Atenolol and chlorthalidone

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of atenolol and chlorthalidone, there are no specific foods that you must exclude from your diet when receiving this medication. 

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• your blood pressure
• how you respond to this medication
• the condition of your kidney

The recommended dose of atenolol and chlorthalidone to treat high blood pressure is one 50/25 mg tablet once daily. The maximum dose is atenolol 100 mg/day and chlorthalidone 25 mg/day. 

Usual Adult Dose for Hypertension:

Initial dose: Atenolol 50 mg-Chlorthalidone 25 mg orally once a day
Maintenance dose: Atenolol 50 to 100 mg-Chlorthalidone 25 mg orally once a day

Use: Treatment of hypertension if the fixed dose combination represents an appropriate dose for the individual patient.

• If you have an allergy to atenolol, chlorthalidone, or any other part of atenolol and chlorthalidone.
• If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
• If you have any of these health problems: Heart block, shock caused by heart problems, or slow heartbeat.
• If you have heart failure (weak heart).
• If you have an adrenal gland tumor called pheochromocytoma.
• If you are not able to pass urine.

This is not a list of all drugs or health problems that interact with this medicine.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take atenolol and chlorthalidone with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Signs of fluid and electrolyte problems like mood changes, confusion, muscle pain or weakness, a heartbeat that does not feel normal, very bad dizziness or passing out, fast heartbeat, more thirst, seizures, feeling very tired or weak, not hungry, unable to pass urine or change in the amount of urine produced, dry mouth, dry eyes, or very bad upset stomach or throwing up.
• Signs of high blood sugar like confusion, feeling sleepy, more thirst, more hungry, passing urine more often, flushing, fast breathing, or breath that smells like fruit.
• Signs of a pancreas problem (pancreatitis) like very bad stomach pain, very bad back pain, or very bad upset stomach or throwing up.
• Feeling cold.
• Very bad dizziness or passing out.
• Slow heartbeat.
• Restlessness.
• Shortness of breath, a big weight gain, or swelling in the arms or legs.
• Low mood (depression).
• Any unexplained bruising or bleeding.
• Feeling very tired or weak.
• Fever or chills.
• Sore throat.
• Yellow skin or eyes.
• A burning, numbness, or tingling feeling that is not normal.

• Tenoretic

Hypersensitivity to atenolol, chlorthalidone, sulfonamide derived drugs, or any component of the formulation; sinus bradycardia, second- or third-degree heart block (except in patients with a functioning artificial pacemaker); cardiogenic shock, overt cardiac failure; anuria

Note: Although the FDA approved product labeling states this medication is contraindicated with other sulfonamide-containing drug classes, the scientific basis of this statement has been challenged. See “Warnings/Precautions” for more detail.

Canadian labeling: Additional contraindications (not in US labeling): Bradycardia (regardless of origin); sick sinus syndrome; cor pulmonale; hypotension; severe peripheral arterial disorders; anesthesia with agents that produce myocardial depression; Pheochromocytoma (in the absence of alpha-blockade); metabolic acidosis; pregnancy; breastfeeding

Note: Dose is individualized; combination product may be substituted for individual components in patients currently maintained on both agents separately or in patients not adequately controlled with monotherapy (using one of the agents or an agent within same antihypertensive class).

Hypertension: Oral: Initial: Atenolol 50 mg and chlorthalidone 25 mg once daily; if optimal blood pressure response not achieved, may increase dose of atenolol to 100 mg (maximum dose: Atenolol 100 mg/day; chlorthalidone 25 mg/day).

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience nausea, vomiting, lack of appetite, or constipation. Have patient report immediately to prescriber signs of fluid and electrolyte problems (mood changes, confusion, muscle pain or weakness, abnormal heartbeat, severe dizziness or passing out, tachycardia, increased thirst, seizures, loss of strength and energy, lack of appetite, urinary retention or change in amount of urine passed, dry mouth, dry eyes, or nausea or vomiting), signs of high blood sugar (confusion, fatigue, increased thirst, increased hunger, polyuria, flushing, fast breathing, or breath that smells like fruit), signs of pancreatitis (severe abdominal pain, severe back pain, severe nausea, or vomiting), sensation of cold, severe dizziness, passing out, bradycardia, agitation, shortness of breath, excessive weight gain, swelling of arms or legs, depression, bruising, bleeding, severe loss of strength and energy, chills, jaundice, burning or numbness feeling, or pharyngitis (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

Applies to atenolol / chlorthalidone: oral tablet

General

The most common adverse reactions were bradycardia, cold extremities, gastrointestinal disturbances, fatigue, hyperuricemia, hyponatremia, hypokalemia, and impaired glucose tolerance.[Ref]

