Compound
The drug Tenorik contains 2 active ingredients: atenolol and chlorthalidone . Today, this drug is available in 2 dosages. 1 tablet may contain 50 mg of atenolol and 12.5 mg of chlorthalidone and 100 mg of atenolol and 25 mg of chlorthalidone , respectively.
The excipients in the drug include corn starch, lactose, sodium lauryl sulfate, polyvinylpyrrolidone , talc, as well as isopropanol , silicon dioxide and magnesium stearate. The film coating of the tablets consists of isopropanol, methylene chloride, hypromellose, talc, titanium dioxide, as well as petroleum jelly and macrogol.
Tenoric
The drug tenoric from the Indian pharmaceutical is a combination drug that has a long-term antihypertensive effect. Such a pronounced effect is due to the coordinated work of two pharmacologically active components: the beta-1 adrenergic blocker atenolol and the diuretic chlorthalidone.
Arterial hypertension is the most common cardiovascular disease in Russia, with which at least 40% of the entire population of the country are familiar to one degree or another. In this regard, the problem of adequate antihypertensive pharmacotherapy becomes particularly important. Clinicians are constantly searching for the most effective drugs and their combinations that can overcome the cardiovascular “epidemic”. Combinations of beta-blockers with diuretics are among the “oldest” and most studied. Among such pharmacological combinations, the drug tenoric occupies a prominent place on Russian pharmacy shelves. According to a pharmacoepidemiological study of patients suffering from arterial hypertension, conducted by scientists from the Russian State Medical University and the Research Institute of Cardiology, among all combined antihypertensive drugs, tenoric is one of the most affordable.
As already mentioned, the drug contains two active ingredients. Atenolol, a cardioselective beta-blocker, reduces the force of heart contractions and slows their frequency. Increasing the dose causes a decrease in the selectivity of the substance. Atenolol does not have internal sympathomimetic activity or membrane-stabilizing effect. The sulfonamide diuretic chlorthalidone promotes the excretion of sodium, chlorine, potassium and magnesium from the body. For the manifestation of the antihypertensive effect, the removal of the first is clinically significant. The therapeutic effect of tenorik after a single dose of the recommended dose lasts for 24 hours.
As the results of clinical studies have shown, the use of tenoric in patients with arterial hypertension led to an improvement in the clinical situation to a greater extent compared with taking atenolol alone or the sulfonamide diuretic indapamide. Tenoric reliably controlled blood pressure both during the day and at night, while atenolol controlled blood pressure only during the day.
Tenoric is available in tablets. The average daily dose of the drug in terms of atenolol is 100 mg; treatment is usually started with a dose of 50 mg. As practice has shown, increasing the dose of tenoric above 100 mg did not lead to a more pronounced decrease in blood pressure, therefore, if it is necessary to enhance the therapeutic effect, you can additionally include another antihypertensive drug from a different group in the pharmacotherapeutic course. Elderly patients should take lower doses of tenoric, and patients with renal failure should reduce the frequency of its use. After long-term drug courses, drug withdrawal is carried out smoothly, excluding abrupt cessation of use. It should be borne in mind that treatment with tenoric may mask conditions caused by excessive secretion of thyroid hormones and hypoglycemia. In smokers, the severity of the therapeutic effect of the drug is usually reduced. While taking tenoric, sensitization to allergens may develop, resulting in severe anaphylactic reactions. Atenolol, which is part of the drug, can reduce the secretion of tear fluid - this should be taken into account in patients who use contact lenses. Due to the possible impairment of glucose tolerance caused by chlorthalidone, tenoric should be used with caution in patients with diabetes mellitus.
Pharmacodynamics and pharmacokinetics
The combined use of atenolol and chlorthalidone slightly affects the pharmacokinetics and pharmacodynamics of each of the active ingredients of the drug.
Atenolol
Absorption and distribution When taking the drug orally, the active substance atenolol is approximately 45-50% absorbed from the gastrointestinal tract. Cmax of this active substance in blood plasma was recorded 2-3 hours after administration. The binding to plasma proteins is quite weak and amounts to only 5-15%.
Metabolism and excretion It has been proven that atenolol does not exhibit significant hepatic metabolism . More than 90% of atenolol , which is absorbed into the systemic circulation, is excreted from the body completely unchanged. And T1/2 reaches about 6-9 hours, but severe renal failure can cause an increase in this indicator, since the kidneys are the main organ through which atenolol .
