Atenolol with Nifedipine

(a ten' oh lole) (nye fed' i peen)

PCI - Contraindicated in pregnancy

LCI - Contraindicated in lactation

Molecule Info

 | See TERMINOLOGY & ABBREVIATIONS |

Indication(s) and Dosage

ANGINA PECTORIS  Adult: Per capsule contains atenolol 50 mg and nifedipine 20 mg: 1 capsule bid.  Renal impairment: Dose reduction may be required.  Max dose: 1 capsule daily.

CrCl

Dosage Recommendation

<15

Contraindicated.

Hepatic impairment: Dose reduction may be required.  Max dose: 1 capsule daily. Oral  Hypertension  Adult: Per capsule contains atenolol 50 mg and nifedipine 20 mg: 1 capsule once or twice daily.  Elderly: Per capsule contains atenolol 50 mg and nifedipine 20 mg: 1 capsule once daily.  Renal impairment: Dose reduction may be required.  Max dose: 1 capsule once daily.

CrCl

Dosage Recommendation

<15

Contraindicated.

Hepatic impairment: Dose reduction may be required.  Max dose: 1 capsule once daily.

Overdose

Symptoms: Bradycardia, hypoglycaemia, bronchospasm, hypotension and acute cardiac failure.  Treatment: Unabsorbed drug may be removed by gastric lavage, activated charcoal and a laxative.  Symptomatic treatment may be required.

Contraindications

History of wheezing, asthma, obstructive respiratory disease, pronounced bradycardia, 2nd or 3rd degree heart block, sick sinus syndrome, SA block, systolic pressure <90 mmHg, overt or decompensated cardiac failure, 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.

Special Precautions

Conduction defects, poor cardiac reserve, controlled CHF, peripheral circulatory disorders, 1st degree heart block, mild heart failure, 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.

Adverse Drug Reaction(s)

Headache, flushing, purpura, impotence, dizziness, GI upsets, oedema, fatigue.

Drug Interactions

If used with clonidine, atenolol can worsen rebound hypertension following clonidine withdrawal.  Reduced hypotensive effect of atenolol with ibuprofenand indometacin.  May increase digoxin level and AV conduction time. Theophylline levels may be increased.  Reduced efficacy of nifedipine withphenytoin, carbamazepine or phenobarbital.  Increased plasma levels of nifedipine with cisapride, quinupristin/dalfopristin, nefazodone, valproic acid and other CYP3A4 enzyme inhibitors.  May potentiate the action of non-depolarising muscle relaxants.  Vagal dominance may occur with anaesthetic agents with cardiac depressant effects.  Increased antihypertensive effect with cimetidine, TCAs, narcotics, barbiturates, nitrates or phenothiazines.  Additive myocardial depression with lidocaine, chloroform, procainamide, β-adrenoceptor stimulants and α-adrenoceptor stimulants.  Nifedipine may reducequinidine levels and increase tacrolimus levels.  Marked heart rate reduction with reserpine, methyldopa, clonidine, guanethidine.  Increased hypoglycaemia with insulin and Oral   antidiabetics.  Potentiation of atrial conduction time and -ve inotropic effect with class I anti-arrhythmics. Potentially Fatal: Exaggeration of bradycardia, hypotension and conduction disturbances with Ca-channel blockers with -ve inotropic effects.  Reduced efficacy of nifedipine with rifampicin.  Excessive increase in BP with MAOIs, adrenaline and noradrenaline.  

Food Interaction

Do not take with grapefruit juice as the bioavailability of nifedipine will be increased.

Lab Interference

Spectrophotometric values of urinary vanillylmandelic acid may be falsely increased by nifedipine.

Pharmacology

Atenolol is a β1-selective adrenergic receptor blocker. It has marked -ve inotropic and chronotropic effects which result in reduction of BP, 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.  Absorption: Atenolol: Consistent but incomplete; about 40-50% of a dose is absorbed from the GI tract.  Nifedipine: Almost completely absorbed from the GI tract.  Distribution: Atenolol: 6-16% bound to plasma proteins.  Enters breast milk & crosses placenta.  Nifedipine: 92-98% bound to plasma proteins.  Enters breast milk.  Metabolism: Atenolol: Little or no hepatic metabolism.  Nifedipine: Extensive hepatic first-pass metabolism via CYP3A4 isoenzyme.  Excretion: Atenolol: Mainly via renal route; plasma half-life: About 6-7 hr.  Nifedipine: 80-95% of dose excreted mainly in the urine, remainder is via the faeces as inactive metabolites; plasma half-life: 6-11 hr.

ATC Classification

C07AB03 - atenolol; Belongs to the class of selective beta-blocking agents.  Used in the treatment of cardiovascular diseases.  C08CA05 - nifedipine; Belongs to the class of dihydropyridine derivative selective calcium-channel blockers with mainly vascular effects.  Used in the treatment of cardiovascular diseases.

Brand/Product Info


Total Products : 1 
Brand Name Manufacturer/Marketer Composition Dosage Form Pack Size & Price
NIDIPRO Square Pharmaceuticals Ltd. Nifedipine 20mg + Atenolol 50mg Capsule 5x10's: 135.50 MRP