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Atenolol/chlorthalidone Disease Interactions

There are 29 disease interactions with atenolol / chlorthalidone.

Major

Atenolol (applies to atenolol/chlorthalidone) hemodialysis

Major Potential Hazard, High plausibility.

Atenolol is moderately removed by conventional hemodialysis. Patients on hemodialysis should receive a dose of atenolol following each dialysis session when they are hemodynamically stable to avoid marked falls in blood pressure. The hemodynamic status should be closely monitored before and after the dose.

References

  1. Braun M, Schafer M, Kirch W "Single intravenous dose kinetics and accumulation of atenolol in patients with impaired renal function and on hemodialysis." Arch Toxicol Suppl 4 (1980): 366-9
  2. Aubert P, Flouvat B, Decourt S, et al. "Pharmacokinetics of atenolol in patients with terminal renal failure and influence of haemodialysis." Br J Clin Pharmacol 9 (1980): 379-85
  3. Campese VM, Feinstein EI, Gura V, Mason WD, Massry SG "Pharmacokinetics of atenolol in patients treated with chronic hemodialysis or peritoneal dialysis." J Clin Pharmacol 25 (1985): 393-5
  4. Seiler KU, Niedermayer W, Wassermann O "Pharmacokinetics of antihypertensive drugs (atenolol, metoprolol, propranolol and clonidine) and their metabolites during intermittent haemodialysis in humans." Proc Eur Dial Transplant Assoc 15 (1978): 607-9
  5. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
View all 5 references
Major

Atenolol (applies to atenolol/chlorthalidone) renal dysfunction

Major Potential Hazard, High plausibility.

Atenolol is eliminated by the kidney. Significant accumulation of the drug occurs in patients with a creatinine clearance below 35 mL/min/1.73 m2. Dosage adjustments are recommended for these patients.

References

  1. Pozet N, Sassard J, McAinsh J, et al. "Pharmacokinetics of atenolol in patients with renal impairment." Eur J Pharmacol 12 (1977): 175-80
  2. Koda RT, Maronde RF, Wan SH "Pharmacokinetics, pharmacology of atenolol and effect of renal disease." Br J Clin Pharmacol 7 (1979): 569-74
  3. Braun M, Schafer M, Kirch W "Single intravenous dose kinetics and accumulation of atenolol in patients with impaired renal function and on hemodialysis." Arch Toxicol Suppl 4 (1980): 366-9
  4. Aubert P, Flouvat B, Decourt S, et al. "Pharmacokinetics of atenolol in patients with terminal renal failure and influence of haemodialysis." Br J Clin Pharmacol 9 (1980): 379-85
  5. Holmes BF, Hood D, Warren D, Smith S, McAinsh J "Atenolol kinetics in renal failure." Clin Pharmacol Ther 28 (1980): 302-9
  6. Schafer M, Kirch W, Kohler H, Mutschler E "Pharmacokinetics of atenolol in relation to renal function." Eur J Clin Pharmacol 19 (1981): 65-71
  7. Giang DW, Isaeff DM "Atenolol overdosage in a patient with progressive renal failure." West J Med 145 (1986): 101-3
  8. Ebihara A, Fujimura A, Kotegawa T "Clinical pharmacology of dilevalol (IV): influence of hepatic and renal functions on the disposition of dilevalol and atenolol in hypertensive subjects." J Clin Pharmacol 30 (1990): 404-8
  9. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
View all 9 references
Major

Beta-blockers (applies to atenolol/chlorthalidone) bradyarrhythmia/AV block

Major Potential Hazard, High plausibility. Applicable conditions: Heart Block, Sinus Node Dysfunction

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to exacerbate these conditions.

References

  1. Williams DO, Crean PA "Effect of intravenous and oral acebutolol in patients with bundle branch block." Int J Cardiol 10 (1986): 119-26
  2. Coventry D, Mashford ML, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  3. Treseder AS, Thomas TP "Sinus arrest due to timolol eye drops." Br J Clin Pract 40 (1986): 256-8
  4. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  6. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  7. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  8. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  9. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  10. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  11. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  12. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  13. "Product Information. Kerlone (betaxolol)." Searle (2001):
  14. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  15. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  16. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  17. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  18. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  19. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  20. Frishman WH "Carvedilol." N Engl J Med 339 (1998): 1759-65
  21. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):
  22. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 22 references
Major

Beta-blockers (applies to atenolol/chlorthalidone) cardiogenic shock/hypotension

Major Potential Hazard, High plausibility.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with hypotension or cardiogenic shock. Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to further depress cardiac output and blood pressure, which can be detrimental in these patients.

References

  1. Isles C, Kholeif M "Profound hypotension after atenolol in severe hypertension." Br Med J 298 (1989): 161-2
  2. Jones MK, Tirlapur VG, Evans PJ "Shock syndrome after acebutolol." Br J Clin Pract 40 (1986): 33-4
  3. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  5. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  6. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  7. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  8. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  9. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  10. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  11. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  12. "Product Information. Kerlone (betaxolol)." Searle (2001):
  13. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  14. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  15. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  16. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  17. "Product Information. OptiPranolol (metipranolol)." Bausch and Lomb, Tampa, FL.
  18. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  19. "Product Information. Betagan Liquifilm (levobunolol)." Allergan Inc, Irvine, CA.
  20. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  21. "Product Information. Acupress (carteolol ophthalmic)." Otsuka American Pharmaceuticals Inc, Rockville, MD.
  22. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc (2001):
  23. Frishman WH "Carvedilol." N Engl J Med 339 (1998): 1759-65
  24. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 24 references
Major

Beta-blockers (applies to atenolol/chlorthalidone) CHF

Major Potential Hazard, High plausibility. Applicable conditions: Congestive Heart Failure

Beta-adrenergic receptor blocking agents (aka beta-blockers) in general should not be used in patients with overt congestive heart failure (CHF). Sympathetic stimulation may be important in maintaining the hemodynamic function in these patients, thus beta-blockade can worsen the heart failure. However, therapy with beta-blockers may be beneficial and can be administered cautiously in some CHF patients provided they are well compensated and receiving digitalis, diuretics, an ACE inhibitor, and/or nitrates. Carvedilol, specifically, is indicated for use with these agents in the treatment of mild to severe heart failure of ischemic or cardiomyopathic origin. There is also increasing evidence that the addition of a beta-blocker to standard therapy can improve morbidity and mortality in patients with advanced heart failure, although it is uncertain whether effectiveness varies significantly with the different agents. Data from one meta-analysis study suggest a greater reduction of mortality risk for nonselective beta-blockers than for beta-1 selective agents.

