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 & peripheral edema are most common
- GI: nausea, anorexia, constipation, dyspepsia
- others: palpitations, flushing, dizziness
* amlodipine followed by diuretics is a common prescribing cascade[7]
* 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 SGLT-2 inhibitor
- 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
- angiotensin II receptor type 2 & 4-stimulating antihypertensive
- 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/perindopril
- amlodipine/celecoxib (Consensi)
- amlodipine/indapamide/telmisartan (Widaplik)
- 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://pubmed.ncbi.nlm.nih.gov/27754879 <Internet> http://circ.ahajournals.org/content/circulationaha/early/2016/10/17/CIR.0000000000000456.full.pdf
- ↑ 7.0 7.1 Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
Geriatric Review Syllabus (GRS12) Colburn JL, Westcott AM, Potter JF (eds) American Geriatrics Society. 2025