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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
• Hepatic impairment
• Elderly patients
• Pulmonary hypertension
• Raynaud's disease
• Hypersensitivity to drug
Use cautiously in:
• aortic stenosis, severe hepatic impairment, heart failure
• elderly patients
• pregnant or breastfeeding patients
• Be aware that this drug may be given alone or with other drugs to relieve hypertension or angina.
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
☞ 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).
• 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.
Pharmacologic: calcium channel blockers
Time/action profile (cardiovascular effects)
Adverse Reactions/Side Effects
Central nervous system
- peripheral edema (most frequent)
- gingival hyperplasia
Drug-Drug interactionStrong 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.
Hepatic ImpairmentOral (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)
- 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 DiagnosesIneffective 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.
- 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.
- 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.