References

  1. Michelson EL, Frishman WH, Lewis JE, et al. "Multicenter clinical evaluation of long-term efficacy and safety of labetalol in treatment of hypertension." Am J Med Oct 17 (1983): 68-80
  2. Myers J, Waga S, Morgan T, et al. "Long-term experiences with labetalol." Med J Aust 1 (1980): 665-6
  3. Tcherdakoff P "Side-effects with long-term labetalol: an open study of 251 patients in a single centre." Pharmatherapeutica 3 (1983): 342-8
  4. Altus P "Timolol-induced congestive heart failure." South Med J 74 (1981): 88
  5. Coventry D, Mashford ML, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  6. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  7. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  8. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  9. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  10. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  11. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  12. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  13. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  14. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  15. "Product Information. Kerlone (betaxolol)." Searle (2001):
  16. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  17. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  18. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  19. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  20. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  21. Chanton E, Fontaine ML, Lechat P, Dussous V, Gagey S, Guillardeau A, Jaillon P, Mesenge C "A randomized trial of beta-blockade in heart failure - the cardiac insufficiency bisoprolol study (CIBIS)." Circulation 90 (1994): 1765-73
  22. Maisel AS "Beneficial effects of metoprolol treatment in congestive heart failure - reversal of sympathetic-induced alterations of immunologic function." Circulation 90 (1994): 1774-80
  23. Melcher A, Erhardt L, Persson H, Rythenalder E "Effects of beta receptor antagonists in patients with clinical evidence of heart failure after myocardial infarction: double blind comparison of metoprolol and xamoterol." Br Heart J 74 (1995): 140-8
  24. Kelly DT "Carvedilol in heart failure." Cardiology 82 Suppl 3 (1993): 45-9
  25. Bristow MR, Renlund DG, Gilbert EM, Olsen SL, Taylor DO, Yanowitz FD "Carvedilol improves left ventricular function and symptoms in chronic heart failure: a double-blind randomized study." J Am Coll Cardiol 25 (1995): 1225-31
  26. Krum H, Sackner-Bernstein JD, Goldsmith RL, et al. "Double-blind, placebo-controlled study of the long-term efficacy of carvedilol in patients with severe chronic heart failure." Circulation 92 (1995): 1499-506
  27. Australia-New Zealand Heart Failure Research Collaborative Group. "Effects of carvedilol, a vasodilator-B-blocker, in patients with congestive heart failure due to ischemic heart disease." Circulation 92 (1995): 212-8
  28. Gass A, Kalman J, Lansman S, Buchholz C, Courtney M, Kukin ML, Steinmetz M "Safety and efficacy of beta blockade in patients with chronic congestive heart failure awaiting transplantation." J Heart Lung Transplant 14 (1995): 1212-7
  29. Adams KF Jr "Current perspectives on B-receptor antagonists in the treatment of symptomatic ventricular dysfunction." Pharmacotherapy 16(2 Pt 2) (1996): 69-77
  30. Bristow MR, Fowler MB, Shusterman NH, Cohn JN, Colucci WS, Gilbert EM, Packer M "The effect of carvedilol on morbidity and mortality in patients with chronic heart failure." N Engl J Med 334 (1996): 1349-55
  31. Erhardt L, Persson SV "Effects of beta receptor antagonists on left ventricular function in patients with clinical evidence of heart failure after myocardial infarction. A double-blind comparison of metoprolol and xamoterol: echocardiographic results from the Metoprolol and..." Eur Heart J 17 (1996): 741-9
  32. Cleland JGF, Swedberg K "Carvedilol for heart failure, with care." Lancet 347 (1996): 1199-201
  33. Abernethy D, Moye LA "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1318
  34. Pop T, Berger J, Von Olshausen K "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1318-20
  35. Cohn JN, Colucci WS, Packer M "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1310-20
  36. Bristow MR, Bowers JA, Fowler MB, Krueger SK, Sackne, Cohn JN, Colucci WS, Gilbert EM, Hershberger R, Packer M, Uretsky BF "Carvedilol inhibits clinical progression in patients with mild symptoms of heart failure." Circulation 94 (1996): 2800-6
  37. Lane G, Garrett J, Tonkin A, Krum H, Macmahon S, Owensby D, Burton R, Doughty R, Ryan J, Shepherd J, Sing, Trotter A, Sharpe N "Randomised, placebo-controlled trial of carvedilol in patients with congestive heart failure due to ischaemic heart disease." Lancet 349 (1997): 375-80
  38. Abraham WT, Bristow MR, Gilbert EM, et al. "Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. MOCHA Investigators." Circulation 94 (1996): 2807-16
  39. Gottlieb SS, Klapholz M, Liang CS, Sackner-Bernstein JD, Colucci WS, Freeman I, Goldscher DA, Kukin ML, Packer M, Pearle D, Kinhal V, Udelson JE "Double-blind, placebo-controlled study of the effects of carvedilol in patients with moderate to severe heart failure. The PRECISE Trial Prospective Randomized Evaluation of Carvedilol on Symptoms an Exercise." Circulation 94 (1996): 2793-9
  40. Doughty RN, Whalley GA, MacMahon S, Gamble G, Sharpe N "Left ventricular remodeling with carvedilol in patients with congestive heart failure due to ischemic heart disease. Australia-Ne Zealand Heart Failure Research Collaborative Group." J Am Coll Cardiol 29 (1997): 1060-6
  41. Boissel JP, Chalon S, Arab T, Cucherat M, Lechat P, Packer M "Clinical effects of beta-adrenergic blockade in chronic heart failure: A meta-analysis of double-blind, placebo-controlled, randomized trials." Circulation 98 (1998): 1184-91
  42. Frishman WH "Carvedilol." N Engl J Med 339 (1998): 1759-65
  43. CIBIS-II Investigators and Committees. "The cardiac insufficiency bisoprolol study II (CIBIS-II): a randomised trial." Lancet 353 (1999): 9-13
  44. Aboyoun CL, Amor R, Keogh AM, Macdonald PS, McCaffrey DJ, Lund M "Tolerability and efficacy of carvedilol in patients with New York Heart Association class IV heart failure." J Am Coll Cardiol 33 (1999): 924-31
  45. Goldstein S, Hjalmarson A, Fagerberg B, et al. "Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF)." JAMA 283 (2000): 1295-302
  46. Coxson P, Phillips KA, Shlipak MG, et al. "Health and economic benefits of increased B-blocker use following myocardial infarction." JAMA 284 (2000): 2748-54
  47. Hart SM "Influence of B-blockers on mortality in chronic heart failure." Ann Pharmacother 34 (2000): 1440-51
  48. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 48 references
Major

Beta-blockers (applies to atenolol/chlorthalidone) diabetes

Major Potential Hazard, High plausibility. Applicable conditions: Diabetes Mellitus

Beta-adrenergic receptor blocking agents (aka beta-blockers) may mask symptoms of hypoglycemia such as tremors, tachycardia and blood pressure changes. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may inhibit catecholamine-mediated glycogenolysis, thereby potentiating insulin-induced hypoglycemia and delaying the recovery of normal blood glucose levels. Since cardioselectivity is not absolute, larger doses of beta-1 selective agents may demonstrate these effects as well. Therapy with beta-blockers should be administered cautiously in patients with diabetes or predisposed to spontaneous hypoglycemia.

References

  1. Darga LL, Franklin BA, Hakim MJ, Lucas CP "Comparison of the effects of guanadrel sulfate and propranolol on blood pressure, functional capacity, serum lipoproteins and glucose in systemic hypertension." Am J Cardiol 67 (1991): 590-6
  2. Aro A, Pietikainen M, Uusitupa M "Severe hypoglycaemia caused by physical strain and pindolol therapy." Ann Clin Res 12 (1980): 25-7
  3. Velde TM, Kaiser FE "Ophthalmic timolol treatment causing altered hypoglycemic response in a diabetic patient." Arch Intern Med 143 (1983): 1627
  4. Delas B, Bennett P, Grimaldi A, et al. "Beta-blockers and hypoglycaemia: assessment of cardioselective and intrinsic sympathomimetic properties in relation to severity of hypoglycaemia." Curr Ther Res Clin Exp 36 (1984): 361-73
  5. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  6. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  7. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  8. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  9. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  10. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  11. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  12. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  13. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  14. "Product Information. Kerlone (betaxolol)." Searle (2001):
  15. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  16. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  17. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  18. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  19. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  20. Acampora R, DeAngelis L, Ragone R, Ziccardi P, DeRosa N, DOnofrio F, Giugliano D, Marfella R "Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension - A randomized, controlled trial." Ann Intern Med 126 (1997): 955-9
  21. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 21 references
Major

Beta-blockers (applies to atenolol/chlorthalidone) hypersensitivity

Major Potential Hazard, High plausibility. Applicable conditions: Allergies

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) in patients with a history of allergic reactions or anaphylaxis may be associated with heightened reactivity to culprit allergens. The frequency and/or severity of attacks may be increased during beta-blocker therapy. In addition, these patients may be refractory to the usual doses of epinephrine used to treat acute hypersensitivity reactions and may require a beta-agonist such as isoproterenol.

References

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  5. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  6. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  8. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  9. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  10. "Product Information. Kerlone (betaxolol)." Searle (2001):
  11. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  12. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  13. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  14. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  15. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  16. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  17. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 17 references
Major

Beta-blockers (applies to atenolol/chlorthalidone) ischemic heart disease

Major Potential Hazard, High plausibility.

Heightened sensitivity to catecholamines may occur after prolonged use of beta-adrenergic receptor blocking agents (aka beta-blockers). Exacerbation of angina, myocardial infarction and ventricular arrhythmias have been reported in patients with coronary artery disease following abrupt withdrawal of therapy. Cessation of beta-blocker therapy, whenever necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks in patients with coronary insufficiency. Patients should be advised not to discontinue treatment without first consulting with the physician. In patients who experience an exacerbation of angina following discontinuation of beta-blocker therapy, the medication should generally be reinstituted, at least temporarily, along with other clinically appropriate measures.

References

  1. Amsterdam EA, Mason DT, Olson HG, Miller RR "Propranolol-withdrawal rebound phenomenon: exacerbation of coronary events after abrupt cessation of antianginal therapy." N Engl J Med 293 (1975): 416-8
  2. Langlois S, Rangno RE "Comparison of withdrawal phenomena after propranolol, metoprolol, and pindolol." Am Heart J 104 (1982): 473-8
  3. Lang E, Schiess W, Szecsi E, Kohlschutter S "Abrupt withdrawal of pindolol or metoprolol after chronic therapy." Br J Clin Pharmacol 13 (1982): s353-7
  4. Yu Y, Hernandez J, Walden RJ, et al. "Withdrawal of beta-blocking drugs." Am Heart J 104 (1982): 515-20
  5. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  6. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  7. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  8. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  9. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  10. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  11. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  12. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  13. "Product Information. Kerlone (betaxolol)." Searle (2001):
  14. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  15. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  16. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  17. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  18. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  19. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  20. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 20 references
Major

Beta-blockers (applies to atenolol/chlorthalidone) PVD

Major Potential Hazard, High plausibility. Applicable conditions: Peripheral Arterial Disease

Due to their negative inotropic and chronotropic effects on the heart, beta-adrenergic receptor blocking agents (aka beta-blockers) reduce cardiac output and may precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may attenuate catecholamine-mediated vasodilation during exercise by blocking beta-2 receptors in peripheral vessels. Therapy with beta-blockers should be administered cautiously in patients with peripheral vascular disease. Close monitoring for progression of arterial obstruction is advised.

