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Tenormin (Atenolol)

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Generic Name: Atenolol
Brand Name: Tenormin
Generic Ingredients: Tenormin + Chlorthalidone Tenoretic
Generic Ingredient: Nebivolol Systolic
Type of Drug: Beta-adrenergic blocking agent.

Prescribed For: Tenormin alone or in combination is prescribed for high blood pressure, abnormal heart rhythms, angina pectoris, and prevention of second heart attack and migraine. It is also usedto treat alcohol withdrawal, stage Ifight, and other anxieties. Nebivolol is currently approved only to treat high blood pressure. Both are used together with other blood-pressure-lowering medications.

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General Information

Tenormin is one of many beta-adrenergic blocking drugs, or beta blockers and primarily blocks the beta, receptor. Nebivolol blocks both the beta, and beta, receptors when taken at high doses by people whose liver breaks down the drug more slowly than average. These drugs interfere with the action of adrenaline and other chemicals in the body that affect many body functions. Individual beta blockers have different characteristics that can make them more suitable for certain conditions or people.
When used to treat high blood pressure, Tenormin may be used either alone or concurrently with other antihypertensive drugs, particularly with a thiazide-type diuretic.

Cautions and Warnings

Do not take these drugs it you are allergic or sensitive to any of their ingredients or to other beta blockers. People with a severe allergy to any substance may be more sensitive to that allergen while taking a beta blocker.
People with angina who take these medicines for high blood pressure risk aggravating their angina if they suddenly stop taking the drug. These people should have their drug dosage reduced gradually over 1-2 weeks.
Tenormin should not be used by those with slow heartbeat, moderate to severe heart block (a condition affecting the heart’s conduction system), congestive heart failure unless it is due to a quickened heart rate that can be treated with Tenormin, or acute heart failure.
Tenormin and nebivolol should be used with caution if you have liver or kidney disease, because your ability to eliminate these drugs from your body may be impaired. Dose adjustments may be needed.
These drugs reduce the amount of blood the heart pumps. This reduction in blood flow may aggravate the condition of people with poor circulation or circulatory disease.
If you are undergoing major surgery, your doctor may want you to stop taking these drugs at least 2 days before surgery.
If you have pheochromocytoma (adrenal gland tumor), use Tenormin with caution.
Tenormin should be usedOfti caution in those with chronic bronchitis, emphysema, or other nonallergic bronchospastic diseases.
People with a history of severe anaphylactic reaction to allergens may be unresponsive to usual doses of epinephrine while taking beta blockers.

Possible Side Effects

Tenormin

Side effects are relatively uncommon and usually mild; they usually develop early in the course of treatment and are rarely a reason to stop taking Tenormin.
Most common: impotence.
Less common: unusual tiredness or weakness, slow heartbeat, heart failure (symptoms include swelling of the legs, ankles, or feet), dizziness, breathing difficulties,      bronchospasm, depression, confusion, anxiety, nervousness, sleeplessness, disorientation, short-term memory loss, emotional instability, cold hands and feet, constipation,      diarrhea, nausea, vomiting, upset stomach, increased sweating, urinary difficulties, cramps, blurred vision, rash, hair loss, stuffy nose, facial swelling, itching, chest      pain, back or joint pain, colitis, drug allergy (symptoms include fever and sore throat), and liver toxicity.
Rare: lupus erythematosus (chronic condition affecting the body’s connective tissue). Contact your doctor if you experience any side effect not listed above.

