Decreased effect with Al and Ca salts, barbiturates, Cholestyramine, NSAIDs ampicillin, rifampicin,

May mask tachycardia from hypoglycemia induced by insulin or oral hypoglycemics

Effect of other antihypetensives may be intensified

May increase the efects of drugs which slow AV conduction, alpha blockers and Alphaadrenergic stimulanta

Enhances action of anesth agents, clonidine, ca antagonists, digitalis, Hypoglycemic agents and NSAIDs

Indication-

Angina Hypertension

Dosage-

initially 1 tabs daily, increase after 14 days to 2 tabs daily if required

Giddiness, headache, fatigue, bradycardia, Nausea, vomiting, diarrhoea, or constipation , stomach discomfort Mild ocular stinging,photophobia, keratitis,

Decreased sexual ability GI disturbances, dyspnoea,

Cold extremities, Insomina, hallucination, drowsiness, and mood alterations AV block, bradycardia,

Rare but occur in patients with pre-esxisting cardiac diseases Include severe bronchospasm, Hypoglycemia, Hypotension, bradyarrhythmias

Rebound phenomenon leading to unstable angina, or MI on sudden withdrawal

Low cardiac output and uncompensated cardiac failure , Sinus bradycardia 1st degree heart block , Cardiogenic shock Bronchospasm Severe haemorrhage Pregnancy

Special precautions-

Bronchospastic disease, hyperthyroidism peripheral vascular disease, undergoing anesthesia

Monitor blood glucose regularly

May mask symptoms of hypoglycemia

Elderly,Gradual withdrawal recommended

Lactation

Angina Hypertension

Refer Atenolol Beta-Adrenergic blockers + Thiazide Diuretics 

1. Allergies- Tell your doctor if you had any unusual or allergic reactions to bet-blockers, sulfonamides, bumetamide.urosemide, acetozolamide or any of the thiazide diuretics. Tell your doctor if you are allergic to any other substances such as foods, or drink

2. Pregnancy- use of beta=blockers duringh pregnancy has been associated with low blood sugar, breathing problems, a slower heart rate, low blod pressure in the new born infant.

3. Breast-feeding- atenol, metoprolol, nadolol, propranolo, timol, and thiazide diuretics pass into breast milk. Thiazide diuretics may decrese the flow of breast milk.

4. Children- Extra caution may be necessary in ifants with jaundice, because these medicines can make the condition worse.

5. Elderly- Side effects especially dizziness or lightheadedness and signs and symptoms of too much potassium loss may occur in elderly.

6. Other medicines- Tell your doctor if you are taking any of the following medicines- Allergy shots or Allergy skin tests - betablockers may increae the risk of serious allergic reactions Aminophylline- or Caffeine or Dyphylline or Oxytriphylline or Theophylline or effect of these medicines and betablocker may be blocked. Antidiabetes, oral- or Insulin- or Clonidine or Guanabenz - effects on blood pressure may be increased. Uwanted efects on the heart may occur when beta-blockers and thizidecdiuretics combinations are used Cocaine - may block the effect of betablockers Digitalis glycosides- use with betablockers and thiazide diuretic combination may cause high blood levels of digoxin and increase side effects Lithium- thizide diuretic in the combination may cause high bloodlevels of lithium, whichmay increse side effecs MAOI- taking betablockers with thiazide diuretic combination while you are taking MAOI may cause severe high blood pressure

7. Other medical problems- Tell your doctor if you have other medical problems- Allergy or Bronchitis or Emphysema - betablockers contained in this combination may increase trouble in breathing Bradycardia or Heart or blood presure disease or - this combination may make the heart problems worse. If treatment is stopped suddenly, unwanted effects may occur Diabete mellitus- betablocker contained in the medicine may cause hyperglycemia Gout or Lupus erythematous or Pancreatitis - thiazide diuretic contained in this medicine may make the condition worse Kidney disease or Liver disease- effects of this medicine may be increased because of slow removal from the body Mental depression or Myasthenia gravis or Pheochromocytoma or Psoriaris or Raymonds syndrome - betablockers contained in this medicine may make the condition worse Overactive thyroid- stopping this medicine may increase symptoms of overactive thyroid

8. Missed dose- If you miss of this medicine take it as soon as possible. However, it it is within 4 hours of your next dose ( 8 hrs if you are using atenolol + chlothiodone, bidoprolol + hydrochlorthiazide , natolol + bendroflumethiazide or extended release propranol + hydrochlorthiazide, ) skip the next dose and go back to your dosing schedule Do not double doses.

Swallow whole. Do not crush/suck

Contraindicated for use during pregnancy and lactation Observe extreme caution if required to be used