References

  1. Michelson EL, Frishman WH, Lewis JE, et al. "Multicenter clinical evaluation of long-term efficacy and safety of labetalol in treatment of hypertension." Am J Med Oct 17 (1983): 68-80
  2. Danielson M, Eliasson K, Hylander B, Lindblad LE "Raynaud's phenomenon caused by beta-receptor blocking drugs." Acta Med Scand 215 (1984): 333-9
  3. Myers J, Waga S, Morgan T, et al. "Long-term experiences with labetalol." Med J Aust 1 (1980): 665-6
  4. Tcherdakoff P "Side-effects with long-term labetalol: an open study of 251 patients in a single centre." Pharmatherapeutica 3 (1983): 342-8
  5. Eliasson K, Sundqvist K, Lins L-E "Peripheral vasospasm during beta-receptor blockade: a comparison between metoprolol and pindolol." Acta Med Scand 665 (1982): 109-12
  6. Lepantalo M "Beta blockade and intermittent claudication." Acta Med Scand 700 (1985): 1-48
  7. Coventry D, Mashford ML, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  8. Coppeto JR "Transient ischemic attacks and amaurosis fugax from timolol." Ann Ophthalmol 17 (1985): 64-5
  9. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  10. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  11. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  12. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  13. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  14. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  15. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  16. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  17. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  18. "Product Information. Kerlone (betaxolol)." Searle (2001):
  19. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  20. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  21. Jesek JK, Thomas EL, Wambsgans KC, Wilmore JH, Broeder CE, Hofman Z, Martin NB, Scruggs KD "Effects of propranolol and pindolol on cardiac output during extended periods of low-intensity physical activity." Am J Cardiol 72 (1993): 1188-95
  22. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  23. Holti G "A double-blind study of the peripheral vasoconstrictor effects of the beta-blocking drug penbutolol in patients with Raynaud's phenomenon." Curr Med Res Opin 6 (1979): 267-70
  24. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  25. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  26. Breckenridge A, Roberts DH "Antihypertensive treatment in concomitant peripheral vascular disease: current experience and the potential of carvedilol." J Cardiovasc Pharmacol 18 Suppl 4 (1991): s78-81
  27. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 27 references
Major

Thiazides (applies to atenolol/chlorthalidone) anuria

Major Potential Hazard, High plausibility.

The use of thiazide diuretics is contraindicated in patients with anuria.

References

  1. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  2. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  3. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  4. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  5. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  6. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  7. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  8. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  9. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
View all 9 references
Major

Thiazides (applies to atenolol/chlorthalidone) electrolyte losses

Major Potential Hazard, High plausibility. Applicable conditions: Hypokalemia, Diarrhea, Electrolyte Abnormalities, Hyperaldosteronism, Hyponatremia, Magnesium Imbalance, Malnourished, Vomiting, Ventricular Arrhythmia, Dehydration

The use of thiazide diuretics is commonly associated with loss of electrolytes, most significantly potassium but also sodium, chloride, bicarbonate, and magnesium. The loss of other electrolytes such as phosphate, bromide and iodide is usually slight. Potassium and magnesium depletion may lead to cardiac arrhythmias and cardiac arrest. Other electrolyte-related complications include metabolic alkalosis and hyponatremia, which are rarely life-threatening. Therapy with thiazide diuretics should be administered cautiously in patients with or predisposed to fluid and electrolyte depletion, including patients with primary or secondary aldosteronism (may have low potassium levels); those with severe or prolonged diarrhea or vomiting; and those with poor nutritional status. Fluid and electrolyte abnormalities should be corrected prior to initiating therapy, and blood pressure as well as serum electrolyte concentrations monitored periodically and maintained at normal ranges during therapy. Patients should be advised to immediately report signs and symptoms of fluid or electrolyte imbalance, including dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, arrhythmia, or gastrointestinal disturbances such as nausea and vomiting. Digitalized patients and patients with a history of ventricular arrhythmias should be monitored carefully, since development of hypokalemia may be particularly dangerous in these patients. The risk of hypokalemia may be minimized by slow diuresis, a lower thiazide dosage, potassium supplementation, or combined use with a potassium-sparing diuretic.

