Hypertension not controlled by monotherapy, patients with angina pectoris & hypertension as co-existing diseases, Post MI, Refractory angina pectoris where nitrate therapy has failed.
Beta-blocker + Calcium-channel blocker; Antihypertensive
This is a fixed-dose combination of Amlodipine and Atenolol. Amlodipine is a dihydropyridine calcium antagonist that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle; it has a greater effect on vascular smooth muscle than on cardiac muscle. Amlodipine is a peripheral vasodilator that acts directly on vascular smooth muscle to cause a reduction in peripheral vascular resistance and reduction in blood pressure. Amlodipine reduces tone, decreases coronary vasoreactivity and lowers cardiac demand by reducing afterload.
Atenolol is a cardioselective beta-blocker. The cardio-selectivity is dose-related. Atenolol causes a reduction in blood pressure by lowering cardiac output, decreasing the plasma renin activity and sympathetic outflow from CNS. Atenolol also causes a reduction in myocardial oxygen demand by virtue of its negative inotropic and negative chronotropic effects.
Initiated with a single dose of Amlodipine 5 mg + Atenolol 50 mg. Depending upon the therapeutic response, titration of the dosage is recommended. In elderly patients, it is advisable to initiate the therapy with Amlodipine 5 mg + Atenolol 25 mg tablet.
Disopyramide: Atenolol reduces the clearance of disopyramide by 20%. Additive negative inotropic effects on the heart may be produced.
Ampicillin: at doses of 1 gm and above may reduce Atenolol levels.
Oral antidiabetics and insulin: Beta-blockers may decrease tissue sensitivity to insulin and inhibit insulin secretion e.g. in response to oral antidiabetics. Atenolol has less potential for these actions.
Hypersensitivity to any of the components. Bronchospasm: The combination should be used with caution in patients with airway obstruction. Renal Impairment: Caution may be necessary if the creatinine clearance is less than 30ml/min. Hepatic impairment: Caution may be necessary in the use of the combination in patients with severe liver damage. Drug withdrawal: Any discontinuation should be gradual & under observation.
Well tolerated. Overall side effects include fatigue, headache, edema, nausea, drowsiness, anxiety & depression.
Pregnancy: The combination should be used during pregnancy only if the expected benefit outweighs the potential foetal risk. Lactation: Nursing mothers should not use the combination. If its use is considered necessary, breast feeding should be stopped.
Though not documented, hypotension and less frequently congestive cardiac failure may occur in cases of overdosage. Unabsorbed drugs may be removed by gastric lavage or administration of activated charcoal. Symptomatic treatment is suggested.
Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.
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