What is amlodipine

Amlodipine also known as amlodipine besylate, is a man-made long-acting dihydropyridine calcium channel blocker. Amlodipine is used alone or in combination with other medications to treat high blood pressure (hypertension) and chest pain (angina pectoris). Amlodipine lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. Amlodipine controls chest pain by increasing the supply of blood to the heart. If taken regularly, amlodipine controls chest pain, but it does not stop chest pain once it starts. Your doctor may prescribe a different medication to take when you have chest pain.

Amlodipine besylate is only available on prescription. Amlodipine besylate comes as tablets or as a liquid to swallow.

High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Key facts

• Amlodipine lowers your blood pressure and makes it easier for your heart to pump blood around your body. Amlodipine is a medicine used to treat high blood pressure. If you have high blood pressure, taking amlodipine helps to prevent future heart disease, heart attacks and strokes.
• Amlodipine is also used to prevent angina (chest pain caused by heart disease).
• Amlodipine has been linked to a low rate of serum enzyme elevations during therapy and to rare instances of clinically apparent acute liver injury.
• It’s usual to take amlodipine once a day.You can take it at any time of day, but try to make sure it’s around the same time each day.
• The most common side effects include headaches, flushing, feeling tired and swollen ankles. These usually improve after a few days.
• Amlodipine can be called amlodipine besilate, amlodipine maleate or amlodipine mesilate. This is because the medicine contains another chemical to make it easier for your body to take up and use it. It doesn’t matter what your amlodipine is called. They all work as well as each other.
• Amlodipine is also called by the brand names Norvasc, Istin and Amlostin.

How does amlodipine work?

Amlodipine is a type of medicine called a calcium channel blocker.

Like other calcium channel blockers, amlodipine works in high blood pressure by relaxing and widening blood vessels. This lowers your blood pressure and makes it easier for your heart to pump blood around your body.

In angina, amlodipine works by improving the blood supply to your heart. Angina is chest pain that comes on when not enough blood gets to the muscles of the heart. It usually happens because the arteries to the heart become hardened and narrowed.

Amlodipine widens the arteries so more oxygen gets to the heart and chest pain is prevented.

What are the differences between amlodipine and other calcium channel blockers?

Amlodipine works as well as other calcium channel blockers for high blood pressure and angina. The side effects are also similar to other calcium channel blockers.

There are some differences, though, between amlodipine and other calcium channel blockers:

the calcium channel blockers, diltiazem and verapamil, have other effects on the heart. They are used for other heart problems and they can also have other side effects.
you only need to take amlodipine once a day, but some other calcium channel blockers need to be taken more often.

How long does amlodipine take to work?

Amlodipine starts to work on the day you start taking it, but it may take a couple of weeks for full effect.

If you’re taking amlodipine for high blood pressure, you may not have any symptoms. In these cases, you may not feel any different when you take amlodipine. This doesn’t mean that the medicine isn’t working and it’s important to keep taking it.

If you’re taking amlodipine for angina, it will probably take a couple of weeks before you feel better. Until then, you’ll still have bouts of chest pain, and you may even find the pain gets worse to start with. Make sure you have your medicine (spray or tablets) for treating angina attacks with you at all times, and use it if you need to.

Can lifestyle changes help?

You can boost the health of your heart by making some key lifestyle changes. These will also help if you have high blood pressure or angina.

• Stop smoking – smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try and avoid secondhand smoke too.
• Cut down on alcohol – drinking too much alcohol raises blood pressure over time. It makes heart failure worse too. Men and women shouldn’t drink more than 14 units of alcohol a week.
• Be more active – regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It doesn’t need to be too energetic – walking every day is enough.
• Eat healthily – aim to eat a diet that includes plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products and lean proteins. It’s a good idea to cut down on salt too. Eating too much salt is the biggest cause of high blood pressure – the more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
• Manage stress – when you’re anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help keep stress at bay.

Can I drink alcohol with amlodipine?

Yes, you can drink alcohol with amlodipine. However, drinking alcohol can increase the blood pressure-lowering effect of amlodipine, which can make you feel sleepy, dizzy or bring on a headache. If this happens to you, it’s best to stop drinking alcohol while you’re taking amlodipine.

Is there any food or drink I need to avoid?

Don’t eat or drink lots of grapefruit or grapefruit juice. This is because grapefruit can increase the concentration of amlodipine in your body and worsen side effects.

