Symptoms of overdose include: bradycardia, marked reduction in blood pressure, congestive heart failure and bronchospasm, seizures, increased sleepiness. Treatment : Careful observation; treatment in the intensive care unit; gastric lavage, administration of activated charcoal and laxatives to prevent absorption of the drug still present in the gastro-intestinal tract; the use of plasma or plasma substitutes to treat reduced blood pressure and shock. . Perhaps the proviron use of hemodialysis or hemoperfusion bronchospasm usually docked using bronchodilators. With a significant diuresis – the introduction of fluids and electrolytes.
Cautions Conditional beta-blocker (atenolol), which is part of “Tenoroksa” :
- can mask the effect of hyperthyroidism and hypoglycemia;
- in the development against the backdrop of bradycardia therapy (. slowing of the heart rate up to 50 cuts per minute) with clinical symptoms should reduce the dose or stop the drug;
- should not be abruptly cancel “Tenoroks” in patients suffering from ischemic heart disease;
- smokers may experience a decrease in the therapeutic effect of the drug;
- special attention should be in cases where the required surgery under general anesthesia in patients taking atenolol. The drug should be discontinued 48 hours prior to surgery. As an anesthetic drug should be chosen with the minimum possible negative inotropic effect.
- May increase sensitivity to allergens and cause severe anaphylactic reactions, and therefore, patients on therapy proviron desensitized should take the drug with caution. These patients may not respond to the usual doses of epinephrine used to treat allergic reactions;
- When using atenolol may decrease the production of tear fluid, which is important for patients using contact lenses.
Conditional action chlorthalidone, a member of the “Tenoroksa” :
- Hypokalemia may occur. It is necessary to regularly monitor the level of potassium, particularly in elderly patients, patients receiving cardiac glycosides for the treatment of heart failure, in patients with an unbalanced diet (low in potassium), or in patients with complaints of violation of the gastrointestinal tract. Patients receiving cardiac glycosides, hypokalemia may predispose to cardiac arrhythmias;
- Caution should be exercised in the appointment of patients with severe renal insufficiency (see section “Dosage and administration”);
- may occur impaired glucose tolerance. To use caution in patients with a known predisposition to diabetes;
- Hyperuricemia may occur. Increased levels of uric acid in blood serum in some cases may require the use of agents that promote excretion of uric acid.
Most hypertensive patients the use of one proviron daily gives satisfactory results. With increasing doses of further lowering blood pressure either does not occur or is insignificant, but it may further be assigned another antihypertensive agent if necessary.
Interaction with other medicinal products
Concomitant therapy with dihydropyridines, eg, nifedipine, may increase the risk of significant decrease in blood pressure in patients with latent heart failure, there may be signs of circulatory disorders.
Cardiac glycosides in combination with beta-blockers may increase the time atrioventricular conduction.
Beta adrenoblokatory may aggravate the “rebound” hypertension, which can occur after clonidine. If assigned to both drugs, beta-blockers should be discontinued for a few days before you stop taking clonidine. When replacing clonidine on beta-blocker latter should be given a few days after cessation of treatment with clonidine.
It should be used with caution in the beta-blocker in combination with class I antiarrhythmics such as disopyramide (cardiodepressivny stacking).
Concomitant use of sympathomimetic agents, eg , epinephrine, norepinephrine may neutralize the effect of beta-blockers (a significant increase in blood pressure).
salicylates and non-steroidal anti-inflammatory drugs (eg, ibuprofen, indomethacin), estrogen may reduce the hypotensive effect of beta-blockers, and the strengthening of the toxic effects of salicylates can be observed at high dosages of salicylates .
Preparations containing lithium should not be used with diuretics, as they may reduce its renal clearance.
caution should be exercised when applying means for general anesthesia in conjunction with the “Tenoroksom”. The anesthesiologist should be informed about the use of “Tenoroksa” and general anesthetic must be selected that has the least, as far as possible negative inotropic effect. The use of beta-blockers with anesthetic drugs may result in increased risk of hypotension. The use of funds for general anesthesia, reducing myocardial contractility, should be avoided. In addition, the enhanced action kuraropodobnyh muscle relaxants.
Do not use in patients with monoamine oxidase inhibitors (possible increase in blood pressure).
Caution should be exercised when using the drug with angiotensin converting enzyme inhibitors (captopril, enalapril), because at the beginning of therapy, possibly a sharp increase in the antihypertensive effect of “Tenoroksa” .
When combined with glucocorticoids, karbenoksolanom, amphotericin B, furosemide may increase potassium excretion.
The funds for general anesthesia: increased antihypertensive effect and the summation of the negative inotropic effect of both.
Insulin and oral antidiabetic drugs: the last action can be strengthened.
The symptoms of hypoglycemia: tachycardia, tremor, sweating, weakness, decreased tone of the eyeball. Regularly monitor blood glucose levels.
Tricyclic antidepressants, barbiturates, phenothiazines, diuretics, vasodilators, and other antihypertensive drugs, alcohol – may increase the antihypertensive effect of “Tenoroksa.”
The use of beta-blockers in combination with calcium channel blockers, has negative inotropic effects, eg , verapomilom, diltiazem can lead to an increase of the effect, especially in patients with reduced myocardial contractility and / or in violation of sinoarterialnoy or atrioventricular conduction. This may cause a pronounced reduction in blood pressure, bradycardia and heart failure.
Calcium channel blocker should not be administered intravenously within 48 hours after the cancellation of a beta-blocker.
When concomitant administration proviron with reserpine, clonidine, guanfacine may cause bradycardia.