Chlorthalidone
Absorption and distribution When taking the drug Tenoric orally, the active substance is chlorthalidone by 60-65%. absorbed from the gastrointestinal tract. Cmax is recorded in blood plasma after approximately 10-12 hours. Chlorthalidone has a strong binding to plasma proteins, which is approximately 70-75%.
Excretion Chlorthalidone is excreted by the kidneys and its T1/2 varies within 50 hours.
Contraindications
It is not recommended to use Tenoric tablets in the treatment regimen:
- with severe attacks of bradycardia ;
- in the presence of cardiogenic shock ;
- with severe and progressive arterial hypotension ;
- with metabolic acidosis ;
- with severe peripheral circulatory disorders;
- with AV blockade of the first and third degree;
- at SSSU ;
- with pheochromocytoma ;
- for heart failure (acute and chronic);
- with vasospastic angina (so-called Prinzmetal angina );
- with progressive bronchial asthma ;
- with obstructive bronchitis ;
- for diabetes mellitus ;
- for hypoglycemia ;
- for gout ;
- with myasthenia gravis ;
- for acute hepatitis ;
- in acute renal failure ;
- in childhood and adolescence up to 18 years of age;
- with hypersensitivity to the components of the drug.
Tenoretic®
Special instructions due to the beta-blocker (atenolol) included in the drug Tenoretic®:
Although Tenoretic® is contraindicated in decompensated heart failure (see section “Contraindications”), it can be used in those patients in whom signs of heart failure are under control, with caution should be exercised in patients with reduced ejection fraction.
Prescribe with caution to patients with first degree atrioventricular block, with Prinzmetal's angina (see section "With caution").
Although Tenoretik® is contraindicated in cases of severe peripheral circulatory disorders (see section “Contraindications”), it can also aggravate less severe peripheral circulatory disorders.
When using the drug, it is possible to mask tachycardia caused by hypoglycemia and mask the symptoms of thyrotoxicosis.
If bradycardia develops (heart rate less than 60 beats/min) with clinical symptoms, the dose of the drug should be reduced (the dose is determined by the attending physician).
Tenoretik® should not be abruptly discontinued in patients with coronary heart disease.
While taking the drug, hypersensitivity reactions are possible, including to allergens, angioedema and urticaria. Therefore, caution should be exercised when prescribing Tenoretic® to patients undergoing desensitization therapy. These patients may not respond to normal doses of epinephrine used to treat allergic reactions.
Although cardioselective beta-blockers have less effect on pulmonary function compared to non-selective beta-blockers, Tenoretic® should be administered with caution to patients with obstructive pulmonary diseases. If bronchial conduction deteriorates, Tenoretik® should be discontinued and therapy with beta-agonists (for example, salbutamol) should be prescribed.
Special instructions due to the action of chlorthalidone, which is part of the drug Tenoretic®:
Hypokalemia may occur while taking Tenoretic®. Potassium levels should be regularly monitored, especially in elderly patients, in patients taking cardiac glycosides for the treatment of chronic heart failure, in patients with an unbalanced diet (food low in potassium) or in patients with complaints of gastrointestinal disorders (vomiting, diarrhea). In patients taking cardiac glycosides, hypokalemia may predispose to cardiac arrhythmias.
Caution should be exercised when prescribing the drug to patients with severe renal failure (see section "Dosage and Administration").
Impaired glucose tolerance may occur. Caution should be exercised if the drug is used in patients with a known predisposition to diabetes mellitus.
Hyperuricemia may occur. Usually there is only a slight increase in serum uric acid concentrations, but in some cases the use of uric acid detoxifying agents may be necessary.
Side effects
When using Tenoric tablets in a treatment regimen, patients may experience discomfort from the following side effects:
From the cardiovascular system: from bradycardia, increased symptoms of heart failure, orthostatic hypotension, cold extremities, the appearance of arrhythmias, AV blockade, symptoms of intermittent claudication, Raynaud's syndrome.
From the central nervous system and peripheral nervous system: from confusion, dizziness, headache, mood swings, acute psychosis, hallucinations, paresthesia, sleep disturbances, increased fatigue, apathy, disorientation, visual impairment.
From the digestive system: from dry mouth, gastrointestinal disorders, increased levels of liver transaminases, hepatotoxicity with intrahepatic cholestasis, nausea (associated with the use of chlorthalidone), constipation, pancreatitis, anorexia.
