II. Mechanism
- See Dihydropyridine Calcium Channel Blocker
-
Dihydropyridines are primarily active at vascular Smooth Muscle
- Contrast with Non-Dihydropyridines which are also active at cardiac Smooth Muscle
- Amlodipine is a preferred first line oral antihypertensive Calcium Channel Blocker
- Long acting and less reflex Tachycardia than other Dihydropyridines, with improved cardiovascular outcomes
- Does not exacerbate Left Ventricular Dysfunction
III. Contraindications
- Consider avoiding in Diabetes Mellitus (relative contraindication)
- May increase Proteinuria
- NOT contraindicated in combination with Beta Blockers
- Contrast with Non-Dihydropyridine Calcium Channel Blockers (Diltiazem, Verapamil) which slow AV nodal conduction
- Relative contraindications (Exercise caution)
IV. Drug Interactions
- See Dihydropyridine Calcium Channel Blocker
-
Clarithromycin
- Increases Calcium Channel Blocker levels via CYP3A4 inhibition especially with Dihydropyridines and over age 65 years
- Provokes Hypotension and Bradycardia
- Risk of Acute Kidney Injury (often requiring hospitalization)
- References
- Increases Calcium Channel Blocker levels via CYP3A4 inhibition especially with Dihydropyridines and over age 65 years
-
Simvastatin
- Limit Simvastatin to a maximum of 20 mg daily
- May increase other drug levels
- Potentiates other medications
V. Dosing: Adults with Hypertension
- Typical dose: 5 mg orally daily
- Start at 2.5 mg daily in elderly, frail patients or hepatic insufficiency
- Maximum: 10 mg orally daily (little benefit over 5 mg, but increased edema)
VI. Dosing: Child with Hypertension
- Available as an oral suspension 1 mg/ml (Katerzia)
- Age under 6 years (NOT FDA approved)
- Start 0.1 to 0.2 mg/kg/day orally daily
- Maximum 0.3 mg/kg/day up to 10 mg orally daily
- Age 6 to 17 years old
- Start 2.5 mg orally daily
- May advance to 5 mg orally daily
VII. Medications: Combinations
- Amlodipine/Olmesartan (Azor)
- Amlodipine/Atorvastatin (Caduet)
- Amlodipine/Valsartan (Exforge)
- Amlodipine/Valsartan/Hydrochlorothiazide (Exforge HCT)
- Amlodipine/Benazepril (Lotrel)
VIII. Adverse Effects
- See Calcium Channel Blocker
-
Peripheral Edema
- Occurs more commonly in women
- Occurs more commonly on Norvasc doses >5 mg
- Adding ACE Inhibitor to regimen decreases edema
- Avoid Diuretics to reduce Dihydropyridine -induced edema
- Dihydropyridine-induced edema mechanism is vasodilation fluid leak into interstitium, NOT Sodium and water retention
IX. Pharmacokinetics
- Slowest onset of action, but longest half life of the Dihydropyridine Calcium Channel Blockers
X. Safety
- Pregnancy Category C
- Avoid in Lactation
XI. Resources
- Amlodipine Besylate Tablet (DailyMed)
XII. References
- (2022) Presc Lett 29(11): 64-5
- (2022) Presc Lett, Resource #381108, Comparison of Calcium Channel Blockers
- (2020) Med Lett Drugs Ther 62(1598): 73-80
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 70-1
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
Images: Related links to external sites (from Bing)
Related Studies
amlodipine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
AMLODIPINE BESYLATE 10 MG TAB | Generic | $0.01 each |
AMLODIPINE BESYLATE 2.5 MG TAB | Generic | $0.01 each |
AMLODIPINE BESYLATE 5 MG TAB | Generic | $0.01 each |
AMLODIPINE-ATORVAST 10-10 MG | Generic | $1.09 each |
AMLODIPINE-ATORVAST 10-20 MG | Generic | $2.38 each |
AMLODIPINE-ATORVAST 10-40 MG | Generic | $1.32 each |
AMLODIPINE-ATORVAST 10-80 MG | Generic | $4.03 each |
