Q: I am currently taking the following medicines for treating hypertension: Amlodipine 10 mg and Atenolol 50 mg. I take Amlodipine once daily and Atenolol twice daily. Can I take both the medicines twice daily? This would help in cutting down the costs to almost 50% since the combination of Amlodipine 5 mg and Atenolol 50 mg is available in the market at 50% of the price of the cost of two separate tablets. Can Amlodipine 5 mg be taken twice daily? Will such dosing have any pharmacokinetic & blood level imbalance?

A:As per globally accepted standard guidelines on the treatment of high blood pressure in patients aged 55 and over, first choice of initial therapy should be either a calcium channel blocker (such as amlodipine - 5 mg daily in the morning; maximum permitted is 10 mg either in the morning or 5 mg twice daily) or a diuretic (such as metolazone sold as Metoz) 2.5 mg daily in the morning. If a second drug is required, add enalapril (sold as Enam) 5-10 mg 1-2 times daily. Atenolol and similar other beta-blockers are not recommended because they perform less well than other drugs, particularly in the elderly, and the increasing evidence that they carry an unacceptable risk of provoking diabetes. Your treatment needs to be reviewed in the light of recent developments. You would most probably stabilize on amlodipine 5-10 mg in the morning with Metoz 2.5 mg in the morning. However, if you wish to continue with current drug regimen, there is no problem in taking amlodipine 5 mg + atenolol 50 mg twice daily.