Indications

This is indicated in-

• Essential hypertension patients
• Post-Ml patients with angina pectoris and hypertension as co-existing disorders
• In individuals with refractory angina pectoris who have failed to respond to nitrate treatment.

Pharmacology

This is an Amlodipine and Atenolol fixed-dose combo. Amlodipine is a dihydropyridine calcium antagonist that blocks calcium ion transmembrane influx into vascular smooth muscle and cardiac muscle. It has a stronger effect on vascular smooth muscle than cardiac muscle. Amlodipine is a peripheral vasodilator that reduces peripheral vascular resistance and blood pressure by acting directly on vascular smooth muscle. By reducing afterload, amlodipine reduces tone, decreases coronary vasoreactivity, and lowers cardiac demand.

Atenolol is a beta-blocker that is cardioselective. Cardio-selectivity is dosage dependent. By lowering cardiac output, decreasing plasma renin activity, and decreasing sympathetic outflow from the CNS, atenolol lowers blood pressure. By virtue of its negative inotropic and negative chronotropic actions, atenolol reduces myocardial oxygen demand.

Dosage & Administration

The recommended dosage is Amlodipine and Atenolol 5/25 mg tablet once daily. If necessary, the dosage may be increased to 5/25 mg two tablets daily or as advised by the physicians. The dosage however should be individualized.

Interaction

Disopyramide: Atenolol lowers disopyramide clearance by 20 percent. It’s possible that additive negative inotropic effects on the heart will occur.

At doses of 1 gm and above, ampicillin may lower Atenolol levels.

Oral antidiabetics and insulin: Beta-blockers may reduce insulin sensitivity and suppress insulin production in response to oral antidiabetics, for example. These actions are less likely with atenolol.

Contraindications

Sinus bradycardia, second and higher degrees of heart block, cardiogenic shock, hypotension, congestive heart failure, and poor left ventricular function are all symptoms of hypersensitivity to any component.

Side Effects

Amlodipine and Atenolol in combination are well tolerated. Fatigue, headache, edema, nausea, sleepiness, anxiety, and depression are all common adverse effects.

Pregnancy & Lactation

Only if the predicted benefit surpasses the potential fetal danger should the combo be used during pregnancy. Nursing mothers should avoid using this combo. Breast-feeding should be discontinued if its usage is deemed necessary.

Precautions & Warnings

Bronchospasm: The combination should be used with caution in patients with airway obstruction.

Renal impairment: The combination can be used in patients with renal impairment. However, caution may be necessary if the creatinine clearance is less than 30 ml/min because of a possible reduction in the excretion of unchanged Atenolol.

Hepatic impairment: Because Amlodipine’s elimination half-life is prolonged in individuals with significant liver disease, caution should be exercised when using the combo.

Because coronary heart disease can go undetected for years, patients should be counseled against abruptly quitting their medication. Any withdrawal should be done slowly and carefully.

Therapeutic Class

Antihypertensive medications in combination.

Storage Conditions

Keep the temperature below 30°C and away from light and moisture. Keep out of children’s reach.

Pharmaceutical Name

Beximco Pharmaceuticals Ltd.

Generic

Amlodipine Besilate + Atenolol