Atenolol + Nifedipine

Indications

Atenolol + Nifedipine is used for: Hypertension, Angina pectoris

Adult Dose

Adult: PO Angina pectoris Per cap contains atenolol 50 mg and nifedipine (sustained release) 20 mg: 1 cap 2 times/day. Hypertension Per cap contains atenolol 50 mg and nifedipine (sustained release) 20 mg: 1 cap 1-2 times/day. Elderly: Per capsule contains atenolol 50 mg and nifedipine (sustained release) 20 mg: 1 capsule once daily. Hepatic impairment: Dose reduction may be required. Max dose: 1 capsule daily.

Child Dose

Renal Dose

Renal impairment: Dose reduction may be required. Max dose: 1 capsule daily. CrCl (ml/min) <15 Contraindicated.

Administration

Contra Indications

History of wheezing, asthma, obstructive respiratory disease, pronounced bradycardia (resting heart rate <50 beats/min prior to treatment), 2nd or 3rd degree heart block, sick sinus syndrome, SA block, systolic pressure <90 mmHg, overt or decompensated cardiac failure (NYHA grades III & IV), aortic stenosis, unstable angina, acute attacks of angina, acute MI or within 1 mth of MI, or for secondary prevention of MI, cardiogenic shock, severe peripheral arterial circulatory disorders, acidosis, severe renal impairment, untreated phaeochromocytoma, malignant hypertension. Lactation, pregnancy, women of child-bearing age.

Precautions

Conduction defects, poor cardiac reserve, controlled CHF, peripheral circulatory disorders, 1st degree heart block, mild heart failure (NYHA grade II), Prinzmetal's angina, renal or hepatic impairment. Discontinue use if heart rate is reduced at a dose of 1 capsule daily or if there is ischaemic pain within 1-4 hr of initiation of therapy. Withdraw gradually in patients with ischaemic heart disease. Adjustment in diabetic control may be required; may mask signs of thyrotoxicosis and modifies tachycardia of hypoglycaemia. Family history of psoriasis.

Pregnancy-Lactation

Interactions

Potentiate effects of other antihypertensives. Atenolol: Reduced hypotensive effect with pseudoephedrine, xylometazoline or NSAIDs. Additive effect with calcium antagonist and catecholamine-depleting drugs e.g. reserpine. Increase risk of bradycardia with amisulpride, flecainide, digitalis glycosides. Increase risk of hypotension with alprostadil, baclofen. Withdrawal of clonidine in patients receiving ?-blockers may result in rebound hypertension. Chlorthalidone: May alter insulin and dosage of oral hypoglycaemic agents required in diabetics. May reduce renal clearance of lithium and increases risk of lithium toxicity. May cause hypokalaemia therefore increase risk of digitalis toxicity. Risk of hypercalcaemia with paricalcitol. Increased risk of hypokalaemia with ritodrine, amphotericin B. Increased responsiveness to tubocurarine. Potentially Fatal: Atenolol: Bradycardia, heart block may occur when used with verapamil or diltiazem. Severe bradycardia, asystole and heart failure have been reported when used with disopyramide. High degree of cardiac depression may occur with methoxyflurane. Chlorthalidone: Risk of cardiac arrhythmias with ketanserin.

Adverse Effects

Side effects of Atenolol + Nifedipine : Headache, flushing, purpura, impotence, dizziness, GI upsets, oedema, fatigue.

Mechanism of Action

Atenolol is a beta 1-selective adrenergic receptor blocker. It has marked -ve inotropic and chronotropic effects which result in reduction of BP (particularly during exercise), myocardial oxygen demand and cardiac output. Nifedipine is a dihydropyridine calcium-channel blocker. It is a coronary and peripheral vasodilator, which reduces BP and peripheral resistance, and increases myocardial oxygen demand.