amlodipine (Norvasc, Amlocard, Amvaz)
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Introduction
Tradename: Norvasc.
Indications
Contraindications
- NOT for use in controlling ventricular response to atrial fibrillation
- does NOT block AV nodal conduction
Dosage
start 2.5 to 5 mg PO QD, max 10 mg QD
Tabs: 2.5, 5, 10 mg.
Pharmacokinetics
- metabolized in the liver by cyt P450 3A4
elimination via liver
Adverse effects
- headache & edema are most common
- GI: nausea, anorexia, constipation, dyspepsia
- others: palpitations, flushing, dizziness
* less likely to cause orthostasis than diuretics []
- drug adverse effects of calcium channel blockers
- drug adverse effects of renin-angiotensin-aldosterone system inhibitors (RAAS inhibitors)
- drug adverse effects of antihypertensive agents
Drug interactions
- fentanyl: severe hypotension may occur
- any drug that inhibits cyt P450 3A4 may increase levels of amlodipine
- any drug that induces cyt P450 3A4 may diminish levels of amlodipine
- doses of simvastatin or lovastatin > 20 mg QD not recommended[6]
- no evidence of significant interaction with atorvastatin, rosuvastatin, pravastatin, fluvastatin, or pitavastatin[6]
- drug interaction(s) of calcium channel blockers with ARBs
- drug interaction(s) of calcium channel blockers with ACE inhibitors
- drug interaction(s) of calcium channel blockers with diuretics
- drug interaction(s) of calcium channel blockers with erythromycin
- drug interaction(s) of calcium channel blockers with clarithromycin
- drug interaction(s) of renin-angiotensin-aldosterone inhibitors with trimethoprim-sulfamethoxazole
- drug interaction(s) of beta-adrenergic receptor antagonists with calcium channel blockers
- drug interaction(s) of NSAIDs & antihypertensives
Laboratory
Mechanism of action
- inhibits L-type calcium channels
- dilation of coronary arteries & arterioles
- increased myocardial oxygen delivery
- decreased systemic vascular resistance
- increased cardiac output
- does not alter AV nodal conduction
- does not alter myocardial contractility
- not a negative cardiac inotrope
- no reflex tachycardia
More general terms
More specific terms
Additional terms
- African American Study of Kidney Disease & Hypertension (AASK)
- ASCOT clinical trial
- cytochrome P450 3A4 (cytochrome P450 C3, nifedipine oxidase, P450-PCN1, NF-25, CYP3A4)
- VALUE trial
Component of
- amlodipine/arginine/perindopril
- amlodipine/celecoxib (Consensi)
- amlodipine/telmisartan (Twynsta)
- amlodipine/olmesartan (Azor)
- amlodipine/hydrochlorothiazide/valsartan
- amlodipine/hydrochlorothiazide/olmesartan (Tribenzor)
- aliskiren/amlodipine/hydrochlorothiazide (Amturnide)
- aliskiren/amlodipine (Tekamlo)
- amlodipine/atorvastatin (Caduet)
- amlodipine/benazepril (Lotrel)
- amlodipine/valsartan (Exforge)
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998 - non formulary drug request
- ↑ Department of Veterans Affairs, VA National Formulary
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16, 18. American College of Physicians, Philadelphia 2012, 2018.
- ↑ 5.0 5.1 5.2 Deprecated Reference
- ↑ 6.0 6.1 6.2 Wiggins BS, Saseen JJ, Page RL 2nd et al Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease. A Scientific Statement From the American Heart Association. Circulation. 2016;134:00-00 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27754879 <Internet> http://circ.ahajournals.org/content/circulationaha/early/2016/10/17/CIR.0000000000000456.full.pdf
- ↑ Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019