Tell your doctor if you have any increased side effects such as dizziness, flushing or headache after eating grapefruit or drinking grapefruit juice.

Otherwise, you can eat and drink normally while taking amlodipine.

How long will I take amlodipine for?

Usually, treatment with amlodipine is long term, even for the rest of your life.

Is amlodipine safe to take for a long time?

Amlodipine is generally safe to take for a long time. In fact, it works best when you take it for a long time.

Is amlodipine addictive?

No, there’s no evidence that amlodipine is addictive.

What will happen if I stop taking amlodipine?

Talk to your doctor if you want to stop taking amlodipine.

Stopping amlodipine may cause your blood pressure to rise – and this may increase your risk of heart attack and stroke.

If you’re bothered by side effects, your doctor may be able to prescribe you a different medicine.

Are there similar medicines to amlodipine?

There are several other calcium channel blockers which work in the same way as amlodipine. They include nifedipine, felodipine, lacidipine and lercanidipine. There are other calcium channel blockers, such as diltiazem and verapamil, that have other effects on the heart.

There are also lots of other types of medicines to lower your blood pressure or treat chest pain. They work in a different way to calcium channel blockers and include:

• ACE (angiotensin converting enzyme) inhibitors – for example ramipril and lisinopril
• angiotensin receptor blockers – for example candesartan
• beta-blockers – for example bisoprolol
• diuretics (water tablets) – for example bendroflumethiazide

If you can’t take amlodipine or other calcium channel blockers because of side effects, you may be able to switch to another blood-pressure lowering medicine. Your doctor will advise which one is best for you depending upon your age, ethnicity and medical history.

Can I come off amlodipine now my blood pressure is lower?

Even if your blood pressure is successfully lowered by amlodipine, it’s best to carry on taking it. If you stop taking amlodipine, your blood pressure could rise back up again.

If you need blood pressure-lowering medicines, you’ll probably need to take them for the rest of your life.

Remember, by keeping your blood pressure low, you’re protecting yourself against having a heart attack or stroke in the future.

Will amlodipine affect my contraception?

Amlodipine won’t affect any type of contraception.

However, some types of hormonal methods of contraception, like the combined contraceptive pill and contraceptive patch, aren’t usually recommended for women taking amlodipine and other medicines for high blood pressure. This is because some hormonal contraceptives can raise your blood pressure and stop amlodipine working properly.

Talk to your doctor if you’re taking combined hormonal contraceptives.

Will amlodipine affect my fertility?

It’s unlikely that amlodipine affects fertility in men or women.

There have been a few reports that calcium channel blockers may reduce the fertility of men who are trying to father a child by IVF (in vitro fertilisation). Nothing definite has been proven, but it’s thought calcium channel blockers may temporarily alter sperm. Talk to your fertility specialist if you’re worried.

Can I drive or ride a bike?

Amlodipine can make some people feel dizzy. If this happens to you, don’t drive a car, ride a bike, or use tools or machinery until you feel better.

Amlodipine mechanism of action

Amlodipine besylate is a second generation calcium channel blocker with antihypertensive and antianginal properties. Amlodipine inhibits the influx of extracellular calcium ions into heart muscle (myocardial smooth muscle cells) and peripheral vascular smooth muscle cells, thereby preventing blood vessels and heart muscle 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. Amlodipine besylate may also modulate multi-drug response activity through inhibition of the p-glycoprotein efflux pump.

Amlodipine uses

Amlodipine besylate is used in the therapy of hypertension and angina pectoris.

How should amlodipine be used?

Amlodipine comes as a tablet to take by mouth. It is usually taken once a day. To help you remember to take amlodipine, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amlodipine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of amlodipine and gradually increase your dose.

Amlodipine controls high blood pressure and chest pain (angina) but does not cure them. Continue to take amlodipine even if you feel well, as you will still be getting the benefits of amlodipine. Do not stop taking amlodipine without talking to your doctor.

You can take amlodipine with or without food.

Swallow amlodipine tablets whole with a drink of water. If it’s easier, you can dissolve the tablets in a glass of water, but if you do this you must drink the solution straight away.

Don’t eat or drink lots of grapefruit or grapefruit juice while you’re taking this medicine. Grapefruit can increase the concentration of amlodipine in your body and worsen side effects.

If you’re taking amlodipine as a liquid, it will come with a plastic syringe or spoon to help you measure out the right dose. If you don’t have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount of medicine. Do not mix the liquid with food or other drinks before taking it.

