Tenoric
Tenoric: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Tenoric
ATX code: C07BB03
Active ingredient: atenolol (Atenolol) + chlortalidone (Chlortalidone)
Manufacturer: Ipka Laboratories, Ltd. (Ipca Laboratories, Ltd.) (India)
Description and photo update: 2019-09-09
Prices in pharmacies: from 118 rubles.
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Tenoric is a combined drug that has a long-term hypotensive effect.
Release form and composition
The dosage form of the release is film-coated tablets: biconvex, round, the color of the shell and core is almost white or white, on one side there is a risk (in blister or non-cell packs of 10 or 14 pcs., In a cardboard box 2-5 or 10 packs and instructions for use of Tenorica).
Active ingredients:
- atenolol - 50 or 100 mg;
- chlorthalidone - 12.5 or 25 mg.
Additional components (50 mg + 12.5 mg / 100 mg + 25 mg):
- kernel: corn starch - 69.95 / 139.8 mg; talc - 5/10 mg; lactose - 46.25 / 92.5 mg; povidone - 4.5 / 9 mg; sodium lauryl sulfate –1.25 / 2.5 mg; magnesium stearate - 3/6 mg; colloidal silicon dioxide - 4.8 / 9.7 mg;
- shell: macrogol-400 - 1 / 0.8 mg; hypromellose - 2.5 / 2 mg; titanium dioxide - 1.2 / 1.2 mg; talc - 1 / 0.8 mg; liquid paraffin - 0.2 / 0.2 mg; carnauba wax - 0.1 / 0.07 mg.
Pharmacological properties
Pharmacodynamics
Tenoric is a combined antihypertensive drug that has a long-term antihypertensive effect.
The therapeutic effect is due to the properties of the active ingredients:
- atenolol: belongs to the number of cardioselective beta 1 -adrenergic blockers. With an increase in the dose, the selectivity of its action decreases. The substance does not have internal membrane stabilizing and sympathomimetic effects. Like other beta-blockers, it has a negative inotropic effect, slows down the heart rate;
- Chlorthalidone: is a non-thiazide sulfonamide diuretic that enhances the release of chlorine and sodium. Increases the release of bicarbonate, magnesium and potassium. The mechanism of antihypertensive action is believed to be related to sodium excretion.
The combined use of these components is more effective than the use of each of the substances as a monopreparation.
The effect of using Tenoric lasts for 24 hours after a single daily dose.
Pharmacokinetics
The combined use of atenolol and chlorthalidone has little effect on the pharmacokinetic parameters of each of them.
Atenolol
After oral administration, atenolol is absorbed from the gastrointestinal tract by 40-50%. C max (maximum concentration) in blood plasma is reached 2–4 hours after administration. Binds to plasma proteins at a level of approximately 6-16%.
Atenolol does not undergo pronounced hepatic metabolism; more than 90% of the substance absorbed into the systemic circulation is excreted unchanged. T 1/2 (half-life) is in the range from 6 to 9 hours, in cases of severe renal failure, this indicator may increase, since the excretion of the substance occurs mainly by the kidneys.
Chlorthalidone
Chlorthalidone after oral administration is absorbed from the gastrointestinal tract by 60%. Time to reach C max in blood plasma is about 12 hours. Plasma protein binding is approximately 75%.
Excretion is carried out by the kidneys, T 1/2 - about 50 hours.
Indications for use
The drug Tenoric is used to treat hypertension.
Contraindications
Absolute:
- hereditary lactose intolerance, galactose / glucose malabsorption syndrome and lactase deficiency;
- collapse, cardiogenic shock;
- severe peripheral circulatory disorders;
- arterial hypotension in severe course (with systolic pressure below 90 mm Hg);
- myasthenia gravis;
- gout;
- metabolic acidosis;
- refractory hypokalemia;
- atrioventricular block II and III degree;
- pheochromocytoma (without combined use with alpha-blockers);
- sick sinus syndrome;
- acute heart failure and chronic heart failure in the stage of decompensation;
- acute hepatitis;
- renal failure (with creatinine clearance less than 35 ml / min);
- age up to 18 years (the safety profile for this group of patients has not been studied);
- individual intolerance to the components of the drug.
Relative (the use of Tenoric requires caution in the presence of the following diseases / conditions):
- Prinzmetal's angina;
- atrioventricular block I degree;
- chronic obstructive pulmonary disease, bronchial asthma;
- thyrotoxicosis;
- diabetes;
- disorders of renal function and water-electrolyte balance of the blood;
- elderly age.
