Atenolol/ChlorthalidoneAtenolol / Chlorthalidone

About Atenolol/Chlorthalidone

Atenolol is a beta blocker that slows the heart and lowers blood pressure; chlorthalidone is a diuretic that makes the kidneys remove extra salt and water. The label approves the combination for the treatment of hypertension, to lower blood pressure, and says it is not for initial therapy: it is meant for people whose blood pressure has already been treated with both drugs, for whom one tablet is more convenient. The usual starting dose is one 50 mg/25 mg tablet once a day, increased to one 100 mg/25 mg tablet once a day if the response is inadequate; if another blood pressure drug is added, the label says to start it at half its usual starting dose. People with reduced kidney function take less: at most 50 mg of atenolol a day when creatinine clearance is 15 to 35 mL/min, and 50 mg every other day below 15.

The combination label has no boxed warning. Its warnings are those of its two parts. Stopping atenolol abruptly in someone with coronary artery disease can worsen angina and has led to heart attacks, so the dose is tapered under supervision. Beta blockers can depress the heart further in heart failure, are generally avoided in asthma and other bronchospastic disease, can mask the fast heartbeat that warns of low blood sugar and of an overactive thyroid, and can cause very slow heart rates or heart block when combined with verapamil or diltiazem; the drug is not given in untreated pheochromocytoma. Chlorthalidone can bring on azotemia in kidney disease, small shifts in fluid and electrolytes can be dangerous in liver disease, and it lowers potassium. It must not be taken with sinus bradycardia, heart block greater than first degree, cardiogenic shock, overt heart failure, anuria, or an allergy to the product or to sulfonamide derived drugs. The most common side effects in atenolol trials were tiredness, dizziness, cold hands and feet and depression; the most common laboratory changes were higher uric acid and lower potassium.

Atenolol can cause fetal harm: it crosses the placenta, and use from the second trimester has been associated with babies born small for their gestational age. It passes into breast milk, and clinically significant slow heart rates have been reported in breastfed infants, so nursing mothers use it with caution. The label advises against routine use with lithium, since diuretics raise the risk of lithium toxicity, and notes that indomethacin and similar anti inflammatory drugs can blunt the blood pressure effect and that reserpine, digoxin, amiodarone and disopyramide add to the slowing of the heart. MedlinePlus adds that chlorthalidone can make skin more sensitive to sunlight and that the prescriber may ask for a low salt diet or more potassium rich foods.

Taking Atenolol/Chlorthalidone

How to take it

Take one tablet once a day at about the same time, preferably in the morning. Keep taking it even when you feel well, and do not stop it suddenly without the prescriber’s advice; the dose is lowered gradually.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed one. Do not take a double dose.

Storage

At room temperature, 68 to 77 degrees Fahrenheit, in a well closed, light resistant container, away from heat and moisture and out of reach of children.

Interactions to know about

Tell the prescriber about verapamil or diltiazem, digoxin, amiodarone, disopyramide, reserpine, clonidine, lithium and anti inflammatory pain relievers such as indomethacin, and about insulin or diabetes pills, since the beta blocker can hide low blood sugar. Alcohol can add to the dizziness.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Atenolol/Chlorthalidone differs from pharmacy to pharmacy

Both components are decades old generics, and the combination tablet is made by several companies, so the tablets cost pharmacies little and the dispensing fee is most of a quote. Pharmacies that carry the combination on a flat price generic list quote it one way; a pharmacy that fills it rarely and orders it in quotes it another. The brand, Tenoretic, is priced as a brand.

Quantity matters: a thirty day fill and a ninety day fill carry different numbers of dispensing fees, and someone on the every other day kidney dose needs half as many tablets a month. Some pharmacies quote the two drugs as separate generic prescriptions differently from the single combination tablet.

Ways to pay less for Atenolol/Chlorthalidone without insurance

• Ask for generic substitution.
• Once your dose is stable, ask the prescriber for a ninety day supply, so you pay fewer dispensing fees.
• Ask whether the pharmacy lists atenolol and chlorthalidone tablets on a flat price generic list.
• Compare more than one pharmacy; for an old generic the quotes differ mostly in the dispensing fee.
• If the combination is quoted high, ask the prescriber whether separate atenolol and chlorthalidone tablets at your current doses are an option.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Atenolol/Chlorthalidone

1. 1.What should I do if I run out and cannot get a refill right away, since I am not supposed to stop this suddenly?
2. 2.Do I need my potassium or kidney function checked while I take this?
3. 3.Which of my other medicines, including over the counter pain relievers, could interfere with it?
4. 4.Is the generic you stock rated equivalent to Tenoretic?

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