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amlodipine besylate


Pharmacologic class: Calcium channel blocker

Therapeutic class: Antihypertensive

Pregnancy risk category C


Inhibits influx of extracellular calcium ions, thereby decreasing myocardial contractility, relaxing coronary and vascular muscles, and decreasing peripheral resistance


Tablets: 2.5 mg, 5 mg, 10 mg

Indications and dosages

Essential hypertension, chronic stable angina pectoris, and vasospastic angina (Prinzmetal's angina)

Adults: 5 to 10 mg P.O. once daily

Dosage adjustment

• Hepatic impairment

• Elderly patients

Off-label uses

• Pulmonary hypertension

• Raynaud's disease


• Hypersensitivity to drug


Use cautiously in:

• aortic stenosis, severe hepatic impairment, heart failure

• elderly patients

• pregnant or breastfeeding patients

• children.


• Be aware that this drug may be given alone or with other drugs to relieve hypertension or angina.

Adverse reactions

CNS: headache, dizziness, drowsiness, light-headedness, fatigue, weakness, lethargy

CV: peripheral edema, angina, bradycardia, hypotension, palpitations

GI: nausea, abdominal discomfort

Musculoskeletal: muscle cramps, muscle pain or inflammation

Respiratory: shortness of breath, dyspnea, wheezing

Skin: rash, pruritus, urticaria, flushing


Drug-drug. Beta-adrenergic blockers: increased risk of adverse effects

Fentanyl, nitrates, other antihypertensives, quinidine: additive hypotension

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Patient monitoring

Monitor patient for worsening angina.

• Monitor heart rate and rhythm and blood pressure, especially at start of therapy.

Assess for heart failure; report signs and symptoms (peripheral edema, dyspnea) to prescriber promptly.

Give sublingual nitroglycerin, as prescribed, if patient has signs or symptoms of acute myocardial infarction (especially when dosage is increased).

Patient teaching

• If patient also uses sublingual nitroglycerin, tell him he can take nitroglycerin as needed for acute angina.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• As appropriate, review all other significant adverse reactions, especially those related to the drugs and behaviors mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


(am-loe-di-peen) ,


(trade name)


Therapeutic: antihypertensives
Pharmacologic: calcium channel blockers
Pregnancy Category: C


Alone or with other agents in the management of hypertension, angina pectoris, and vasospastic (Prinzmetal’s) angina.


Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction.

Therapeutic effects

Systemic vasodilation resulting in decreased BP.
Coronary vasodilation resulting in decreased frequency and severity of attacks of angina.


Absorption: Well absorbed after oral administration (64–90%).
Distribution: Probably crosses the placenta.
Protein Binding: 95–98%.
Metabolism and Excretion: Mostly metabolized by the liver.
Half-life: 30–50 hr (↑ in geriatric patients and patients with hepatic impairment).

Time/action profile (cardiovascular effects)

POunknown6–924 hr


Contraindicated in: Hypersensitivity;Systolic BP <90 mm Hg.
Use Cautiously in: Severe hepatic impairment (dosage reduction recommended);Aortic stenosis;History of HF; Obstetric / Lactation / Pediatric: Children <6 yr (safety not established); Geriatric: Dose reduction recommended; ↑ risk of hypotension.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • fatigue


  • peripheral edema (most frequent)
  • angina
  • bradycardia
  • hypotension
  • palpitations


  • gingival hyperplasia
  • nausea


  • flushing


Drug-Drug interaction

Strong CYP3A4 inhibitors, including ketoconazole, itraconazole, and ritonavir may ↑ levels.Additive hypotension may occur when used concurrently with fentanyl, other antihypertensives, nitrates, acute ingestion of alcohol, or quinidine.Antihypertensive effects may be ↓ by concurrent use of nonsteroidal anti-inflammatory agents.May ↑ risk of neurotoxicity with lithium.↑ risk of myopathy with simvastatin (do not exceed 20 mg/day of simvastatin).May ↑ cyclosporine levelsGrapefruit juice ↑ serum levels and effect.


Oral (Adults) 5–10 mg once daily; antihypertensive in fragile or small patients or patients already receiving other antihypertensives—initiate at 2.5 mg/day, ↑ as required/tolerated (up to 10 mg/day) as an antihypertensive therapy with 2.5 mg/day in patients with hepatic insufficiency.
Oral (Geriatric Patients) Antihypertensive—Initiate therapy at 2.5 mg/day, ↑ as required/tolerated (up to 10 mg/day); antianginal—initiate therapy at 5 mg/day, ↑ as required/tolerated (up to 10 mg/day).
Oral (Children 6–17 yr) 2.5–5 mg once daily

Hepatic Impairment

Oral (Adults) Antihypertensive—Initiate therapy at 2.5 mg/day, ↑ as required/tolerated (up to 10 mg/day); antianginal—initiate therapy at 5 mg/day, ↑ as required/tolerated (up to 10 mg/day).

Availability (generic available)

Tablets: 2.5 mg, 5 mg, 10 mg Cost: Generic — 2.5 mg $11.35 / 100, 5 mg $12.86 / 100, 10 mg $8.42 / 100
In combination with: aliskiren (Tekamlo), aliskiren/hydrochlorothiazide (Amturnide), atorvastatin (Caduet), benazepril (Lotrel), olmesartan (Azor), telmisartan (Twynsta), valsartan (Exforge), olmesartan/hydrochlorothiazide (Tribenzor), and valsartan/hydrochlorothiazide (Exforge HCT). See combination drugs.

