetic outflow to the periphery and (3) suppression of renin activity. The results from long-term studies have not shown any diminution of the antihypertensive efficacy of atenolol with prolonged use.
In man, absorption of an oral dose is rapid and consistent but incomplete. Approximately 50% of an oral dose is absorbed from the gastrointestinal tract, the remainder being excreted unchanged in the feces. Peak blood levels are reached between 2 and 4 hours after ingestion. Unlike propranolol or metoprolol, but like nadolol, hydrophilic atenolol undergoes little or no metabolism by the liver, and the absorbed portion is eliminated primarily by renal excretion. Atenolol also differs from propranolol in that only a small amount (6 - 16%) is bound to proteins in the plasma. This kinetic profile results in relatively consistent plasma drug levels with about a fourfold interpatient variation. There is no information as to the pharmacokinetic effect of atenolol on chlorthalidone.
The elimination half-life of atenolol is approximately 6 to 7 hours and there is no alteration of the kinetic profile of the drug by chronic administration. Following doses of 50 mg or 100 mg, both beta-blocking and antihypertensive effects persist for at least 24 hours. When renal function is impaired, elimination of atenolol is closely related to the glomerular filtration rate; but significant accumulation does not occur until the creatinine clearance falls below 35 mL/min/1.73m2 (see prescribing information for atenolol [TENORMIN®]).
In general, elderly patients present higher atenolol plasma levels with total clearance values about 50% lower than younger subjects. The half-life is markedly longer in the elderly compared to younger subjects. The reduction of atenolol clearance follows the general trend that the elimination of renally excreted drugs is decreased with increasing age.
Chlorthalidone is a monosulfonamyl diuretic which differs chemically from thiazide diuretics in that a double ring system is incorporated in its structure. It is an oral diuretic with prolonged action and low toxicity. The diuretic effect of the drug occurs within 2 hours of an oral dose. It produces diuresis with greatly increased excretion of sodium and chloride. At maximal therapeutic dosage, chlorthalidone is approximately equal in its diuretic effect to comparable maximal therapeutic doses of benzothiadiazine diuretics. The site of action appears to be the cortical diluting segment of the ascending limb of Henle's loop of the nephron.
Tenoretic is indicated in the treatment of hypertension. This fixed dose combination drug is not indicated for initial therapy of hypertension. If the fixed dose combination represents the dose appropriate to the individual patient's needs, it may be more convenient than the separate components.
Tenoretic is contraindicated in patients with: sinus bradycardia; heart block greater than first degree; cardiogenic shock; overt cardiac failure (see WARNINGS); anuria; hypersensitivity to this product or to sulfonamide-derived drugs.
Sympathetic stimulation is necessary in supporting circulatory function in congestive heart failure, and beta blockade carries the potential hazard of further depressing myocardial contractility and precipitating more severe failure.
IN PATIENTS WITHOUT A HISTORY OF CARDIAC FAILURE, continued depression of the myocardium with beta-blocking agents over a period of time can, in some cases, lead to cardiac failure. At the first sign or symptom of impending cardiac failure, patients should be treated appropriately according to currently recommended guidelines, and the response observed closely. If cardiac failure continues despite adequate treatment, Tenoretic should be withdrawn. (See DOSAGE AND ADMINISTRATION.)
Since atenolol is excreted via the kidneys, Tenoretic should be used with caution in patients with impaired renal function.
In patients with renal disease, thiazides may precipitate azotemia. Since cumulative effects may develop in the presence of impaired renal function, if progressive renal impairment becomes evident, Tenoretic should be discontinued.
In patients with impaired hepatic function or progressive liver disease, minor alterations in fluid and electrolyte balance may precipitate hepatic coma. Tenoretic should be used with caution in these patients.
Following abrupt cessation of therapy with certain beta-blocking agents in patients with coronary artery disease, exacerbations of angina pectoris and, in some cases, myocardial infarction have been reported. Therefore, such patients should be cautioned against interruption of therapy without the physician's advice. Even in the absence of overt angina pectoris, when discontinuation of Tenoretic is planned, the patient should be carefully observed and should be advised to limit physical activity to a minimum. Tenoretic should be reinstated if withdrawal symptoms occur. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue Tenoretic therapy abruptly even in patients treated only for hypertension.
