T concor AM 2.5mg
Reading File
Finding Sources
Finding Sources
Searching the Web
Concor AM 2.5mg bisoprolol amlodipine fixed dose combination indications dosage
Reading File
Reading File
Finding Sources
Reading File
Finding Sources
Here is a complete drug profile for Concor AM 2.5mg:
Concor AM 2.5mg
What Is It?
Concor AM 2.5mg is a fixed-dose combination tablet containing:
- Bisoprolol fumarate 2.5 mg - highly selective beta-1 adrenergic receptor blocker
- Amlodipine besilate 5 mg - long-acting dihydropyridine calcium channel blocker
Manufacturer: Merck. Dosed once daily.
Indications
- Hypertension - substitution therapy in patients whose blood pressure is already adequately controlled on the individual components at the same doses
- Angina pectoris (chronic stable angina) - both components have anti-anginal properties
- Patients requiring combination antihypertensive therapy with complementary mechanisms
Mechanism of Action
Bisoprolol (Beta-1 Blocker)
Bisoprolol is a highly selective β1 adrenergic receptor antagonist lacking intrinsic sympathomimetic or membrane-stabilizing activity. It has a higher degree of β1 selectivity than atenolol, metoprolol, or betaxolol. It lowers BP by:
- Reducing heart rate and cardiac output
- Decreasing renin release from the kidney
- Reducing myocardial oxygen demand (beneficial in angina)
(Goodman & Gilman's Pharmacological Basis of Therapeutics)
Amlodipine (Dihydropyridine CCB)
Amlodipine inhibits calcium influx into arterial smooth muscle cells, causing vasodilation. It is more selective as a vasodilator with less cardiac depressant effect than verapamil or diltiazem. It lowers BP by reducing peripheral vascular resistance. Reflex sympathetic activation can cause mild tachycardia - which is counteracted by bisoprolol in this combination.
(Katzung's Basic and Clinical Pharmacology)
Why Combine These Two?
This is a pharmacologically rational pairing:
| Property | Bisoprolol | Amlodipine | Net Effect |
|---|---|---|---|
| Heart rate | Decreases | May increase (reflex tachycardia) | Balanced |
| Peripheral resistance | Minimal effect | Decreases | Reduced BP |
| Cardiac output | Decreases | Maintained/increased | Balanced |
| Vasodilation | No | Yes | Added BP lowering |
Together they provide additive antihypertensive efficacy while offsetting each other's adverse hemodynamic effects (amlodipine-induced reflex tachycardia is blunted by bisoprolol).
Pharmacokinetics
Bisoprolol
- Oral bioavailability: ~90%
- Elimination: 50% renal (unchanged) + 50% hepatic metabolism (inactive metabolites)
- Half-life: 11-17 hours (supports once-daily dosing)
Amlodipine
- Half-life: ~35-50 hours (very long - slow onset/offset, very smooth BP control)
- Metabolism: Hepatic (CYP3A4)
- Bioavailability: ~60-65%
Available Strengths (Concor AM range)
| Tablet | Bisoprolol | Amlodipine |
|---|---|---|
| Concor AM 2.5mg | 2.5 mg | 5 mg |
| Concor AM 5/5mg | 5 mg | 5 mg |
| Concor AM 5/10mg | 5 mg | 10 mg |
| Concor AM 10/5mg | 10 mg | 5 mg |
| Concor AM 10/10mg | 10 mg | 10 mg |
Concor AM 2.5mg (bisoprolol 2.5mg + amlodipine 5mg) is the lowest bisoprolol dose option - useful for patients sensitive to beta-blockade or initiating therapy.
Dosing
One tablet once daily, preferably in the morning, with or without food. Do not crush or chew.
Contraindications
- Acute decompensated heart failure
- Cardiogenic shock
- Second or third degree AV block (without pacemaker)
- Sick sinus syndrome
- Severe bradycardia (HR < 60 bpm)
- Severe hypotension
- Severe obstructive airways disease (asthma, severe COPD) - relative contraindication for bisoprolol component
- Severe aortic stenosis (amlodipine component)
- Pregnancy (beta-blockers and CCBs have fetal risk)
Side Effects
From bisoprolol:
- Bradycardia, hypotension
- Fatigue, dizziness
- Cold extremities, exercise intolerance
- Bronchospasm (in susceptible patients)
- Masking of hypoglycemia symptoms in diabetics
From amlodipine:
- Peripheral edema (most common, dose-dependent)
- Flushing, headache
- Palpitations (reflex tachycardia - less common due to bisoprolol)
- Gingival hyperplasia (rare)
Key Clinical Points
- Cardiac evidence: Bisoprolol showed a 34% mortality benefit in the CIBIS-II trial in heart failure patients - one of the most beta-1 selective agents available. (Goodman & Gilman's)
- Angina benefit: Both components reduce anginal frequency - bisoprolol by limiting rate-pressure product; amlodipine by reducing afterload and coronary vasospasm.
- Avoid abrupt discontinuation - bisoprolol must be tapered, especially in ischemic heart disease patients (risk of rebound angina/MI).
- Renal impairment: Bisoprolol dose adjustment needed in severe renal impairment (CrCl < 20 mL/min); amlodipine does not require dose adjustment.
- Drug interactions: Amlodipine is a CYP3A4 substrate - simvastatin (cap 20mg), cyclosporine, tacrolimus levels may increase.
Sources: Goodman & Gilman's Pharmacological Basis of Therapeutics; Katzung's Basic and Clinical Pharmacology 16th Ed; Lippincott Illustrated Reviews Pharmacology; Merck Concor AM product information
This is a shared conversation. Sign in to Orris to start your own chat.