Who can and can’t take amlodipine

Amlodipine can be taken by adults and children aged 6 years and over.

Amlodipine isn’t suitable for some people.

To make sure amlodipine is safe for you, tell your doctor if you:

• have had an allergic reaction to amlodipine or any other medicines in the past
• are trying to get pregnant, are already pregnant or you are breastfeeding
• have liver or kidney disease
• have heart failure or you’ve recently had a heart attack

Amlodipine besylate special precautions

Before taking amlodipine:

• tell your doctor and pharmacist if you are allergic to amlodipine, any other medications, or any ingredients in amlodipine tablets. Ask your pharmacist for a list of the ingredients.

• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: certain medications for seizures such as carbamazepine (Carbatrol, Equetro, Tegretol), phenytoin (Dilantin, Phenytek), and phenobarbital; clarithromycin (Biaxin, in Prevpac); cyclosporine (Neoral, Sandimmune); efavirenz (Sustiva); indinavir (Crixivan); itraconazole (Onmel, Sporanox); ketoconazole (Nizoral); lovastatin (Altoprev, in Advicor); nefazodone;nelfinavir (Viracept); nevirapine (Viramune); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane, in Rifamate), ritonavir (Norvir, in Kaletra), simvastatin (Zocor, in Simcor, in Vytorin), and tacrolimus (Astragraf SL, Prograf). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• tell your doctor if you have or have ever had heart failure or heart or liver disease.

• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking amlodipine, call your doctor.

Pregnancy and breastfeeding

Amlodipine is not normally recommended in pregnancy or when breastfeeding.

If you’re trying to get pregnant or you’re already pregnant, talk to your doctor about the benefits and possible harms of taking amlodipine. There may be other medicines that are safer for you.

Amlodipine and breastfeeding

Small amounts of amlodipine may get into breast milk, but it’s not known if this is harmful to the baby. Talk to your doctor as other medicines might be better while you’re breastfeeding.

Tell your doctor if you’re:

• trying to get pregnant
• pregnant
• breastfeeding

Cautions with other medicines

If you take other medicines that lower blood pressure, such as ramipril and lisinopril, at the same time as amlodipine, the combination can sometimes lower your blood pressure too much. This may make you feel dizzy or faint. If this keeps happening to you, tell your doctor as your dose may need to be changed.

Some medicines can interfere with the way amlodipine works.

Tell your doctor if you’re taking any of these medicines before starting amlodipine:

• the antibiotics clarithromycin, erythromycin or rifampicin
• medicines for high blood pressure including diltiazem and verapamil
• the antifungals itraconazole or ketoconazole
• medicines to treat HIV or HCV (hepatitis C virus)
• the anti-epilepsy medicines, carbamazepine, phenytoin, phenobarbital (phenobarbitone) or primidone
• medicines to suppress your immune system such as ciclosporin or tacrolimus
• more than 20mg a day of the cholesterol-lowering medicine, simvastatin

Mixing amlodipine with herbal remedies or supplements

St John’s wort, a herbal medicine taken for depression, is thought to interfere with the way amlodipine works. Talk to your doctor if you’re thinking about taking St John’s wort.

Amlodipine dosage

Take amlodipine exactly as your doctor has told you, and follow the directions on the label. If you’re not sure, check with your doctor or pharmacist.

It’s usual to take amlodipine once a day. You can take amlodipine at any time of day, but try to make sure it’s around the same time every day.

Amlodopine comes as 5mg and 10mg tablets.

Your dose of amlodipine depends on why you need the medicine.

To decide the correct dose for you, your doctor will check your blood pressure and ask if you’re getting any side effects.

Depending on why you’re taking amlodipine, the usual starting dose is 5mg once a day.

If the starting dose isn’t working well enough (your blood pressure does not lower enough, or your angina isn’t controlled), you may need to increase your dose to 10mg. Adjust dosage according to blood pressure goals. In general, wait 7 to 14 days between titration steps. Titrate more rapidly, however, if clinically warranted, provided the patient is assessed frequently.

Small, fragile, or elderly patients, or patients with hepatic insufficiency may be started on 2.5 mg once daily and this dose may be used when adding amlodipine besylate to other antihypertensive therapy.

Doses may be lower for children.

