Amlodipine

(am - L O H - dih - p een)

CLASSIFICATION(S): Calcium channel blocker PREGNANCY CATEGORY: C Rx: Amvaz, Norvasc.
SEE ALSO CALCIUM CHANNEL BLOCKING AGENTS.

USES (1) Hypertension alone or in combination with other antihypertensives. (2) Chronic stable angina alone or in combination with other antianginal drugs. (3) Vasospastic (Prinzmetals or variant) angina alone or in combination with other antianginal drugs. ACTION/KINETICS Action Inhibits influx of calcium through the cell membrane, resulting in a depression of automaticity and conduction velocity in cardiac muscle. Decreases SA and AV conduction and prolongs AV node effective and functional refractory periods. Slight decrease in HR. Possible slight decrease in myocardial contractility. CO is increased; moderate decrease in peripheral vascular resistance. Pharmacokinetics 1 Peak plasma levels: 612 hr. t /2, elimination: 3050 hr. 90% metabolized in the liver to inactive metabolites; 10% excreted unchanged in the urine. Plasma protein binding: About 93%. CONTRAINDICATIONS Use with grapefruit juice. SPECIAL CONCERNS Use with caution in clients with CHF and in those with impaired hepatic function or reduced hepatic blood flow. Safety and efficacy have not been determined in children. SIDE EFFECTS Most Common Edema, palpitations, dizziness/lightheadedness, headache, fatigue/lethargy, flushing. CNS: Headache, fatigue, lethargy, somnolence, dizziness, lightheadedness, sleep disturbances, depression, amne-

sia, psychosis, hallucinations, paresthesia, asthenia, insomnia, abnormal dreams, malaise, anxiety, tremor, hand tremor, hypoesthesia, vertigo, depersonalization, migraine, apathy, agitation, amnesia. GI: Nausea, abdominal discomfort, cramps, dyspepsia, diarrhea, constipation, vomiting, dry mouth, thirst, flatulence, dysphagia, loose stools. CV: Peripheral edema, palpitations, hypotension, syncope, bradycardia, unspecified arrhythmias, tachycardia, ventricular extrasystoles, peripheral ischemia, cardiac failure, pulse irregularity, increased risk of MI. Dermatologic: Dermatitis, rash, pruritus, urticaria, photosensitivity, petechiae, ecchymosis, purpura, bruising, hematoma, cold/ clammy skin, skin discoloration, dry skin. Musculoskeletal: Muscle cramps, pain, or inflammation; joint stiffness or pain, arthritis, twitching, ataxia, hypertonia. GU: Polyuria, dysuria, urinary frequency, nocturia, sexual difficulties. Respiratory: Nasal or chest congestion, sinusitis, rhinitis, SOB, dyspnea, wheezing, cough, chest pain. Ophthalmic: Diplopia, abnormal vision, conjunctivitis, eye pain, abnormal visual accommodation, xerophthalmia. Miscellaneous: Tinnitus, flushing, sweating, weight gain, epistaxis, anorexia, increased appetite, taste perversion, parosmia. ADDITIONAL DRUG INTERACTIONS Diltiazem Plasma levels of amlodipine further BP Grapefruit juice / Plasma amlodipine levels Indinavir + Ritonavir / Amlodipine AUC R/T inhibition of CYP3A4 metabolism of amlodipine HOW SUPPLIED Tablets: 2.5 mg, 5 mg, 10 mg. DOSAGE TABLETS Hypertension. Adults, usual, individualized: 5 mg/day, up to a maximum of 10 mg/day. Titrate the dose over 714 days. Adjust dose to client needs. Chronic stable or vasospastic angina. Adults: 510 mg, using the lower dose for elderly clients and those with hepatIV = Intravenous

C = see color insert

H = Herbal

E = sound alike drug

AMLODIPINE
2. Review list of drugs prescribed to prevent interactions. 3. Monitor VS, ECG, CBC, renal and LFTs. Reduce dose in elderly and clients with liver dysfunction. CLIENT/FAMILY TEACHING 1. Take as directed, once daily. May take with/without meals; food helps decrease stomach upset. Avoid grapefruit juice; increases drug concentrations. 2. Report S&S of chest pain, SOB, dizziness, swelling of extremities, irregular pulse, or altered vision immediately. Keep record of BP and pulse. 3. Use NTG SL for angina as directed; report lack of response. 4. Use caution, may experience lightheadedness or dizziness. 5. Ask for generic; cost savings. 6. Keep all FU appointments to assess response and adverse SE. OUTCOMES/EVALUATE Desired BP control Frequency/intensity of angina

ic insufficiency. Most clients require 10 mg.

NURSING CONSIDERATIONS
E Do not confuse amlodipine with amiloride (a diuretic) or Norvasc with Navane (an antipsychotic). ADMINISTRATION/STORAGE 1. Food does not affect bioavailability of amlodipine. 2. Elderly clients, small/fragile clients, or those with hepatic insufficiency may be started on 2.5 mg/day. May also use this dose when adding amlodipine to other antihypertensive therapy. 3. Can be given safely with ACEI, betablockers, nitrates (long-acting), nitroglycerin (sublingual), or thiazides. 4. Store from 2530C (5986F). ASSESSMENT 1. Note reasons for therapy, history of CAD or CHF, angina. Monitor carefully with angina as CCBs may cause increase in frequency/intensity of pain with severe CAD initially and with dose increase.

Bold Italic = life threatening side effect

= black box warning

W = Available in Canada