Tenochek tabs #28

Tenochek user manual

You can buy Tenochek here

Tenochek is a combined antihypertensive drug.

Release form and composition

Dosage form - tablets: flat, round, with beveled edges, almost white / white, with a dividing line on one side and embossed "TC" on the other (10 or 14 pcs. In blisters, in a cardboard box 1-3 blisters and instructions for use of Tenochek).
Composition of 1 tablet:
    active substances: atenolol - 50 mg, amlodipine - 5 mg;
    auxiliary components: calcium hydrogen phosphate (dibasic calcium phosphate), purified talc, colloidal silicon dioxide, sodium starch glycolate, povidone-30, corn starch, microcrystalline cellulose, magnesium stearate, isopropanol.

Pharmacodynamics

Tenochek is a preparation containing two active ingredients that determine its properties.

Atenolol

Atenolol is a cardioselective β1-blocker. It has hypotensive, antianginal and antiarrhythmic effects. Reduces the intracellular flow of calcium ions, as well as the formation of adenosine triphosphate (ATP) and cyclic adenosine monophosphate (cAMP) stimulated by catecholamines. Does not possess membrane stabilizing and internal sympathomimetic activity. On the first day after taking Tenochek, due to a decrease in cardiac output, a reactive increase in total peripheral vascular resistance (OPSR) occurs, the severity of which gradually decreases within 1-3 days.
The hypotensive effect is associated with a decrease in cardiac output, activity of the renin-angiotensin system (RAS) and baroreceptor sensitivity, as well as with an effect on the central nervous system. The antihypertensive effect is manifested by a decrease in systolic and diastolic blood pressure (BP) and a decrease in minute and stroke volume, persists for 24 hours after administration, with regular use, blood pressure stabilization is noted by the end of the second week of treatment. Used in medium recommended doses, atenolol does not affect the tone of the peripheral arteries.
The antianginal effect is manifested in a decrease in the sensitivity of the myocardium to the effects of sympathetic innervation, as well as in a decrease in heart rate (HR) and myocardial contractility, as a result of which myocardial oxygen demand decreases.
The heart rate decreases both at rest and during exercise. Due to an increase in the tension of the muscle fibers of the ventricles and an increase in the end diastolic pressure in the left ventricle, an increase in myocardial oxygen demand is possible, especially in patients with chronic heart failure.
A negative chronotropic effect appears 1 hour after taking the drug, reaches a maximum after 2–4 hours and lasts up to 24 hours.
The antiarrhythmic action is to suppress sinus tachycardia. It is determined by the following properties of atenolol: a decrease in the rate of propagation of excitation through the sinoatrial node, inhibition of heterogeneous automatism, lengthening of the refractory period, elimination of arrhythmogenic sympathetic influences on the cardiac conduction system.
Atenolol inhibits impulse conduction mainly in the antegrade direction, to a lesser extent in the retrograde direction through the AV node and along additional pathways.
The drug increases the survival rate of patients after myocardial infarction by reducing the incidence of ventricular arrhythmias and the occurrence of angina attacks.
When used in therapeutic concentrations, atenolol has no effect on β2-adrenergic receptors. Unlike nonselective β-blockers, it has a less pronounced effect on lipid metabolism, smooth muscles of peripheral arteries and bronchi. It slightly reduces the vital capacity of the lungs, almost does not reduce the bronchodilating effect of isoproterenol. In a daily dose of more than 100 mg, it can affect β2-adrenergic receptors.

Amlodipine

Amlodipine is a slow calcium channel blocker (BMCC), a dihydropyridine derivative. It has antianginal, antihypertensive, vasodilating and antispasmodic effects.
The drug blocks the flow of calcium ions into smooth muscle cells of blood vessels and myocardium through cell membranes.
The antianginal effect is explained by the ability to expand peripheral arterioles, as a result of which the systemic vascular resistance decreases, the load on the heart decreases. This reduces myocardial oxygen demand. At the same time, due to the expansion of the coronary arteries, the supply of oxygen to the myocardium increases, which is especially important for patients with angiospastic angina.
The mechanism of hypotensive action is associated with the direct effect of amlodipine on vascular smooth muscle.
The drug has antithrombotic and antiatherosclerotic activity. It has a mild natriuretic effect. Increases the rate of glomerular filtration. Does not adversely affect the lipid composition of blood plasma and metabolism. In diabetic nephropathy, it does not increase the severity of microalbuminuria.