From the hematopoietic system: leukopenia, purpura, thrombocytopenia, agranulocytosis, eosinophilia.
Dermatological reactions: alopecia, dry eyes, psoriasis-like reactions, exacerbation of psoriasis, skin rash, photosensitivity.
From the respiratory system: from bronchospasm .
From laboratory parameters: hyperuricemia, hyponatremia, hypokalemia .
Other: from an increase in the number of antinuclear antibodies, decreased potency, impaired glucose tolerance .
However, the drug Tenorik is most often well tolerated by patients. Side effects are rare and so mild that they are rather transient in nature.
Tenorik tablets: instructions for use
For adults, the average dose of Tenoric is most often prescribed, which is 100 mg, and the recommended starting dose is 50 mg once a day. For older people, Tenoric is most often prescribed in lower doses. In patients with impaired renal function, it is recommended to reduce the frequency of taking the drug if necessary. Please note that the instructions for use of Tenorik contain information that after a long course of treatment with Tenorik, withdrawal should not be carried out abruptly, but gradually.
Tenoric®
General precautions for atenolol and chlorthalidone
Renal dysfunction
Caution should be exercised when prescribing the drug to patients with renal failure. In patients with impaired renal function, Tenoric® should be prescribed after titrating the dose of the individual components of the drug, taking into account the degree of reduction in glomerular filtration rate.
Thiazide and thiazide-like diuretics may cause azotemia in patients with impaired renal function. Like other thiazide-like diuretics, chlorthalidone is ineffective when creatinine clearance is less than 30 ml/min.
Elderly age
In elderly patients, the drug should be used with extreme caution due to changes in the pharmacokinetics of both active substances.
In case of increasing bradycardia, arterial hypotension, atrioventricular block, bronchospasm, ventricular arrhythmias, severe liver and kidney dysfunction in elderly patients, it is necessary to reduce the dose or stop treatment.
In elderly patients, it is recommended to regularly monitor renal function (at least once every 4-5 months).
In patients with severe atherosclerosis of the cerebral and coronary arteries, the drug should be used with extreme caution due to the risk of severe arterial hypotension.
Other
The drug Tenoric® should not be used to relieve a hypertensive crisis.
The use of Tenoric® in patients with acute myocardial infarction is not recommended due to insufficient experience in clinical use.
Atenolol
Discontinuation of therapy and “oricochete syndrome” of arterial hypertension).
Medicines that deplete catecholamine stores (for example, reserpine or guanethidine) may enhance the effect of beta-blockers. Therefore, patients taking such combinations of drugs should be under constant medical supervision to detect a significant decrease in blood pressure or bradycardia.
Laboratory research
Atenolol should be discontinued before testing the content of catecholamines, normetanephrine and vanillylmandelic acid in the blood and urine, as well as the titer of antinuclear antibodies in the blood.
Chlorthalidone
Liver dysfunction
When using thiazide and thiazide-like diuretics in patients with impaired liver function, hepatic encephalopathy may develop.
In patients with severe liver failure or hepatic encephalopathy, the use of the drug is contraindicated.
In patients with mild to moderate hepatic impairment and/or progressive liver disease, the drug should be used with caution, since even a slight change in water and electrolyte balance can cause hepatic coma.
Water-electrolyte balance and metabolic disorders
Potassium
Hypokalemia may occur when taking thiazide and thiazide-like diuretics. Hypokalemia increases the risk of developing heart rhythm disturbances (including severe arrhythmias). In patients taking cardiac glycosides, hypokalemia increases the toxic effects of the latter and may predispose to cardiac arrhythmias.
Potassium levels should be regularly monitored, especially in elderly patients, in patients taking cardiac glycosides for the treatment of chronic heart failure, in patients with an unbalanced diet (foods low in potassium) or in patients with complaints of gastrointestinal disorders (vomiting, diarrhea). If hypokalemia occurs, appropriate treatment should be prescribed.
Sodium
Like other diuretics, chlorthalidone can rarely cause hyponatremia, sometimes leading to serious complications.
Calcium
Thiazide and thiazide-like diuretics can reduce the excretion of calcium ions by the kidneys, leading to a slight and temporary increase in calcium levels in the blood plasma. In some patients, with long-term use of diuretics, pathological changes in the parathyroid glands with hypercalcemia and hyperphosphatemia were observed, but without the typical complications of hyperparathyroidism (nephrolithiasis, decreased bone mineral density, peptic ulcer). Severe hypercalcemia may be a manifestation of previously undiagnosed hyperparathyroidism.
