Atenolol + Nifedipine

Atenolol + Nifedipine is an antihypertensive agent belonging to the Beta-Blockers / Calcium antagonists class.

Atenolol + Nifedipine is used to reduce high blood pressure levels (hypertension) which may be caused by genetic and/or environmental factors. It is also used in the treatment of angina pectoris, which is a type of heart disease characterized by chest pain or pressure and heaviness in the chest. It may be caused by various factors including emotional stress, smoking, coronary artery disease, etc.

Atenolol consistent but incomplete about 40-50% of a dose is absorbed from the GI tract. About 6-16% bound to plasma proteins. Enters breast milk & crosses placenta. Little or no hepatic metabolism. It is mainly excreted via the renal route and having a plasma half-life of about 6-7 hours.

Nifedipine almost completely absorbed from the GI tract. Nifedipine: is about 92-98% bound to plasma proteins. Enters breast milk. Nifedipine is extensive hepatic first-pass metabolism via CYP3A4 isoenzyme. Nifedipine is about 80-95% of dose excreted mainly in the urine, remainder is via the faeces as inactive metabolites and plasma half-life is about 6-11 hours (sustained release).

Atenolol + Nifedipine shows common side effects like Blurred Vision, Sweating, Tiredness, Dehydration, Constipation, Dizziness, Headache, Nausea, Cold hands or feet, Muscle cramps, Difficulty breathing, Tightness in the chest.

Atenolol + Nifedipine is available in the form of Oral Capsule.

Atenolol + Nifedipine is available in India, US, Singapore, Canada, China, Japan and Australia.

Atenolol + Nifedipine belonging to the Beta-Blockers / Calcium antagonists, acts as an antihypertensive agent.

Atenolol is a β₁-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.

The Data of onset of action of Atenolol + Nifedipine is not clinically established.

The Data of Tmax of Atenolol + Nifedipine is not available.

The Data of duration of Action of Atenolol + Nifedipine is approximately 12-24 hours.

Atenolol + Nifedipine is available in the form Oral Capsule.

Atenolol + Nifedipine Tablet is taken orally, usually once or twice daily.

Atenolol + Nifedipine is a combination medicine used for the treatment of mild to moderate hypertension (high blood pressure) and to prevent chest pain (angina). Patients are advised to maintain a strict exercise and diet regimen along with this medicine to get the best possible effect. This medicine is not recommended for use in patients less than 18 years of age.

Atenolol + Nifedipine is an antihypertensive agent belonging to the Beta-Blockers / Calcium antagonists class.

Atenolol is a β₁-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.

Atenolol + Nifedipine is approved for use in the following clinical indications

• Hypertension

Atenolol + Nifedipine is used to reduce high blood pressure levels (hypertension) which may be caused by genetic and/or environmental factors.

• Angina pectoris

Atenolol + Nifedipine is used in the treatment of angina pectoris which is a type of heart disease characterized by chest pain or pressure and heaviness in the chest. It may be caused by various factors including emotional stress, smoking, coronary artery disease, etc.

• Hypertension

Adult Oral Dose: Per capsule contains atenolol 50 mg and nifedipine (sustained release) 20 mg: 1 capsule once or twice daily.

• Angina pectoris

Adult Oral Dose: Per capsule contains atenolol 50 mg and nifedipine (sustained release) 20 mg: 1 capsule twice daily.

Atenolol + Nifedipine is available in the form of Oral Capsule.

• Dosage Adjustment in Kidney Patient

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

CrCl (ml/min) <15 is Contraindicated

• Dosage Adjustment in Hepatic impairment Patient

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

Avoid consumption of herbal products you are taking, especially St. John's wort.