Bradycardia and heart block can occur and the left ventricular end diastolic pressure can rise when beta-blockers are administered with verapamil or diltiazem. Patients with pre-existing conduction abnormalities or left ventricular dysfunction are particularly susceptible. (See PRECAUTIONS.)
PATIENTS WITH BRONCHOSPASTIC DISEASE SHOULD, IN GENERAL, NOT RECEIVE BETA BLOCKERS. Because of its relative beta1-selectivity, however, Tenoretic may be used with caution in patients with bronchospastic disease who do not respond to or cannot tolerate, other antihypertensive treatment. Since beta1-selectivity is not absolute, the lowest possible dose of Tenoretic should be used and a beta2-stimulating agent (bronchodilator) should be made available. If dosage must be increased, dividing the dose should be considered in order to achieve lower peak blood levels.
Chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery, however the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.
Tenoretic may be used with caution in diabetic patients. Beta blockers may mask tachycardia occurring with hypoglycemia, but other manifestations such as dizziness and sweating may not be significantly affected. At recommended doses atenolol does not potentiate insulin-induced hypoglycemia and, unlike nonselective beta blockers, does not delay recovery of blood glucose to normal levels.
Insulin requirements in diabetic patients may be increased, decreased or unchanged; latent diabetes mellitus may become manifest during chlorthalidone administration.
Beta-adrenergic blockade may mask certain clinical signs (eg, tachycardia) of hyperthyroidism. Abrupt withdrawal of beta blockade might precipitate a thyroid storm; therefore, patients suspected of developing thyrotoxicosis from whom Tenoretic therapy is to be withdrawn should be monitored closely.
Because calcium excretion is decreased by thiazides, Tenoretic should be discontinued before carrying out tests for parathyroid function. Pathologic changes in the parathyroid glands, with hypercalcemia and hypophosphatemia, have been observed in a few patients on prolonged thiazide therapy; however, the common complications of hyperparathyroidism such as renal lithiasis, bone resorption, and peptic ulceration have not been seen.
Hyperuricemia may occur, or acute gout may be precipitated in certain patients receiving thiazide therapy.
Tenoretic should not be given to patients with untreated pheochromocytoma.
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 this drug 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 or breast-feeding may be at risk for hypoglycemia and bradycardia. Caution should be exercised when Tenoretic is administered during pregnancy or to a woman who is breast-feeding. (See PRECAUTIONS, Nursing Mothers.)
Tenoretic was studied for teratogenic potential in the rat and rabbit. Doses of atenolol/chlorthalidone of 8/2, 80/20, and 240/60 mg/kg/day were administered orally to pregnant rats with no evidence of embryofetotoxicity observed. Two studies were conducted in rabbits. In the first study, pregnant rabbits were dosed with 8/2, 80/20, and 160/40 mg/kg/day of atenolol/chlorthalidone. No teratogenic effects were noted, but embryonic resorptions were observed at all dose levels (ranging from approximately 5 times to 100 times the maximum recommended human dose1). In the second rabbit study, doses of atenolol/chlorthalidone were 4/1, 8/2, and 20/5 mg/kg/day. No teratogenic or embryotoxic effects were demonstrated.
Atenolol has been shown to produce a dose-related increase in embryo/fetal resorptions in rats at doses equal to or greater than 50 mg/kg/day or 25 or more times the maximum recommended human antihypertensive dose.1 Although similar effects were not seen in rabbits, the compound was not evaluated in rabbits at doses above 25 mg/kg/day or 12.5 times the maximum recommended human antihypertensive dose.1
Thiazides cross the placental barrier and appear in cord blood. The use of chlorthalidone and related drugs in pregnant women requires that the anticipated benefits of the drug be weighed against possible hazards to the fetus. These hazards include fetal or neonatal jaundice, thrombocytopenia and possibly other adverse reactions which have occurred in the adult.
Tenoretic may aggravate peripheral arterial circulatory disorders.
