Amlodipine + Atenolol
Calcium Channel Blocker · Antihypertensive
Also known as Amlong-AT, Betacard-AM, Aten-AM, Amlovas-AT
- ONSET
- 1h · Amlodipine: Gradual, within hours. Atenolol: Within 1 hour.
- PEAK
- 9h · Amlodipine: 6-12 hours. Atenolol: 2-4 hours.
- t½
- 1.7d · Amlodipine: 30-50 hours. Atenolol: 6-9 hours; prolonged in renal impairment.
- DURATION
- 1d · Amlodipine: Approximately 24 hours. Atenolol: Approximately 24 hours.
Mechanism
Amlodipine, a dihydropyridine calcium channel blocker, inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle, leading to peripheral vasodilation and reduced peripheral vascular resistance. Atenolol, a selective beta-1 adrenergic receptor blocker, reduces heart rate and myocardial contractility, thereby decreasing cardiac output. The combination provides complementary actions, reducing blood pressure more effectively by targeting different physiological mechanisms. Combination rationale: This fixed-dose combination leverages the complementary actions of amlodipine and atenolol to achieve superior blood pressure control compared to monotherapy, often with a lower incidence of dose-dependent side effects. Amlodipine's peripheral vasodilation is balanced by atenolol's reduction in reflex tachycardia, while atenolol's cardiac depressant effects are mitigated by amlodipine's peripheral vasodilatory action, resulting in improved tolerability and enhanced antihypertensive efficacy, thereby improving patient compliance.
Indications
Dosing
- Adult
- Typically 1 tablet once daily orally. Common strengths available in India include Amlodipine 5mg + Atenolol 25mg or Amlodipine 5mg + Atenolol 50mg. Dosing should be individualized based on patient response and tolerability.
- Pediatric
- Not recommended for pediatric use as safety and efficacy have not been established.
- Renal adjustment
- Amlodipine requires no dose adjustment in renal impairment. For atenolol, dose reduction is necessary: for creatinine clearance (CrCl) 15-35 mL/min, reduce by half (e.g., alternate day therapy); for CrCl < 15 mL/min, reduce to one-fourth (e.g., every 3-4 days). Atenolol is removed by dialysis; administer dose after dialysis.…
Pharmacokinetics
Contraindications
- Bradycardia (heart rate < 50 bpm)
- Second or third-degree atrioventricular (AV) block
- Sick sinus syndrome (unless permanent pacemaker is in place)
- Cardiogenic shock
- Decompensated heart failure
- Severe hypotension
- Untreated pheochromocytoma
- Metabolic acidosis
- Severe peripheral arterial disease
- Bronchial asthma or severe chronic obstructive pulmonary disease (COPD)
- Hypersensitivity to amlodipine, atenolol, or any components of the formulation
Side effects
- Significant bradycardia or heart block
- Exacerbation of heart failure
- Severe hypotension
- Bronchospasm (in susceptible individuals)
- Hepatotoxicity (rare, amlodipine)
- Peripheral ischemia (rare)
- Allergic reactions (angioedema, rash)
Pregnancy & lactation
D (Based on Atenolol; Amlodipine is Category C). Atenolol use during the second and third trimesters of pregnancy has been associated with intrauterine growth retardation, prematurity, and neonatal bradycardia.
Both amlodipine and atenolol are excreted into breast milk. Atenolol appears in breast milk in concentrations higher than in maternal plasma, with potential for significant infant exposure, leading to bradycardia and hypoglycemia in the infant. Due to the potential for serious adverse reactions in nursing infants, breastfeeding is generally not recommended during treatment with this combination, or a decision should be made to discontinue the drug or discontinue nursing, taking into account the importance of the drug to the mother.
Related guidelines
Other Calcium Channel Blocker drugs
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