Formulary
Co-tenidone: Indications, Dosing, Side Effects and Interactions
Co-tenidone clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Co-tenidone: Indications, Dosing, Side Effects and Interactions
Co-tenidone clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Hypertension**
- **Adult** (By Mouth): 50/12.5 mg daily, alternatively increased if necessary to 100/25 mg daily, doses higher than 50 mg atenolol rarely necessary.
Cautions
For all beta-adrenoceptor blockers (systemic) Diabetes; first-degree AV block; history of obstructive airways disease (introduce cautiously); myasthenia gravis; portal hypertension (risk of deterioration in liver function); psoriasis; symptoms of hypoglycaemia may be masked; symptoms of thyrotoxicosis may be masked Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: in combination with verapamil or diltiazem (risk of heart block) with bradycardia (heart rate less than 50 beats per minute), or second- or third-degree AV block (contra-indicated; risk of complete heart block, asystole) in diabetes mellitus patients with frequent hypoglycaemic episodes (risk of suppressing hypoglycaemic symptoms) if prescribed a non-selective beta-blocker (including topical beta-blockers) in a history of asthma requiring treatment (contra-indicated in asthma; risk of increased bronchospasm) Cautions For all thiazides and related diuretics Diabetes; gout; risk of hypokalaemia; systemic lupus erythematosus Cautions, further information Existing conditions Thiazides and related diuretics can exacerbate diabetes, gout, and systemic lupus erythematosus. Potassium loss Hypokalaemia can occur with thiazides and related diuretics. Hypokalaemia is dangerous in severe cardiovascular disease and in patients also being treated with cardiac glycosides. Often the use of potassium-sparing diuretics avoids the need to take potassium supplements. In hepatic impairment, hypokalaemia caused by diuretics can precipitate encephalopathy. Elderly Lower initial doses of diuretics may be necessary in the elderly because they are particularly susceptible to the side-effects. The dose should then be adjusted according to renal function. M Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: with current significant hypokalaemia (serum potassium less than 3 mmol/L), hyponatraemia (serum sodium less than 130 mmol/L), or hypercalcaemia (corrected serum calcium greater than 2.65 mmol/L)-contra-indicated; hypokalaemia, hyponatraemia, and hypercalcaemia can be precipitated by a thiazide diuretic with a history of gout (gout can be precipitated by a thiazide diuretic)
Contraindications
For all beta-adrenoceptor blockers (systemic) Asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; phaeochromocytoma (apart from specific use with alpha-blockers); Prinzmetal's angina; second-degree AV block; severe peripheral arterial disease; sick sinus syndrome; third-degree AV block; uncontrolled heart failure Contra-indications, further information Bronchospasm Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken. Contra-indications For all thiazides and related diuretics Addison's disease; hypercalcaemia; hyponatraemia; refractory hypokalaemia; symptomatic hyperuricaemia
Side effects
For all beta-adrenoceptor blockers (systemic) Common or very common Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; rash (reversible on discontinuation); Raynaud's phenomenon; sleep disorders; syncope; visual impairment; vomiting Uncommon Alopecia; atrioventricular block; bronchospasm Rare or very rare Hallucination; psoriasis exacerbated Side-effects, further information With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. Overdose Therapeutic overdosages with beta-blockers may cause lightheadedness, dizziness, and possibly syncope as a result of bradycardia and hypotension; heart failure may be precipitated or exacerbated. With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. For details on the management of poisoning, see Beta-blockers, under Emergency treatment of poisoning . Side-effects For all thiazides and related diuretics Common or very common Alkalosis hypochloraemic; constipation; diarrhoea; dizziness; electrolyte imbalance; erectile dysfunction; fatigue; headache; hyperglycaemia; hyperuricaemia; nausea; postural hypotension; skin reactions; vomiting Uncommon Agranulocytosis; aplastic anaemia; leucopenia; pancreatitis; photosensitivity reaction; thrombocytopenia Rare or very rare Paraesthesia Side-effects For co-tenidone Common or very common Gastrointestinal disorder; glucose tolerance impaired Rare or very rare Dry mouth; hepatic disorders; intermittent claudication; mood altered; neutropenia; psychosis Frequency not known Lupus-like syndrome
Pregnancy
For all beta-adrenoceptor blockers (systemic) Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. Pregnancy For all thiazides and related diuretics Thiazides and related diuretics should not be used to treat gestational hypertension. They may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, and hypoglycaemia; placental perfusion may also be reduced. Stimulation of labour, uterine inertia, and meconium staining have also been reported. Pregnancy For co-tenidone Avoid. Diuretics not used to treat hypertension in pregnancy.
Breast feeding
For all beta-adrenoceptor blockers (systemic) With systemic use in the mother, infants should be monitored as there is a risk of possible toxicity due to beta-blockade. However, the amount of most beta-blockers present in milk is too small to affect infants. Breast feeding For co-tenidone Atenolol present in milk in greater amounts than some other beta-blockers. Possible toxicity due to beta-blockade-monitor infant. Large doses of chlortalidone may suppress lactation.
Hepatic impairment
For all thiazides and related diuretics In general, manufacturer advises caution in mild to moderate impairment; avoid in severe impairment.
Renal impairment
For all thiazides and related diuretics In general, manufacturers advise caution in mild to moderate impairment (risk of electrolyte imbalance and reduced renal function); avoid in severe impairment (ineffective if creatinine clearance less than 30 mL/minute). See Prescribing in renal impairment .
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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