Periodic determination of serum electrolytes to detect possible electrolyte imbalance should be performed at appropriate intervals.
Patients should be observed for clinical signs of fluid or electrolyte imbalance; i.e., hyponatremia, hypochloremic alkalosis, and hypokalemia. Serum and urine electrolyte determinations are particularly important when the patient is vomiting excessively or receiving parenteral fluids. Warning signs or symptoms of fluid and electrolyte imbalance include dryness of the mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, and gastrointestinal disturbances such as nausea and vomiting.
Measurement of potassium levels is appropriate especially in elderly patients, those receiving digitalis preparations for cardiac failure, patients whose dietary intake of potassium is abnormally low, or those suffering from gastrointestinal complaints.
Hypokalemia may develop especially with brisk diuresis, when severe cirrhosis is present, or during concomitant use of corticosteroids or ACTH.
Interference with adequate oral electrolyte intake will also contribute to hypokalemia. Hypokalemia can sensitize or exaggerate the response of the heart to the toxic effects of digitalis (eg, increased ventricular irritability). Hypokalemia may be avoided or treated by use of potassium supplements or foods with a high potassium content.
Any chloride deficit during thiazide therapy is generally mild and usually does not require specific treatment except under extraordinary circumstances (as in liver disease or renal disease). Dilutional hyponatremia may occur in edematous patients in hot weather; appropriate therapy is water restriction rather than administration of salt except in rare instances when the hyponatremia is life-threatening. In actual salt depletion, appropriate replacement is the therapy of choice.
Tenoretic may potentiate the action of other antihypertensive agents used concomitantly. Patients treated with Tenoretic plus a catecholamine depletor (eg, reserpine) should be closely observed for evidence of hypotension and/or marked bradycardia which may produce vertigo, syncope or postural hypotension.
Calcium channel blockers may also have an additive effect when given with Tenoretic. (See WARNINGS.)
Disopyramide is a Type I antiarrhythmic drug with potent negative inotropic and chronotropic effects. Disopyramide has been associated with severe bradycardia, asystole and heart failure when administered with beta blockers.
Amiodarone is an antiarrhythmic agent with negative chronotropic properties that may be additive to those seen with beta blockers.
Thiazides may decrease arterial responsiveness to norepinephrine. This diminution is not sufficient to preclude the therapeutic effectiveness of norepinephrine. Thiazides may increase the responsiveness to tubocurarine.
Concomitant use of prostaglandin synthase inhibiting drugs, eg, indomethacin, may decrease the hypotensive effects of beta blockers.
Lithium generally should not be given with diuretics because they reduce its renal clearance and add a high risk of lithium toxicity. Read prescribing information for lithium preparations before use of such preparations with Tenoretic.
Beta blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine. If the two drugs are coadministered, the beta blocker should be withdrawn several days before the gradual withdrawal of clonidine. If replacing clonidine by beta-blocker therapy, the introduction of beta blockers should be delayed for several days after clonidine administration has stopped.
While taking beta blockers, patients with a history of anaphylactic reaction to a variety of allergens may have a more severe reaction on repeated challenge, either accidental, diagnostic or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat the allergic reaction.
Both digitalis glycosides and beta-blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.
In patients receiving thiazides, sensitivity reactions may occur with or without a history of allergy or bronchial asthma. The possible exacerbation or activation of systemic lupus erythematosus has been reported. The antihypertensive effects of thiazides may be enhanced in the postsympathectomy patient.
Two long-term (maximum dosing duration of 18 or 24 months) rat studies and one long-term (maximum dosing duration of 18 months) mouse study, each employing dose levels as high as 300 mg/kg/day or 150 times the maximum recommended human antihypertensive dose1, did not indicate a carcinogenic potential of atenolol. A third (24 month) rat study, employing doses of 500 and 1,500 mg/kg/day (250 and 750 times the maximum recommended human antihypertensive dose1) resulted in increased incidences of benign adrenal medullary tumors in males and females, mammary fibroadenomas in females, and anterior pituitary adenomas and thyroid parafollicular cell carcinomas in males. No evidence of a mutagenic potential of atenolol was uncovered in the dominant lethal test (mouse), in vivo cytogenetics test (Chinese hamster) or Ames test (S typhimurium).