Adult Dose for Hypertension

Use: Alone or in combination with other antihypertensive agents to treat hypertension

• Initial dose: 5 mg orally once a day
• Maintenance dose: 5 to 10 mg orally once a day
• Maximum dose: 10 mg/day

Comments:

• Patients who are small or fragile may be started on 2.5 mg orally once a day.
• The dosage should be adjusted according to patient response. In general, titration should proceed over 7 to 14 days. If clinically warranted, titration may proceed more rapidly, provided the patient is assessed frequently.

Adult Dose for Angina Pectoris

Uses:

• Alone or in combination with other antianginal agents for the symptomatic treatment of chronic stable angina
• Alone or in combination with other antianginal agents for the treatment of confirmed/suspected vasospastic angina
• To reduce the risk of hospitalization for angina and to reduce the risk of a coronary revascularization procedure in patients with recently documented coronary heart disease by angiography and without heart failure or an ejection fraction less than 40%

Maintenance dose: 5 to 10 mg orally once a day
Maximum dose: 10 mg/day

Comments:

• In clinical studies, most patients with angina or coronary artery disease (coronary heart disease) required 10 mg orally once a day.
• The dosage should be adjusted according to patient response. In general, titration should proceed over 7 to 14 days. If clinically warranted, titration may proceed more rapidly, provided the patient is assessed frequently.

Adult Dose for Coronary Artery Disease

Uses:

• Alone or in combination with other antianginal agents for the symptomatic treatment of chronic stable angina
• Alone or in combination with other antianginal agents for the treatment of confirmed/suspected vasospastic angina
• To reduce the risk of hospitalization for angina and to reduce the risk of a coronary revascularization procedure in patients with recently documented coronary heart disease by angiography and without heart failure or an ejection fraction less than 40%

Maintenance dose: 5 to 10 mg orally once a day
Maximum dose: 10 mg/day

Comments:

• In clinical studies, most patients with angina or coronary artery disease (coronary heart disease) required 10 mg orally once a day.
• The dosage should be adjusted according to patient response. In general, titration should proceed over 7 to 14 days. If clinically warranted, titration may proceed more rapidly, provided the patient is assessed frequently.

Geriatric Dose for Hypertension

Use: Alone or in combination with other antihypertensive agents to treat hypertension

• Initial dose: 2.5 mg orally once a day
• Maintenance dose: 2.5 to 10 mg orally once a day
• Maximum dose: 10 mg/day

Comment:

• The dosage should be adjusted according to patient response. In general, titration should proceed over 7 to 14 days. If clinically warranted, titration may proceed more rapidly, provided the patient is assessed frequently.

Geriatric Dose for Angina Pectoris

Uses:

• Alone or in combination with other antianginal agents for the symptomatic treatment of chronic stable angina
• Alone or in combination with other antianginal agents for the treatment of confirmed/suspected vasospastic angina
• To reduce the risk of hospitalization for angina and to reduce the risk of a coronary revascularization procedure in patients with recently documented coronary heart disease by angiography and without heart failure or an ejection fraction less than 40%

Initial dose: 5 mg orally once a day
Maintenance dose: 5 to 10 mg orally once a day
Maximum dose: 10 mg/day

Comments:

• In clinical studies, most patients with angina or coronary artery disease (coronary heart disease) required 10 mg orally once a day.
• The dosage should be adjusted according to patient response. In general, titration should proceed over 7 to 14 days. If clinically warranted, titration may proceed more rapidly, provided the patient is assessed frequently.

Pediatric Dose for Hypertension

• Use: Alone or in combination with other antihypertensive agents to treat hypertension

6 to 17 years:

• Maintenance dose: 2.5 to 5 mg orally once a day
• Maximum dose: 5 mg/day

Comments:

• Doses higher than 5 mg have not been studied in pediatric patients.
• The dosage should be adjusted according to patient response. In general, titration should proceed over 7 to 14 days. If clinically warranted, titration may proceed more rapidly, provided the patient is assessed frequently.

Renal Dose Adjustments

• Data not available

Liver Dose Adjustments

• Hypertension: Initial dose: 2.5 mg orally once a day
• Angina pectoris/coronary artery disease (coronary heart disease): Initial dose: 5 mg orally once a day

Comments:

• Most patients with angina or coronary heart disease will require a dosage of 10 mg/day.
• The dosage should be adjusted according to patient response. In general, titration should proceed over 7 to 14 days. If clinically warranted, titration may proceed more rapidly, provided the patient is assessed frequently.

What should I do if I forget a dose?