Nursing implications

Nursing assessment

  • Monitor BP and pulse before therapy, during dose titration, and periodically during therapy. Monitor ECG periodically during prolonged therapy.
    • Monitor intake and output ratios and daily weight. Assess for signs of HF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).
  • Angina: Assess location, duration, intensity, and precipitating factors of patient’s anginal pain.
  • Lab Test Considerations: Total serum calcium concentrations are not affected by calcium channel blockers.

Potential Nursing Diagnoses

Ineffective tissue perfusion (Indications)
Acute pain (Indications)


  • Do not confuse amlodipine with amiloride. Do not confuse Norvasc with Navane.
  • Oral: May be administered without regard to meals.

Patient/Family Teaching

  • Advise patient to take medication as directed, even if feeling well. Take missed doses as soon as possible unless almost time for next dose; do not double doses. May need to be discontinued gradually.
    • Advise patient to avoid large amounts (6–8 glasses of grapefruit juice/day) during therapy.
    • Instruct patient on correct technique for monitoring pulse. Instruct patient to contact health care professional if heart rate is <50 bpm.
    • Caution patient to change positions slowly to minimize orthostatic hypotension.
    • May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
    • Instruct patient on importance of maintaining good dental hygiene and seeing dentist frequently for teeth cleaning to prevent tenderness, bleeding, and gingival hyperplasia (gum enlargement).
    • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken, to avoid alcohol, and to consult health care professional before taking any new medications, especially cold preparations.
    • Advise patient to notify health care professional if irregular heartbeats, dyspnea, swelling of hands and feet, pronounced dizziness, nausea, constipation, or hypotension occurs or if headache is severe or persistent.
    • Caution patient to wear protective clothing and use sunscreen to prevent photosensitivity reactions.
    • Advise patient to inform health care professional of medication regimen before treatment or surgery.
  • Angina: Instruct patient on concurrent nitrate or beta-blocker therapy to continue taking both medications as directed and to use SL nitroglycerin as needed for anginal attacks.
    • Advise patient to contact health care professional if chest pain does not improve or worsens after therapy, if it occurs with diaphoresis, if shortness of breath occurs, or if severe, persistent headache occurs.
    • Caution patient to discuss exercise restrictions with health care professional before exertion.
  • Hypertension: Encourage patient to comply with other interventions for hypertension (weight reduction, low-sodium diet, smoking cessation, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension.
    • Instruct patient and family in proper technique for monitoring BP. Advise patient to take BP weekly and to report significant changes to health care professional.

Evaluation/Desired Outcomes

  • Decrease in BP.
  • Decrease in frequency and severity of anginal attacks.
    • Decrease in need for nitrate therapy.
    • Increase in activity tolerance and sense of well-being.
Drug Guide, © 2015 Farlex and Partners


A trademark for the drug amlodipine besylate.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


Amlodepine besylate, see there.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
References in periodicals archive ?
Cards can be printed directly from the AffordRx website, along with a Norvasc coupon or any other available prescription discount cards.
Norvasc (amlodipine is the generic name) is a long-acting calcium channel blocker.
Drug Retail/100 Tabs Cost Mark Up % Celebrex 100mg $130.27 $0.60 21,712% Claritin 10mg $215.17 $0.71 3,306% Keflex 250mg $157.39 $1.88 8,372% Lipitor 20mg $272.37 $5.80 4,696% Norvasc 10mg $188.29 $0.14 134,493% Paxil 20mg $220.27 $7.60 2,898% Prevacid 30mg $44.77 $1.01 34,136% Prilosec 20mg $360.97 $0.52 69,417% Drug Retail/100 Tabs Cost % Mark Up Prozac 20mg $247.47 $0.11 224,973% Tenormin 50mg $104.47 $0.13 80,362% Vasotec 10mg $102.37 $0.20 51,185% Xanax 1mg $136.79 $0.024 569,958% Zestril 20mg $89.89 $3.20 2,809% Zithromax 600mg $1,482.19 $18.78 7,892% Zocor 40mg $350.27 $8.63 4,059% Zoloft 50mg $206.87 $1.75 11,821%
Pfizer's suit alleges that PITC was planning to import a cheaper version of the hypertension drug Norvasc. Pfizer alleges the Indian company that manufactures the cheaper product is not licensed by Pfizer to produce the drug.
The combination of the calcium-channel blocker amlodipine (Norvasc) and the ACE inhibitor perindopril (Aceon) "not only led to fewer cardiovascular events, but it also saved lives."
A third double-blind, placebo-controlled trial--IDNT (Irbesartan Diabetic Nephropathy Trial (3)--randomized 1715 patients to irbesartan, amlodipine (Norvasc), or placebo for a median follow-up of 2.6 years.
For instance, say a patient has high blood pressure and the doctor prescribes the brand Norvasc. At the pharmacy the patient asks for a generic alternative but none exists because Norvasc is not available generically.
Shortly before his death, he began to take Norvasc to help control headaches, which he began to experience in December of 1999.
By way of example, Goodman cites the calcium-channel blockers, like Pfizer's Norvasc, which treat high blood pressure and can cost more than $2 per pill.
For example, Pfizer has a product called "Norvasc" in most EU Member States, but not in Spain, where it is called "Norvas", because in Spanish words do not customarily end in "c".