Q: I am 42 years old. I take Tenoric 50. Does this medicine have any side effects?

A:Tenoric 50 is the brand name of a combination product that contains two ingredients: atenolol (a medicine that belongs to beta blockers class) and chlorthalidone, a diuretic. In the past five years, there has been a sea change in the way high blood pressure is treated. In terms of its safety and efficacy, beta blockers (such as atenolol) have been placed at fourth position, mainly because they can lead to development of diabetes. They should only be used when other medicines are either ineffective or not tolerated. As per globally accepted guidelines, patients below the age of 55 years (more so if they are sexually active males) should be initially prescribed a drug belonging to the ACE inhibitors group such as enalapril (sold under the brand name of BQL, Enam, etc) starting at 5mg daily and increasing gradually to 10mg, 1-2 times daily. If the response after three weeks is not adequate, then one of the following two drugs should be added: - A diuretic (that helps produce more urine and gets rid of salt) such as low-dose indapamide 1.5mg (a common brand name being Indicontin Continus) in the morning OR - Amlodipine 5mg (a common brand name being Amlodac etc.) once daily. Generally a two-drug regimen is adequate in most patients. The combined side effects of atenolol + chlorthalidone are: Cold extremities, bradycardia (low pulse rate), exertional tiredness, brochospasm (asthma type breathlessness), heart failure, stomach upset, gouty arthritis, photosensitivity, blood disorders, weakness, impotence, risk of developing diabetes, etc. It should be withdrawn if dry eyes or skin rash occurs. In general, one should avoid the use of fixed-dose combinations (FDCs). Medicines are discovered individually and are supposed to be taken separately. A huge number of irrational, illegal combinations of drugs are being sold in India; quite a few without mandatory approval of the Drugs Controller General, India (DCGI). Except in a few cases (such as TB medicines), it is always better to take medicines separately, so that dosage can be adjusted and side effects monitored.