References

  1. Tarssanen L, Lindy S "Serum calcium and phosphorus in patients treated with thiazides and furosemide." Acta Med Scand 194 (1973): 319-22
  2. Leigh H "Letter: Factitious hypokalemia." Ann Intern Med 80 (1974): 111-2
  3. Moore TD, Bechtel TP "Hyponatremia secondary to tolbutamide and chlorothiazide." Am J Hosp Pharm 36 (1979): 1107-10
  4. Schreiner AM, Falch DK "Changes in urinary electrolytes versus serum electrolytes during treatment of primary hypertension with chlorthalidone alone and in combination with spironolactone." Acta Med Scand 209 (1981): 111-4
  5. Khatri IM, Fletcher R, Freis ED, Papademetriou V "Diuretic-induced hypokalemia in uncomplicated systemic hypertension: effect of plasma potassium correction on cardiac arrhythmias." Am J Cardiol 52 (1983): 1017-22
  6. Borhani N, Caggiula A, Dunkle S, Farrier N, Kuller L "Relationship of diuretic therapy and serum magnesium levels among participants in the Multiple Risk Factor Intervention Trial." Am J Epidemiol 122 (1985): 1045-59
  7. Remenchik AP, Johnston LC "Potassium depletion produced by administration of chlorthalidone to nonedematous patients with arterial hypertensin." Am J Med Sci 252 (1966): 171-6
  8. Gebott MD, Katz FH, Eckert RC "Hypokalemia caused by surreptitious self-administration of diuretics." Ann Intern Med 76 (1972): 85-90
  9. Fichman MP, Telfer N, Kleeman CR, Vorherr H "Diuretic-induced hyponatremia." Ann Intern Med 75 (1971): 853-63
  10. Espiner EA, Stewart DE, Ikram H, Nicholls MG "Arrhythmogenic potential of diuretic induced hypokalaemia in patients with mild hypertension and ischaemic heart disease." Br Heart J 54 (1985): 290-7
  11. Kuller LH, Cohen JD, Neaton J, Hulley SB "Unexpected effects of treating hypertension in men with electrocardiographic abnormalities: a critical analysis." Circulation 73 (1986): 114-23
  12. Landmann-Suter R, Struyvenberg A "Initial potassium loss and hypokalaemia during chlorthalidone administration in patients with essential hypertension: the influence of dietary sodium restriction." Eur J Clin Invest 8 (1978): 155-64
  13. Navarro RP, Nuffort P, O'Brien DK, Spencer DL "Diuretic induced hypokalemia in the elderly." J Fam Pract 14 (1982): 685-9
  14. Douglas JE, Oh SJ, Brown RA "Hypokalemic vacuolar myopathy associated with chlorthalidone treatment." JAMA 216 (1971): 1858-9
  15. Pines A, Werner D, Lieberman P, Frankl O, Mozes B, Olchovsky D "Thiazide-induced hyponatremia: an unusual neurologic course." South Med J 79 (1986): 629-31
  16. Jensen OB, Reske-Nielsen E, Mosdal C "Hypokalemic myopathy during treatment with diuretics." Acta Neurol Scand 55 (1977): 465-82
  17. 3d, Huntington RW, Cembrowski GS "Probable fatal cardiac dysrhythmia secondary to diuretic-induced hypokalemia." Am J Forensic Med Pathol 2 (1981): 243-8
  18. Frisof KB, Podany EC, Sumiye L, Vivian AS "Potassium loss associated with hydrochlorothiazide versus chlorthalidone." Clin Ther 4 (1981): 308-20
  19. Gisholt K, Berg KJ, Wideroe TE "Potassium deficiency in hypertensives treated with diuretics. Analysis of three alternative treatments by an oral test for potassium deficiency." Eur J Clin Pharmacol 7 (1974): 401-5
  20. Bleicher SJ, Chowdhury FR "Chlorthalidone--induced hypokalemia and abnormal carbohydrate metabolism." Horm Metab Res 2 (1970): 13-6
  21. Carney SL, Morgan TO "Diuretic-induced hypokalemia and altered renal function." Int J Clin Pharmacol Ther Toxicol 24 (1986): 665-7
  22. Hardarson T, Ragnarsson J, Snorrason SP "Ventricular dysrhythmias in middle-aged hypertensive men treated either with a diuretic agent or a beta-blocker." Acta Med Scand 221 (1987): 143-8
  23. Hollifield JW, Slaton PE "Thiazide diuretics, hypokalemia and cardiac arrhythmias." Acta Med Scand Suppl 647 (1981): 67-73
  24. Price M, Notargiacomo A, Fletcher RD, Freis ED, Gottdiener J, Papademetriou V "Effect of diuretic therapy on ventricular arrhythmias in hypertensive patients with or without left ventricular hypertrophy." Am Heart J 110 (1985): 595-9
  25. Khatri IM, Fletcher R, Freis ED, Papademetriou V "Diuretic-induced hypokalemia in uncomplicated systemic hypertension: effect of plasma potassium correction on cardiac arrhythmias." Am J Cardiol 52 (1983): 1017-22
  26. Narins RG, Krishna GG "Hemodynamic consequences of diuretic-induced hypokalemia." Am J Kidney Dis 12 (1988): 329-31
  27. Baron DN, Polanska AI "Hyponatraemia associated with hydrochlorothiazide treatment ." Br Med J 1 (1978): 175-6
  28. Pinnock CA "Hyponatraemia associated with hydrochlorothiazide treatment ." Br Med J 1 (1978): 48
  29. Tannenberg AM, Haskell LP, Itescu S "Thiazide-induced clinically significant hypophosphatemia ." Clin Nephrol 27 (1987): 161-2
  30. Millard PH, Byatt CM, Levin GE "Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions." J R Soc Med 83 (1990): 704-8
  31. Egner W, Bain PG, Walker PR "Thiazide-induced dilutional hyponatraemia masquerading as subarachnoid haemorrhage ." Lancet 2 (1986): 634
  32. Haffner C, Harris P, Stableforth DE, Benfield GF "Dilutional hyponatraemia masquerading as subarachnoid haemorrhage in patient on hydrochlorothiazide/amiloride/timolol combined drug ." Lancet 2 (1986): 341
  33. Gould L, Reddy CV, Singh BK, Zen B "Life-threatening reaction to thiazides." N Y State J Med 80 (1980): 1975-6
  34. Seelig CB "Magnesium deficiency in two hypertensive patient groups." South Med J 83 (1990): 739-42
  35. Hamilton J, Peters RW, Hamilton BP "Incidence of cardiac arrhythmias associated with mild hypokalemia induced by low-dose diuretic therapy for hypertension." South Med J 82 (1989): 966-9,
  36. Gimenez L, Kone B, Watson AJ "Thiazide-induced hyponatremia." South Med J 79 (1986): 1456-7
  37. Anderson RJ, Holland OB, Blomqvist G, Kuhnert L, Padia M, Pollard J "Ventricular ectopic activity with diuretic therapy." Am J Hypertens 1 (1988): 380-5
  38. Mayan H, Friedman E, Mouallem M, Farfel Z, Shemesh Y, Pauzner R "Cardiac conduction defects associated with hyponatremia." Clin Cardiol 14 (1991): 165-8
  39. Kaur J, Wahi PL "Polythiazide as a diuretic. A clinical trial." J Indian Med Assoc 48 (1967): 13-7
  40. Mroczek WJ "Indapamide: clinical pharmacology, therapeutic efficacy in hypertension, and adverse effects." Pharmacotherapy 3 (1983): 61-7
  41. Beling S, Zisblatt M, Neiss ES, Webb E, Losi M, Vukovich RA "Long-term experience with indapamide." Am Heart J 106 (1983): 258-62
  42. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
  43. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  44. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  45. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  46. Stern A "Metolazone, a diuretic agent." Am Heart J 91 (1976): 262-3
  47. Roman J, Shiner P, Black W "Severe electrolyte disturbances associated with metolazone and furosemide." South Med J 71 (1978): 381
  48. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  49. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  50. Ghose RR "Letter: Hyponatraemia and diuretics." Lancet 1 (1975): 578-9
  51. Aakvaag A, Brors O, Enger E, Foss OP, Jacobsen S "Effects of hydroflumethiazide in congestive heart failure: renal electrolyte excretion related to urinary thiazide excretion and aldosterone." Acta Pharmacol Toxicol (Copenh) 49 (1981): 399-406
  52. Aakvaag A, Brors O, Foss OP, Jacobsen S "Effect of repeated doses of hydroflumethiazide on renal excretion of electrolytes and uric acid in healthy subjects." Acta Pharmacol Toxicol (Copenh) 48 (1981): 145-50
  53. el-Meheiry MM, Soliman MD, Nabih AE "A clinical study of a new diuretic, Trichlormethiazide." J Trop Med Hyg 69 (1966): 209-14
  54. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  55. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  56. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  57. Marthedal NJ, Husby S "Hyponatraemia due to a thiazide diuretic. A case report." Acta Med Scand 210 (1981): 523-4
  58. Andersson O, Berglund G, Larsson O, Wilhelmsen L "Antihypertensive effect and side-effects of bendroflumethiazide and propranolol." Acta Med Scand 199 (1976): 499-506
  59. Gudbrandsson T, Hansson L "Combination therapy with saluretics and atenolol in essential hypertension. Effects on blood pressure, electrolytes and uric acid." Acta Med Scand Suppl 625 (1979): 86-91
  60. Berglund G, Wilhelmsen L, Elmfeldt D, Wedel H "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl 672 (1983): 79-83
  61. Condon JR, Nassim R "Hypophosphataemia and hypokalaemia." Br Med J 1 (1970): 110
  62. Dargie HJ, Kennedy AC, Winchester JF, Boddy K, Boyle P, Mahaffey ME, Kellett RJ, Ward DM "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther 28 (1980): 611-8
  63. Lee MR, Morgan DB "Familial hyperkalaemia responsive to benzothiadiazine diuretic." Lancet 1 (1980): 879
  64. Hesp R, Wilkinson PR "Potassium supplementation of thiazide therapy." Lancet 2 (1976): 1144
  65. Struthers AD, Whitesmith R, Reid JL "Prior thiazide diuretic treatment increases adrenaline-induced hypokalaemia." Lancet 1 (1983): 1358-61
  66. Bryant R, Ising H, Petri M, Cumber P, Grimes L, Treby D, Rawlins D "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing 15 (1986): 151-5
  67. Starr JM, Whalley LJ "Hypertensive Old People in Edinburgh (HOPE) Study: electrocardiographic changes after captopril or bendrofluazide treatment." Age Ageing 22 (1993): 343-8
  68. Ramsay LE, Toner JM "Thiazide-induced hypokalaemia; prevalence higher in women." Br J Clin Pharmacol 18 (1984): 449-52
  69. Brunner S, Jorgensen FS "The long-term effect of bendroflumethiazide on renal calcium and magnesium excretion and stone formation in patients with recurring renal stones." Scand J Urol Nephrol 8 (1974): 128-31
  70. Backman U, Johansson G, Wikstrom B, Danielson BG, Fellstrom B, Ljunghall S "Calcium and magnesium metabolism during long-term treatment with thiazides." Scand J Urol Nephrol 15 (1981): 257-62
  71. Medical Research Council Working Party on Mild to Moderate Hypertension. "Ventricular extrasystoles during thiazide treatment: substudy of MRC mild hypertension trial." Br Med J (Clin Res Ed) 287 (1983): 1249-53
  72. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  73. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
  74. Read SJ, Whiting GF, Trenerry HM "Hyponatraemia and raised creatine kinase level associated with indapamide." Med J Aust 161 (1994): 607-8
  75. Chan TY "Indapamide-induced severe hyponatremia and hypokalemia." Ann Pharmacother 29 (1995): 1124-8
  76. Rumboldt Z, Ljutic D, Sardelic S, Simunic M "Ramipril decreases chlorthalidone-induced loss of magnesium and potassium in hypertensive patients." J Clin Pharmacol 35 (1995): 1150-5
  77. Brater DC "Drug therapy: Diuretic therapy." N Engl J Med 339 (1998): 387-95
  78. Gates JR, Palmer BF, Lader M "Causes and management of hyponatremia." Ann Pharmacother 37 (2003): 1694-702
View all 78 references
Major

Thiazides (applies to atenolol/chlorthalidone) liver disease

Major Potential Hazard, High plausibility.

Patients with severe liver disease or cirrhosis are very susceptible to thiazide-induced hypokalemic hypochloremic alkalosis. Blood ammonia concentrations may be further increased in patients with previously elevated concentrations. Hepatic encephalopathy and death have occurred secondary to the electrolyte alterations accompanying diuretic use. Therapy with thiazide diuretics should be administered cautiously in patients with impaired hepatic function or progressive liver disease, and discontinued promptly if signs of impending hepatic coma appear (e.g., tremors, confusion, and increased jaundice).

References

  1. Aneckstein AG, Weingold AB "Chlorothiazide-induced hepatic coma in pregnancy." Am J Obstet Gynecol 95 (1966): 136-7
  2. Walker JG, Scott A, Senewiratne B, Sherlock S "Complications of diuretic therapy in hepatic cirrhosis." Lancet 1 (1966): 1049-52
  3. Walker JG, Scott A, Senewiratne B, Sherlock S "The complications of diuretic therapy in patients with cirrhosis." Ann N Y Acad Sci 139 (1966): 497-505
  4. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  5. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  6. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  7. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  8. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  9. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  10. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  11. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  12. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
View all 12 references
Major

Thiazides (applies to atenolol/chlorthalidone) lupus erythematosus

Major Potential Hazard, Low plausibility.

