Twincard 50/25

Introduction
Twincard 50/25 is a medicine used to treat hypertension (high blood pressure). Twincard 50/25 is a combination of two medicines that helps to control blood pressure when a single medication is not effective. It helps to reduce chances of any future heart attack and stroke. Twincard 50/25 is taken with or without food, preferably in the morning to avoid frequent urination at night. Keep taking it for as long as advised by your doctor. Even if you feel well, do not stop this medicine on your own because high blood pressure often has no symptoms. If you stop taking it, your condition may get worse. Keeping active with regular exercise, reducing your weight and eating a healthy diet will also help control your blood pressure. Follow your doctor’s advice while taking this medicine. Nausea, headache, and fatigue are some common side effects of this medicine. Consult your doctor If any of these bother you, or get worse, or do not go away. Drink plenty of fluids while taking medicine to overcome muscle weakness, dry mouth, and extreme thirst. Dizziness or headache may occur due to low blood pressure but this gets better with time. Before taking it, let your doctor know if you have any liver or kidney problems. Pregnant or breastfeeding women should also consult their doctor for advice before taking this medicine. You also need to tell your doctor what other medicines you are taking especially those used to treat high blood pressure or heart conditions. You should have your blood pressure, kidney function, blood sugar level and the levels of salts such as potassium or magnesium checked regularly to make sure that this medicine is working properly.

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Uses of Twincard 50/25
Hypertension (high blood pressure)
Side effects of Twincard 50/25
Common
Nausea
Diarrhea
Headache
Fatigue
Dizziness
Cold extremities
Increased blood uric acid
Decreased potassium level in blood
Glucose intolerance
Slow heart rate
Decreased sodium level in blood
Decreased magnesium level in blood
Increased calcium level in blood
Increased blood lipid level
How to use Twincard 50/25
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Twincard 50/25 may be taken with or without food, but it is better to take it at a fixed time.
How Twincard 50/25 works
Twincard 50/25 is a combination of two blood-pressure lowering medicines: Atenolol and Chlorthalidone. Atenolol is a beta blocker which works specifically on the heart to reduce heart rate and make the heart more efficient at pumping blood throughout the body. Chlorthalidone is a diuretic which lowers blood pressure by removing extra water and certain electrolytes from the body. Over time it also relaxes blood vessels and improves blood flow.
Quick Tips
It is a combination of two blood pressure lowering medications used for the treatment of high blood pressure.
It can be taken with or without food.
Do not stop taking Twincard 50/25 suddenly as it can cause your blood pressure to rise suddenly thereby increasing the risk of heart attack and stroke.
It may cause dizziness. If this happens to you, get up slowly when rising from a sitting or lying position.
It can hide symptoms of low blood sugar if you’re diabetic. Monitor your blood sugar levels regularly.
Twincard 50/25 may cause dehydration. Drink plenty of fluids and Inform your doctor if you develop extreme thirst, muscle weakness or very dry mouth.
Brief Description
Indication
Adult: Per tab contains Atenolol (mg)/Chlorthalidone (mg): 50/25 or 100/25. Initially one tab of 50/25 once daily; may increase to one tab of 100/25 based on response.

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Administration
Concomitant admin w/ reserpine may increase hypotension and bradycardia. Additive w/ Ca channel blockers, hydralazine, methyldopa. Increased risk of bradycardia and heart block w/ verapamil and diltiazem. May decrease hypotensive effects w/ NSAIDs (e.g. indometacin). Enhanced bradycardic effect w/ disopyramide, amiodarone or digitalis glycosides. May exacerbate rebound HTN upon discontinuance of clonidine treatment.
Adult Dose
Bronchospastic disease, renal or hepatic impairment, elderly. May aggravate peripheral arterial circulatory disorder. Beta-blocker can depress myocardial contractility; continued use in patients without history of cardiac failure may in some cases, lead to cardiac failure. Caution in patients receiving anaesthetic agents that may depress myocardium. In patients with coronary artery disease, abrupt withdrawal may cause angina pectoris exacerbation, MI. Atenolol may mask signs (tachycardia) of hypoglycaemia and thyrotoxicosis. Latent DM may manifest with Chlorthalidone therapy. Chlorthalidone can cause hyperuricaemia and precipitate gout. Monitor renal functions, potassium levels, and signs of fluid and electrolytes imbalance. Discontinue if progressive renal impairment is evident. Not recommended in pregnancy and lactation. Safety and efficacy in paediatric patients have not been established. Lactation: excreted in breast milk, use caution

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Renal Dose
Atenolol is a beta-blocker that acts preferentially on the ?1 adrenergic receptors in the heart. Chlorthalidone is a thiazide-like diuretic that reduces BP possibly by inhibiting sodium reabsorption at the beginning of the distal convulated tubule. Combination of the two drugs results in additive antihypertensive action.
Precaution
Hypertension
Side Effect
Renal impairment: CrCl (ml/min) 15-35 Max dose of Atenolol component: 50 mg/day <15 Max dose of Atenolol component: 50 mg every other day. _ Pregnancy Category Note Atenolol: Dyspnoea, wheeziness, bradycardia, hypotension, cold extremities, fatigue, dizziness, insomnia, lethargy, confusion, headache, depression, nightmares, nausea, diarrhoea, constipation, impotence, paraesthesia, rash, Raynaud's phenomenon. Chlorthalidone: Orthostatic hypotension, GI disturbances, jaundice, pancreatitis, vertigo, lethargy, paraesthesia, photosensitivity, rash, muscle cramps, hypokalaemia, hyponatraemia, hyperglycaemia, hyperuricaemia or gout, leucopenia, agranulocytosis, aplastic anaemia, thrombocytopenia. Potentially Fatal: Atenolol: Heart failure, 2nd or 3rd degree AV block. Chlorthalidone: Hypersensitivity reaction including toxic epidermal necrolysis. _ Interaction Sinus bradycardia, 2nd or 3rd degree heart block, cardiogenic shock, anuria, hypersentivity to either product or sulphonamide derivatives.