Pharmacokinetics

Atenolol

    absorption: entering the gastrointestinal tract, atenolol is rapidly absorbed in an amount of about 50% of the dose received. Bioavailability is 40-50%. The maximum concentration (Cmax) is observed after 2–4 hours;
    distribution: from 6 to 16% of the dose binds to plasma proteins. Atenolol poorly penetrates the placental and blood-brain barriers. In small quantities it passes into breast milk;
    metabolism and excretion: the drug is almost not metabolized in the liver. It is excreted by the kidneys by glomerular filtration mainly unchanged (85-100%). The half-life (T1 / 2) is 6-9 hours.
Pharmacokinetics in special cases:
    age: in elderly patients, T1 / 2 increases;
    renal function: in case of impaired renal function, atenolol accumulates in the body. T1 / 2 increases: with creatinine clearance (CC) 15-35 ml / min / 1.73 m2 - up to 16-27 hours, with CC <15 ml / min / 1.73 m2 - up to> 27 hours.

Amlodipine

    absorption: entering the gastrointestinal tract, amlodipine is rapidly and almost completely (90%) absorbed. Cmax is observed 6–12 hours after taking the drug. Bioavailability - 60–65%;
    distribution: the equilibrium concentration (Css) is established within 7-8 days of regular administration of the drug. The volume of distribution (Vd) is 20 l / kg. More than 95% of the received dose binds to plasma proteins. Penetrates the blood-brain barrier;
    metabolism and excretion: amlodipine is metabolized mainly in the liver, resulting in the formation of metabolites that do not have pharmacological activity. It is excreted by the kidneys in the form of inactive metabolites about 60% of the dose, unchanged - less than 10%, through the intestines and with bile in the form of metabolites - 20-25%, a small amount is excreted in the form of metabolites in breast milk.

Indications for use

Tenochek is used to treat hypertension and prevent angina attacks.

Contraindications

Absolute:
    cardiomegaly without signs of heart failure;
    Prinzmetal's angina;
    acute heart failure;
    chronic heart failure stage IIB – III in the phase of decompensation;
    severe bradycardia;
    sinoatrial blockade;
    AV block II and III degree;
    severe arterial hypotension;
    sick sinus syndrome;
    chronic obstructive pulmonary disease;
    bronchial asthma;
    metabolic acidosis;
    age under 18;
    co-administration of monoamine oxidase inhibitors (MAO);
    hypersensitivity to the components of the drug.
Relative (the use of Tenochek tablets requires special care):
    AV block I degree;
    chronic heart failure in the compensation phase;
    aortic stenosis;
    chronic renal failure;
    liver dysfunction;
    psoriasis;
    myasthenia gravis;
    obliterating diseases of peripheral vessels (symptom of intermittent claudication, Raynaud's syndrome);
    pheochromocytoma;
    thyrotoxicosis;
    hypoglycemia;
    diabetes;
    depression;
    elderly age;
    the period of pregnancy and lactation.

Instructions for use: method and dosage

Tenochek tablets should be taken orally with a sufficient amount of water.
At the beginning of treatment, adults are usually prescribed 1 tablet 1 time per day. If the severity of the decrease in blood pressure is not enough, the daily dose is increased to the maximum - 2 tablets.
If necessary, discontinuation of the drug is done gradually, reducing the dose for at least 2 weeks (by 25% every 3-4 days). It is impossible to abruptly interrupt the reception of Tenochek, as this is fraught with the development of severe arrhythmias and myocardial infarction, especially in patients with coronary heart disease.

Side effects

Tenochek is generally well tolerated. In some cases, the following side effects are noted:
    on the part of the cardiovascular system: shortness of breath, palpitations, marked decrease in blood pressure, violation of AV conduction, flushing to the skin of the face, bradycardia, development or worsening of symptoms of heart failure, peripheral edema;
    from the musculoskeletal system: muscle cramps, myalgia;
    from the hematopoietic system: aplastic anemia, thrombocytopenic purpura, thrombosis;
    from the central and peripheral nervous system: fatigue, drowsiness, headache, sleep disturbance, lethargy, dizziness, hallucinations, decreased concentration, depression; rarely - visual impairment, asthenia, mood changes, paresthesia;
    from the digestive system: abdominal pain, diarrhea / constipation, dry mouth, gingival hyperplasia, nausea, vomiting; rarely - dyspepsia, increased activity of hepatic transaminases, cholestatic jaundice;
    from the endocrine system: hypoglycemia, hyperlipidemia, decreased libido, decreased potency, gynecomastia;
    from the respiratory system: apnea, dyspnea, bronchospasm;
    on the part of the skin: itching, dermatitis, urticaria, photosensitivity; rarely - exudative erythema multiforme;
    others: increased urination.

Overdose

In case of taking an excessive dose of Tenochek, the following symptoms are possible: a pronounced decrease in blood pressure, AV-blockade of II and III degrees, severe bradycardia, an increase in symptoms of heart failure, hypoglycemia, bronchospasm.
Hemodialysis is ineffective. Treatment is carried out in order to eliminate the developed disorders.