Metabolic

Common (1% to 10%): Hyperuricemia, hyponatremia, hypokalemia, impaired glucose tolerance

Chlorthalidone (chlortalidone):
Frequency not reported: Anorexia, hyperglycemia, hyperuricemia[Ref]

Cardiovascular

Common (1% to 10%): Bradycardia, cold extremities
Rare (less than 0.1%): Heart failure deterioration, heart block precipitation, postural hypotension, intermittent claudication increased, Raynaud's phenomenon

Atenolol:
Very common (10% or more): Cold extremities (up to 12%)
Common (1% to 10%): Bradycardia, postural hypotension
Postmarketing reports: Sick sinus syndrome, Raynaud's phenomenon

Chlorthalidone (chlortalidone):
Frequency not reported: Orthostatic hypotension, necrotizing angiitis[Ref]

Gastrointestinal

Common (1% to 10%): Gastrointestinal disturbances
Rare (less than 0.1%): Dry mouth
Frequency not reported: Constipation

Atenolol:
Common (1% to 10%): Diarrhea, nausea
Postmarketing reports: Dry mouth

Chlorthalidone (chlortalidone):
Frequency not reported: Gastric irritation, vomiting, cramping, constipation, pancreatitis[Ref]

Other

Common (1% to 10%): Fatigue

Atenolol:
Very common (10% or more): Tiredness (up to 26%)
Common (1% to 10%): Fatigue, lethargy

Chlorthalidone (chlortalidone):
Frequency not reported: Weakness[Ref]

Psychiatric

Uncommon (0.1% to 1%): Sleep disturbances
Rare (less than 0.1%): Mood changes, nightmares, confusion, psychoses, hallucinations

Atenolol:
Very common (10% or more): Depression (up to 12%)
Common (1% to 10%): Dreaming
Postmarketing reports: Hallucinations, psychoses

Chlorthalidone (chlortalidone):
Frequency not reported: Restlessness[Ref]

Hepatic

Uncommon (0.1% to 1%): Transaminase levels increased
Rare (less than 0.1%): Hepatic toxicity

Atenolol:
Postmarketing reports: Liver enzymes elevated, bilirubin elevated

Chlorthalidone (chlortalidone):
Frequency not reported: Intrahepatic cholestatic jaundice[Ref]

Dermatologic

Rare (less than 0.1%): Purpura, alopecia, psoriasiform skin reaction, psoriasis exacerbation, skin rashes
Frequency not reported: Angioedema, urticaria

Atenolol:
Postmarketing reports: Psoriasiform rash, psoriasis exacerbation, purpura, reversible alopecia

Chlorthalidone (chlortalidone):
Frequency not reported: Purpura, photosensitivity, rash, urticaria, cutaneous vasculitis, toxic epidermal necrolysis[Ref]

Nervous system

Rare (less than 0.1%): Dizziness, headache, paresthesia

Atenolol:
Very common (10% or more): Dizziness (up to 13%)
Common (1% to 10%): Vertigo, lightheadedness, drowsiness
Postmarketing reports: Headache

Chlorthalidone (chlortalidone):
Frequency not reported: Vertigo, paresthesia[Ref]

Hematologic

Rare (less than 0.1%): Thrombocytopenia, leukopenia

Atenolol:
Postmarketing reports: Thrombocytopenia

Chlorthalidone (chlortalidone):
Frequency not reported: Leukopenia, agranulocytosis, thrombocytopenia, aplastic anemia[Ref]

Ocular

Rare (less than 0.1%): Dry eyes, visual disturbances

Atenolol:
Postmarketing reports: Visual disturbance

Chlorthalidone (chlortalidone):
Frequency not reported: Xanthopsia[Ref]

Respiratory

Rare (less than 0.1%): Bronchospasm

Atenolol:
Common (1% to 10%): Wheeziness, dyspnea[Ref]

Genitourinary

Rare (less than 0.1%): Impotence

Atenolol:
Postmarketing reports: Impotence, Peyronie's disease

Chlorthalidone (chlortalidone):
Frequency not reported: Glycosuria[Ref]

Immunologic

Very rare (less than 0.01%): Antinuclear antibodies increased
Frequency not reported: Hypersensitivity reactions

Atenolol:
Postmarketing reports: Development of antinuclear antibodies[Ref]

Musculoskeletal

Frequency not reported: Lupus-like syndrome

Atenolol:
Common (1% to 10%): Leg pain
Postmarketing reports: Lupus syndrome

Chlorthalidone (chlortalidone):
Frequency not reported: Muscle spasm[Ref]

Some side effects of atenolol / chlorthalidone may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.