Cardioselective b-blockers (beta- blockers) / thiazide-related diuretics (thiazides).

Generic

Tablets.

Tablets, co-tenidone 50/12.5 (atenolol 50mg, chlortalidone 12.5mg), 100/25 (atenolol 100mg, chlortalidone 25mg). Available from APS, Cox, CP, Generics UK, Hillcross, Lagap, Norton.

Hypertension.

One daily.

2nd or 3rd degree AV block, sinus bradycardia, sick sinus syndrome, severe peripheral arterial disease, uncompensated cardiac failure, cardiogenic shock, hypotension, right ventricular failure secondary to pulmonary hypertension, significant cardiomegaly, untreated phaechromocytoma. Anuria, severe or progressive renal failure.

Poor cardiac reserve should be controlled with digitalis and diuretics. History of bronchospasm (cardio-selective b-blockers usually have a lesser effect on airways resistance than the non-selective type but their use should also be avoided in patients with wheezing or obstructive airways disease unless there are compelling clinical reasons).

Diabetes; metabolic acidosis. Asthenic symptoms. Cerebrovascular insufficiency. Renal or hepatic impairment, thyrotoxic crisis. General anaesthesia; consider withdrawal before elective surgery. Pregnancy, lactation. Withdraw gradually. Gout, diabetes, hyperlipidaemia. Monitor electrolyte levels; thiazides can cause hypokalaemia so K +-supplements may be required.

Clonidine withdrawal, verapamil, diltiazem, class II antiarrhythmics, cardiac depressant anaesthetics, hypoglycaemics, reserpine, other antihypertensives, ergot alkaloids, cimetidine, rifampicin, theophylline, warfarin, CNS depressants, sympathomimetics, indometacin (indomethacin). Lithium, NSAIDs, digitalis, allopurinol, amantadine.

Cold extremities, sleep disturbances (particularly with the more lipophilic drugs) bradycardia, exertional failure, hypotension, GI upset. If unexplained dry eyes or skin rash occur withdraw gradually. Gout, photosensitivity, rash, blood dyscrasias, weakness.

(POM)