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Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.
Typical usage: Mild to moderate hypertension. Angina pectoris. Prinzmetals angina.
Side Effects: Headache, peripheral oedema, fatigue, somnolence, nausea, abdominal pain, flushing, dyspepsia, palpitations, dizziness. Rarely pruritus, rash, dyspnoea, asthenia, muscle cramps. Potentially Fatal: Hypotension, bradycardia, conductive system delay and CCF.
Drug Interaction: Increased metabolism with rifampin. Reduced hypotensive effect with calcium. Potentiates effects of thiazide diuretics and ACE inhibitors. Avoid combination with ?-blockers in patients with markedly impaired left ventricular function. May increase serum levels of CYP1A2 substrates e.g. aminophylline, fluvoxamine, ropinirole. CYP3A4 inhibitors (e.g. clarithromycin, doxycycline, isoniazid, nicardipine) may increase the effects of amlodipine. Additive BP-lowering effects when used with sildenafil, tadalafil or vardenafil.
Mechanism Of Action: Amlodipine relaxes peripheral and coronary vascular smooth muscle. It produces coronary vasodilation by inhibiting the entry of Ca ions into the voltage-sensitive channels of the vascular smooth muscle and myocardium during depolarisation. It also increases myocardial O2 delivery in patients with vasospastic angina.
There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
Typical usage: Hypertension, angina pectoris. Cardiac arrhythmias. Migraine prophylaxis.
Side Effects: Bronchospasm; cold extremities, fatigue, dizziness, insomnia, lethargy, confusion, headache, depression, nightmares, nausea, diarrhoea, constipation, impotence and paraesthesia. Potentially Fatal: Heart failure, 2nd or 3rd degree AV block.
Drug Interaction: Calcium channel blockers and digoxin can cause lowering of blood pressure and heart rate to dangerous levels when administered together with atenolol. Atenolol can mask the early warning symptoms of low blood sugar (hypoglycemia), and should be used with caution in patients receiving treatment for diabetes.
Mechanism Of Action: Atenolol is a competitive cardioselective ?1-blocker. It does not have effect on ?2-receptors except in high doses. Its cardioselectivity is dose-related. Atenolol reduces resting and exercise-induced heart rate as well as myocardial contractility. Peripheral ?-blockade may result in vasoconstriction. Atenolol reduces BP and heart rate which results in reduced myocardial work and O2 requirement leading to improved exercise tolerance and reduced frequency and intensity of anginal attack.