Home Drug Guide Amlodipine Besylate and Benazepril Hydrochloride

Drug Guide

Generic Name

Amlodipine Besylate and Benazepril Hydrochloride

Brand Names Lotrel

Classification

Therapeutic: Antihypertensive

Pharmacological: Calcium channel blocker and ACE inhibitor combination

FDA Approved Indications

  • Hypertension (high blood pressure)

Mechanism of Action

Amlodipine is a calcium channel blocker that decreases vascular resistance and blood pressure by inhibiting calcium influx into vascular smooth muscle and myocardium. Benazepril is an angiotensin-converting enzyme (ACE) inhibitor that lowers blood pressure by inhibiting the formation of angiotensin II, leading to vasodilation and decreased aldosterone secretion.

Dosage and Administration

Adult: Typically 5 mg once daily, titratable up to 10 mg based on response.

Pediatric: Not approved for pediatric use.

Geriatric: Initial dose may be lower; closely monitor due to increased sensitivity.

Renal Impairment: Adjust dosage based on renal function; monitor blood pressure and renal parameters.

Hepatic Impairment: Use caution; monitor for adverse effects; dose adjustments may be necessary.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Protein binding of amlodipine approximately 93%; benazepril approximately 95%.

Metabolism: Amlodipine is primarily metabolized in the liver; benazepril is a prodrug converted to benazeprilat in the liver.

Excretion: Amlodipine is excreted mainly via hepatic metabolism; benazeprilat is eliminated renally.

Half Life: Amlodipine approximately 30-50 hours; benazeprilat approximately 10-11 hours.

Contraindications

  • Hypersensitivity to amlodipine, benazepril, or other ACE inhibitors.
  • History of angioedema related to previous ACE inhibitor therapy.

Precautions

  • Use with caution in patients with aortic stenosis, renal artery stenosis, or intravascular volume depletion.
  • Pregnancy Category D; contraindicated in pregnancy due to risk of fetal injury or death.
  • Monitor blood pressure, renal function, and serum potassium regularly during therapy.

Adverse Reactions - Common

  • Swelling of the face, lips, tongue, or throat (angioedema) (Less than 1%)
  • Dizziness or lightheadedness, especially after the first dose (Common)
  • Cough (Common)

Adverse Reactions - Serious

  • Angioedema requiring medical attention (Rare)
  • Hypotension, especially in volume-depleted patients (Rare)
  • Elevated serum potassium (hyperkalemia) (Rare)

Drug-Drug Interactions

  • Other antihypertensives, diuretics, potassium-sparing agents, lithium, aliskiren.

Drug-Food Interactions

  • Foods high in potassium, salt substitutes containing potassium.

Drug-Herb Interactions

  • Potential interactions with herbal products that affect blood pressure or potassium levels, such as Ginseng or St. John's Wort.

Nursing Implications

Assessment: Monitor blood pressure, renal function, and serum electrolytes before and during therapy.

Diagnoses:

  • Risk for hypotension, risk for decreased cardiac output.

Implementation: Administer as prescribed, typically once daily. Educate patients on the importance of adherence and monitoring symptoms.

Evaluation: Assess for blood pressure control and adverse effects; adjust dosage as needed.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Do not discontinue abruptly.
  • Report signs of angioedema, persistent cough, or hyperkalemia.
  • Avoid potassium-rich foods or supplements unless directed.

Special Considerations

Black Box Warnings:

  • Fetal toxicity; contraindicated during pregnancy.

Genetic Factors: Patients with a history of angioedema may be at increased risk.

Lab Test Interference: May elevate serum potassium and serum creatinine.

Overdose Management

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

Treatment: Supportive care with intravenous fluids; vasopressors for hypotension; calcium gluconate for calcium channel blocker overdose; dialysis in severe cases.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable under recommended storage conditions.

🛡️ 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.