The use of thiazide diuretics has been reported to possibly exacerbate or activate systemic lupus erythematosus. Reported cases have generally been associated with chlorothiazide and hydrochlorothiazide. Therapy with thiazide diuretics should be administered cautiously in patients with a history or risk of SLE.

References

  1. Orton PW, Lee LA, Norris DA, Jones SK, Huff JC, Reed BR "Subacute cutaneous lupus erythematosus associated with hydrochlorothiazide therapy." Ann Intern Med 103 (1985): 49-51
  2. Romagnoli M, Parodi A, Rebora A "Subacute cutaneous lupus erythematosus-like eruption caused by hydrochlorothiazide." Photodermatol 6 (1989): 100-2
  3. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  4. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  5. Kohn SR, Goodrich AL "Hydrochlorothiazide-induced lupus erythematosus: a new variant?" J Am Acad Dermatol 28 (1993): 1001-2
  6. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  7. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  8. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  9. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  10. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  11. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  12. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  13. Eckman JM, Rich MW "Can hydrochlorothiazide cause lupus?" J Rheumatol 22 (1995): 1001
  14. Deng JS, Brown CW "Thiazide diuretics induce cutaneous lupus-like adverse reaction." J Toxicol Clin Toxicol 33 (1995): 729-33
View all 14 references
Major

Thiazides (applies to atenolol/chlorthalidone) renal function disorders

Major Potential Hazard, High plausibility. Applicable conditions: Renal Dysfunction

Thiazide diuretics may be ineffective when the glomerular filtration rate is low (GFR < 25 mL/min) because they are not expected to be filtered into the renal tubule, their site of action. In addition, thiazide diuretics decrease the GFR and may precipitate azotemia in renal disease. Cumulative effects may also develop because most of these drugs are excreted unchanged in the urine by glomerular filtration and active tubular secretion. Therapy with thiazide diuretics should be administered cautiously at reduced dosages in patients with renal impairment. If renal function becomes progressively worse, as indicated by rising BUN or serum creatinine levels, an interruption or discontinuation of thiazide therapy should be considered.

References

  1. Fleuren HLJ, Verwey-van Wissen C, van Rossum JM "Dose-dependent urinary excretion of chlorthalidone." Clin Pharmacol Ther 25 (1979): 806-12
  2. Beermann B, Groschinsky-Grind M, Rosen A "Absorption, metabolism, and excretion of hydrochlorothiazide." Clin Pharmacol Ther 19 (1975): 531-7
  3. Niemeyer C, Wais U, Hasenfub G, et al. "Pharmacokinetics of hydrochlorothiazide in relation to renal function." Eur J Clin Pharmacol 24 (1983): 661-5
  4. Brater DC, Gehr TW, Sica DA, et al. "Metolazone pharmacokinetics and pharmacodynamics in renal transplantation." Int J Clin Pharmacol Ther Toxicol 29 (1991): 116-23
  5. Jones B, Nanra RS "Double-blind trial of antihypertensive effect of chlorothiazide in severe renal failure." Lancet 2 (1979): 1258-60
  6. Carney SL, Morgan TO "Diuretic-induced hypokalemia and altered renal function." Int J Clin Pharmacol Ther Toxicol 24 (1986): 665-7
  7. Ballon HS, Rae A, Cameron EC, Magil AB "Acute interstitial nephritis associated with thiazide diuretics. Clinical and pathologic observations in three cases." Am J Med 69 (1980): 939-43
  8. Magil AB "Drug-induced acute interstitial nephritis with granulomas." Hum Pathol 14 (1983): 36-41
  9. Recalde M, Delevett AF "Diuretic-induced renal colic." JAMA 225 (1973): 992
  10. Burckhardt D, Dubach UC, Zimmerli M, Riess W, Theobald W, Vuillard P "Pharmacokinetic studies with chlorthalidone (Hygroton) in man." Eur J Clin Pharmacol 12 (1977): 375-82
  11. Dargie H, Kennedy AC, Dargie EN, Morgan HG, Tilstone WJ "Pharmacokinetics of metolazone in normal subjects and in patients with cardiac or renal failure." Clin Pharmacol Ther 16 (1974): 322-9
  12. Bennett WM, Porter GA "Efficacy and safety of metolazone in renal failure and the nephrotic syndrome." J Clin Pharmacol 13 (1973): 357-64
  13. Craswell PW, Moorhead JF, Varghese Z, Ezzat E, Kopstein J "Use of metolazone, a new diuretic, in patients with renal disease." Nephron 12 (1974): 63-73
  14. Acchiardo SR, Skoutakis VA "Clinical efficacy, safety, and pharmacokinetics of indapamide in renal impairment." Am Heart J 106 (1983): 237-44
  15. Wu MJ, Brennan L, Laquer UJ "A multicenter study of indapamide in hypertensive patients with impaired renal function." Clin Ther 5 (1982): 121-8
  16. Klunk LJ, Neiss ES, Ringel S "The disposition of 14C-indapamide in man." J Clin Pharmacol 23 (1983): 377-84
  17. Barnes AJ, Newstead CG, Moore RH "Interstitial nephritis associated with indapamide." BMJ 300 (1990): 1344
  18. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  19. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  20. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  21. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  22. G, Seyffart "Drug Dosage in Renal Insufficiency." Dordrecht, The Netherlands: Kluwer Academic Publishers 1 (1991): 227-8
  23. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  24. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  25. Hobbs DC, Twomey TM "Kinetics of polythiazide." Clin Pharmacol Ther 23 (1978): 241-6
  26. Baba WI, Lant AF, Wilson GM "Localization of the site of action of oral diuretics in the human kidney." Clin Sci 33 (1967): 11-27
  27. Brors O, Jacobsen S "Distribution of elimination of hydroflumethiazide in man." Eur J Clin Pharmacol 16 (1979): 125-31
  28. Brors O, Jacobsen S, Haffner JF "Excretion of hydroflumethiazide in bile and urine of man." Eur J Clin Pharmacol 15 (1979): 287-9
  29. Doluisio JT, Frome EL, Smith RB, Yakatan GJ "Pharmacokinetics of orally administered hydroflumethiazide in man." J Clin Pharmacol 17 (1977): 37-47
  30. el-Meheiry MM, Soliman MD, Nabih AE "A clinical study of a new diuretic, Trichlormethiazide." J Trop Med Hyg 69 (1966): 209-14
  31. Acchiardo SR, Skoutakis VA, Meyer MC, Sketris IS "The pharmacokinetics of trichlormethiazide in hypertensive patients with normal and compromised renal function." Eur J Clin Pharmacol 20 (1981): 453-7
  32. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  33. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  34. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  35. Larsson GB, Langer L, Nassberger L "Thiazide-induced kidney damage with circulating antibodies against myeloperoxidase and cardiolipin." J Intern Med 233 (1993): 493-4
  36. Beermann B, Groschinsky-Grind M, Lindstrom B "Pharmacokinetics of bendroflumethiazide." Clin Pharmacol Ther 22 (1977): 385-8
  37. Beermann B, Groschinsky-Grind M, Wikland B, Lindstrom B "Pharmacokinetics of bendroflumenthiazide in hypertensive patients." Eur J Clin Pharmacol 13 (1978): 119-24
  38. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  39. Read SJ, Whiting GF, Trenerry HM "Hyponatraemia and raised creatine kinase level associated with indapamide." Med J Aust 161 (1994): 607-8
  40. Gadallah M, Plante GE, Massry SG, Madkour H "Comparison between the effects of indapamide and hydrochlorothiazide on creatinine clearance in patients with impaired renal function and hypertension." Am J Nephrol 15 (1995): 251-5
  41. Brater DC "Drug therapy: Diuretic therapy." N Engl J Med 339 (1998): 387-95
View all 41 references
Moderate

Beta-blockers (applies to atenolol/chlorthalidone) cerebrovascular insufficiency

Moderate Potential Hazard, Moderate plausibility.

Beta-adrenergic blocking agents (beta-blockers), should be used with caution in patients with cerebrovascular insufficiency because of their potential effects relative to blood pressure and pulse. If signs or symptoms suggesting reduced cerebral blood flow are observed, consideration should be given to discontinuing these agents.

References

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  4. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  5. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  6. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  7. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  8. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  9. "Product Information. Kerlone (betaxolol)." Searle (2001):
  10. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  11. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  12. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  14. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  15. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  16. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 16 references
Moderate

Beta-blockers (applies to atenolol/chlorthalidone) glaucoma

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension

Systemic beta-adrenergic receptor blocking agents (aka beta-blockers) may lower intraocular pressure. Therefore, patients with glaucoma or intraocular hypertension may require adjustments in their ophthalmic regimen following a dosing change or discontinuation of beta-blocker therapy.