Fertility of male or female rats (evaluated at dose levels as high as 200 mg/kg/day or 100 times the maximum recommended human dose1) was unaffected by atenolol administration.
Six month oral administration studies were conducted in rats and dogs using Tenoretic doses up to 12.5 mg/kg/day (atenolol/chlorthalidone 10/2.5 mg/kg/day -- approximately five times the maximum recommended human antihypertensive dose1). There were no functional or morphological abnormalities resulting from dosing either compound alone or together other than minor changes in heart rate, blood pressure and urine chemistry which were attributed to the known pharmacologic properties of atenolol and/or chlorthalidone.
Chronic studies of atenolol performed in animals have revealed the occurrence of vacuolation of epithelial cells of Brunner's glands in the duodenum of both male and female dogs at all tested dose levels (starting at 15 mg/kg/day or 7.5 times the maximum recommended human antihypertensive dose1) and increased incidence of atrial degeneration of hearts of male rats at 300 but not 150 mg atenolol/kg/day (150 and 75 times the maximum recommended human antihypertensive dose,1 respectively).
Pregnancy Category D: See WARNINGS - Pregnancy and Fetal Injury
Atenolol is excreted in human breast milk at a ratio of 1.5 to 6.8 when compared to the concentration in plasma. Caution should be exercised when atenolol is administered to a nursing woman. Clinically significant bradycardia has been reported in breast-fed infants. Premature infants, or infants with impaired renal function, may be more likely to develop adverse effects.
Neonates born to mothers who are receiving atenolol at parturition or breast-feeding may be at risk for hypoglycemia and bradycardia. Caution should be exercised when Tenoretic is administered during pregnancy or to a woman who is breast-feeding. (See WARNINGS, Pregnancy and Fetal Injury.)
Safety and effectiveness in pediatric patients have not been established.
Clinical studies of Tenoretic did not include sufficient numbers of subjects aged 65 and over 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.
Tenoretic is usually well tolerated in properly selected patients. Most adverse effects have been mild and transient. The adverse effects observed for Tenoretic are essentially the same as those seen with the individual components.
The frequency estimates in the following table were derived from controlled studies in which adverse reactions were either volunteered by the patient (US studies) or elicited, eg, by checklist (foreign studies). The reported frequency of elicited adverse effects was higher for both atenolol and placebo-treated patients than when these reactions were volunteered. Where frequency of adverse effects for atenolol and placebo is similar, causal relationship to atenolol is uncertain.
Volunteered (US Studies) | Total − Volunteered and Elicited (Foreign + US Studies) | |||
Atenolol (n=164) % | Placebo (n=206) % | Atenolol (n=399) % | Placebo (n=407) % | |
CARDIOVASCULAR | ||||
Bradycardia | 3 | 0 | 3 | 0 |
Cold Extremities | 0 | 0.5 | 12 | 5 |
Postural Hypotension | 2 | 1 | 4 | 5 |
Leg Pain | 0 | 0.5 | 3 | 1 |
CENTRAL NERVOUS SYSTEM/ NEUROMUSCULAR | ||||
Dizziness | 4 | 1 | 13 | 6 |
Vertigo | 2 | 0.5 | 2 | 0.2 |
Light-headedness | 1 | 0 | 3 | 0.7 |
Tiredness | 0.6 | 0.5 | 26 | 13 |
Fatigue | 3 | 1 | 6 | 5 |
Lethargy | 1 | 0 | 3 | 0.7 |
Drowsiness | 0.6 | 0 | 2 | 0.5 |
Depression | 0.6 | 0.5 | 12 | 9 |
Dreaming | 0 | 0 | 3 | 1 |
GASTROINTESTINAL | ||||
Diarrhea | 2 | 0 | 3 | 2 |
Nausea | 4 | 1 | 3 | 1 |
RESPIRATORY (see WARNINGS) | ||||
Wheeziness | 0 | 0 | 3 | 3 |
Dyspnea | 0.6 | 1 | 6 | 4 |
During postmarketing experience, the following have been reported in temporal relationship to the use of the drug: elevated liver enzymes and/or bilirubin, hallucinations, headache, impotence, Peyronie's disease, postural hypotension which may be associated with syncope, psoriasiform rash or exacerbation of psoriasis, psychoses, purpura, reversible alopecia, thrombocytopenia, visual disturbance, sick sinus syndrome, and dry mouth. Tenoretic, like other beta blockers, has been associated with the development of antinuclear antibodies (ANA), lupus syndrome, and Raynaud’s phenomenon.
