Home Drug Guide Amlodipine Besylate

Drug Guide

Generic Name

Amlodipine Besylate

Brand Names Norvasc, Norliqva

Classification

Therapeutic: Antihypertensive, Antianginal

Pharmacological: Calcium Channel Blocker (Dihydropyridine)

FDA Approved Indications

  • Chronic stable angina pectoris
  • Vasospastic angina (Prinzmetal's or variant angina)
  • Hypertension

Mechanism of Action

Amlodipine inhibits the influx of calcium ions into vascular smooth muscle and cardiac muscle, resulting in relaxation of vascular smooth muscle and coronary vasodilation, decreasing blood pressure and myocardial oxygen demand.

Dosage and Administration

Adult: Starting dose typically 5 mg once daily; can be titrated to 10 mg based on response.

Pediatric: Not approved for use in children under 6 years of age; for children 6 years and older, dose as per physician discretion, generally starting with 2.5-5 mg once daily.

Geriatric: Start at lower dose (e.g., 2.5 mg) and titrate carefully.

Renal Impairment: No dose adjustment needed in mild to moderate impairment; use caution and monitor in severe impairment.

Hepatic Impairment: Use with caution; start at lower dose due to reduced clearance.

Pharmacokinetics

Absorption: Well absorbed with oral bioavailability of approximately 64-90%.

Distribution: Widely distributed; protein binding approximately 95%.

Metabolism: Extensively metabolized in the liver, primarily via CYP3A4 enzymes.

Excretion: Metabolites excreted mainly in urine; less than 10% is unchanged drug.

Half Life: Averages 30-50 hours, allowing for once-daily dosing.

Contraindications

  • Hypersensitivity to amlodipine or dihydropyridines.
  • Severe hypotension.
  • Obstruction of the left ventricle.

Precautions

  • Use cautiously in heart failure, hepatic impairment, or in combo with other antihypertensive agents; monitor blood pressure and edema.

Adverse Reactions - Common

  • Swelling (edema) (Common)
  • Dizziness (Common)
  • Flushing (Common)
  • Palpitations (Common)

Adverse Reactions - Serious

  • Severe hypotension (Rare)
  • Worsening angina or myocardial infarction (Rare)
  • Allergic reactions, including angioedema (Rare)

Drug-Drug Interactions

  • Simvastatin (risk of myopathy), CYP3A4 inhibitors (e.g., azole antifungals, macrolides)

Drug-Food Interactions

  • Grapefruit juice (increases plasma levels)

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure and heart rate regularly; assess for signs of edema, dizziness, or fluid overload.

Diagnoses:

  • Risk for falls due to hypotension or dizziness.
  • Ineffective tissue perfusion.

Implementation: Administer medication as prescribed; counsel patient on potential side effects and interactions; encourage compliance and regular monitoring.

Evaluation: Assess blood pressure response and symptom control; adjust dose as needed.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report swelling, dizziness, or chest pain.
  • Avoid grapefruit juice and alcohol.
  • Do not discontinue abruptly without physician advice.

Special Considerations

Black Box Warnings:

  • None

Genetic Factors: CYP3A4 genetic variations may alter drug metabolism.

Lab Test Interference: None noted.

Overdose Management

Signs/Symptoms: Severe hypotension, tachycardia or bradycardia, dizziness, or loss of consciousness.

Treatment: Supportive care, vasopressors if needed, calcium gluconate IV may be used in calcium channel blocker overdose; gastric lavage or activated charcoal if ingestion is recent.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable until expiration date on packaging.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.