Drug Interactions

•    Tenormin may interact with surgical anesthetics to increase the risk of heart problems during surgery. Some anesthesiologists recommend gradually stopping the drug by 2          days before surgery.
•    Tenormin may interfere with the normal signs of low blood sugar and with oral antidiabetic drugs.
•    Tenormin increases the blood-pressure-lowering effects of
other blood-pressure-reducing agents, including clonidine,
guanabenz, and reserpine; and calcium channel blockers,such as nifedipine.
•    Aspirin-containing drugs, indomethacin, and sulfinpyrazone may interfere with the blood-pressure-lowering effect of atenoloi.
•    Cocaine may reduce the effectiveness of all beta blockers.
•    Tenormin may worsen the problem of cold hands and feet associated with taking ergot alkaloids, used to treat migraine. Gangrene is a possibility in people taking both           anergot and Tenormin.
•    Tenormin will counteract thyroid hormone replacements.
•    Calcium channel blockers, diphenhydramine, flecainide, hydralazine, contraceptive drugs, propafenone, haloperidol, phenothiazine sedatives—molindone and others—quinolone         antibacterials, and quinidine may increase the amount of Tenormin in the bloodstream and lead to increased Tenormin effects.
•    Tenormin should not be taken within 2 weeks of taking a monoamine oxidase inhibitor (MAGI) antidepressant.
•    Cimetidine increases the amount of Tenormin absorbed into the bloodstream from oral tablets.
•    Tenormin may interfere with the effectiveness of some anti-asthma drugs, including theophylline and aminophylline, and especially ephedrine and isoproterenol.
•    Combining Tenormin with phenytoin or digitalis drugs may result in excessive slowing of the heart, possibly causing heart block (disruption of the electrical impulses that       control heart rate).
•    If you stop smoking while taking Tenormin, your dose may have to be reduced because your liver will break down the drug more slowly.
•    Aluminum salts, barbiturates, calcium salts, cholestyramine, colestipol, ampicillin, and rifampin may reduce the effectiveness of Tenormin.
•    Beta blockers may increase the effects of gabapentin, lidocaine, or prazosin, leading to undesirable reactions or toxicity.
•    Beta blockers may block the effects of epinephrine.
•    Fluoxetine, paroxetine, bupropion, propafenone, quinidine, duloxetine, and terbinafine can substantially increase the amount of nebivolol in the blood by interfering with        its breakdown by liver enzymes. Amiodarone, cimetidine, and sertraline also have this interaction but the effect is smaller. Avoid these combinations.
•    Other drugs that can increase nebivolol levels but to a much smaller extent are antihistamines, celecoxib, chlorpheniramine, chlorpromazine, citalopram, clemastine,           clomipramine, diphenhydramine, doxepin, doxorubicin, escitalopram, halotantrine, histamine, hydroxyzine, levomepromazine, methadone, metoclopramide, mibefradil, midodrine,       moclobemide, perphenazine, ranitidine, haloperidol, ritonavir, ticlopidine, and tripelennamine.
•    Dexamethasone, rifampin, and sildenafil reduce blood levels of nebivolol but the combined effect on blood pressure is moderate.

Food Interactions

These drugs may be taken without regard to food or meals.

Usual Dose:

Tenormin

Adult: 50 mg a day. Some people may require doses of 100-200 mg a day. Dosages over 100 mg a day are not likely to produce additional benefit to those being treated for hypertension. People with kidney disease may need only 50 mg every other day. Older adults should be treated more cautiously and may need a lower dose.
Child: not recommended.

Overdosage

Symptoms of overdose include changes in heartbeat—unusually slow, unusually fast, or irregular—severe dizziness or fainting, breathing difficulties, bluish-colored fingernails or palms, and seizures. Heart failure and shock may also result from a beta blocker overdose. The victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.

Special Information

These drugs are meant to be taken continuously.
When ending treatment, dosage should be reduced gradually over a period of about 2 weeks. Do not stop taking these drugs unless directed to do so by your doctor. Abrupt withdrawal may cause chest pain, breathing difficulties, increased sweating, and unusually fast or irregular heartbeat.
Call your doctor at once if you develop back or joint pain, breathing difficulties, cold hands or feet, depression, rash, or changes in heartbeat. Tenormin may produce an undesirable lowering of blood pressure, leading to dizziness or fainting; call your doctor if this happens. Call your doctor if you experience persistent or bothersome anxiety, diarrhea, constipation, impotence, headache, itching, nausea or vomiting, nightmares or vivid dreams, upset stomach, insomnia, stuffy nose, frequent urination, unusual tiredness, or weakness.
Tenormin may cause drowsiness, lightheadedness, dizziness, or blurred vision. Be careful when driving or performing complex tasks.
It is best to take beta blockers at the same time each day. If you forget a dose, take it as soon as you remember. If you take nebivolol and do not remember until your next dose, continue with your regular schedule. If you take Tenormin once a day and it is within 8 hours of your next dose, skip the dose you forgot and continue with your regular schedule. If you take Tenormin twice a day and it is within 4 hours of your next dose, skip the one you forgot and continue with your regular schedule. Never take a double dose of Tenormin or nebivolol.

Special Populations

Pregnancy/breast-feeding: Infants born to women who took a beta blocker while pregnant had lower birth weights, low blood pressure, and reduced heart rates. These drugs should be avoided by pregnant women and women who might become pregnant while taking them.
Tenormin and nebivolol pass into breast milk. Nursing mothers should use infant formula.
Seniors: Seniors taking Tenormin should use the lowest effective dose as this group is more likely to have decreased heart, kidney, and liver function, and to be taking additional medications. Dosage adjustment of nebivolol is not necessary in seniors.

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