AMLODIPINE

(am-lo'di-peen)
Norvasc
Classifications: CARDIOVASCULAR AGENT; CALCIUM CHANNEL BLOCKER;
ANTIHYPERTENSIVE AGENT
Prototype: Nifedipine
Pregnancy Category: C

Availability
2.5 mg, 5 mg, 10 mg tablets

Actions
Amlodipine is a calcium channel blocking agent that selectively blocks calcium ion
reflux across cell membranes of cardiac and vascular smooth muscle without changing
serum calcium concentrations. It predominantly acts on the peripheral circulation,
decreasing peripheral vascular resistance, and increases cardiac output.

Therapeutic Effects
Amlodipine reduces systolic, diastolic, and mean arterial blood pressure.

Uses
Treatment of mild to moderate hypertension and angina.

Contraindications
Hypersensitivity to amlodipine; pregnancy (category C).

Cautious Use
Liver disease; concomitant use with hypotension; CHF; lactation; older adults.

Route & Dosage

Hypertension
Adult: PO 5–10 mg once daily
Geriatric: Start with 2.5 mg, adjust dose at intervals of not less than 2 wk

Hepatic Impairment
Start with 2.5 mg, adjust dose at intervals of not less than 2 wk
Administration
Oral
 Give drug without regard to meals.
 Prescribed initial dosages of 2.5 mg daily are common if added to a regimen
including other antihypertensive drugs.
 Note: Doses are usually titrated over a period of 14 d or more rapidly if
warranted.
 Store at 15°–30° C (59°–86° F).

Adverse Effects ( 1%)

CV: Palpitations, flushing tachycardia, peripheral or facial edema, bradycardia, chest
pain, syncope, postural hypotension. CNS: Light-headedness, fatigue, headache. GI:
Abdominal pain, nausea, anorexia, constipation, dyspepsia, dysphagia, diarrhea,
flatulence, vomiting. Urogenital: Sexual dysfunction, frequency, nocturia. Respiratory:
Dyspnea. Skin: Flushing, rash. Other: Arthralgia, cramps, myalgia.

Interactions
Drug: Adenosine may increase the risk of bradycardia; bosentan may decrease efficacy
of amlodipine; additive hypotensive effects with other ANTIHYPERTENSIVE AGENTS;
AZOLE ANTIFUNGALS (e.g., fluconazole, itraconazole) may inhibit metabolism of
amlodipine; itraconazole may increase edema. Food: Grapefruit juice may increase
amlodipine levels. Herbal: Ephedra, Ma Huang, melatonin may antagonize
antihypertensive effects.

Pharmacokinetics
Absorption: >90% absorbed from GI tract. Onset: Gradual. Peak: 6–9 h. Duration: 24
h. Distribution: >95% protein bound. Metabolism: Extensively metabolized in the liver
to inactive metabolites. Elimination: Inactive metabolites primarily excreted in urine
(<5%–10% excreted unchanged), 20%–25% excreted in feces. Half-Life: <45 y: 28–69 h;
>60 y: 40–120 h.

NURSING IMPLICATIONS
Assessment & Drug Effects

 Monitor BP for therapeutic effectiveness. BP reduction is greatest after peak

levels of amlodipine are achieved 6–9 h following oral doses.
 Monitor for S&S of dose-related peripheral or facial edema that may not be
accompanied by weight gain; rarely, severe edema may cause discontinuation of
drug.
  Monitor BP with postural changes. Report postural hypotension. Monitor more
frequently when additional antihypertensives or diuretics are added.
 Monitor heart rate; dose-related palpitations (more common in women) may
occur.

Patient & Family Education

 Report significant swelling of face or extremities.

 Take care to have support when standing & walking due to possible dose-related
light-headedness/dizziness.
 Report shortness of breath, palpitations, irregular heartbeat, nausea, or
constipation to physician.
 Do not breast feed while taking this drug without consulting physician.

Common adverse effects in italic, life-threatening effects underlined: generic names in bold; classifications
in SMALL CAPS; Canadian drug name; Prototype drug

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