Cardiovascular: orthostatic hypotension; Gastrointestinal: anorexia, gastric irritation, vomiting, cramping, constipation, jaundice (intrahepatic cholestatic jaundice), pancreatitis; CNS: vertigo, paresthesia, xanthopsia; Hematologic: leukopenia, agranulocytosis, thrombocytopenia, aplastic anemia; Hypersensitivity: purpura, photosensitivity, rash, urticaria, necrotizing angiitis (vasculitis) (cutaneous vasculitis), Lyell's syndrome (toxic epidermal necrolysis); Miscellaneous: hyperglycemia, glycosuria, hyperuricemia, muscle spasm, weakness, restlessness. Clinical trials of Tenoretic conducted in the United States (89 patients treated with Tenoretic) revealed no new or unexpected adverse effects.
In addition, a variety of adverse effects not observed in clinical trials with atenolol but reported with other beta-adrenergic blocking agents should be considered potential adverse effects of atenolol. Nervous System: Reversible mental depression progressing to catatonia; an acute reversible syndrome characterized by disorientation for time and place, short-term memory loss, emotional lability, slightly clouded sensorium, decreased performance on neuropsychometrics; Cardiovascular: Intensification of AV block (see CONTRAINDICATIONS); Gastrointestinal: Mesenteric arterial thrombosis, ischemic colitis; Hematologic: Agranulocytosis; Allergic: Erythematous rash, fever combined with aching and sore throat, laryngospasm and respiratory distress.
There have been reports of skin rashes and/or dry eyes associated with the use of beta-adrenergic blocking drugs. The reported incidence is small, and, in most cases, the symptoms have cleared when treatment was withdrawn. Discontinuance of the drug should be considered if any such reaction is not otherwise explicable. Patients should be closely monitored following cessation of therapy. (See DOSAGE AND ADMINISTRATION.)
The oculomucocutaneous syndrome associated with the beta blocker practolol has not been reported with atenolol (TENORMIN). Furthermore, a number of patients who had previously demonstrated established practolol reactions were transferred to atenolol (TENORMIN) therapy with subsequent resolution or quiescence of the reaction.
Clinically important changes in standard laboratory parameters were rarely associated with the administration of Tenoretic. The changes in laboratory parameters were not progressive and usually were not associated with clinical manifestations. The most common changes were increases in uric acid and decreases in serum potassium.
No specific information is available with regard to overdosage and Tenoretic in humans. Treatment should be symptomatic and supportive and directed to the removal of any unabsorbed drug by induced emesis, or administration of activated charcoal. Atenolol can be removed from the general circulation by hemodialysis. Further consideration should be given to dehydration, electrolyte imbalance and hypotension by established procedures.
Overdosage with atenolol has been reported with patients surviving acute doses as high as 5 g. One death was reported in a man who may have taken as much as 10 g acutely.
The predominant symptoms reported following atenolol overdose are lethargy, disorder of respiratory drive, wheezing, sinus pause, and bradycardia. Additionally, common effects associated with overdosage of any beta-adrenergic blocking agent are congestive heart failure, hypotension, bronchospasm, and/or hypoglycemia. Other treatment modalities should be employed at the physician's discretion and may include:
BRADYCARDIA: Atropine 1-2 mg intravenously. If there is no response to vagal blockade, give isoproterenol cautiously. In refractory cases, a transvenous cardiac pacemaker may be indicated. Glucagon in a 10 mg intravenous bolus has been reported to be useful. If required, this may be repeated or followed by an intravenous infusion of glucagon 1-10 mg/h depending on response.
