Atenolol nifedipine - oral


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
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.
Dosage Details
Oral
Angina pectoris
Adult: Per capsule contains atenolol 50 mg and nifedipine (sustained release) 20 mg: 1 capsule bid.

Oral
Hypertension
Adult: Per capsule contains atenolol 50 mg and nifedipine (sustained release) 20 mg: 1 capsule once or twice daily.
Elderly: Per capsule contains atenolol 50 mg and nifedipine (sustained release) 20 mg: 1 capsule once daily.
Renal Impairment
Oral:
Angina pectoris: Dose reduction may be required. Max dose: 1 capsule daily.
CrClDosage
<15Contraindicated.
Hypertension: Dose reduction may be required. Max dose: 1 capsule once daily.
CrClDosage
<15Contraindicated.
Hepatic Impairment
Oral:
Angina pectoris: Dose reduction may be required. Max dose: 1 capsule daily.
Hypertension: Dose reduction may be required. Max dose: 1 capsule once daily.
Contraindications
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.
Special 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.
Adverse Reactions
Headache, flushing, purpura, impotence, dizziness, GI upsets, oedema, fatigue.
Overdosage
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.
Drug Interactions
If used with clonidine, atenolol can worsen rebound hypertension following clonidine withdrawal. Reduced hypotensive effect of atenolol with ibuprofen and indometacin. May increase digoxin level and AV conduction time. Theophylline levels may be increased. Reduced efficacy of nifedipine with phenytoin, carbamazepine or phenobarbital. Increased plasma levels of nifedipine with cisapride, quinupristin/dalfopristin, nefazodone, valproic acid and other CYP3A4 enzyme inhibitors (e.g. erythromycin, ketoconazole, itraconazole, fluconazole, fluoxetine, protease 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 (e.g. isoprenaline) and α-adrenoceptor stimulants (e.g. noradrenaline). Nifedipine may reduce quinidine 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 (e.g. disopyramide and amiodarone).
Potentially Fatal: Exaggeration of bradycardia, hypotension and conduction disturbances with Ca-channel blockers with -ve inotropic effects (e.g. diltiazem and verapamil). 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.
Action
Description: 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.
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, remainder is via the faeces as inactive metabolites; plasma half-life: 6-11 hr (sustained release).
Storage
Store below 30°C. Protect from light and moisture.
Disclaimer: This information is independently developed by MIMS based on Atenolol + Nifedipine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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