Indamide may add to or potentiate the action of other antihypertensive drugs The antihypertensive effect of the drug may be enhanced in the post sympatomized patient

Indapamide may decrease arterial responsiveness to norephinephrine but this diminution is not sufficient to preclude effectiveness of the pressor agent for the therapeutic use.

Indapamide should not be given concomittantly with lithium because it reduces its renal clearance leading to high risk of lithium toxicity.

Atenlolol- Catecholamine-depleting drugs eg resperpine and calcium channel blockers may be an additive effect when given with atenolol

Hypertension

Headache, back pain, asthenia, flu syndrome

Abdominal pain, constipation, diarrhea,

dyspepsia, nausea, vomiting,

Peripheral edema, dizziness, nervousness, hypertonia,

Rhinitis, cough, pharryngitis, sinusitis, conjunctivitis,

Fatigue, lethargy, malaise, muscle cramps,

numbness and tingling of extremities

Anxiety, lightheadedness, drowsiness,

vertigo, insomnia,depression

Blurred vision, constipation, gastric irritation,

anorexia, orthostatic hypotension, chest pain,

Nocturia, priuritus, vasculitis,

impotence or reduced libido,

Rhinorrhea, flushing, hyperuricemia,

hyperglycemia,hyponatremia, hypochloremia,

Increase in serum urea nitrogen, glysosuria,

weight loss, dry mouth

Bradycardia, postural hypotension, leg pain, vertigo,

whezing,dyspnea, bronchospasm

Hypesenrivity ,

anuria, sinus bradycardia,

severe hepatic insufficiency,

heart block greater than first degree, cardiogenic shock, and overt cardiac failure.

Special precautions-

Should be used with caution in impaired renal andhepatic function,pregnancy and lactation

Indapamide may decrease serum PBI levels without signs of thyroid disturbance and hence its treatment should be discontinued before tests for parathyroid are performed.

Serum concentrations of glucose,uric acid, serum electrolytes should be monitored routinely during treatment with indapamide.

Atenlol should be used with caution in diabetic patients ifa beta-blocking agent is required.

Abrupt withdrawal of atenolol may cause angina pectoris and precipitate myocardial infarction.

Indication-

Hypertension

Dosage

On tablet once daily

Pharmacology-

Indapamide-

Indapmideis annoral antihypertensive/diuretic. The possible beneficial pharmacological effects of indapmide in the treatment of hypertension include a reduction in cardiac hypertrophy and thickening of arterial walls, a prevention of the accumulation of the embryonic form of fibronectin in the coronary vessels, free radical scavenging leading to stimulation of vasodilator elcosanoid formatiuon, and interaction with renal carbonic anhydrase.

Atenolol-

Atenolol is beta 1 sewlective(cardioselective )adrenergic receptor -blocking agent without membrane stabilizing or intrinsic sympathomimmetic (partial agonist) activities. Atenolol works through an inhibitory process.

Rationale for combination-

The rational is two-fold.- It is expected that this approach will result in a reduction in the adverse effects associated with high dose monotherapy and an enhancement of the antihypertensive efficacy of the individual agents.

In addition, combination therapy may enhance patient compliance.

Caution to be excrecised while using during pregnancy and lactation