References

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  5. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  6. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  8. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  9. "Product Information. Kerlone (betaxolol)." Searle (2001):
  10. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  11. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  12. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  14. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  15. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  16. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 16 references
Moderate

Beta-blockers (applies to atenolol/chlorthalidone) hyperlipidemia

Moderate Potential Hazard, Moderate plausibility.

Beta-adrenergic receptor blocking agents (aka beta-blockers) may alter serum lipid profiles. Increases in serum VLDL and LDL cholesterol and triglycerides, as well as decreases in HDL cholesterol, have been reported with some beta-blockers. Patients with preexisting hyperlipidemia may require closer monitoring during beta-blocker therapy, and adjustments made accordingly in their lipid-lowering regimen.

References

  1. Weiner L, Rossner S "Atenolol and metoprolol: comparison of effects on blood pressure and serum lipoproteins, and side effects." Eur J Clin Pharmacol 24 (1983): 573-7
  2. Valimaki M, Maass L, Harno K, Nikkila EA "Lipoprotein lipids and apoproteins during beta-blocker administration: comparison of penbutolol and atenolol." Eur J Clin Pharmacol 30 (1986): 17-20
  3. Disler LJ, Joffe BI, Seftel HC "Massive hypertriglyceridemia associated with atenolol." Am J Med 85 (1988): 586-7
  4. Heller FR, Martiat P, Harvengt C, Nieuwenhuyze YV "Short-term effects of beta blockers atenolol, nadolol, pindolol, and propranolol on lipoprotein metabolism in normolipemic subjects." J Clin Pharmacol 27 (1987): 475-80
  5. Darga LL, Franklin BA, Hakim MJ, Lucas CP "Comparison of the effects of guanadrel sulfate and propranolol on blood pressure, functional capacity, serum lipoproteins and glucose in systemic hypertension." Am J Cardiol 67 (1991): 590-6
  6. Weiner L, Rossner S "Atenolol and metoprolol: comparison of effects on blood pressure and serum lipoproteins, and side effects." Eur J Clin Pharmacol 24 (1983): 573-7
  7. Weiner L, Rossner S "Atenolol 50 mg or metoprolol 200 mg: a comparison of antihypertensive efficacy, side effects and lipoprotein changes." Acta Med Scand 677 (1983): 153-7
  8. Ferrara LA, Scilla A, Marotta T, et al. "Effect of oxprenolol and metoprolol on serum lipid concentration." Eur J Clin Pharmacol 26 (1984): 331-4
  9. Fiorella G, Pasotti C, Capra A, et al. "Effects of pindolol and metoprolol on plasma lipids and lipoproteins." Br J Clin Pharmacol 13 (1982): s435-9
  10. Carlson LA, Ribacke M, Terent A "A long-term study on the effect of pindolol on serum lipoproteins: a preliminary report." Br J Clin Pharmacol 24 (1987): s61-2
  11. Chin B, Schoenfeld BH, Samuel P, et al. "Comparison of the effect of pindolol versus propranolol on the lipid profile in patients treated for hypertension." Br J Clin Pharmacol 24 (1987): s63-4
  12. Carlson LA, Ribacke M, Terent A "Long-term effect of pindolol on lipids and lipoproteins in men with newly diagnosed hypertension." Eur J Clin Pharmacol 36 (1989): 347-50
  13. Sasaki J, Ideishi M, Saku K, et al. "Effects of pindolol on serum lipids, apolipoproteins, and lipoproteins in patients with mild to moderate essential hypertension." Clin Ther 11 (1989): 219-24
  14. Szollar LG, Meszaros I, Tornoci L, et al. "Effect of metoprolol and pindolol monotherapy on plasma lipid- and lipoprotein-cholesterol levels (including the HDL subclasses) in mild hypertensive males and females." J Cardiovasc Pharmacol 15 (1990): 911-7
  15. Foss PO, Fossbakk B, Leren P, Nordvik B "The effect of enalapril and timolol on blood lipids." Acta Med Scand 223 (1988): 321-6
  16. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  17. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  18. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  19. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  20. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  21. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  22. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  23. Ballantyne D, Northcote RJ, Packard CJ "The effect of sotalol on plasma lipoproteins and apolipoproteins." Clin Chim Acta 158 (1986): 187-91
  24. Hietanen E, Lehtonen A, Peltonen P, Nikkila EA, Marniemi J "Effect of sotalol withdrawal on serum lipids and lipoprotein lipase activity." Int J Clin Pharmacol Ther Toxicol 21 (1983): 73-6
  25. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  26. "Product Information. Kerlone (betaxolol)." Searle (2001):
  27. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  28. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  29. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  30. Simona F, James R, Pometta D, Safran AB, Sansonetti A "Effects of ocular carteolol and timolol on plasma high-density lipoprotein cholesterol level." Am J Ophthalmol 117 (1994): 683
  31. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  32. Clucas A, Miller N "Effects of acebutolol on the serum lipid profile." Drugs 36 Suppl 2 (1988): 41-50
  33. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  34. Kasiske BL, Louis TA, Ma JZ, Kalil RS "Effects of antihypertensive therapy on serum lipids." Ann Intern Med 122 (1995): 133-41
  35. Lind L, Pollare T, Lithell H, Berne C "Long-term metabolic effects of antihypertensive drugs." Am Heart J 128 (1994): 1177-83
  36. Arakawa K, Kajiyama G, Koga S, Ogawa N, Sasaki J, Tanaka N, Kusukawa R, Mori H, Takagi R "Effect of bevantolol and propranolol on serum lipids in patients with essential hypertension." Int J Clin Pharmacol Ther 32 (1994): 660-4
  37. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  38. Andersson PE, Lithell H "Metabolic effects of carvedilol in hypertensive patients." Eur J Clin Pharmacol 52 (1997): 13-7
  39. Gordon NF, Duncan JJ, Scott CB "Effects of atenolol versus enalapril on cardiovascular fitness and serum lipids in physically active hypertensive men." Am J Cardiol 79 (1997): 1065-9
  40. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 40 references
Moderate

Beta-blockers (applies to atenolol/chlorthalidone) hyperthyroidism

Moderate Potential Hazard, High plausibility.

When beta-adrenergic receptor blocking agents (aka beta-blockers) are used to alleviate symptoms of hyperthyroidism such as tachycardia, anxiety, tremor and heat intolerance, abrupt withdrawal can exacerbate thyrotoxicosis or precipitate a thyroid storm. To minimize this risk, cessation of beta-blocker therapy, when necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks. Patients should be advised not to discontinue treatment without first consulting with the physician. Close monitoring is recommended during and after therapy withdrawal.

References

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  5. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  6. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  8. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  9. "Product Information. Kerlone (betaxolol)." Searle (2001):
  10. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  11. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  12. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  14. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  15. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  16. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 16 references
Moderate

Beta-blockers (applies to atenolol/chlorthalidone) myasthenia gravis

Moderate Potential Hazard, Low plausibility. Applicable conditions: Myoneural Disorder

Beta-adrenergic receptor blocking agents (aka beta-blockers) may potentiate muscle weakness consistent with certain myasthenic symptoms such as diplopia, ptosis, and generalized weakness. Several beta-blockers have been associated rarely with aggravation of muscle weakness in patients with preexisting myasthenia gravis or myasthenic symptoms. Use cautiously in patients with myasthenia gravis.

References

  1. Aimard G, Confavreux C, Charles N "Fulminant myasthenia gravis soon after initiation of acebutolol therapy." Eur Neurol 30 (1990): 279-81
  2. Berstein LP, Henkind P "Additional information on adverse reactions to timolol." Am J Ophthalmol 92 (1981): 295-6
  3. Coppeto JR "Timolol-associated myasthenia gravis." Am J Ophthalmol 98 (1984): 244-5
  4. Verkijk A "Worsening of myasthenia gravis with timolol maleate eyedrops." Ann Neurol 17 (1985): 211-2
  5. Herishanu Y, Rosenberg P "Beta-blockers and myasthenia gravis." Ann Intern Med 83 (1975): 834-5
  6. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  7. Lam KSL, Choi KL, Kung AWC, Wat MS, Ip TP "Phaeochromocytoma associated with myasthenia gravis precipitated by propranolol treatment." Aust N Z J Med 25 (1995): 257
View all 7 references
Moderate

Beta-blockers (applies to atenolol/chlorthalidone) pheochromocytoma

Moderate Potential Hazard, Moderate plausibility.

Administration of beta-blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta-mediated vasodilatation in skeletal muscle. In patients with pheochromocytoma, an alpha-blocking agent should be initiated prior to the use of any beta-blocking agent. Caution should be taken in the administration of these agents to patients suspected of having pheochromocytoma.

References

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  4. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  5. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  6. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  7. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  8. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  9. "Product Information. Kerlone (betaxolol)." Searle (2001):
  10. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  11. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  12. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  14. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  15. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  16. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 16 references
Moderate

Beta-blockers (applies to atenolol/chlorthalidone) psoriasis

Moderate Potential Hazard, Moderate plausibility.

The use of beta-blockers in psoriatic patients should be carefully weighed since the use of these agents may cause an aggravation in psoriasis.