HEART BLOCK (SECOND OR THIRD DEGREE): Isoproterenol or transvenous pacemaker.
CONGESTIVE HEART FAILURE: Digitalize the patient and administer a diuretic. Glucagon has been reported to be useful.
HYPOTENSION: Vasopressors such as dopamine or norepinephrine (levarterenol). Monitor blood pressure continuously.
BRONCHOSPASM: A beta2-stimulant such as isoproterenol or terbutaline and/or aminophylline.
HYPOGLYCEMIA: Intravenous glucose.
ELECTROLYTE DISTURBANCE: Monitor electrolyte levels and renal function. Institute measures to maintain hydration and electrolytes.
Based on the severity of symptoms, management may require intensive support care and facilities for applying cardiac and respiratory support.
Symptoms of chlorthalidone overdose include nausea, weakness, dizziness and disturbances of electrolyte balance.
DOSAGE MUST BE INDIVIDUALIZED. (See INDICATIONS AND USAGE.)
Chlorthalidone is usually given at a dose of 25 mg daily; the usual initial dose of atenolol is 50 mg daily. Therefore, the initial dose should be one Tenoretic 50 tablet given once a day. If an optimal response is not achieved, the dosage should be increased to one Tenoretic 100 tablet given once a day.
When necessary, another antihypertensive agent may be added gradually beginning with 50 percent of the usual recommended starting dose to avoid an excessive fall in blood pressure.
Since atenolol is excreted via the kidneys, dosage should be adjusted in cases of severe impairment of renal function. No significant accumulation of atenolol occurs until creatinine clearance falls below 35 mL/min/1.73m2 (normal range is 100-150 mL/min/1.73m2); therefore, the following maximum dosages are recommended for patients with renal impairment.
Creatinine Clearance (mL/min/1.73m2) | Atenolol Elimination Half-Life (hrs) | Maximum Dosage |
15-35 | 16-27 | 50 mg daily |
<15 | >27 | 50 mg every other day |
Tenoretic 50 Tablets (atenolol 50 mg and chlorthalidone 25 mg), NDC 0310-0115, (white, round, biconvex, uncoated tablets with Tenoretic on one side and 115 on the other side, bisected) are supplied in bottles of 100 tablets.
Tenoretic 100 Tablets (atenolol 100 mg and chlorthalidone 25 mg), NDC 0310-0117, (white, round, biconvex, uncoated tablets with Tenoretic on one side and 117 on the other side) are supplied in bottles of 100 tablets.
Store at controlled room temperature, 20-25°C (68-77°F) [see USP]. Dispense in well-closed, light-resistant containers.
Tenoretic is a trademark of the AstraZeneca group of companies.
©AstraZeneca 2002, 2003, 2004, 2008
Manufactured for:
AstraZeneca Pharmaceuticals LP
Wilmington, DE 19850
By: IPR Pharmaceuticals, Inc.
Canóvanas, PR 00729
AstraZeneca
Rev July 2011
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| Marketing Information | |||
| Marketing Category | Application Number or Monograph Citation | Marketing Start Date | Marketing End Date |
| NDA | NDA018760 | 09/01/1990 | |
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UTINOR 400 mg Tablets
(norfloxacin)
Utinor contains a medicine called norfloxacin. This is an antibiotic which works against a large number of bacteria.
Utinor is used for infections of the urinary system. It works by killing bacteria that can cause infections of your urinary system.
Do not take Utinor if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before taking Utinor.
Check with your doctor or pharmacist before taking your medicine if:
If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking Utinor.
Diarrhoea is a common problem caused by antibiotics, which usually ends when the antibiotic is discontinued. Sometimes after starting the treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two more months after having taken the last dose of the antibiotic. If this occurs, you should speak to your doctor as soon as possible.
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. This includes herbal medicines. This is because Utinor can affect the way some other medicines work. Also some other medicines can affect the way Utinor works.
Some medicines can reduce the amount of Utinor that gets into the body. Leave a gap of at least two hours after taking Utinor before taking any of these medicines:
If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking Utinor.