Atenolol + Nifedipine is contraindicated in patients with

• Diabetes
• Low Blood Pressure
• Hyperthyroidism
• Asthma
• Kidney Disease
• Peripheral Vascular Disease (PVD)
• Glaucoma
• Myasthenia Gravis
• Tachycardia
• Heart Failure

• Do not use Atenolol + Nifedipine if you are allergic to Atenolol + Nifedipine or any of its components.
• Do not use Atenolol + Nifedipine if you have any history of severe kidney or liver diseases, low potassium levels (hypokalaemia), chest pain (angina), poor blood circulation or controlled heart failure, first-degree heart block, diabetes, thyrotoxicosis (a condition caused by an overactive thyroid gland), liver problems, and adrenal gland diseases.
• Do not use Atenolol + Nifedipine if you have anuria (kidneys aren't producing urine), fluid or electrolyte imbalance, lupus erythematosus (an autoimmune inflammatory disease-causing scaly red patches on the skin), gout, abnormal heart rhythms, thyroid disorders, and asthma.
• Do not use Atenolol + Nifedipine if you are a breastfeeding mother, since it may pass into the breast milk.
• Do not use Atenolol + Nifedipine if you plan to conceive or are pregnant.
• Atenolol + Nifedipine can increase the chances of light-headedness so rise slowly if you are sitting/lying and avoid operating any machine or doing any work that needs mental alertness.
• Atenolol + Nifedipine is not recommended in people less than 18 years of age.

Avoid consumption of alcohol along with Atenolol + Nifedipine as it is known to cause a blood pressure drop.

Women who are breastfeeding may experience severe harmful effects after taking Atenolol + Nifedipine. It should only be taken after medical advice.

Atenolol + Nifedipine has many dangerous side effects in pregnant women. If you are pregnant, do not consume Atenolol + Nifedipine without medical advice.

Avoid consumption of herbal products you are taking, especially St. John's wort.

Atenolol + Nifedipine is known to interact when taken with an anticancer drug (quinidine), antiepileptic medicine (phenytoin), anti TB drug (rifampicin), antibiotics (erythromycin), other blood pressure-lowering pills (chlorthalidone, ramipril, metoprolol, lisinopril, amlodipine, candesartan, baclofen, levodopa, clonidine) and anti-psychotic drugs (alprazolam, risperidone, amisulpride, pimozide), anti-HIV drug (nelfinavir, ritonavir, saquinavir or amprenavir), drugs used to treat insomnia or anxiety (Phenobarbital).

The common side effects of Atenolol + Nifedipine include the following

● Blurred Vision, Sweating, Tiredness, Dehydration, Constipation, Dizziness, Headache, Nausea, Cold hands or feet, Muscle cramps, Difficulty breathing, Tightness in the chest.

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.

Pharmacodynamic

Atenolol: Competitively and selectively blocks β₁-adrenergic receptors but has little or no effect on β₂-receptors except at high doses. It has negative inotropic effects without intrinsic sympathomimetic and membrane-stabilizing activities. Its mechanism of action in the treatment of hypertension is unclear but may be associated with reduction of cardiac rate and contractility.

Nifedipine: Nifedipine is an inhibitor of L-type voltage gated calcium channels that reduces blood pressure and increases oxygen supply to the heart. Immediate release nifedipine's duration of action requires dosing 3 times daily. Nifedipine dosing is generally 10-120mg daily. Patients should be counselled regarding the risk of excessive hypotension, angina, and myocardial infarction.

Pharmacokinetics

• 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, the remainder is via the faeces as inactive metabolites; plasma half-life: 6-11 hours (sustained release).

1. Solomon SA, Ramsay LE, Yeo WW, Parnell L, Morris-Jones W. Beta blockade and intermittent claudication: placebo-controlled trial of atenolol and nifedipine and their combination. British Medical Journal. 1991 Nov 2;303(6810):1100-4.
2. Akhras F, Jackson G. Efficacy of nifedipine and isosorbide mononitrate in combination with atenolol in stable angina. The Lancet. 1991 Oct 26;338(8774):1036-9.
3. Findlay IN, MacLeod K, Ford M, Gillen G, Elliott AT, Dargie HJ. Treatment of angina pectoris with nifedipine and atenolol: efficacy and effect on cardiac function. Heart. 1986 Mar 1;55(3):240-5.

• https://www.mims.com/india/drug/info/atenolol + nifedipine?type=full&mtype=generic
• https://www.apollopharmacy.in/salt/ATENOLOL+NIFEDIPINE
• https://www.myupchar.com/en/medicine/atenolol-nifedipine-p37143116#use_dose
• https://www.practo.com/medicine-info/cardules-plus-20-capsule-49550
• https://www.1mg.com/generics/atenolol-nifedipine-400361