Betacal Tablet: Blister pack of 5 x 10\'s tablets
Betacal Tablet: Each uncoated tablet contains AmlodipineBesylate BP equivalent to Amlodipine BP 5 mg and AtenololBP 50 mg.
Betacal is a fixed-dose combination of Amlodipine andAtenolol. Amlodipine is a dihydropyridine calcium antagonistthat inhibits the transmembrane influx of calcium ions intovascular smooth muscle and cardiac muscle; it has a greatereffect on vascular smooth muscle cells than on cardiac musclecells. Amlodipine is a peripheral vasodilator that acts directlyon vascular smooth muscle to cause a reduction in peripheralvascular resistance and reduction in blood pressure.Amlodipine reduces tone, decreases coronary vasoreactivityand lowers cardiac demand by reducing afterload. Atenolol isa cardioselective beta-blocker. It does not possess anymembrane-stabilising action. The cardioselectivity is doserelated. Atenolol causes a reduction in blood pressure bylowering cardiac output, decreasing the plasma renin activityand sympathetic outflow from CNS. Atenolol also causes areduction in myocardial oxygen demand by virtue of itsnegative inotropic and negative chronotropic effects.
Betacal is indicated for the treatment of hypertension andchronic stable angina.
The recommended dosage is one tablet of Betacal daily. Ifnecessary, the dosage may be increased to two tablets daily.The dosage however should be individualized.
Hypersensitivity to either component, sinus bradycardia,second and higher degrees of heart block, cardiogenic shock,hypotension, congestive heart failure, poor left ventricularfunction.
DRUG INTERACTIONS: Disopyramide: Atenolol reduces theclearance of disopyramide by 20%. Additive negative inotropiceffects on the heart may be produced. Ampicillin: Ampicillin atdoses of 1 g and above may reduce atenolol levels. OralAntidiabetics and Insulin: Beta-blockers may decrease tissuesensitivity to insulin and inhibit insulin secretion eg. inresponse to oral antidiabetics. Atenolol has less potential forthese actions. The heart rate may not be reliable as an earlywarning of hypoglycemia. HYPOTENSION: Excessive fall of blood pressure can occur in some patients especially theelderly. AGGRAVATION OF ANGINA: Rarely patients,particularly those with severe obstructive coronary arterydisease, have developed increased frequency, duration and/orseverity of angina or acute myocardial infarction on startingcalcium channel blocker therapy. DRUG WITHDRAWAL:Since coronary heart disease may exist without beingrecognised, patients should be warned against stopping thedrug suddenly. Any discontinuation should be gradual andunder observation. BRONCHOSPASM: The combinationshould be used with caution in patients with airwayobstruction. RENAL IMPAIRMENT: The combination can beused in patients with renal impairment. However, caution maybe necessary if the creatinine clearance is less than 30 ml/minbecause of possible reduction in the excretion of unchangedAtenolol. HEPATIC IMPAIRMENT: Caution may be
The combination of Amlodipine and Atenolol is well tolerated.Side effects include headache, palpitations, flushing, edema,depression, dizziness, dyspepsia, dyspnea, muscle cramps,fatigue, cold extremities and bradycardia.
Though not documented, hypotension and less frequentlycongestive cardiac failure may occur in cases of overdosage.Unabsorbed drugs may be removed by gastric lavage oradministration of activated charcoal. Symptomatic treatment issuggested.