Because of their effect on calcium metabolism, thiazide and thiazide-like diuretics may affect laboratory parameters of parathyroid function. You should stop taking the drug before testing the function of the parathyroid glands.
Glucose
Impaired glucose tolerance may occur. Caution should be exercised if the drug is used in patients with a known predisposition to diabetes mellitus.
Uric acid
Hyperuricemia may occur when taking the drug. Usually there is only a slight increase in serum uric acid concentrations, but in some cases the use of uric acid detoxifying agents may be necessary.
In patients with gout, taking the drug may increase the frequency of attacks or worsen the course of gout. Careful monitoring of patients with gout and impaired uric acid metabolism (hyperurecemia) is necessary.
Lipids
With long-term use of thiazide and thiazide-like diuretics, the concentration of total cholesterol, low-density lipoprotein cholesterol and triglycerides in the blood plasma may increase.
Immune system disorder
There are reports that thiazide and thiazide-like diuretics may cause exacerbation or progression of systemic lupus erythematosus, as well as lupus-like reactions.
In patients receiving thiazide-like diuretics (including chlorthalidone), hypersensitivity reactions may occur even in the absence of a history of allergic reactions or asthma.
Photosensitivity
Cases of the development of photosensitivity reactions when taking thiazide and thiazide-like diuretics have been described. If photosensitivity occurs while taking the drug, treatment should be discontinued. If continued use of the drug is necessary, the skin should be protected from exposure to sunlight or artificial ultraviolet rays.
Overdose
In case of an overdose of Tenoric, the patient may experience severe discomfort from severe bradycardia, arterial hypotension, acute heart failure, bronchospasm, convulsions, and increased drowsiness.
To relieve these symptoms, in some cases, hospitalization in the ICU may be necessary, where gastric lavage . In case of severe arterial hypotension and severe shock, it is recommended to administer plasma or a plasma substitute, and in case of bronchospasm , use bronchodilators. If necessary, hemodialysis or hemoperfusion is also performed.
Interaction
Concomitant use of Tenoric with dihydropyridine ( Nifedipine ) and its derivatives may cause an increased risk of developing arterial hypotension , and in patients who suffer from latent heart failure, circulatory disorders may occur with this combination .
It is also necessary to avoid simultaneous use of cardiac glycosides and beta-blockers , as this can significantly increase AV conduction time.
Beta blockers can also provoke an exacerbation of rebound hypertension , which tends to occur after abrupt withdrawal of clonidine . If both drugs are indicated in the treatment regimen, then the use of beta-blockers must be stopped for several days before completing clonidine . If it is necessary to replace clonidine with a beta-blocker , then the latter is prescribed a couple of days after completion of therapy using clonidine .
Please note that beta blockers concomitantly with class 1 antiarrhythmic drugs, as additive cardiodepressive effects may occur with this combination.
The concomitant use of sympathomimetic drugs such as epinephrine (adrenaline), norepinephrine (norepinephrine) neutralize the effect of beta-blockers .
The hypotensive effect of beta-blockers also reduced by substances such as ibuprofen, indomethacin , which are classified as salicylates and NSAIDs. By the way, the use of large doses of salicylates enhances the toxic effect of these substances on the central nervous system.
Taking medications that contain lithium should also be avoided while using diuretics. This combination causes a decrease in the renal clearance of lithium.
An increased risk and rapid development of arterial hypotension can be provoked by a combination of beta-blockers and general anesthesia . There is also a risk of increased effects of curare-like muscle relaxants.
When taking the drug Tenorik together with MAO class inhibitors, it causes an increase in blood pressure.
When taking Tenoric tablets together with ACE inhibitors ( captopril, enalapril ), a sharp increase in the antihypertensive effect may occur at the initial stage of therapy.
When Tenorik is combined with GCS, amphotericin B, and furosemide, potassium excretion increases.
The effect of insulin and the effectiveness of oral hypoglycemic agents may be reduced when used simultaneously with Tenoric. That is why patients taking these medications need to regularly monitor their blood glucose levels.
Antihypertensive drugs such as tricyclic antidepressants, phenothiazines , as well as barbiturates, diuretics and vasodilators can enhance the antihypertensive effect of Tenorika tablets.
