COMBINATION DRUG

Amlodipine besylate and benazepril hydrochloride

(am - L O H - dih - p een, be h- NAY Z - eh -pr il l)
CLASSIFICATION(S): Antihypertensive PREGNANCY CATEGORY: D Rx: Lotrel.
SEE ALSO AMLODIPINE AND BENAZEPRIL HYDROCHLORIDE.

USES Hypertension (not indicated for initial therapy). CONTENT Amlodipine besylate (calcium channel blocker), 2.5 mg, 5 mg, or 10 mg with benazepril hydrochloride (ACE inhibitor), 10 mg, 20 mg, or 40 mg with the following available combinations: 2.5/10 mg, 5/10 mg, 5/20 mg, 5/40 mg, 10/20 mg, and 10/40 mg. ACTION/KINETICS Action Benazepril (and its active metabolite benazeprilat) inhibit angiotensin-converting enzyme resulting in decreased plasma angiotensin II, which leads to decreased vasopressor activity and decreased aldosterone secretion. Amlodipine inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle, resulting in a depression of automaticity and conduction velocity. There is a reduction of both supine and standing BP, with no compensatory tachycardia. Pharmacokinetics Absorption of either drug is not affected by food. Peak plasma levels, amlodipine: 612 hr; benazepril and benazeprilat: 0.52 hr and 1.54 hr, respectively. Amlodipine is metabolized in the liver and excreted through the urine. Benazepril and metabolites are excret1 ed through the urine. t /2, elimination, amlodipine: 2 days; benazeprilat: 1011 hr.

CONTRAINDICATIONS Hypersensitivity to benazepril, to any other ACE inhibitor, or to amlodipine. Lactation. SPECIAL CONCERNS When used in pregnancy during the second and third trimesters, ACE inhibitors can cause injury and even death to the developing fetus. When pregnancy is detected, discontinue the ACE inhibitor as soon as possible. Use amlodipine with caution in clients with severe aortic stenosis and in severe renal or hepatic disease. In clients with CHF, with or without associated renal insufficiency, benazepril may cause excessive hypotension. Safety and efficacy have not been determined in children. SIDE EFFECTS Most Common Cough, hypotension, edema (dependent, angioedema, facial edema), headache, dizziness. See Amlodipine and Benazepril hydrochloride for a complete list of possible side effects. LABORATORY TEST CONSIDERATIONS Serum creatinine (especially in those with renal insufficiency, those pretreated with a diuretic, and those with renal artery stenosis). Serum bilirubin, uric acid. DRUG INTERACTIONS See Amlodipine and Benazepril hydrochloride. HOW SUPPLIED See Content. DOSAGE CAPSULES. Hypertension. One 2.5/10, 5/10, 5/20, 5/40, 10/20, or 10/40 capsule daily. For the small, elderly, frail, or hepatically impaired, initial amlodipine dose is 2.5 mg.

NURSING CONSIDERATIONS
ADMINISTRATION/STORAGE 1. To minimize dose-independent hazards, it is usually appropriate to begin Lotrel therapy only after a client has: Failed to achieve the desired antihypertensive effect with one or the other monotherapy, or
IV = Intravenous

C = see color insert

H = Herbal

E = sound alike drug

AMLODIPINE BESYLATE/BENAZEPRIL HYDROCHLORIDE

sore throat occurstop drug and report. 3. Lie or sit down if experiencing dizziness or lightheadedness when standing. 4. Poor fluid intake, excessive perspiration, diarrhea, or vomiting can lead to excessive fall in BP resulting in lightheadedness or fainting. 5. Use reliable contraception; stop drug/report if pregnant. 6. Review importance of lifestyle changes on BP: weight control, regular exercise, smoking cessation, and moderate intake of alcohol and salt 7. Keep BP and weight log for provider review; report any adverse effects. OUTCOMES/EVALUATE Control of BP

Demonstrated inability to achieve adequate antihypertensive effect with amlodipine therapy without developing edema. 2. Store from 1530C (5986F). ASSESSMENT 1. List reasons for therapy, other agents trialed, outcome. 2. Monitor VS, EKG, CBC, K+, renal and LFTs. 3. Note culture, risk factors, CAD, CHF, if renal artery stenosis; assess for pregnancy. CLIENT/FAMILY TEACHING 1. Lotrel is a combination of two drugs in one capsule to better control BP. Take at the same time each day. 2. If swelling of extremities/face, cough, SOB, dizziness, abdominal pain, dark urine, yellowing of skin, persistent

Bold Italic = life threatening side effect

= black box warning

W = Available in Canada