This combination is indicated for:

• Patients with essential hypertension
• Patients suffering from both angina pectoris and hypertension
• Post–myocardial infarction (post-MI) patients
• Patients with resistant angina pectoris where nitrate therapy has been ineffective

This is a fixed-dose combination of amlodipine and atenolol. Amlodipine is a dihydropyridine calcium channel blocker that inhibits the entry of calcium ions into vascular smooth muscle and cardiac muscle cells, with a greater effect on vascular smooth muscle. It acts as a peripheral vasodilator, reducing vascular resistance and lowering blood pressure. It also decreases coronary artery tone, reduces vasospasm, and lowers cardiac workload by decreasing afterload.

Atenolol is a cardioselective beta-blocker whose selectivity depends on the dose. It lowers blood pressure by reducing cardiac output, suppressing renin release, and decreasing sympathetic nervous system activity. It also reduces myocardial oxygen demand through its negative inotropic and chronotropic effects.

The recommended dosage is Amlodipine and Atenolol 5/25 mg tablet once daily. If necessary, the dosage may be increased to 5/25 mg two tablets daily or as advised by the physicians. The dosage however should be individualized.

Disopyramide: Atenolol may decrease the clearance of disopyramide by about 20%, which can lead to additive negative effects on cardiac contractility.

Ampicillin: High doses (1 g or more) may reduce plasma levels of atenolol.

Oral antidiabetics & insulin: Beta-blockers may reduce insulin sensitivity and inhibit insulin release, especially in response to oral antidiabetic drugs. However, atenolol has a relatively lower risk of these effects.

This combination is contraindicated in patients with hypersensitivity to any component, sinus bradycardia, second or higher degree heart block, cardiogenic shock, hypotension, congestive heart failure, and impaired left ventricular function.

This combination is generally well tolerated. Common side effects may include fatigue, headache, edema, nausea, drowsiness, anxiety, and depression.

This combination should be used during pregnancy only if the expected benefit justifies the potential risk to the fetus. It is not recommended during breastfeeding. If treatment is essential, breastfeeding should be discontinued.

Bronchospasm: Use cautiously in patients with airway diseases.

Renal impairment: Can be used, but caution is required if creatinine clearance is below 30 mL/min due to reduced excretion of atenolol.

Hepatic impairment: Use with caution in severe liver disease, as amlodipine elimination may be prolonged.

Drug withdrawal: Sudden discontinuation should be avoided, especially in patients with coronary artery disease. Dose reduction should be gradual and monitored.

Although not well documented, overdose may lead to hypotension and, less commonly, congestive heart failure. Unabsorbed drug may be removed by gastric lavage or activated charcoal. Supportive and symptomatic treatment is recommended.

Combined antihypertensive preparations

Store below 30°C temperature, protected from light and moisture. Keep out of reach of children.