Taking beta-blockers together with calcium channel blockers has a negative inotropic effect and leads to the potency of this effect. decreased myocardial contractile function should be especially careful , since this treatment regimen can cause severe arterial hypotension , severe bradycardia and heart failure . Be careful! Do not use a calcium channel blocker for 48 hours after you stop taking beta blockers .
Severe bradycardia can also occur when Tenoric is co-administered with reserpine, clonidine, and guanfacine.
Please also pay special attention to the fact that taking two or more medications can either weaken or enhance the effectiveness of each other.
Description of the drug TENORIK
Slow calcium channel blockers (SCBs, e.g. verapamil, diltiazem)
- increased negative inotropic effect of atenolol, especially in patients with reduced myocardial contractility and/or with impaired sinoatrial or AV conduction. This may lead to the development of severe hypotension, bradycardia or heart failure. Slow calcium channel blockers should not be used intravenously within 48 hours after discontinuation of beta-blockers.
Class I antiarrhythmic drugs (disopyramide) and amiodarone
- it is possible to increase the atrial conduction time and enhance the negative inotropic effect of atenolol; the cardiodepressive effect may be additive.
Norepinephrine (norepinephrine), epinephrine (adrenaline)
- possible significant increase in blood pressure
Cardiac glycosides, reserpine, alpha-methyldopa, guanfacine or clonidine
- due to the possible appearance of potassium and/or magnesium deficiency in connection with taking this combination of beta-blockers, the sensitivity of the heart muscle to cardiac glycosides may increase, and, accordingly, the frequency of their side effects may increase.
Clonidine
- Abrupt withdrawal of clonidine can lead to an increase in blood pressure, so discontinuation of clonidine should be done gradually and only a few days after discontinuation of beta-blockers.
Tricyclic antidepressants, barbiturates, phenothiazines, diuretics, vasodilators and other antihypertensive drugs, ethanol
- the antihypertensive effect may be enhanced.
ACE inhibitors (captopril, enalapril)
- at the beginning of therapy, a sharp increase in the antihypertensive effect of the drug is possible.
Salicylates and other NSAIDs
- a decrease in the antihypertensive effect of beta-blockers is possible, and with a high dose of salicylates - an increase in the toxic effect of salicylates on the central nervous system. With simultaneous use of this combination with NSAIDs, the diuretic and hypotensive effects may be weakened.
Lithium
- decreased excretion of lithium and increased cardio- and neurotoxic effect of lithium.
Curare-like muscle relaxants (tubocurarine)
- it is possible to strengthen or weaken the neuromuscular blockade.
GCS, carbenoxolone, amphotericin B, furosemide
- it is possible to increase the excretion of potassium ions.
Allopurinol
- may increase the incidence of hypersensitivity reactions to chlorthalidone.
Lorthalidone may increase the risk of adverse reactions due to amaptadine.
Anticholinergic drugs (eg, atropine, biperiden) may increase the bioavailability of chlorthalidone, reducing gastrointestinal motility and gastric emptying.
The pharmacological effects of calcium salts and vitamin D may be increased to clinically significant levels when used concomitantly with chlorthalidone.
Concomitant use with cyclosporine increases the risk of developing hyperuricemia and complications such as gout.
Cholestyramine interferes with the absorption of chlorthalidone (the pharmacological effect of chlorthalidone may be reduced).
The simultaneous use of chlorthalidone with methotrexate and cyclophosphamide can lead to potentiation of the pharmacological effect of anticancer drugs. Interactions caused by the combination of chlorthalidone and atenolol, which are part of the drug Atenolol compositum San dose*.
Insulin and hypoglycemic agents for oral administration, the effect of the latter may be enhanced. It is necessary to regularly monitor the concentration of glucose in the blood, since signs of hypoglycemia (tremor, tachycardia) may be masked or weakened by taking Atenolol compositum Sandozk
Drugs for general anesthesia: enhancing the antihypertensive effect and summing up the negative inotropic effect of both drugs. Slow calcium channel blockers (SCBs), dihydropyridine derivatives (for example, nifedipine): the risk of arterial hypotension may increase; in patients with latent heart failure, signs of circulatory disorders may appear . Baclofen: may enhance antihypertensive effect
Reviews of Tenorique
Tenorik's average rating on the forums is only 3.3 on a 5-point scale.
The main advantages of the drug Tenorik forum visitors include:
- efficiency;
- low price.