It is not recommended to prescribe Tenoric to lactating and pregnant women.
Tenoric, instructions for use: method and dosage
Tenoric tablets are taken orally with a sufficient amount of water, without chewing, in the morning before meals.
The initial daily dose for arterial hypertension is 1 tablet 50 mg + 12.5 mg.
The maximum per day can be taken 1 tablet 100 mg + 25 mg. A further increase in the dose does not lead to an increase in the Tenoric effect; if necessary, it is possible to use another drug with an antihypertensive effect.
For elderly patients, the dosage regimen is determined by the doctor (usually lower doses are required).
When creatinine clearance is less than 35 ml / min, Tenoric can be used only after titrating doses of individual active components of the drug.
The maximum dose of atenolol depending on creatinine clearance (ml / min / 1.73 m 2):
- CC 15–35: 50 mg once a day;
- CC up to 15: 50 mg 1 time in 2 days.
The dose of Tenoric should be reduced by reducing the frequency of administration.
After long-term treatment, it is recommended to cancel the drug gradually.
If you miss a single dose, you should not double the next one. Missing a dose may be accompanied by a decrease in the effectiveness of therapy.
Side effects
- digestive tract: pancreatitis, dryness of the oral mucosa, gastrointestinal disorders (in the form of nausea, constipation, anorexia), functional liver disorders (may be accompanied by symptoms of intrahepatic cholestasis), increased activity of hepatic transaminases in blood serum;
- cardiovascular system: Raynaud's syndrome, bradycardia, arrhythmias (including atrioventricular block), cold extremities, intermittent claudication, increased symptoms of chronic heart failure, orthostatic hypotension (may occur with fainting);
- central nervous system: disorientation, hallucinations, confusion, headache, dizziness, apathy, paresthesia, increased fatigue, sleep disturbances, mood lability, acute psychosis;
- respiratory system: bronchospasm (with bronchial asthma or indications in history of bronchospasm);
- hematopoietic system: leukopenia, eosinophilia, purpura, agranulocytosis, thrombocytopenia;
- laboratory parameters: hypokalemia, hyponatremia (associated with chlorthalidone), hyperuricemia, impaired glucose tolerance;
- organ of vision: dryness of the mucous membrane of the eyes, visual impairment;
- skin: exacerbation of the course of psoriasis, alopecia, psoriasis-like skin reactions, photosensitivity, skin rash;
- others: a decrease in potency, an increase in the titer of antinuclear antibodies (the clinical significance of this disorder is not clear).
Overdose
The main symptoms: increased sleepiness, bronchospasm, arterial hypotension, severe bradycardia, acute heart failure, convulsions.
Therapy: careful monitoring of the patient's condition. If necessary, hospitalization is carried out in the intensive care unit, gastric lavage is prescribed, the intake of activated charcoal and drugs with laxatives.
Other possible measures (depending on the symptoms of the overdose):
- bronchospasm: use of bronchodilators;
- arterial hypotension and shock: the introduction of plasma substitutes or plasma;
- significant diuresis: the introduction of electrolytes and fluids.
It is possible to carry out hemoperfusion or hemodialysis.
special instructions
Possible Tenoric effects associated with the active substance atenolol:
- masking hypoglycemia (signs - tremor, tachycardia, general weakness, increased sweating, decreased eyeball tone) and thyrotoxicosis phenomena;
- a decrease in the therapeutic effect against the background of smoking;
- the development of severe anaphylactic reactions (due to increased sensitivity to allergens), in this regard, patients on desensitized therapy should take Tenoric with great caution (such patients may not respond to usual doses of epinephrine);
- decreased production of tear fluid (important for patients who wear contact lenses);
- deterioration in the background of ischemic heart disease (therapy should not be abruptly canceled);
- the development of bradycardia (with a heart rate of less than 50 beats / min) with manifestations of clinical symptoms (dose reduction or drug withdrawal is required);
- deterioration of bronchial conductivity in patients with broncho-obstructive syndrome (requires the appointment of beta-adrenergic agonists, for example, salbutamol).
Possible Tenoric effects associated with the active substance - chlorthalidone:
- the development of hypokalemia, in connection with which it is necessary to regularly monitor the potassium content, especially in elderly patients, with combined use with cardiac glycosides for the treatment of chronic heart failure, with complaints of gastrointestinal tract disorders and an unbalanced diet (low potassium content);
- the occurrence of impaired glucose tolerance; if you have a predisposition to the development of diabetes mellitus, you need to be careful;
- development of hyperuricemia; as a rule, there is only a slight increase in the serum concentration of uric acid in the blood, however, in some cases, it may be necessary to use drugs that promote its excretion.