References

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  5. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  6. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  8. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  9. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  10. "Product Information. Kerlone (betaxolol)." Searle (2001):
  11. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  12. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  13. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  14. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  15. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  16. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 16 references
Moderate

Beta-blockers (applies to atenolol/chlorthalidone) tachycardia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Tachyarrhythmia

Beta-adrenergic blockade in patients with Wolff-Parkinson-White syndrome and tachycardia has been associated with severe bradycardia requiring treatment with a pacemaker. In one case, this result was reported after an initial dose of 5 mg propranolol. The use of beta-adrenergic receptor blocking agents (aka beta-blockers) should be administered cautiously in these patients.

References

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  5. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  6. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Blocadren (timolol)." Merck & Company Inc (2001):
  8. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  9. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  10. "Product Information. Kerlone (betaxolol)." Searle (2001):
  11. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  12. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  13. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  14. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  15. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  16. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 16 references
Moderate

Cardioselective beta-blockers (applies to atenolol/chlorthalidone) asthma/COPD

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Chronic Obstructive Pulmonary Disease

Patients with bronchospastic disease, should, in general, not receive beta blockers, including cardioselective beta-blockers. Because of the relative beta-1 selectivity, cardioselective beta-blockers may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Because beta-1 selectivity is not absolute, the lowest possible dose of these agents should be used. Consider administering in smaller doses to avoid the higher plasma levels associated with the longer dosing intervals. If dosage must be increased, dividing the dose should be considered to achieve lower peak blood levels. It is recommended to have bronchodilators, including beta-2 agonists, readily available or administered concomitantly if necessary.

References

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  4. "Product Information. Kerlone (betaxolol)." Searle (2001):
  5. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  6. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  7. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):
View all 7 references
Moderate

Thiazides (applies to atenolol/chlorthalidone) asthma

Moderate Potential Hazard, Moderate plausibility.

Thiazide diuretics should be used with caution in patients with history of bronchial asthma as sensitivity reactions may occur.

References

  1. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  2. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  3. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  4. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  5. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  6. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  7. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  8. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  9. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
View all 9 references
Moderate

Thiazides (applies to atenolol/chlorthalidone) diabetes

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus, Abnormal Glucose Tolerance

Thiazide diuretics may cause hyperglycemia and glycosuria in patients with diabetes. They may also precipitate diabetes in prediabetic patients. These effects are usually reversible following discontinuation of the drugs. Therapy with thiazide diuretics should be administered cautiously in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Patients with diabetes mellitus should be monitored more closely during thiazide therapy, and their antidiabetic regimen adjusted accordingly.

References

  1. Pollare T, Lithell H, Berne C "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." N Engl J Med 321 (1989): 868-73
  2. Goldman JA, Neri A, Ovadia J, de, Eckerling B, Vries A "Effect of chlorothiazide on intravenous glucose tolerance in pregnancy." Am J Obstet Gynecol 105 (1969): 556-60
  3. Moses H, Miller NR "Transient oculomotor nerve palsy. Association with thiazide-induced glucose intolerance." JAMA 240 (1978): 1887-8
  4. Buse J, Kansal PC, Buse MG "Thiazide diuretics and control of diabetes mellitus." South Med J 62 (1969): 1372-9
  5. Andersen OO, Persson I "Carbohydrate metabolism during treatment with chlorthalidone and ethacrynic acid." Br Med J 2 (1968): 798-801
  6. Ahearn D, Curtis J, Sandler SG, Varney R, Horrigan F "Chlorthalidone-induced hyperosmolar hyperglycemic nonketotic coma." JAMA 220 (1972): 1592-3
  7. Bleicher SJ, Chowdhury FR "Chlorthalidone--induced hypokalemia and abnormal carbohydrate metabolism." Horm Metab Res 2 (1970): 13-6
  8. Diamond MT "Hyperglycemic hyperosmolar coma associated with hydrochlorothiazide and pancreatitis." N Y State J Med 72 (1972): 1741-2
  9. Pickens PT, Jones IG "Diabetes mellitus following oral diuretics." Practitioner 199 (1967): 209-10
  10. Beling S, Zisblatt M, Neiss ES, Webb E, Losi M, Vukovich RA "Long-term experience with indapamide." Am Heart J 106 (1983): 258-62
  11. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
  12. Dollery CT, Schumer B, Kohner E, Murphy MB, Lewis PJ "Glucose intolerance in hypertensive patients treated with diuretics: a fourteen-year follow-up." Lancet 2 (1982): 1293-5
  13. Allen EW, Seltzer HS "Hyperglycemia and inhibition of insulin secretion during administration of diazoxide and trichlormethiazide in man." Diabetes 18 (1969): 19-28
  14. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  15. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  16. Bell DS "Insulin resistance. An often unrecognized problem accompanying chronic medical disorders." Postgrad Med 93 (1993): 99-103,
  17. Berlin I "Prazosin, diuretics, and glucose intolerance." Ann Intern Med 119 (1993): 860
  18. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  19. Mather H, Rowe P "Hyperosmolar non-ketotic diabetes mellitus associated with metolazone." Br Med J 291 (1985): 25-6
  20. Domenet JG "Diabetogenic effect of oral diuretics." Br Med J 3 (1968): 188
  21. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  22. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  23. Arnfred J, Christensen CK, Mogensen CE, Hermansen K, Nielsen OH, Orskov H, Beck-Nielsen H, Hansen HE, Schmitz O "Insulin action in insulin-dependent diabetics after short-term thiazide therapy." Diabetes Care 9 (1986): 631-6
  24. Buys D, Blayac JP, Loubatieres-Mariani MM, Puech R, Ribes G "Effects of a new benzothiadiazine derivative, LN 5330, on insulin secretion." Arch Int Pharmacodyn Ther 253 (1981): 154-63
  25. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  26. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  27. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  28. Andersson O, Berglund G, Widgren B "Low-dose antihypertensive treatment with a thiazide diuretic is not diabetogenic. A 10-year controlled trial with bendroflumethiazide." Acta Med Scand 220 (1986): 419-24
  29. Berglund G, Wilhelmsen L, Elmfeldt D, Wedel H "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl 672 (1983): 79-83
  30. Dargie HJ, Kennedy AC, Winchester JF, Boddy K, Boyle P, Mahaffey ME, Kellett RJ, Ward DM "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther 28 (1980): 611-8
  31. Bryant R, Ising H, Petri M, Cumber P, Grimes L, Treby D, Rawlins D "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing 15 (1986): 151-5
  32. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  33. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
  34. Dollerup J, Knudsen RE, Mogensen CE, Schmitz A, Nielsen S "Enalapril versus bendroflumethiazide in type 2 diabetes complicated by hypertension." Q J Med 87 (1994): 747-54
  35. Harper R, Heaney AP, Johnston GD, Atkinson AB, Gormley M, Bell PM, Ennis CN, Sheridan B "A comparison of the effects of low- and conventional-dose thiazide diuretic on insulin action in hypertensive patients with NIDDM." Diabetologia 38 (1995): 853-9
  36. Sever PS, Hughes AD, Feher MD, Pickkers P, Schachter M "Thiazide-induced hyperglycaemia: a role for calcium-activated potassium channels?" Diabetologia 39 (1996): 861-4
View all 36 references
Moderate

Thiazides (applies to atenolol/chlorthalidone) hyperlipidemia

Moderate Potential Hazard, Moderate plausibility.

Thiazide diuretics may increase serum triglyceride and cholesterol levels, primarily LDL and VLDL. Whether these effects are dose-related and sustained during chronic therapy are unknown. Patients with preexisting hyperlipidemia may require closer monitoring during thiazide therapy, and adjustments made accordingly in their lipid-lowering regimen

References

  1. Pollare T, Lithell H, Berne C "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." N Engl J Med 321 (1989): 868-73
  2. Ames RP, Hill P "Increase in serum-lipids during treatment of hypertension with chlorthalidone." Lancet 1 (1976): 721-3
  3. Pollare T, Lithell H, Berne C "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." N Engl J Med 321 (1989): 868-73
  4. Berglund G, Fager G, Bondjers G, Elmfeldt D, Smith U, Lager I, Olofsson SO, Wiklund O "Effects of anti-hypertensive therapy on serum lipoproteins. Treatment with metoprolol, propranolol and hydrochlorothiazide." Artery 11 (1983): 283-96
  5. Beling S, Zisblatt M, Neiss ES, Webb E, Losi M, Vukovich RA "Long-term experience with indapamide." Am Heart J 106 (1983): 258-62
  6. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
  7. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  8. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  9. Luther RR, Estep CB, Glassman HN, Maurath CJ, Jordan DC "The effects of terazosin and methyclothiazide on blood pressure and serum lipids." Am Heart J 117 (1989): 842-7
  10. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  11. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  12. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  13. Smith WM "Diuretics and cholesterol elevation." JAMA 242 (1979): 1612
  14. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  15. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  16. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  17. Berglund G, Wilhelmsen L, Elmfeldt D, Wedel H "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl 672 (1983): 79-83
  18. Dargie HJ, Kennedy AC, Winchester JF, Boddy K, Boyle P, Mahaffey ME, Kellett RJ, Ward DM "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther 28 (1980): 611-8
  19. Bryant R, Ising H, Petri M, Cumber P, Grimes L, Treby D, Rawlins D "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing 15 (1986): 151-5
  20. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  21. Kasiske BL, Louis TA, Ma JZ, Kalil RS "Effects of antihypertensive therapy on serum lipids." Ann Intern Med 122 (1995): 133-41
  22. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
  23. Ames RP "A comparison of blood lipid and blood pressure responses during the treatment of systemic hypertension with indapamide and with thiazides." Am J Cardiol 77 (1996): b12-6
View all 23 references
Moderate

Thiazides (applies to atenolol/chlorthalidone) hyperparathyroidism

Moderate Potential Hazard, Moderate plausibility.