It is also particularly important to tell your doctor or pharmacist if you take:
If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking Utinor.
Take Utinor with a glass of water. Take Utinor at least one hour before or two hours after food or milk.
Keep out of the sun as much as possible while taking Utinor. This is because the medicine may cause an allergic reaction in some patients when they go in the sun.
Do not take Utinor if you are pregnant or think you might become pregnant. This is because it may affect the baby.
Do not breast-feed if you are taking Utinor. This is because small amounts may pass into the mother’s milk.
Ask your doctor for advice before taking any medicine, if you are pregnant or breast-feeding.
You may feel dizzy while taking Utinor. If this happens do not drive or use any tools or machines.
Always take Utinor exactly as your doctor told you. You should check with your doctor or pharmacist if you are not sure.
REMEMBER, this medicine is for you. Do not share it with anyone else. It may not suit them.
The dose depends on your illness and how bad it is. The usual dose is:
If the infection comes back, your treatment can be for up to 12 weeks.
If you take more Utinor than you should, talk to your doctor straight away.
Keep taking these tablets until the course is finished. Keep taking them, even if you start to feel better after a few days.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
Like all medicines Utinor can cause side effects, although not everybody gets them. The following side effects may happen with this medicine:
Heart and circulation
Skin and hair
Nervous system
Eyes or ears
Infections
Stomach and gut
Blood
Joints and muscles
Urinary
Mental illness
If any of these side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.
Keep your tablets out of the reach of children.
Your tablets should be kept below 25°C, in a dry place out of direct sunlight.
Do not put your tablets in another container, as they might get mixed up.
If you have any tablets left over when your doctor tells you to stop taking them, return them to the pharmacist.
Do not take them after the expiry date that is clearly marked on the pack.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.
Utinor tablets are off-white oval shaped tablets marked ‘MSD 705’.
Utinor Tablets are available in blister packs of 2, 6, 7 and 14 tablets, and bottles of 50.
Not all pack sizes may be marketed.
The marketing Authorisation Holder is
Utinor tablets are made by
This leaflet was last approved in March 2009
This leaflet gives you some of the most important patient information about Utinor. If you have any questions after you have read it, ask your doctor or pharmacist, who will give you further information.
denotes registered trademark of
© Merck Sharp & Dohme Limited 2009. All rights reserved.
(logo) MSD
PIL.NRX.08.UK.2828
Prazin may be available in the countries listed below.
Alprazolam is reported as an ingredient of Prazin in the following countries:
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Bombard may be available in the countries listed below.
In some countries, this medicine may only be approved for veterinary use.
Deltamethrin is reported as an ingredient of Bombard in the following countries:
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Bihyper may be available in the countries listed below.
Bendroflumethiazide is reported as an ingredient of Bihyper in the following countries:
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Apo-Cal may be available in the countries listed below.
Calcium Carbonate is reported as an ingredient of Apo-Cal in the following countries:
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Nicoazolin may be available in the countries listed below.
Fluconazole is reported as an ingredient of Nicoazolin in the following countries:
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In the US, Clinoril (sulindac systemic) is a member of the drug class nonsteroidal anti-inflammatory agents and is used to treat Ankylosing Spondylitis, Familial Adenomatous Polyposis, Gout - Acute, Juvenile Rheumatoid Arthritis, Osteoarthritis, Pain and Rheumatoid Arthritis.
US matches:
Sulindac is reported as an ingredient of Clinoril in the following countries:
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Aciclo Ahimsa may be available in the countries listed below.
Aciclovir is reported as an ingredient of Aciclo Ahimsa in the following countries:
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Buspirona Genfar may be available in the countries listed below.
Buspirone is reported as an ingredient of Buspirona Genfar in the following countries:
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Benagol may be available in the countries listed below.
Amylmetacresol is reported as an ingredient of Benagol in the following countries:
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Nicobion may be available in the countries listed below.
Nicotinamide is reported as an ingredient of Nicobion in the following countries:
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Benur may be available in the countries listed below.