Special instructions

During the period of therapy, monitoring of laboratory parameters is required:
    all patients: blood pressure and heart rate - daily at the beginning of treatment, then every 3-4 months;
    elderly people: kidney function - every 4–5 months;
    patients with diabetes mellitus: the level of glucose in the blood - every 4–5 months.
The doctor should teach patients how to calculate the heart rate and warn that if this indicator drops below 50 beats / min, an urgent doctor's consultation is required.
If the elderly have a significant decrease in blood pressure (systolic below 100 mm Hg), severe bradycardia (heart rate less than 50 beats / min), severe renal / liver dysfunction, AV blockade, ventricular arrhythmia or bronchospasm develop, reduce the dose Tenochek or cancel the drug.
With extreme caution, the Tenochek dose should be selected for patients with compensated chronic heart failure.
Atenolol can reduce the formation of tear fluid, which should be considered in patients who use contact lenses.
Tenochek with thyrotoxicosis can mask some symptoms of hyperthyroidism, for example, tachycardia. It is strictly forbidden for such patients to abruptly cancel the drug, since symptoms may increase.
The drug slightly increases the hypoglycemia caused by insulin, but does not interfere with the restoration of glucose concentration to normal levels.
If depression develops against the background of antihypertensive therapy, the drug should be canceled.
Patients who are planning to undergo surgery using general anesthesia should stop taking Tenochek 48 hours before surgery and notify the anesthesiologist about therapy so that he chooses an anesthetic with a minimal negative inotropic effect.
The drug should be temporarily discontinued before the study of antinuclear antibody titers, as well as the concentrations of catecholamines and vanillyl mandelic acid in urine and blood.
In patients with a burdened allergic history, Tenochek can increase the severity of allergic reactions and eliminate the effect of epinephrine administered in usual doses.
When carrying out combination therapy with clonidine, in order to avoid the development of a withdrawal syndrome, Tenochek should be discontinued a few days before clonidine.
Drugs that reduce the supply of catecholamines (such as reserpine) may increase the effect of atenolol. When using such a combination, the patient should be carefully monitored in order to timely identify the possible development of bradycardia and a pronounced decrease in blood pressure.
Patients who require the appointment of verapamil (intravenously) should cancel Tenochek at least 48 hours in advance.
In smokers, the effectiveness of atenolol is reduced.

Influence on the ability to drive vehicles and complex mechanisms

Tenochek can reduce concentration of attention, which should be taken into account by patients employed in potentially hazardous industries or performing work that requires speed of reactions and increased attention.

Application during pregnancy and lactation

Tenochek for pregnant and breastfeeding women is prescribed only if the expected benefit outweighs the potential risks. Careful medical supervision is required.

Childhood use

Tenochek is not prescribed for children and adolescents under 18 years of age.

With impaired renal function

Patients with chronic renal failure should be especially careful during treatment.

For violations of liver function

Patients with impaired hepatic function should be especially careful during treatment.

Use in the elderly

Elderly patients during the period of therapy should be under constant medical supervision.

Drug interactions

    antihypertensive drugs of other pharmacological groups: there is an additive antihypertensive effect;
    cardiac glycosides, amiodarone: the likelihood of a violation of AV conduction and the development of bradycardia increases;
    cimetidine: the metabolism of atenolol is inhibited, as a result of which its plasma concentration increases;
    reserpine, verapamil, clonidine, methyldopa: the risk of developing severe bradycardia increases;
    derivatives of ergotamine and xanthine: the effectiveness of atenolol decreases;
    derivatives of phenothiazine: the concentration of atenolol and amlodipine in the blood serum increases;
    phenytoin and drugs for anesthesia (with intravenous administration): the severity of the cardiodepressant effect of atenolol increases;
    means for inhalation general anesthesia (derivatives of hydrocarbons): suppression of myocardial function and a pronounced decrease in blood pressure is possible;
    lidocaine: it is possible to slow down the excretion of Tenochek's active substances, as a result of which the risk of developing a toxic effect increases;
    non-depolarizing muscle relaxants: their action is prolonged;
    coumarins: their anticoagulant effect is enhanced;
    mineralocorticoids, glucocorticosteroids, non-steroidal anti-inflammatory drugs, estrogens: the hypotensive effect of Tenochek is weakened;
    oral hypoglycemic agents, insulin: under the influence of atenolol, the symptoms of hypoglycemia are masked;
    iodine-containing X-ray contrast agents (when administered intravenously), allergen extracts for skin tests, and allergens used for immunotherapy: increases the risk of anaphylaxis and severe systemic allergic reactions.

Terms and conditions of storage

Store at temperatures below 25 ° C in a dry place, out of reach of children, protected from light.
Shelf life is 2 years.

Reviews

Reviews about Tenochek are few, but mostly positive: the drug effectively reduces high blood pressure, is well tolerated. The disadvantage is the impossibility of abrupt termination of admission, since withdrawal syndrome develops.

Terms of sell

You can buy Tenochek without a prescription from a doctor.