Urinary calcium excretion is decreased by thiazide diuretics during chronic administration. Pathologic changes in the parathyroid gland with hypercalcemia and hypophosphatemia have been reported during prolonged therapy. However, the common complications of hyperparathyroidism such as renal lithiasis, bone resorption, and peptic ulceration have not been seen. Clinicians should be cognizant of these effects when prescribing or administering thiazide therapy to patients with hyperparathyroidism. These drugs should be discontinued before carrying out tests for parathyroid function.

References

  1. Anderson PE, Austin SM, Ellis GG "Case report: metolazone-associated hypercalcemia and acute pancreatitis." Am J Med Sci 302 (1991): 235-7
  2. Tarssanen L, Lindy S "Serum calcium and phosphorus in patients treated with thiazides and furosemide." Acta Med Scand 194 (1973): 319-22
  3. Gammon GD, Docherty JP "Thiazide-induced hypercalcemia in a manic-depressive patient." Am J Psychiatry 137 (1980): 1453-5
  4. Parfitt AM "Thiazide-induced hypercalcemia in vitamin D-treated hypoparathyroidism." Ann Intern Med 77 (1972): 557-63
  5. Alfrey AC, Schrier RW, Reeve EB, Popovtzer MM, Subryan VL "The acute effect of chlorothiazide on serum-ionized calcium. Evidence for a parathyroid hormone-dependent mechanism." J Clin Invest 55 (1975): 1295-302
  6. Pickleman JR, Farland M, Paloyan E "Hyperparathyroidism coexisting with hypertension and prolonged thiazide administration." JAMA 210 (1969): 1243-5
  7. Parfitt AM "Chlorothiazide-induced hypercalcemia in juvenile osteoporosis and hyperparathyroidism." N Engl J Med 281 (1969): 55-9
  8. Palmer FJ "Letter: Chlorthalidone-induced hypercalcemia." JAMA 229 (1974): 267
  9. Friedman R, Goltzman D, Hakim R, Meltzer S, Tolis G "Severe hypercalcemia associated with hydrochlorothiazide and calcium carbonate therapy." Can Med Assoc J 121 (1979): 591-4
  10. Tannenberg AM, Haskell LP, Itescu S "Thiazide-induced clinically significant hypophosphatemia ." Clin Nephrol 27 (1987): 161-2
  11. Millard PH, Byatt CM, Levin GE "Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions." J R Soc Med 83 (1990): 704-8
  12. Balizet L "Recurrent parathyroid adenoma. Association with prolonged thiazide administration." JAMA 225 (1973): 1238-9
  13. Pickleman JR, Farland M, Paloyan E "Hyperparathyroidism coexisting with hypertension and prolonged thiazide administration." JAMA 210 (1969): 1243-5
  14. Duarte CG, Becker KL, Pace A, Winnacker JL "Thiazide-induced hypercalcemia." N Engl J Med 284 (1971): 828-30
  15. Adams PH, Klimiuk PS, Davies M "Primary hyperparathyroidism and thiazide diuretics." Postgrad Med J 57 (1981): 80-3
  16. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  17. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  18. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  19. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  20. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  21. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  22. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  23. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  24. Hilker RR "Reversible hypercalcemia associated with prolonged thiazide administration to control hypertension." J Occup Med 12 (1970): 444-5
  25. Brunner S, Jorgensen FS "The long-term effect of bendroflumethiazide on renal calcium and magnesium excretion and stone formation in patients with recurring renal stones." Scand J Urol Nephrol 8 (1974): 128-31
  26. Backman U, Johansson G, Wikstrom B, Danielson BG, Fellstrom B, Ljunghall S "Calcium and magnesium metabolism during long-term treatment with thiazides." Scand J Urol Nephrol 15 (1981): 257-62
  27. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
View all 27 references
Moderate

Thiazides (applies to atenolol/chlorthalidone) hyperuricemia

Moderate Potential Hazard, High plausibility. Applicable conditions: Gout

Thiazide diuretics decrease the rate of uric acid excretion. Hyperuricemia occurs frequently but is usually asymptomatic and rarely leads to clinical gout except in patients with a history of gout or chronic renal failure. Therapy with thiazide diuretics should be administered cautiously in such patients.

References

  1. Guidotti FP, Lapidus PW "Gout in orthopaedic practice: review of 232 cases." Clin Orthop 28 (1963): 97-110
  2. Aissa AH, Laville M, Pozet N, Labeeuw M, Sassard J, Zech PY "Uric acid renal handling: spontaneous changes and influence of a thiazide alone or associated with triamterene." Int J Clin Pharmacol Ther Toxicol 26 (1988): 79-83
  3. Beling S, Zisblatt M, Neiss ES, Webb E, Losi M, Vukovich RA "Long-term experience with indapamide." Am Heart J 106 (1983): 258-62
  4. Slotkoff L "Clinical efficacy and safety of indapamide in the treatment of edema." Am Heart J 106 (1983): 233-7
  5. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  6. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  7. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  8. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  9. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  10. Aakvaag A, Brors O, Foss OP, Jacobsen S "Effect of repeated doses of hydroflumethiazide on renal excretion of electrolytes and uric acid in healthy subjects." Acta Pharmacol Toxicol (Copenh) 48 (1981): 145-50
  11. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  12. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  13. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  14. Gudbrandsson T, Hansson L "Combination therapy with saluretics and atenolol in essential hypertension. Effects on blood pressure, electrolytes and uric acid." Acta Med Scand Suppl 625 (1979): 86-91
  15. Berglund G, Wilhelmsen L, Elmfeldt D, Wedel H "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl 672 (1983): 79-83
  16. Dargie HJ, Kennedy AC, Winchester JF, Boddy K, Boyle P, Mahaffey ME, Kellett RJ, Ward DM "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther 28 (1980): 611-8
  17. Bryant R, Ising H, Petri M, Cumber P, Grimes L, Treby D, Rawlins D "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing 15 (1986): 151-5
  18. Backman U, Johansson G, Wikstrom B, Danielson BG, Fellstrom B, Ljunghall S, Odlind B "Effects of bendroflumethiazide on urate metabolism during treatment of patients with renal stones." J Urol 127 (1982): 1207-10
  19. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
  20. Freis ED "The efficacy and safety of diuretics in treating hypertension." Ann Intern Med 122 (1995): 223-6
View all 20 references
Moderate

Thiazides (applies to atenolol/chlorthalidone) thyroid function tests

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Thyroid Disease

Thiazide diuretics may decrease serum PBI (protein-bound iodine) levels without associated thyroid disturbance. Clinicians should be cognizant of this effect when prescribing or administering thiazide therapy to patients with thyroid disorders.

References

  1. Hansen JM, Siersbaek-Nielsen K, Skovsted L, Bech K "Influence of thiazides on thyroid parameters in man." Acta Endocrinol (Copenh) 89 (1978): 673-8
  2. "Product Information. HydroDIURIL (hydrochlorothiazide)." Merck & Company Inc (2002):
  3. "Product Information. Lozol (indapamide)." Rhone Poulenc Rorer (2002):
  4. "Product Information. Zaroxolyn (metolazone)." Rhone Poulenc Rorer (2001):
  5. "Product Information. Thalitone (chlorthalidone)." Monarch Pharmaceuticals Inc (2001):
  6. "Product Information. Diuril (chlorothiazide)." Merck & Company Inc (2001):
  7. "Product Information. Enduron (methyclothiazide)." Abbott Pharmaceutical (2001):
  8. "Product Information. Metahydrin (trichlormethiazide)." Hoechst Marion Roussel (2001):
  9. "Product Information. Diucardin (hydroflumethiazide)." Wyeth-Ayerst Laboratories (2001):
  10. "Product Information. Renese-R (reserpine-polythiazide)." Pfizer US Pharmaceuticals, New York, NY.
View all 10 references

Atenolol/chlorthalidone drug interactions

There are 591 drug interactions with atenolol / chlorthalidone.

Atenolol/chlorthalidone alcohol/food interactions

There are 5 alcohol/food interactions with atenolol / chlorthalidone.

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.