Amdocal Plus 25

Indications

Amlodipine and Atenolol are used to manage:

• Essential hypertension
• Co-existing angina pectoris and hypertension
• Post-myocardial infarction (MI) patients
• Refractory angina pectoris unresponsive to nitrate therapy

Pharmacology

This medication combines Amlodipine, a dihydropyridine calcium antagonist, and Atenolol, a cardioselective beta-blocker. Amlodipine works by inhibiting calcium influx into vascular and cardiac muscle, primarily affecting vascular smooth muscle to reduce peripheral resistance and blood pressure. It enhances coronary blood flow by decreasing afterload and vasoreactivity. Atenolol lowers blood pressure through reduced cardiac output and decreased sympathetic activity, while its cardioselectivity lowers myocardial oxygen demand through negative inotropic and chronotropic effects.

Dosage & Administration

The standard dose is one Amlodipine 5 mg/Atenolol 25 mg tablet daily. Dosage may be increased to two tablets daily or adjusted as per physician recommendations. Dosing should be personalized based on individual needs.

Interaction

• Disopyramide: Atenolol can reduce disopyramide clearance, potentially causing additive negative inotropic effects.
• Ampicillin: High doses may lower Atenolol levels.
• Oral Antidiabetics and Insulin: Beta-blockers like Atenolol can decrease insulin sensitivity, though Atenolol is less likely to affect insulin secretion compared to other beta-blockers.

Contraindications

This medication is contraindicated for individuals with hypersensitivity to its components, sinus bradycardia, heart block, cardiogenic shock, hypotension, congestive heart failure, and poor left ventricular function.

Side Effects

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

Pregnancy & Lactation

Use during pregnancy only if the benefits outweigh the risks. Not recommended for nursing mothers; breastfeeding should be discontinued if the medication is deemed necessary.

Precautions & Warnings

• Bronchospasm: Use cautiously in patients with airway obstruction.
• Renal Impairment: Caution is advised if creatinine clearance is below 30 ml/min due to potential reduced Atenolol excretion.
• Hepatic Impairment: Exercise caution in severe liver damage due to prolonged Amlodipine elimination.
• Drug Withdrawal: Gradual discontinuation is recommended to avoid sudden withdrawal effects, especially in coronary heart disease patients.

Overdose Effects

Overdose may lead to hypotension or, rarely, congestive cardiac failure. Treatment includes gastric lavage or activated charcoal for unabsorbed drugs and symptomatic management.

Therapeutic Class

Combined Antihypertensive Preparations

Storage Conditions

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