II. Mechanism

  1. Dihydropyridine Calcium Channel Blockers
    1. Dihydropyridines are primarily active at vascular Smooth Muscle
    2. Contrast with Non-Dihydropyridines which are also active at cardiac Smooth Muscle
  2. Nifedipine (Procardia) is prototype for class

III. Contraindications

  1. Avoid in Diabetes Mellitus (may increase Proteinuria)

IV. Drug Interactions

  1. Clarithromycin
    1. Increases Calcium Channel Blocker levels via CYP3A4 inhibition especially with Dihydropyridines and over age 65 years
      1. Provokes Hypotension and Bradycardia
      2. Risk of Acute Kidney Injury (often requiring hospitalization)
    2. References
      1. Gandhi (2013) JAMA 310(23):2544-53 [PubMed]

V. Preparations: Oral

  1. Nifedipine (Procardia)
  2. Amlodipine (Norvasc)
    1. Dosing
      1. 2.5-5mg PO qd (MAX 10mg qd)
    2. Advantages
      1. Does not exacerbate Left Ventricular Dysfunction
  3. Felodipine
  4. Nimodipine (Nymalize)

VI. Preparations: Parenteral (Hypertensive Emergency)

  1. Background
    1. Counter Cerebral Vessel spasm (e.g. early Subarachnoid Hemorrhage, CVA)
  2. Clevidipine (Cleviprex)
  3. Nicardipine

VII. Adverse Effects

  1. See Calcium Channel Blocker
  2. Peripheral Edema (Norvasc)
    1. Occurs more commonly in women
    2. Occurs more commonly on Norvasc doses >5 mg
    3. Adding ACE Inhibitor to regimen decreases edema

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Related Studies

Cost: Medications

amlodipine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
AMLODIPINE BESYLATE 10 MG TAB Generic $0.02 each
AMLODIPINE BESYLATE 2.5 MG TAB Generic $0.02 each
AMLODIPINE BESYLATE 5 MG TAB Generic $0.02 each
AMLODIPINE-ATORVAST 10-10 MG Generic $4.38 each
AMLODIPINE-ATORVAST 10-20 MG Generic $4.45 each
AMLODIPINE-ATORVAST 10-40 MG Generic $5.66 each
AMLODIPINE-ATORVAST 10-80 MG Generic $5.25 each
AMLODIPINE-ATORVAST 5-10 MG Generic $4.03 each
AMLODIPINE-ATORVAST 5-20 MG Generic $4.14 each
AMLODIPINE-ATORVAST 5-40 MG Generic $5.37 each
AMLODIPINE-BENAZEPRIL 10-20 MG Generic $0.23 each
AMLODIPINE-BENAZEPRIL 10-40 MG Generic $0.26 each
AMLODIPINE-BENAZEPRIL 2.5-10 Generic $0.39 each
AMLODIPINE-BENAZEPRIL 5-10 MG Generic $0.27 each
AMLODIPINE-BENAZEPRIL 5-20 MG Generic $0.20 each
AMLODIPINE-BENAZEPRIL 5-40 MG Generic $0.24 each
AMLODIPINE-OLMESARTAN 10-20 MG Generic $0.88 each
AMLODIPINE-OLMESARTAN 10-40 MG Generic $1.09 each
AMLODIPINE-OLMESARTAN 5-20 MG Generic $0.91 each
AMLODIPINE-OLMESARTAN 5-40 MG Generic $1.09 each
AMLODIPINE-VALSARTAN 10-160 MG Generic $0.61 each
AMLODIPINE-VALSARTAN 10-320 MG Generic $0.63 each
AMLODIPINE-VALSARTAN 5-160 MG Generic $0.40 each
AMLODIPINE-VALSARTAN 5-320 MG Generic $0.62 each
AMLODIPINE-VALSARTAN-HYDROCHLOROTHIAZIDE 10-160-12.5 MG TAB Generic $2.54 each
AMLODIPINE-VALSARTAN-HYDROCHLOROTHIAZIDE 10-160-25 MG TAB Generic $3.20 each
AMLODIPINE-VALSARTAN-HYDROCHLOROTHIAZIDE 10-320-25 MG TAB Generic $3.05 each
AMLODIPINE-VALSARTAN-HYDROCHLOROTHIAZIDE 5-160-12.5 MG TAB Generic $1.94 each
AMLODIPINE-VALSARTAN-HYDROCHLOROTHIAZIDE 5-160-25 MG TAB Generic $2.93 each
norvasc (on 6/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
NORVASC 10 MG TABLET Generic $0.02 each
NORVASC 2.5 MG TABLET Generic $0.02 each
NORVASC 5 MG TABLET Generic $0.02 each

Ontology: Dihydropyridines (C0012315)

Definition (MSH) Pyridine moieties which are partially saturated by the addition of two hydrogen atoms in any position.
Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D004095
English Dihydropyridines, Dihydropyridine, Dihydropyridines [Chemical/Ingredient], dihydropyridines, dihydropyridine
Swedish Dihydropyridiner
Czech dihydropyridiny
Finnish Dihydropyridiinit
Russian DIGIDROPIRIDINY, ДИГИДРОПИРИДИНЫ
Japanese ジヒドロピリジン
Croatian Not Translated[Dihydropyridines]
Polish Dihydropirydyny pochodne
Portuguese Di-Hidropiridinas
French Dihydropyridines
German Dihydropyridine
Italian Diidropiridine
Spanish Dihidropiridinas

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