AMLODIPINE h�p://www.robholland.com/Nursing/Drug_Guide/data/monographfr...

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

Availability
2.5 mg, 5 mg, 10 mg tablets

Ac�ons
Amlodipine is a calcium channel blocking agent that selec�vely blocks calcium ion reflux across cell
membranes of cardiac and vascular smooth muscle without changing serum calcium concentra�ons. It
predominantly acts on the peripheral circula�on, decreasing peripheral vascular resistance, and increases
cardiac output.

Therapeu�c Effects
Amlodipine reduces systolic, diastolic, and mean arterial blood pressure.

Uses
Treatment of mild to moderate hypertension and angina.

Contraindica�ons
Hypersensi�vity to amlodipine; pregnancy (category C).

Cau�ous Use
Liver disease; concomitant use with hypotension; CHF; lacta�on; 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

Administra�on
Oral

• Give drug without regard to meals.

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• Prescribed ini�al dosages of 2.5 mg daily are common if added to a regimen including other
an�hypertensive drugs.
• Note: Doses are usually �trated over a period of 14 d or more rapidly if warranted.
• Store at 15°–30° C (59°–86° F).

Adverse Effects ( 1%)

CV: Palpita�ons, flushing tachycardia, peripheral or facial edema, bradycardia, chest pain, syncope, postural
hypotension. CNS: Light-headedness, fa�gue, headache. GI: Abdominal pain, nausea, anorexia,
cons�pa�on, dyspepsia, dysphagia, diarrhea, flatulence, vomi�ng. Urogenital: Sexual dysfunc�on,
frequency, nocturia. Respiratory: Dyspnea. Skin: Flushing, rash. Other: Arthralgia, cramps, myalgia.

Interac�ons
Drug: Adenosine may increase the risk of bradycardia; bosentan may decrease efficacy of amlodipine;
addi�ve 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
an�hypertensive effects.

Pharmacokine�cs
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 inac�ve metabolites. Elimination:
Inac�ve 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 Implica�ons
Assessment & Drug Effects

• Monitor BP for therapeu�c effec�veness. BP reduc�on is greatest a�er 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 discon�nua�on of drug.
• Monitor BP with postural changes. Report postural hypotension. Monitor more frequently when
addi�onal an�hypertensives or diure�cs are added.
• Monitor heart rate; dose-related palpita�ons (more common in women) may occur.

Pa�ent & Family Educa�on

• Report significant swelling of face or extremi�es.

• Take care to have support when standing & walking due to possible dose-related light-
headedness/dizziness.
• Report shortness of breath, palpita�ons, irregular heartbeat, nausea, or cons�pa�on to physician.
• Do not breast feed while taking this drug without consul�ng physician.

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

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