Totaretic

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

- Rash
- Slower than normal heart beat (bradycardia)
- Disturbed sleep
- Changes in mood
- Blood disorders
- Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
- High blood glucose level (hyperglycaemia)
- High blood uric acid level (hyperuricaemia) which can cause kidney problems and gout
- Cold extremities, eg hands and feet
- Breathing difficulties due to a narrowing of the airways (bronchospasm)
- A drop in blood pressure that occurs when going from lying down to sitting or standing, which results in dizziness and lightheadedness (postural hypotension)
- Disturbances in the levels of chemical components (electrolytes) in the blood
- Deterioration of heart failure

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

When taken together with cisapride, sertindole, sotalol, astemizole, terfenadine or beta-agonist bronchodilators such as salbutamol, there may be an increased risk of abnormal heart rhythm, if low blood potassium (hypokalaemia) occurs with chlortalidone. If hypokalaemia does not occur, this risk is removed. When taken together with other medicines which can cause hypokalaemia e.g. corticosteroids, carbenoxolone or beta-agonist bronchodilators such as salbutamol, there may be an increased risk of developing hypokalaemia. Potassium supplements may be required. When taken together with cardiac glycosides such as digoxin, there is an increased risk of adverse effects if low blood potassium (hypokalaemia) occurs with chlortalidone. There is also an increased risk of extremely slow heart rate when atenolol is taken with digoxin. Chlortalidone reduces the ability of the body to remove the medicine lithium. As this may give rise to adverse effects this medicine should not generally be taken with lithium. In diabetic patients, atenolol can prolong the lowering of blood sugar (hypoglycaemia) caused by insulin or other antidiabetic medicines. Individuals should monitor their blood sugar, as atenolol can also mask the signs of hypoglycaemia. Chlortalidone may increase blood sugar. When atenolol is taken together with calcium channel blockers such as verapamil, nifedipine or diltiazem, the risk of slow heart rate, hypotension and heart failure may be increased. Neither atenolol nor calcium channel blockers should be given intravenously within 48 hours of discontinuing the other. If atenolol is taken together with clonidine, there is a risk of a rebound increase in blood pressure if clonidine is stopped. The atenolol should be stopped several days before slowly stopping the clonidine. For further interactions of with the atenolol component of this medicine please refer to the atenolol monograph.

Other medicines containing the same active ingredients

AtenixCo	Co-tenidone	Tenchlor
Tenoret 50	Tenoretic

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