DAROXIME 250 Price

Overview

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This medicine contains an important and useful components, as it consists of
Cefuroxime (as Aextil)is available in the market in concentration

Name

Amlodipine + Atenolol

Precaution

- **Caution in Heart Failure**: When using amlodipine in combination with atenolol, caution is required in patients with heart failure. Atenolol can reduce heart rate and contractility, while amlodipine can cause peripheral vasodilation. Together, they may worsen symptoms of heart failure in certain patients, especially if heart failure is not well-controlled. - **Hypotension**: Both amlodipine and atenolol lower blood pressure. Combining them can result in additive hypotension, increasing the risk of dizziness, lightheadedness, or fainting, especially when standing. Monitoring blood pressure regularly is crucial. - **Bradycardia**: Atenolol, a beta-blocker, can cause bradycardia (slow heart rate). Amlodipine, by dilating blood vessels, may indirectly cause reflex tachycardia. This combination could lead to a compensatory increase in heart rate, which may cause erratic heart rhythms or discomfort. - **Liver and Renal Function**: Both amlodipine and atenolol are metabolized by the liver, though atenolol is primarily excreted unchanged in the urine. Caution is advised when administering the combination to patients with hepatic or renal impairment, and regular monitoring is recommended. - **Diabetes**: Atenolol may mask signs of hypoglycemia in diabetic patients, while amlodipine can exacerbate swelling, which could complicate diabetes management. Close monitoring of blood sugar levels and careful adjustment of diabetes medications may be necessary. - **Elderly Patients**: Older adults are more sensitive to the effects of both medications, particularly the risk of hypotension, bradycardia, and dizziness. Initiating therapy at lower doses and gradual dose titration is recommended.

Indication

- **Hypertension**: Amlodipine and atenolol are commonly prescribed together for the treatment of hypertension. Amlodipine is a calcium channel blocker that helps relax blood vessels, while atenolol, a beta-blocker, reduces heart rate and decreases cardiac output. Together, they effectively lower blood pressure through complementary mechanisms. - **Angina Pectoris**: For patients with angina, the combination of amlodipine and atenolol can help prevent chest pain by reducing heart rate, contractility, and the oxygen demand of the heart, while also dilating the coronary arteries. - **Post-Myocardial Infarction (MI)**: The combination may be used in post-MI patients to prevent future cardiac events. Amlodipine can improve coronary blood flow, while atenolol reduces the workload on the heart, decreasing the likelihood of recurrence. - **Coronary Artery Disease (CAD)**: Amlodipine and atenolol are used in CAD patients to relieve symptoms like chest pain (angina) and to reduce the risk of future heart-related issues. - **Chronic Stable Angina**: This combination can reduce the frequency and severity of angina attacks by improving myocardial oxygen supply and reducing demand. - **Arrhythmias (Off-Label)**: Although not the first line of treatment, this combination may be used in certain arrhythmias when other medications are ineffective. Atenolol can control the heart rate, and amlodipine helps by maintaining adequate blood flow.

Contra indication

- **Severe Bradycardia**: Both amlodipine and atenolol may slow the heart rate. Combining them can be dangerous in patients with pre-existing bradycardia or heart block greater than first-degree. - **Severe Hypotension**: Contraindicated in patients with hypotension or low blood pressure (systolic blood pressure less than 90 mmHg) due to the risk of worsening hypotension from the combined vasodilation (amlodipine) and beta-blockade (atenolol). - **Asthma and COPD**: Atenolol, being a beta-blocker, can exacerbate bronchospasm and worsen conditions like asthma and COPD, so this combination should be avoided in patients with these respiratory conditions. - **Severe Peripheral Arterial Disease**: The combination of amlodipine and atenolol should not be used in patients with severe peripheral arterial disease, as amlodipine may worsen symptoms like claudication, and atenolol may reduce the heart's ability to compensate for reduced blood flow. - **Caution with Diabetes**: Atenolol can mask hypoglycemia symptoms, making it harder for diabetic patients to recognize low blood sugar levels, which may lead to dangerous consequences. While amlodipine doesn’t have the same effect, caution should still be exercised in diabetic patients. - **Uncontrolled Heart Failure**: In patients with decompensated heart failure, beta-blockers like atenolol should be used with caution. The vasodilatory effect of amlodipine may further decrease the already reduced blood flow, which can worsen heart failure symptoms.