Discussion participants believe that the disadvantages of this drug are that these blood pressure pills:
- may become a cause of hair loss and impotence ;
- cause convulsions .
Having analyzed the reviews of doctors about Tenorik on the forums, we can conclude that before starting to use it, it is necessary to consult with your doctor. Also, reviews of Tenorik often contain a recommendation that older people should not take this drug.
In search engines, one of the most common questions is “Tenoric Tablets for what?” Experts answer that these tablets are used in treatment regimens exclusively for arterial hypertension.
There is no information about the drug Tenoric on Wikipedia.
TENORIC (tablets)
And my husband took pills only when his blood pressure increased—about 50-100 mg.
And it always helped. The photo shows packages of 50 and 100 mg tablets. All the time I used to buy 50 mg tablets, and if necessary, I took two tablets. Prices (50 mg) have fluctuated greatly in recent years (we live in the Rostov region) from 130 to 200 rubles. In April 2021, I bought it at this price (pictured) - that is, the price has decreased. And it turned out that taking 100 mg tablets is more profitable.
Tenoric is a medicine made in India. For me this is a big plus. We were in India (Goa) in 2014 and brought a lot of medicines with us. All tourists take them from there - there are practically no counterfeits, all medicines are “fresh”, unlike our pharmacies. And they have a shelf life of 3 years. It was the tenor player that was not brought. But if we end up in India again (we dream!), we will definitely bring the entire set of medicines we need. As we can see on the label, the active ingredients are the same atenolol I previously took plus chlorthalidone (a diuretic). All details about the properties, methods of use, interactions with other medications and contraindications are written in the attached instructions. Now, in general, if a doctor prescribes some medicine, I don’t immediately run to the pharmacy to buy it. And first I study everything very carefully (I find the same instructions on the Internet), and also read reviews about the application. I started doing this after one day, after a severe allergic reaction (swelling of the throat, tongue, swollen lymph nodes), one unfortunate doctor prescribed me a medicine, which, as I found out later, could lead to very sad consequences. In short, tenoric is a combined antihypertensive drug, beta blocker + diuretic. In simple terms, it is intended to reduce blood pressure, but it, like regular atenolol, also reduces the heart rate, that is, it fights tachycardia.
The package contains two of these tablets. Moreover, each tablet corresponds to one day of the week. Comfortable. They don’t take more than one tablet a day, so you won’t forget whether you took it today. I now take a pill in the morning, but sometimes I forget whether I took it or not. It is recommended to consume it before meals, with plenty of water.
At the beginning of this year, my attacks (pain in the heart area) became more frequent and my heart rate increased to 100-110. I also added anaprilin to the tenoric to reduce the heart rate. Pulse decreased. Then I went to a cardiologist at a private medical center, took tests, and was examined. The doctor prescribed me a course of treatment for a month (five types of medicines a day), and replaced Tenoric with Betaloc, Diroton and Veroshpiron, explaining that these were good, European, proven brands. I honestly drank for a month, measuring my blood pressure and pulse twice a day, my pulse stabilized, but for some reason my blood pressure became even higher. Maybe the medicine you bought was expired? I took it twice from different pharmacies in the city, the expiration date has not yet passed, but the release date is 2021. The second cardiologist I contacted advised me to continue the prescribed treatment by increasing the dose of the main tablets (from 50 to 100 mg). And he also said that now “nobody will write you a tenor.” But when one day the pressure rose to 200120 (with an increased dose of medication) and I had to call an ambulance, I again returned to the tenor. And now my blood pressure and pulse are at normal levels. I only take one 100 mg tablet and nothing else. Almost simultaneously, a cardiologist from a private medical center in Moscow also canceled tenoric for my sister, saying that it was “yesterday and a medicine for the poor.” But the Concor prescribed to her also did not quite suit her, as it reduced her heart rate too much. So, you still need to, following the advice and prescriptions of doctors, listen to your body and choose what suits you. All the best to you, don't get sick.
Tenorika price, where to buy
The average price of Tenorik in Ukraine is 35 UAH.
You can buy the medicine Tenorik in Moscow for 102 rubles.
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
- Online pharmacies in KazakhstanKazakhstan
ZdravCity
- Tenoric tablets p.p.o.
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Pharmacy24
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- Tenoric tablets Tenoric tablets. 62.5 mg No. 28 India, IPCA
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