Slow release nifedipine plus atenolol in chronic stable angina pectoris.

Challenor, V. F.; Waller, Derek G.; Renwick, A. G.; George, C. F.

doi:10.1111/j.1365-2125.1989.tb03536.x

Cited by 10 publications

(7 citation statements)

References 18 publications

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“…Furthermore, although there was an option to increase the daily dose of the combination, only two patients from this group required additional therapy. These results are in agreement with those of Challenor et al , 13 who showed that adding nifedipine to atenolol resulted in a fall in both GTN consumption and angina attacks of some 25% and 36% respectively. In this study these benefits are maintained over a longer dosing period and there doesn't appear to be any significant tachyphylaxis.…”

Section: Discussionsupporting

confidence: 93%

Tolerance and Long‐term Efficacy of a Fixed Combination of Atenolol and Nifedipine in the Treatment of Angina Pectoris

Saul¹,

Oliver²,

Russell³

1992

Int J Clinical Practice

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SUMMARYTo monitor the tolerance and long‐term efficacy of a low‐dose fixed combination of 50 mg atenolol and 20 mg nifedipine (slow release formulation) in patients with stable angina pectoris, 157 patients received treatment twice daily in a multi‐centre, open‐label fashion for periods up to 12 months following a four week run‐in period on atenolol 50 mg twice daily. A total of 122 patients completed the study and had data from all treatment visits. In these patients the median number of weekly anginal attacks was halved, compared to the run‐in period on atenolol alone following one month's fixed combination treatment, and this benefit was maintained throughout the 12‐month study period. In addition, GTN consumption similarly declined on the fixed combination in comparison with the run‐in period.Treatment with the fixed combination was not associated with any long‐term increase in the frequency of reported side‐effects or adverse biochemical changes compared to run‐in. The fixed combination of atenolol 50 mg and nifedipine 20 mg reduced anginal frequency and GTN consumption compared to atenolol alone without causing any increase in adverse effects.

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Section: Discussionsupporting

confidence: 93%

Tolerance and Long‐term Efficacy of a Fixed Combination of Atenolol and Nifedipine in the Treatment of Angina Pectoris

Saul¹,

Oliver²,

Russell³

1992

Int J Clinical Practice

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“…Although 13 out of 18 patients experienced such effects, none were severe enough to warrant withdrawal from the study [38]. There was some suggestion of a dose-related increase in unwanted effects, as has been observed with nifedipine monotherapy [62].…”

Section: Unwanted Effects During Combination Treatmentmentioning

confidence: 89%

“…We have recently assessed the efficacy of nifedipine in a slow-release formulation at doses of 20 mg and 40 mg b.i.d, when added to atenolol 50 mg b.i.d, in 18 patients with chronic stable angina [38]. The addition of the lower dose nifedipine to atenolol did not significantly alter the weekly consumption of GTN or the mean number of anginal attacks.…”

Section: Duration Of Action Of Beta-adrenoceptor Antagonist--nifedipimentioning

confidence: 99%

Beta-adrenoceptor antagonists plus nifedipine in the treatment of chronic stable angina pectoris

Challenor

Waller

George

1989

Cardiovasc Drug Ther

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The antianginal effects of beta-adrenoceptor antagonists are achieved by a reduction in myocardial oxygen demand. This is a rational approach to treatment in patients whose angina is caused by a fixed stenosis. However, dynamic coronary vasospasm is an important factor in patients with chronic stable angina. Nifedipine increases myocardial oxygen supply by reducing coronary vascular tone and is a logical approach to treatment in these patients. For monotherapy of angina, nifedipine is less effective than the beta-adrenoceptor antagonists, but the combination has additive effects in reducing the frequency of anginal episodes and improving exercise tolerance. Plasma concentrations of nifedipine are closely related to clinical efficacy, and the variable first-pass metabolism of the drug leads to wide interindividual differences in peak concentrations and duration of action. Increasing the size of individual doses of nifedipine carries a risk of enhanced side effects due to high peak plasma concentrations. Optimal treatment may be more appropriately achieved in some patients by a slow release formulation, but with an increased frequency of administration.

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“…The mean maximum concentration after intravenous administration of 1 mg nifedipine is 26 ng ml-' [20]. Although a concentration of at least 30-35 ng ml-' is necessary to demonstrate a 20% improvement in exercise tolerance in patients with angina receiving atenolol, individual patients will respond to lower concentrations [21]. The dose of nisoldipine associated with symptomatic benefit in the presence of effective 3-adrenoceptor blockade has not been determined.…”

Section: Discussionmentioning

confidence: 99%

A comparison of the acute haemodynamic effects of nisoldipine and nifedipine during treatment with atenolol in patients with coronary artery disease

Donaldson¹,

Dawkins

Waller³

1993

Brit J Clinical Pharma

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1 The acute haemodynamic effects of intravenous nisoldipine (1, 2, 4 ,ug kg-') and nifedipine (2.5, 5, 10 jig kg-') were compared in a randomised, within-patient crossover study. Fifteen male patients with stable angina pectoris treated with atenolol were studied after undergoing routine cardiac catheterisation. 2 Nisoldipine caused a dose-related fall in systemic vascular resistance (maximum 22%) associated with an increase in heart rate and cardiac index (18%) and a fall in mean arterial pressure (7%). 3 By contrast, nifedipine was associated with a significant increase in heart rate but systemic vascular resistance, cardiac index and mean arterial pressure remained unaltered.4 At doses with equivalent effects on heart rate (2 jig kg-' nisoldipine; 10 jig kg-' nifedipine) acute dosing with nisoldipine caused a significantly greater fall in systemic vascular resistance and increase in cardiac index, whilst nifedipine caused a greater reduction in stroke volume index and left ventricular stroke work index. 5 The results suggest that, when combined with atenolol, acute dosing with nisoldipine may have a more complementary haemodynamic profile than nifedipine. The implications of this finding for chronic oral dosing in patients with impaired left ventricular function should be evaluated.

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Slow release nifedipine plus atenolol in chronic stable angina pectoris.

Cited by 10 publications

References 18 publications

Tolerance and Long‐term Efficacy of a Fixed Combination of Atenolol and Nifedipine in the Treatment of Angina Pectoris

Tolerance and Long‐term Efficacy of a Fixed Combination of Atenolol and Nifedipine in the Treatment of Angina Pectoris

Beta-adrenoceptor antagonists plus nifedipine in the treatment of chronic stable angina pectoris

A comparison of the acute haemodynamic effects of nisoldipine and nifedipine during treatment with atenolol in patients with coronary artery disease

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