Side Effect

- **Common Side Effects**: - Dizziness and lightheadedness, especially when standing up (orthostatic hypotension) - Fatigue or weakness - Swelling of the legs and feet (peripheral edema) - Bradycardia (slow heart rate) - Nausea or gastrointestinal discomfort - Cold hands or feet - Insomnia or vivid dreams (atenolol-related) - **Serious Side Effects**: - Severe hypotension or shock - Heart block or complete heart failure - Angina or chest pain due to excessive beta-blockade - Liver dysfunction (rare, requires monitoring of liver enzymes) - Severe bradycardia or worsening heart failure - Respiratory distress or bronchospasm (particularly from atenolol in asthma/COPD patients) - Shortness of breath or swelling due to worsening heart failure symptoms - **Electrolyte Imbalances**: Both drugs can cause imbalances like low potassium or sodium levels, which may require monitoring. - **Allergic Reactions**: Rare, but anaphylaxis or angioedema can occur with either medication, especially in patients with a history of drug allergies.

Pregnancy Category ID

17

Mode of Action

- **Amlodipine (Calcium Channel Blocker)**: Amlodipine inhibits the influx of calcium ions into smooth muscle cells of the arterial walls and cardiac muscle cells via L-type calcium channels. This causes smooth muscle relaxation, which results in vasodilation, reduced peripheral vascular resistance, and lower blood pressure. In addition, amlodipine helps to dilate the coronary arteries, improving oxygen supply to the heart muscle, which is beneficial in treating angina. - **Atenolol (Beta-Blocker)**: Atenolol works by blocking the beta-1 adrenergic receptors in the heart. This leads to a decrease in heart rate, contractility, and cardiac output, all of which reduce the heart's oxygen demand. Additionally, atenolol decreases renin release from the kidneys, lowering blood pressure. These combined effects help in controlling hypertension, angina, and post-MI conditions. - **Synergistic Effect**: When used together, amlodipine and atenolol complement each other. Amlodipine’s vasodilation improves blood flow to the heart and reduces vascular resistance, while atenolol reduces the heart’s workload by lowering the heart rate and contractility, leading to better control of both blood pressure and angina symptoms.

Interaction

- **Other Antihypertensive Drugs**: Combining amlodipine and atenolol with other antihypertensive drugs, such as ACE inhibitors or diuretics, can lead to an enhanced hypotensive effect. Blood pressure should be monitored closely to avoid excessive lowering. - **CYP3A4 Inhibitors**: Amlodipine is metabolized by the CYP3A4 enzyme. Drugs that inhibit this enzyme, such as ketoconazole or grapefruit juice, may increase amlodipine levels, potentially leading to excessive vasodilation and hypotension. - **CYP2D6 Inhibitors**: Atenolol is metabolized through the CYP2D6 pathway. Drugs like fluoxetine or quinidine that inhibit this enzyme may raise atenolol plasma concentrations, potentially leading to bradycardia or hypotension. - **NSAIDs**: Nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) can reduce the blood pressure-lowering effects of both amlodipine and atenolol. The combination of these medications should be used with caution, and blood pressure should be regularly monitored. - **Diuretics**: Diuretics (e.g., furosemide) used alongside amlodipine and atenolol can enhance the blood pressure-lowering effects but may also increase the risk of electrolyte imbalances like hypokalemia. - **Alcohol**: Alcohol can enhance the hypotensive effects of both amlodipine and atenolol, potentially causing dizziness, lightheadedness, or fainting. Moderate or minimal alcohol consumption is recommended.

Pregnancy Category Note

Information not available

Adult Dose

- **Hypertension**: For most adults, the starting dose is 5 mg of amlodipine once daily, combined with 25 mg to 50 mg of atenolol once daily. The doses may be adjusted depending on the response and tolerability. - **Angina**: For chronic stable angina, the combination typically starts with 5 mg of amlodipine once daily and 50 mg of atenolol once daily. Adjustments may be made based on symptom control. - **Post-Myocardial Infarction (MI)**: After an MI, the initial dose is usually 5 mg of amlodipine once daily and 50 mg of atenolol once daily. The dose of atenolol may be increased based on the patient’s tolerance and heart rate.

Child Dose

- **Children 6-17 years old**: The combination of amlodipine and atenolol is not typically used in children unless specifically recommended by a healthcare provider. Dosing in pediatric patients would be individualized based on the child’s condition, weight, and response to therapy. - **Children under 6 years**: The use of amlodipine and atenolol is not recommended for children under 6 due to the lack of safety data.

Renal Dose

- **Renal Impairment**: In patients with renal impairment, atenolol should be used cautiously, as it is excreted primarily by the kidneys. The dose of atenolol may need to be reduced, especially in severe renal dysfunction. Amlodipine, which is metabolized in the liver, does not require dose adjustment in renal impairment but should still be used with caution.

Administration

Information not available