Each capsule contains atenolol BP 50 mg and nifedipine USP 20 mg.
Cardiovascular therapeutic agent (antihypertensive and antianginal).
Pharmacology: Atenolol has an energy-sparing effect on the myocardium by avoiding the response to excessive β-adrenoreceptor stimulation which occurs during reflex tachycardia. This protection causes a reduced influx of Ca++ through the receptor-controlled Ca++-conducting channels. The result is an energy-sparing mechanism which makes more energy available in the form of adenosine triphosphate (ATP), so that structure and functions are maintained. The calcium antagonist, nifedipine also limit Ca++ influx but their mode of action differs from that of the β-blockers in that, they interact directly with the Ca++-conducting channels. In the myocardium, this causes energy preservation; in the vasculature, it results in coronary and peripheral vasodilatation. The antihypertensive effect of the calcium antagonists is readily explicable in forms of their direct inhibitor effect on Ca++ influx in response to membrane depolarisation. As for the β-blockers, there is as yet no satisfactory explanations for their blood pressure-lowering effect; although inhibition of a cyclic adenosine monophosphate (cAMP)-dependent smooth muscle contraction mechanism may be involved.
In marked contrast to the blood pressure-lowering effect of either verapamil or diltiazem (both of which have a direct inhibitory effect on atrionodal conduction), the blood pressure-lowering effect of nifedipine is accompanied by reflex tachycardia caused by excessive sympathetic drive. Since the β-blockers attenuate this reflex-induced tachycardia, and because the vasculature is highly sensitive to the calcium antagonistic activity of the dihydropyridine-based calcium antagonists, combined therapy of calcium antagonists (nifedipine) and β-blockers offers an advantage in the management of either hypertension or ischemic heart disease.
Another benefit to be obtained from the combination is in the management of cardiovascular disorders is that whereas some β-blockers alter the LDL/HDL cholesterol rates and so creates conditions which may favour atherosclerotic plaque formation, the calcium antagonists slow atherosclerosis. Also, the combined use of β-blockers and calcium antagonist is particularly advantageous in the management of ischemic heart disease because the calcium antagonists slow down ischemia-induced catecholamine release from the myocardium. In the presence of β-blockade, a raised level of catecholamines in the coronary circulation would promote coronary vasoconstriction, although the β-selective agents might ameliorate this effect to some extent.
Mechanism of Action: Nifedipine inhibits the influx of calcium into the heart muscle cells, smooth muscle cells of the coronary arteries and peripheral arterioles (resistance vessels). Nifedipine brings about an improvement in the oxygen supply to the heart muscle with simultaneous reduction of oxygen requirements, thereby exerting an antianginal effect. Normalisation of elevated blood pressure is brought about by a reduction of peripheral resistance through the dilation of the arterioles.
Pharmacokinetics: Mean peak plasma nifedipine level, following administration of capsule is 40.9 ng/mL. The Cmax of 45.7 ng/mL is observed at 5.3 hrs (Tmax) after administration of one Beta-Nicardia capsule. The T½ elimination for Beta-Nicardia capsule is 9 hrs.
Mild to moderate hypertension; resistant hypertension; stable angina pectoris; hypertension not responding to single drug therapy or a calcium antagonist monotherapy is adequate.
Adults: 1 cap daily, increasing to 1 cap every 12 hrs if necessary.
Elderly: Maximum of 1 cap daily or as directed by the physician.
Hypertension: Adults: 1 cap daily or 2 caps if required.
Elderly: 1 cap daily (maximum).
Angina: Adults: 1 cap daily or 2 caps daily if required. Patients can use additional nifedipine or prophylactic nitrate therapy.
Elderly: 1 cap once or twice daily.
2nd or 3rd degree heart block; cardiogenic shock; overt heart failure; women of childbearing age; lactating mothers; co-administration with cardiac depressants eg, verapamil; unstable angina; severe aortic stenosis; within a month of postmyocardial infarction; wheezing; asthma.
Cardiac: Care is needed in patients with conduction defects or poor cardiac reserve. At start of therapy, patients may experience angina attacks or increase in frequency, duration and severity of angina attacks. There have been isolated reports of myocardial infarction.
Care is needed in co-administration with class I antiarrhythmic agents and with anaesthetics.
Avoid use in patients with reversible obstructive airways disease unless there are compelling clinical reasons. In such case, use with caution.
Caution when shifting patients from clonidine.
Withdrawal of Beta-Nicardia should be gradual in patients with ischemic heart disease.
Diabetes: Patients may require adjustment of their diabetic therapy. The tachycardia of hypoglycemia may be modified.
Hepatic or Renal Impairment: Beta-Nicardia is considered inappropriate in patients with marked renal impairment (ie, creatinine clearance <15 mL/min/1.73 m2, serum creatinine >600 micromoles/L). Care is needed in patients with marked hepatic impairment.
Use in children: Beta-Nicardia is not indicated for children.
Flushing, headache, fatigue, dizziness, dry eyes, skin rash, oedema, gingival hyperplasia, gynaecomastia. Rarely, hypersensitivity-type jaundice, impotency, mood changes.
Discontinue in case of myocardial infarction ischemic pain.
Headache, flushing, fatigue, dizziness and oedema may occur. Skin rashes and dry eyes have been reported with β-blockers, discontinue if they occur. Rare reports of jaundice and gingival hyperplasia with nifedipine which may regress on withdrawal of therapy.
Drug interaction with cimetidine, quinidine, rifampicin, digoxin, cardiodepressants, grapefruit juice.
Store below 30°C. Protect from light.
C07FB03 - atenolol and nifedipine ; Belongs to the class of selective beta-blocking agents in combination with other antihypertensives. Used in the treatment of cardiovascular diseases.
Beta-Nicardia cap
10 × 10's
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