Taking Tenoric should be discontinued 48 hours before surgery. The surgeon-anesthesiologist must be informed about the therapy being performed. The general anesthetic with the least negative inotropic effect should be chosen for the operation.
During the use of Tenoric, care must be taken when driving vehicles and performing potentially hazardous activities that require an increased concentration of attention and quick psychomotor reactions.
Application during pregnancy and lactation
It is not recommended to use Tenoric tablets during pregnancy / lactation.
Pediatric use
For patients under 18 years of age, the drug is not prescribed.
With impaired renal function
- renal failure (in patients with creatinine clearance less than 35 ml / min): therapy is contraindicated;
- impaired renal function: Tenoric should be used with caution.
For violations of liver function
Patients with acute hepatitis are contraindicated to take Tenoric.
Use in the elderly
Elderly patients should be careful during therapy.
Drug interactions
With the combined use of Tenoric with some drugs / substances, the following effects may develop:
- blockers of slow calcium channels, dihydropyridine derivatives: an increase in the likelihood of arterial hypotension; with latent (latent) heart failure - the appearance of signs of circulatory disorders;
- cardiac glycosides: an increase in the time of atrioventricular conduction;
- clonidine (after its cancellation): exacerbation of "rebound" hypertension, after the end of the combination, you must first cancel Tenoric, then a few days later clonidine;
- class I antiarrhythmics, including disopyramide: summation of the cardiodepressant effect (the combination requires caution);
- salicylates, estrogens, non-steroidal anti-inflammatory drugs, including indomethacin, ibuprofen: a decrease in the hypotensive effect of Tenoric, with a high dose of salicylates - an increase in their toxic effect on the central nervous system;
- sympathomimetic agents, including epinephrine, norepinephrine: neutralizing the Tenoric effect (in the form of a significant increase in blood pressure);
- lithium preparations: decreased renal clearance (the combination is not recommended);
- agents for general anesthesia: development of interaction (combination requires caution);
- monoamine oxidase inhibitors: increase in blood pressure (the combination should not be used);
- glucocorticosteroids, carbenoxolone, amphotericin B, furosemide: increased excretion of potassium ions;
- angiotensin-converting enzyme inhibitors: a sharp increase in its antihypertensive effect at the beginning of therapy (the combination requires caution);
- diuretics, tricyclic antidepressants, phenothiazides, barbiturates, vasodilators and other drugs with an antihypertensive effect, ethanol: increasing the antihypertensive effect of Tenoric;
- insulin and oral hypoglycemic agents: enhancing their action (requires regular monitoring of blood glucose concentration);
- reserpine, clonidine, guanfacine: development of severe bradycardia;
- blockers of slow calcium channels, which have a negative inotropic effect, including verapamil, diltiazem: an increase in this effect, especially with reduced myocardial contractility and / or atrioventricular / sinoatrial conduction disorders, which can lead to severe arterial hypotension, heart failure and severe bradycardia (after Withdrawal of Tenoric should not be injected intravenously with slow calcium channel blockers for 48 hours).
Analogs
Analogs of Tenoric are: Ategexal compositum, Tenoretic, Tenonorm, Atenolol comp., Tenorox, Atenolol compositum Sandoz, etc.
Terms and conditions of storage
Store in a dark and dry place at temperatures up to 25 ° C. Keep out of the reach of children.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Tenorica
Patients recommend the drug as an inexpensive and effective means of controlling blood pressure. Reviews about Tenorica are mostly positive. A convenient dosing regimen and no decrease in effectiveness with prolonged use are noted. The development of adverse reactions is rarely reported.
The price of Tenoric in pharmacies
The approximate price for Tenoric (28 tablets per pack) is: 50 mg + 12.5 mg - 125-157 rubles, 100 mg + 25 mg - 162-210 rubles.
Tenoric: prices in online pharmacies
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Drug name Price Pharmacy |
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Tenoric 50 mg + 12.5 mg film-coated tablets 28 pcs. 118 RUB Buy |
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Tenoric tablets p.p. 50mg + 12.5mg 28 pcs. 132 RUB Buy |
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Tenoric 100 mg + 25 mg film-coated tablets 28 pcs. 147 RUB Buy |
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Tenoric tablets p.p. 100mg + 25mg 28 pcs. 173 r Buy |
Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