If you forget to take a dose of amlodipine, take it as soon as you remember that day and then carry on as normal. If you forget to take the dose for the whole day, skip the missed dose and carry on as normal the next day. Do not take a double dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

An overdose of amlodipine can cause dizziness and sleepiness.

The amount of amlodipine that can lead to an overdose varies from person to person. Call your doctor or go to accident and emergency department straight away if you take too much amlodipine by accident

If you need to go to a hospital accident and emergency department, do not drive yourself – get someone else to drive you or call for an ambulance.

Take the amlodipine packet or leaflet inside it plus any remaining medicine with you.

Amlodipine side effects

Like all medicines, amlodipine can cause side effects although not everyone gets them. Side effects often improve as your body gets used to the medicine.

Common side effects

These common side effects happen in more than 1 in 100 people. They are usually mild and short-lived.

Talk to your doctor or pharmacist if the side effects bother you or last for more than a few days:

• headache
• dizziness
• flushing
• a pounding heartbeat
• swelling of the hands, feet, ankles, or lower legs
• upset stomach
• stomach pain
• dizziness or lightheadedness
• drowsiness
• excessive tiredness

Serious side effects

Serious side effects after taking amlodipine are rare and happen in less than 1 in 10,000 people.

Tell a doctor straight away if you get:

• stomach problems – severe pain in your tummy, with or without bloody diarrhoea, feeling sick and being sick can be signs of pancreatitis
• yellow skin or eyes – this can be a sign of liver problems
• chest pain that is new or worse – this needs to be checked out as chest pain is a possible symptom of a heart attack

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to amlodipine.

Contact a doctor straight away if:

• you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you’re wheezing
• you get tightness in the chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

These are warning signs of a serious allergic reaction. A serious allergic reaction is an emergency.

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment:

• more frequent or more severe chest pain
• rapid, pounding, or irregular heartbeat
• fainting

These are not all the side effects of alendronic acid. For a full list, see the leaflet inside your medicine packet.

Symptoms of overdose may include:

• dizziness
• fainting
• rapid heartbeat

How to cope with side effects

What to do about:

• headaches – make sure you rest and drink plenty of fluids. Don’t drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking amlodipine. Talk to your doctor if they last longer than a week or are severe.
• feeling dizzy – if amlodipine makes you feel dizzy, stop what you’re doing and sit or lie down until you feel better
• flushing – try cutting down on coffee, tea and alcohol. It might help to keep the room cool and use a fan. You could also spray your face with cool water or sip cold or iced drinks. The flushing should go away after a few days. If it doesn’t go away, or if it’s causing you problems, contact your doctor.
• swollen ankles – raise your legs while you’re sitting down

Amlodipine and Benazepril

How should amlodipine and benazepril be used?

Before taking amlodipine and benazepril:

• tell your doctor and pharmacist if you are allergic to amlodipine (Norvasc, in Caduet, others), benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec, in Vaseretic), fosinopril, lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), trandolapril (Mavik), any other medications, or or any of the ingredients in amlodipine and benazepril capsules. Ask your pharmacist for a list of the ingredients.

• tell your doctor or pharmacist if you are taking valsartan and sacubitril (Entresto) or if you have stopped taking it within the last 36 hours. Your doctor will probably tell you not to take amlodipine and benazepril, if you are also taking valsartan and sacubitril. Also, tell your doctor if you have diabetes and you are taking aliskiren (Tekturna, in Amturnide, Tekamlo, Tekturna HCT). Your doctor will probably tell you not to take amlodipine and benazepril if you have diabetes and you are also taking aliskiren.

• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: diuretics (‘water pills’), lithium (Lithobid), and potassium supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• tell your doctor if you have recently had severe diarrhea or vomiting and if you have or have ever had diabetes; heart failure; lupus; scleroderma (a condition in which extra tissue grows on the skin and some organs); or heart, liver, or kidney disease.

• tell your doctor if you are breast-feeding.

• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking amlodipine and benazepril.

• talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.

Amlodipine and benazepril side effects

Amlodipine and benazepril may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• cough
• headache
• dizziness
• swelling of the hands, feet, ankles, or lower legs

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment:

• swelling of the face, throat, tongue, lips, or eyes
• hoarseness
• difficulty swallowing or breathing
• fainting
• severe skin rash
• yellowing of the skin or eyes
• more frequent or more severe chest pain

Amlodipine and benazepril may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.