Amlodipine -Atenolol Overdose Management: A Physician’s Nightmare.

The author reports a case of a 22-year-old female, daughter of a known hypertensive patient, who happened to consume her mother’s medicine. Her mother was on a fixed drug combination (FDC) of amlodipine and atenolol. The patient was brought to the emergency department with drowsiness following ingestion of 15 tablets of amlodipine-atenolol FDC (5+ 50 mg). On evaluation, she had refractory bradycardia and hypotension along with hyperkalemia. She was managed initially with gastric lavage with activated charcoal, and subsequently with supplementation of atropine, inotropes, anti-hyperkalaemic measures, pacemaker and levosimendan.

Efficacy and tolerability of trandolapril in mild to moderate hypertension--a double blind comparative clinical trial with enalapril in Indian population.

Several large scale clinical trials have demonstrated that angiotensin converting enzyme inhibitors offer cardiovascular and renal protection independent of their effects on systolic BP. Trandolapril is a new angiotensin converting enzyme inhibitor approved for the treatment of hypertension. The potential advantages of this drug are long duration of action and better tolerability. The objective of the study was to compare the efficacy and tolerability of trandolapril with that of enalapril in mild to moderate hypertension in Indian population. In this double blind, multicentric, parallel comparative clinical study, 120 patients with mild to moderate hypertension were randomly assigned to receive trandolapril 2 mg or enalapril 5 mg once daily for 8 weeks. The attainment of sitting diastolic blood pressure <90 mmHg at the end of 8th week was considered as primary outcome measure and attainment of diastolic blood pressure <90 mmHg or reduction of at least 10 mmHg diastolic blood pressure compared to baseline at any visit was considered as secondary outcome measures. 98.4% patients treated with trandolapril and 92.6% patients treated with enalapril fulfilled the primary outcome measure. 54, 72 and 62% patients on trandolapril and 52, 61 & 64% patients on enalapril fulfilled secondary outcome measure at the end of 2nd, 4th and 8th week respectively. Also trandolapril was better tolerated than enalapril with no significant abnormality in lab parameters.

Tuberculosis of the breast.

Nowadays, tuberculosis of the breast is relatively rare compared to other forms of extrapulmonary tuberculosis. The incidence of tuberculosis of the breast has decreased mainly due to effective antituberculous chemotherapy. We report two cases of tuberculosis of the breast.