Indications Ancor-A is indicated for the treatment of hypertension as a substitution therapy in patients adequately controlled with the individual components given concurrently at the same dose level as in the combination, but as separate tablets.

Pharmacology

Amlodipine: A dihydropyridine calcium channel blocker that inhibits calcium ion influx into vascular smooth muscle and cardiac muscle. It acts directly on vascular smooth muscle to reduce peripheral resistance and lower blood pressure.
Bisoprolol Fumarate: A selective β1-adrenoceptor blocker with no intrinsic sympathomimetic or membrane-stabilizing activity. It reduces heart rate, cardiac output, and myocardial oxygen demand without significant effect on β2-receptors of bronchial or vascular smooth muscle.

Dosage & Administration One tablet once daily in patients whose blood pressure is adequately controlled with separately administered monocomponent products of the same dose as the recommended fixed-dose combination.

Interactions

Not recommended: Verapamil, diltiazem, and centrally acting antihypertensive drugs.
Use with caution: CYP3A4 inhibitors/inducers, simvastatin, tacrolimus, cyclosporine, antiarrhythmics, parasympathomimetics, topical beta-blockers (e.g., eye drops), insulin, oral antidiabetics, anesthetics, digitalis glycosides, NSAIDs, sympathomimetics, and other antihypertensives.
Consideration: Mefloquine, rifampicin, ergotamine derivatives, MAO inhibitors (except MAO-B inhibitors).

Contraindications

Acute heart failure or episodes of decompensation
Cardiogenic shock
Second or third-degree AV block
Sick sinus syndrome
Symptomatic bradycardia or hypotension
Severe bronchial asthma or COPD
Severe peripheral arterial disease or Raynaud’s syndrome
Untreated pheochromocytoma
Metabolic acidosis
Hypersensitivity to bisoprolol, amlodipine, dihydropyridine derivatives, or excipients

Side Effects

Common: Dizziness, headache, somnolence, palpitations, flushing, cold extremities, nausea, vomiting, diarrhea, constipation, abdominal pain, edema, fatigue.
Uncommon: Insomnia, mood changes, depression, tremor, visual disturbances, tinnitus, conduction disorders, bradycardia, hypotension, dyspnea, rhinitis, alopecia, rash, pruritus, arthralgia, myalgia, muscle cramps, back pain, nocturia, impotence, gynecomastia, asthenia, chest pain, weight changes.
Rare: Allergic reactions, nightmares, hallucinations, confusion, hearing disorders, hepatitis, elevated triglycerides and liver enzymes.

Pregnancy & Lactation Not recommended during pregnancy and lactation.

Precautions & Warnings

Use cautiously in heart failure; abrupt withdrawal may worsen ischemic heart disease.
Avoid in obstructive airway disease unless clinically necessary.
Use with caution in diabetes, fasting, AV block, Prinzmetal’s angina, peripheral arterial disease, psoriasis, and thyroid disorders.
During anesthesia, inform the anesthetist about beta-blocker therapy.
Gradual withdrawal is advised before surgery (about 48 hours prior).

Use in Special Populations

Geriatric: Usual dose may be used; caution with dose increase.
Pediatric: Safety and efficacy not established below 10 years.
Liver disease: Use with caution; amlodipine elimination may be prolonged.
Kidney disease: No adjustment needed for mild/moderate impairment; use caution in severe cases (CrCl <20 mL/min).

Overdose Effects

Bisoprolol: Bradycardia, hypotension, bronchospasm, acute cardiac insufficiency, hypoglycemia.
Amlodipine: Peripheral vasodilation, reflex tachycardia, severe hypotension, possible shock. Treatment is supportive and symptomatic.

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