AMLODIPINE-ATORVAST 5-10 MG | Generic | $2.08 each |
AMLODIPINE-ATORVAST 5-20 MG | Generic | $1.13 each |
AMLODIPINE-ATORVAST 5-40 MG | Generic | $1.50 each |
AMLODIPINE-BENAZEPRIL 10-20 MG | Generic | $0.15 each |
AMLODIPINE-BENAZEPRIL 10-40 MG | Generic | $0.16 each |
AMLODIPINE-BENAZEPRIL 2.5-10 | Generic | $0.11 each |
AMLODIPINE-BENAZEPRIL 5-10 MG | Generic | $0.11 each |
AMLODIPINE-BENAZEPRIL 5-20 MG | Generic | $0.13 each |
AMLODIPINE-BENAZEPRIL 5-40 MG | Generic | $0.16 each |
AMLODIPINE-OLMESARTAN 10-20 MG | Generic | $0.39 each |
AMLODIPINE-OLMESARTAN 10-40 MG | Generic | $0.40 each |
AMLODIPINE-OLMESARTAN 5-20 MG | Generic | $0.36 each |
AMLODIPINE-OLMESARTAN 5-40 MG | Generic | $0.45 each |
AMLODIPINE-VALSARTAN 10-160 MG | Generic | $0.54 each |
AMLODIPINE-VALSARTAN 10-320 MG | Generic | $0.70 each |
AMLODIPINE-VALSARTAN 5-160 MG | Generic | $0.49 each |
AMLODIPINE-VALSARTAN 5-320 MG | Generic | $0.58 each |
norvasc (on 3/15/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
NORVASC 10 MG TABLET | Generic | $0.02 each |
NORVASC 5 MG TABLET | Generic | $0.01 each |
katerzia (on 10/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
KATERZIA 1 MG/ML SUSPENSION | $3.53 per ml |
Ontology: Amlodipine (C0051696)
Definition (MSH) | A long-acting dihydropyridine calcium channel blocker. It is effective in the treatment of ANGINA PECTORIS and HYPERTENSION. |
Definition (CHV) | a drug used to treat high blood pressure and chest pain (angina) |
Definition (NCI) | A synthetic dihydropyridine and a calcium channel blocker with antihypertensive and antianginal properties. Amlodipine inhibits the influx of extracellular calcium ions into myocardial and peripheral vascular smooth muscle cells, thereby preventing vascular and myocardial contraction. This results in a dilatation of the main coronary and systemic arteries, decreased myocardial contractility, increased blood flow and oxygen delivery to the myocardial tissue, and decreased total peripheral resistance. This agent may also modulate multi-drug response (MDR) activity through inhibition of the p-glycoprotein efflux pump. |
Definition (CSP) | long-acting dihydropyridine calcium channel blocker; it is effective in the treatment of angina pectoris and hypertension. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D017311 |
SnomedCT | 391763001, 108537001, 386864001 |
LNC | LP28516-0, MTHU013162 |
English | Amlodipine, 3,5-Pyridinedicarboxylic acid, 2-((2-aminoethoxy)methyl)-4-(2-chlorophenyl)-1,4-dihydro-6-methyl-, 3-ethyl 5-methyl ester, AMLODIPINE, Amlodipine [Chemical/Ingredient], amLODIPine, Amlodipine - chemical, Amlodipine - chemical (substance), amlodipine, Amlodipine (product), Amlodipine (substance) |
Swedish | Amlodipin |
Czech | amlodipin |
Finnish | Amlodipiini |
Russian | AMLODIPIN, АМЛОДИПИН |
Japanese | アムロジピン |
Spanish | amlodipino, amlodipino (sustancia), amlodipina, amlodipino (producto), amlodipina (producto), amlodipina (sustancia), Amlodipino |
Croatian | AMLODIPIN |
Polish | Amlodypina |
French | Amlodipine |
German | Amlodipin |
Italian | Amlodipina |
Portuguese | Amlodipino |
Ontology: Norvasc (C0162712)
Definition (CHV) | brand name of a hypertension drug |
Definition (CHV) | brand name of a hypertension drug |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D017311 |
English | istin, norvasc [brand name], norvasc, Istin, Mack Brand of Amlodipine Besilate, Pfizer Brand of Amlodipine Besilate, Amlor, Norvasc |