Combicard

Combicard 5 mg + 50 mg Tablet: Each tablet contains Amlodipine + Atenolol 5 mg + 50 mg.

Combicard is a fixed-dose combination of Amlodipine and Atenolol. Amlodipine is a dihydropyridine calcium antagonist that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle; it has a greater efffect on vascular smooth muscle than on cardiac muscle. Amlodipine is a peripheral vasodilator that acts directly on vascular smooth muscle to cause a reduction in peripheral vascular resistance and reduction in blood pressure. Amlodipine reduces tone, decreases coronary vasoreactivity and lowers cardiac demand by reducing after load. Atenolol is a cardioselective beta-blocker. The cardio-selectivity is doserelated. Atenolol causes a reduction in blood pressure by lowering cardiac output, decreasing the plasma renin activity and sympathetic outflow from CNS. Atenolol also causes a reduction in myocardial oxygen demand by virtue of its negative inotropic and negative chronotropic effects.

• Patients with essential hypertension

• Patients with angina pectoris & hypertension as co-existing diseases

• Post-MI patients

• Patients with refractory angina pectoris where nitrate therapy has failed

The therapy is initiated with a single dose of Amlodipine 5 mg plus Atenolol 50 mg. Depending on the therapeutic response, titration of the dosage is recommended.

In elderly patients, it is advisable to initiate therapy with ½ tablet of the fixed-dose combination of Amlodipine & Atenolol, i.e., 2.5 mg of Amlodipine & 25 mg of Atenolol.

● Disopyramide: Atenolol reduces the clearance of disopyramide by 20%, potentially leading to additive negative inotropic effects on the heart.

● Ampicillin: Doses of 1 g and above may reduce Atenolol levels.

● Oral Antidiabetics and Insulin: Beta-blockers may decrease tissue sensitivity to insulin and inhibit insulin secretion, for example, in response to oral antidiabetics. Atenolol has less potential for these actions compared to other beta-blockers.

This combination is contraindicated in patients with:

● Hypersensitivity to either component

● Sinus bradycardia

● Second and higher-degree heart block

● Cardiogenic shock

● Hypotension

● Congestive heart failure

● Poor left ventricular function

The combination of Amlodipine and Atenolol is well tolerated. Overall side effects include fatigue, headache, edema, nausea, drowsiness, anxiety, and depression.

Overdose:

Though not well-documented, hypotension and, less frequently, congestive cardiac failure may occur in cases of overdose. Unabsorbed drugs may be removed by gastric lavage or administration of activated charcoal. Symptomatic treatment is recommended.

Pregnancy: The combination should be used during pregnancy only if the expected benefit outweighs the potential fetal risk.

Nursing Mothers: The combination should not be used by nursing mothers. If its use is considered necessary, breastfeeding should be discontinued.

● Bronchospasm: The combination should be used with caution in patients with airway obstruction.

● Renal Impairment: The combination can be used in patients with renal impairment. However, caution may be necessary if creatinine clearance is less than 30 ml/min, due to possible reduction in the excretion of unchanged Atenolol.

● Hepatic Impairment: Caution may be necessary in patients with severe liver damage due to the prolonged elimination half-life of Amlodipine.

● Drug Withdrawal: Since coronary heart disease may exist without being recognized, patients should be warned against stopping the drug suddenly. Any discontinuation should be gradual and under medical supervision.

Store in a cool and dry place below 30ºC. Protect from light and moisture.

Medicine: Keep out of reach of children.