Nifedipine + Atenolol Pharmacology
Nifedipine + Atenolol
Nifedipine
Migraine: It is used in migraine by reducing intracellular Ca+2 overload due to brain hypoxia and other causes.
2 to 3minutes for sublingual
2 to 3minutes for sublingual
2.Palpitation
3.Hypotension
4.Nausea
5.Edema
6.Headache
7.Dizziness
8.Fatigue
9.Orthostatic hypotension
10.Leg cramps
11.Rashes
12.Gingival hyperplasia
13.Congestive heart failures
2.Heart failure
3.Aortic stenosis
4.Hypotension
5.Cardiogenic shock
6.Hypersensitivity to the drug
7.Unstable angina
8.Coronary artery diseases
2.Cardiovascular insufficiency
3.Hypotension
4.Left ventricular outflow obstruction
5.Hepatic impairment
6.Slowly withdraw the drug with caution
7.Use cautiously along with other antihypertensive drugs
8.Diabetes mellitus
2.Hypertensive emergencies
3.Prinzmetal`s angina and Stable angina
4.As Tocolytic agent
5.In mountain sickness
6.Bronchial asthma
7.Peripheral vascular disorders
8. Migraine prophylaxis
9.Oesophageal spasm
Beta-blockers: Though advantageous in some, concomitant use results in increased adverse effects like bradycardia and conduction disturbances.
Digitalis Glycosides: Increased serum digoxin levels with pssible toxicity.
Magnesium Sulphate: With parenteral magnesium suplhate neuromuscular blockade and hypotension may occur.
Theophyllines: Increased pharmacological effects of theophylline, resulting in toxicity.
Quinidine: Hypotension, bradycardia, ventricular tachycardia, AV block and pulmonary oedema may occur. Serum quinidine levels may also be decreased by nifedipine.
Anticoagulants: Increased prothrombin time.
Fentanyl: Severe hypotension or increased fluid requirements.
Maximum daily dose: 120mg
Hypertension: 20mg twice daily or 30 to 60mg once daily extended release formulations. Adjust the dosage based on patient`s response.Maximum dose: 4omg twice daily
Maximum dose for extended release formulations: 120mg/day
Emergency reduction of blood pressure: Chew 10mg tablet and at the same time swallow another 10mg tablet. Repeat at every 20 to 30minutes.
As Tocolytic: 10mg sublingually and repeat at 20minutes for 2 to 3 doses.
Maintenance dosage: 10 to 20mg orally every 4 to 6 hours
Children:
For hypertensive emergencies: 250mcg to 500mcg/kg/dose 3 to 4 times daily.
Atenolol
Antimigraine action: Atenolol is useful in migraine due to its beta blockade action. Through beta blockade action it inhibits vasodilation and relieves migraine.
2.Gastrointestinal problems
3.Nausea
4.Tiredness
5.Sinus bradycardia
6.Depression
7.Rash
8.Dizziess
9.Fatigue
10.Vomiting
11.Diarrhoea
12.Bronchospasm
13.Fever
14.Leg pain
15.Changes in kidney function tests
16.Changes in liver function tests.
2.Second or third degree heart block
3.Heart failure
4.Cardiogenic shock
5.Sinus bradycardia
2.Hepatic impairment
3.Renal impairment
4.The drug should be gradually withdraw with caution
5.Bronchospastic disorders
6.Diabetes mellitus
7.Hyper thyroidism
2. Angina
3.Myocardial infarction
4.Migraine prophylaxis
Analgesics: NSAIDs antagonise hypotensive effect.
Antibacterials (Rifampicin): Reduce plasma concentration of atenolol.
Antidiabetics: Enhanced hypoglycemic effect.
Antihypertensives: Enhanced hypotensive effect, with clonidine there is increased severity of rebound hypertension.
Calcium channel Blockers: increased risk of bradycardia and AV block with diltiazem, severe hypotension and heart failure with verapamil, nifedipine
Cardiac glycosides: Increased AV block and bradycardia.
Cholinergics: Effects antagonised by atenolol.
Corticosteroids: Antagonism of hypotensive effect.
Ergotamine: Increased peripheral vasoconstriction
Sympathomimetics: Severe hypertension with adrenaline and noradrenaline.
Lab. Tests: Interferes with Glucose or insulin tolerence tests.
Children: 1 to 1.3 mg/kg/day once daily or as two divided doses
Angina: Starts with 50mg single dose orally, and then gradually increases to 100mg/day based on patient`s response at one week intervals
Maximum dose: 200mg/day
Myocardial infarction: 5mg I.V. over 5minuts twice daily at 10minuts intervals. Then after 10minuts starts oral therapy with 50mg dose. Then 50mg at 12th hour. And increases to 100mg/day once daily or in two divided doses up to 9days
Migraine prophylaxis: 50 - 150mg / day in divided doses
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