Doxazosin mesilate (a derivative of Doxazosin) is reported as an ingredient of Benur in the following countries:
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In the US, Kinlytic (urokinase systemic) is a member of the drug class thrombolytics and is used to treat Deep Vein Thrombosis, Heart Attack, Pulmonary Embolism and Thrombotic/Thromboembolic Disorder.
US matches:
Urokinase is reported as an ingredient of Kinlytic in the following countries:
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Vincristina Martian may be available in the countries listed below.
Vincristine sulfate (a derivative of Vincristine) is reported as an ingredient of Vincristina Martian in the following countries:
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Chlorpheniramine/Pseudoephedrine/Ibuprofen contains a nonsteroidal anti-inflammatory drug (NSAID). It may cause an increased risk of serious and sometimes fatal heart and blood vessel problems (eg, heart attack, stroke). The risk may be greater if you already have heart problems or if you take Chlorpheniramine/Pseudoephedrine/Ibuprofen for a long time. Do not use Chlorpheniramine/Pseudoephedrine/Ibuprofen right before or after bypass heart surgery.
Chlorpheniramine/Pseudoephedrine/Ibuprofen may cause an increased risk of serious and sometimes fatal stomach ulcers and bleeding. Elderly patients may be at greater risk. This may occur without warning signs.
Relieving symptoms such as pain and sinus congestion due to colds, upper respiratory infections, and allergies. It may also used for other conditions as determined by your doctor.
Chlorpheniramine/Pseudoephedrine/Ibuprofen is an antihistamine, analgesic, and decongestant combination. The antihistamine works by blocking the action of histamine, which helps reduce symptoms such as watery eyes and sneezing. The analgesic works in the brain to help decrease pain. The decongestant works by constricting blood vessels and reducing swelling in the nasal passages, which decreases stuffiness.
Contact your doctor or health care provider right away if any of these apply to you.
Some medical conditions may interact with Chlorpheniramine/Pseudoephedrine/Ibuprofen. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
Some MEDICINES MAY INTERACT with Chlorpheniramine/Pseudoephedrine/Ibuprofen. Tell your health care provider if you are taking any other medicines, especially any of the following:
This may not be a complete list of all interactions that may occur. Ask your health care provider if Chlorpheniramine/Pseudoephedrine/Ibuprofen may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Use Chlorpheniramine/Pseudoephedrine/Ibuprofen as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Ask your health care provider any questions you may have about how to use Chlorpheniramine/Pseudoephedrine/Ibuprofen.
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:
Constipation; diarrhea; dizziness; drowsiness; excitability; headache; loss of appetite; nausea; nervousness or anxiety; trouble sleeping; upset stomach; vomiting; weakness.
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody or black, tarry stools; change in the amount of urine produced; chest pain; confusion; dark urine; depression; fainting; fast, slow, or irregular heartbeat; fever, chills, or persistent sore throat; hallucinations; mood or mental changes; numbness of an arm or leg; one-sided weakness; red, swollen, blistered, or peeling skin; ringing in the ears; seizures; severe dizziness, lightheadedness, or headache; severe drowsiness; severe or persistent stomach pain or nausea; severe vomiting; shortness of breath; stiff neck; sudden or unexplained weight gain; swelling of hands, legs, or feet; tremor; unusual bruising or bleeding; unusual joint or muscle pain; unusual tiredness or weakness; vision or speech changes; vomit that looks like coffee grounds; yellowing of the skin or eyes.
This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include blurred vision; confusion; hallucinations; seizures; severe dizziness, lightheadedness, or headache; severe drowsiness; severe nausea or stomach pain; slow or troubled breathing; unusual bleeding or bruising; unusually fast, slow, or irregular heartbeat; vomit that looks like coffee grounds.
Store Chlorpheniramine/Pseudoephedrine/Ibuprofen at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Avoid temperatures above 104 degrees F (40 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Chlorpheniramine/Pseudoephedrine/Ibuprofen out of the reach of children and away from pets.
This information is a summary only. It does not contain all information about Chlorpheniramine/Pseudoephedrine/Ibuprofen. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.
