Both carboxolone may increase BP due to fluid retention but  there may be an additive effect of chlorthalidone.

Atenolol+

Pseudoephidrine/xylometazoline-

Reduced hypotensive effect with pseudoephidrine /xylometazoline

Amisulphide/alprostadil/flecanide-

Increasec risk of bardycardia with amisulphide, alprostadil, flecainide

Bactofen-

Increase risk of hypotension with baclofen

Sulphonylureas-

Reduced effect of sulphonylureas

Chlorthalidone-

May alter insulin requirements and impair diabetic control in diabetics using oral diabetic medicine

Lithium-

May reduce renal claearance of lithium toxicity.

Digitalis-

May enhance digitalis toxicity

Hypertension

Atenolol

Bradycardia, heart failure deterioration

Precipitation of heart block, internittant caldication

Reynaud syndrome

Confusion, dizziness, headache, mood changes, nightmares

Dry mouth, GI disturbances

Chlorthalidone- May cause hypersentivity rractions and rarely hyponatraemia

Diabetes and gout may be precipitated

Gastric irritation, vomiting, constipation

Cholestatic jaundice

Atenolol- Heart failure 2nd or 3rd degree AV block

Hypersensitivity

Sinus bradycardia, 2nd or 3rd degree heart block

Cardiogenic shock

Hyptension, severe peripheral arterial circulatory disturbances

Sick sinus syndrome

Untreated phaeochromocytoma, uncontrolled heart failure

Hypersenstivity to either products or sulphonamide derivative

Pregnancy

Special precautions

Caution  patients with history of heart failure, poor cardiac resrve 1st degree block or anaphylactic reactions to allergens

Renal or herpatic impairment

Elcetrolyte disturbances

History of bronchospasm. May mask tachycardia as a symptom of hypoglycemia

May mask symptoms of throtoxocosis

May increase frequency and duration of angina attacks in patients with Prinzmetal angina

Aviod abrupt withdrawal in patients with hyperthyroidism may precipitate thyroid storm.

Patients with pre-disposition to DM

Chlorthalidone- May precipitate acute gout in some patients

Lactation Avoid in patients ith reversible obstructive airways disease

Monitor serum K levels esp. in elderly patients receiving digitalis prepn. for cardiac failure, patients on low K diet or patients suffering from GI complaints

Patients with known pre-diposition to DM

Indication-

Hypertension

Dosage-

Atenolol/ chlorthalidone 50/ 12.5mg or 100/25mg

Take 1 tablet once daily

Contraindicated for use during pregnancy and lactation

Use with caution