Uses of Twincard: - Hypertension (high blood pressure) Adult: Per tab contains Atenolol (mg)/Chlorthalidone (mg): 50/25 or 100/25. Initially one tab of 50/25 once daily; may increase to one tab of 100/25 based on response.

Combined antihypertensive preparations

Atenolol is a beta1-selective (cardio selective) beta-adrenergic receptor blocking agentwithout membrane stabilizing or intrinsic sympathomimetic (partial agonist) activities.This preferential effect is not absolute, however, and at higher doses, Atenolol inhibitsbeta-2-adrenoreceptors, chiefly located in the bronchial and vascular musculature.ChlorthalidoneChlorthalidone is a monosulfonamyl double ring system which differs chemically fromthiazide diuretics in that a double ring system is incorporated in its' structure. It is an oraldiuretic with prolonged action and low toxicity. The diuretic of the drug occurs within 2 hours of an oral dose. It produces diuresis with greatly increased excretion of sodium andchloride. At maximal therapeutic dosage, Chlorthalidone is approximately equal in itsdiuretic 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.

How to use Atenolol + Chlorthalidone: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Atenolol + Chlorthalidone may be taken with or without food, but it is better to take it at a fixed time. Administration: Concomitant admin w/ reserpine may increase hypotension and bradycardia. Additive w/ Ca channel blockers, hydralazine, methyldopa. Increased risk of bradycardia and heart block w/ verapamil and diltiazem. May decrease hypotensive effects w/ NSAIDs (e.g. indometacin). Enhanced bradycardic effect w/ disopyramide, amiodarone or digitalis glycosides. May exacerbate rebound HTN upon discontinuance of clonidine treatment. Adult Dose: Bronchospastic disease, renal or hepatic impairment, elderly. May aggravate peripheral arterial circulatory disorder. Beta-blocker can depress myocardial contractility; continued use in patients without history of cardiac failure may in some cases, lead to cardiac failure. Caution in patients receiving anaesthetic agents that may depress myocardium. In patients with coronary artery disease, abrupt withdrawal may cause angina pectoris exacerbation, MI. Atenolol may mask signs (tachycardia) of hypoglycaemia and thyrotoxicosis. Latent DM may manifest with Chlorthalidone therapy. Chlorthalidone can cause hyperuricaemia and precipitate gout. Monitor renal functions, potassium levels, and signs of fluid and electrolytes imbalance. Discontinue if progressive renal impairment is evident. Not recommended in pregnancy and lactation. Safety and efficacy in paediatric patients have not been established. Lactation: excreted in breast milk, use caution Renal Dose: Atenolol is a beta-blocker that acts preferentially on the ?1 adrenergic receptors in the heart. Chlorthalidone is a thiazide-like diuretic that reduces BP possibly by inhibiting sodium reabsorption at the beginning of the distal convulated tubule. Combination of the two drugs results in additive antihypertensive action.

Sinus bradycardia, 2nd or 3rd degree heart block, cardiogenic shock, anuria, hypersentivity to either product or sulphonamide derivatives.

Atenolol and Chlorthalidone combination is contraindicated in hypersensitivity to this product or to sulfonamide-derived drugs. It is also contraindicated in patients with sinus bradycardia, heart block greater than first degree, cardiogenic shock, overt cardiac failure and anuria.

Common - Nausea - Diarrhea - Headache - Fatigue - Dizziness - Cold extremities - Increased blood uric acid - Decreased potassium level in blood - Glucose intolerance - Slow heart rate - Decreased sodium level in blood - Decreased magnesium level in blood - Increased calcium level in blood - Increased blood lipid level Renal impairment: CrCl (ml/min) 15-35 Max dose of Atenolol component: 50 mg/day <15 Max dose of Atenolol component: 50 mg every other day.

Pregnancy Category D. Atenolol & Chlorthalidone combination can cause fetal harm to the developing baby and may appear in breast milk. So it should not be taken during pregnancy & lactation.

Precaution: Hypertension

No specific information is available with regard to overdosage of this combination 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.

Store in cool and dry place, protected from light.

Combined antihypertensive preparations

Atenolol and chlorthalidone have been used singly and concomitantly for the treatment of hypertension. 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 drugs. Atenolol is a beta1-selective (cardioselective) beta-adrenergic receptor blocking agent that provides- reduction in resting and exercise heart rates and cardiac output reduction of systolic and diastolic blood pressure at rest and on exercise reduction in reflex orthostatic tachycardia. Chlorthalidone is a monosulfonamyl diuretic with prolonged action and low toxicity. It produces diuresis with greatly increased excretion of sodium and chloride at distal convoluted tubule of the nephron.

Atenolol: Dyspnoea, wheeziness, bradycardia, hypotension, cold extremities, fatigue, dizziness, insomnia, lethargy, confusion, headache, depression, nightmares, nausea, diarrhoea, constipation, impotence, paraesthesia, rash, Raynaud's phenomenon. Chlorthalidone: Orthostatic hypotension, GI disturbances, jaundice, pancreatitis, vertigo, lethargy, paraesthesia, photosensitivity, rash, muscle cramps, hypokalaemia, hyponatraemia, hyperglycaemia, hyperuricaemia or gout, leucopenia, agranulocytosis, aplastic anaemia, thrombocytopenia. Potentially Fatal: Atenolol: Heart failure, 2nd or 3rd degree AV block. Chlorthalidone: Hypersensitivity reaction including toxic epidermal necrolysis.