II. Mechanism

  1. Dihydropyridine Calcium Channel Blockers
  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. Preparation: Nifedipine

VI. Preparation: Amlodipine (Norvasc)

  1. Dosing
    1. 2.5-5mg PO qd (MAX 10mg qd)
  2. Advantages
    1. Does not exacerbate Left Ventricular Dysfunction

VII. Preparation: Nimodipine

  1. Indications: Counter Cerebral Vessel spasm
    1. Early Subarachnoid Hemorrhage
    2. Early Cerebrovascular Accident (CVA)

VIII. Adverse Effects: 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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Cost: Medications

amlodipine (on 1/21/2015 at Medicaid.Gov Survey of pharmacy drug pricing)
AMLODIPINE BESYLATE 10 MG TAB Generic $0.03 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 $4.39 each
AMLODIPINE-ATORVAST 10-20 MG Generic $5.88 each
AMLODIPINE-ATORVAST 10-40 MG Generic $6.63 each
AMLODIPINE-ATORVAST 10-80 MG Generic $5.99 each
AMLODIPINE-ATORVAST 2.5-10 MG Generic $3.70 each
AMLODIPINE-ATORVAST 2.5-20 MG Generic $5.26 each
AMLODIPINE-ATORVAST 5-10 MG Generic $4.65 each
AMLODIPINE-ATORVAST 5-20 MG Generic $5.58 each
AMLODIPINE-ATORVAST 5-40 MG Generic $5.99 each
AMLODIPINE-ATORVAST 5-80 MG Generic $5.18 each
AMLODIPINE-BENAZEPRIL 10-20 MG Generic $0.40 each
AMLODIPINE-BENAZEPRIL 10-40 MG Generic $0.46 each
AMLODIPINE-BENAZEPRIL 2.5-10 Generic $0.62 each
AMLODIPINE-BENAZEPRIL 5-10 MG Generic $0.44 each
AMLODIPINE-BENAZEPRIL 5-20 MG Generic $0.40 each
AMLODIPINE-BENAZEPRIL 5-40 MG Generic $0.43 each
AMLODIPINE-VALSARTAN 10-160 MG Generic $4.88 each
AMLODIPINE-VALSARTAN 10-320 MG Generic $6.07 each
AMLODIPINE-VALSARTAN 5-160 MG Generic $4.29 each
AMLODIPINE-VALSARTAN 5-320 MG Generic $5.48 each
norvasc (on 1/1/2015 at Medicaid.Gov Survey of pharmacy drug pricing)
NORVASC 10 MG TABLET Generic $0.03 each
NORVASC 2.5 MG TABLET Generic $0.02 each
NORVASC 5 MG TABLET Generic $0.02 each
nimodipine (on 11/19/2014 at Medicaid.Gov Survey of pharmacy drug pricing)
NIMODIPINE 30 MG CAPSULE Generic $8.59 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: Nimodipine (C0028094)

Definition (NCI_NCI-GLOSS) Belongs to a family of drugs called calcium channel blockers. It is being investigated for use with anticancer drugs to prevent or overcome drug resistance and improve response to chemotherapy.
Definition (NCI) A dihydropyridine derivative and an analogue of the calcium channel blocker nifedipine, with antihypertensive activity. Nimodipine inhibits the transmembrane influx of calcium ions in response to depolarization in smooth muscle cells, thereby inhibiting vascular smooth muscle contraction and inducing vasodilatation. Nimodipine has a greater effect on cerebral arteries than on peripheral smooth muscle cells and myocardial cells, probably because this agent can cross the blood brain barrier due to its lipophilic nature. Furthermore, this agent also inhibits the drug efflux pump P-glycoprotein, which is overexpressed in some multi-drug resistant tumors, and may improve the efficacy of some antineoplastic agents.
Definition (MSH) A calcium channel blockader with preferential cerebrovascular activity. It has marked cerebrovascular dilating effects and lowers blood pressure.
Definition (CSP) 1,4 dihydropyridine; centrally acting calcium channel blocker used in the treatment of a wide range of disorders, including drug withdrawal, AIDS motor/cognitive disorder, and post cardiac surgery recovery.
Definition (PDQ) A dihydropyridine derivative and an analogue of the calcium channel blocker nifedipine, with antihypertensive activity. Nimodipine inhibits the transmembrane influx of calcium ions in response to depolarization in smooth muscle cells, thereby inhibiting vascular smooth muscle contraction and inducing vasodilatation. Nimodipine has a greater effect on cerebral arteries than on peripheral smooth muscle cells and myocardial cells, probably because this agent can cross the blood brain barrier due to its lipophilic nature. Furthermore, this agent also inhibits the drug efflux pump P-glycoprotein, which is overexpressed in some multi-drug resistant tumors, and may improve the efficacy of some antineoplastic agents. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=41210&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=41210&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C692" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D009553
SnomedCT 387502003, 87285001
English Nimodipine, 3,5-Pyridinedicarboxylic acid, 1,4-dihydro-2,6-dimethyl-4-(3-nitrophenyl)-, 2-methoxyethyl 1-methylethyl ester, NIMO, nimodipine, nimodipine (medication), NIMODIPINE, Nimodipine [Chemical/Ingredient], niMODipine, NiMODipine, Nimodipine (product), Nimodipine (substance)
Swedish Nimodipin
Czech nimodipin
Finnish Nimodipiini
Russian NIMODIPIN, НИМОДИПИН
Japanese ニモジピン
Spanish nimodipina, nimodipino, nimodipino (producto), nimodipino (sustancia), nimodipina (producto), nimodipina (sustancia), Nimodipino
Polish Nimodypina
French Nimodipine
German Nimodipin
Italian Nimodipina
Portuguese Nimodipino

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