Amlodipine

Aka: Amlodipine, Norvasc, Katerzia

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II. Mechanism

  1. See Dihydropyridine Calcium Channel Blocker
  2. Dihydropyridines are primarily active at vascular Smooth Muscle
    1. Contrast with Non-Dihydropyridines which are also active at cardiac Smooth Muscle
  3. Amlodipine is a preferred first line oral antihypertensive Calcium Channel Blocker
    1. Long acting and less reflex Tachycardia than other Dihydropyridines, with improved cardiovascular outcomes
    2. Does not exacerbate Left Ventricular Dysfunction

III. Contraindications

  1. Consider avoiding in Diabetes Mellitus (relative contraindication)
    1. May increase Proteinuria
  2. NOT contraindicated in combination with Beta Blockers
    1. Contrast with Non-Dihydropyridine Calcium Channel Blockers (Diltiazem, Verapamil) which slow AV nodal conduction
  3. Relative contraindications (Exercise caution)
    1. Aortic Stenosis
    2. Severe Coronary Artery Disease

IV. Drug Interactions

  1. See Dihydropyridine Calcium Channel Blocker
  2. 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]
  3. Simvastatin
    1. Limit Simvastatin to a maximum of 20 mg daily
  4. May increase other drug levels
    1. Cyclosporine
    2. Tacrolimus
  5. Potentiates other medications
    1. Digoxin
    2. Beta Blockers

V. Dosing: Adults with Hypertension

  1. Typical dose: 5 mg orally daily
    1. Start at 2.5 mg daily in elderly, frail patients or hepatic insufficiency
  2. Maximum: 10 mg orally daily (little benefit over 5 mg, but increased edema)

VI. Dosing: Child with Hypertension

  1. Available as an oral suspension 1 mg/ml (Katerzia)
  2. Age under 6 years (NOT FDA approved)
    1. Start 0.1 to 0.2 mg/kg/day orally daily
    2. Maximum 0.3 mg/kg/day up to 10 mg orally daily
  3. Age 6 to 17 years old
    1. Start 2.5 mg orally daily
    2. May advance to 5 mg orally daily

VII. Medications: Combinations

  1. Amlodipine/Olmesartan (Azor)
  2. Amlodipine/Atorvastatin (Caduet)
  3. Amlodipine/Valsartan (Exforge)
  4. Amlodipine/Valsartan/Hydrochlorothiazide (Exforge HCT)
  5. Amlodipine/Benazepril (Lotrel)

VIII. Adverse Effects

  1. See Calcium Channel Blocker
  2. Peripheral Edema
    1. Occurs more commonly in women
    2. Occurs more commonly on Norvasc doses >5 mg
    3. Adding ACE Inhibitor to regimen decreases edema
    4. Avoid Diuretics to reduce Dihydropyridine -induced edema
      1. Dihydropyridine-induced edema mechanism is vasodilation fluid leak into interstitium, NOT Sodium and water retention

IX. Pharmacokinetics

  1. Slowest onset of action, but longest half life of the Dihydropyridine Calcium Channel Blockers

X. Safety

  1. Pregnancy Category C
  2. Avoid in Lactation

XI. Resources

  1. Amlodipine Besylate Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3d14c6b5-a70a-477f-b332-fa5b93a6296f

XII. References

  1. (2022) Presc Lett 29(11): 64-5
  2. (2022) Presc Lett, Resource #381108, Comparison of Calcium Channel Blockers
  3. (2020) Med Lett Drugs Ther 62(1598): 73-80
  4. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 70-1
  5. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

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
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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