Amlodipine

Amlodipine

[5mg tablets 4 cents]

ADMINISTRATION ROUTES:

  • PO, NG

ALTERNATIVE NAMES:

  • Apo-amlodipine, Calvasc, Norvasc

ICU INDICATIONS:

  1. hypertension
  2. afterload reduction
  3. angina (can be used for treatment of angina but is rarely used for this indication in the ICU setting)

PRESENTATION AND ADMINISTRATION:

  • PO / NG:
    Apo-amlodipine 5mg and 10mg (white), Calvasc 5mg and 10mg (white), Norvasc 5mg and 10mg (white).
    Tablets may be crushed for NG administration.

DOSAGE:

  • Hypertension & afterload reduction:
    Usual dosage 5mg daily; increasing to maximum 10mg daily

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • 0.05-0.2mg/kg daily oral. Has not been adequately studied for use in children under 6.

CLINICAL PHARMACOLOGY:

  • Amlodipine is a dihydropyridine calcium channel blocker. Amlodipine is a peripheral arterial vasodilator that acts directly on vascular smooth muscle to cause a reduction in peripheral vascular resistance and reduction in blood pressure. It does not cause significant negative inotropy. Peak plasma concentrations between 6 and 12 hours after oral administration.

CONTRAINDICATIONS:

  • Known hypersensitivity to amlodipine

WARNINGS

  • Increased Angina and/or Myocardial Infarction
    Rarely, patients, particularly those with severe obstructive coronary artery disease, have developed documented increased frequency, duration and/or severity of angina or acute myocardial infarction on starting calcium channel blocker therapy or at the time of dosage increase. The mechanism of this effect has not been elucidated.

PRECAUTIONS

  • General
    Caution should be exercised when administering amlodipine as with any other peripheral vasodilator particularly in patients with severe aortic stenosis. Since amlodipine besylate is extensively metabolized by the liver and the plasma elimination half-life (T1⁄2) is 56 hours in patients with impaired hepatic function, caution should be exercised when administering amlodipine besylate to patients with severe hepatic impairment.
  • Laboratory Tests:
    No tests in addition to routine ICU tests are required.
  • Drug/Laboratory Test Interactions:
    None known.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Synergistic with other antihypertensives

ADVERSE REACTIONS

  • Body as a Whole:
    Allergic reaction, back pain, hot flushes, malaise, pain, rigors, weight gain, weight decrease.
  • Cardiovascular System:
    Arrhythmia (including ventricular tachycardia and atrial fibrillation), bradycardia, chest pain, hypotension, peripheral ischemia, syncope, tachycardia, postural dizziness, postural hypotension, vasculitis.
  • Digestive System:
    Anorexia, constipation, dyspepsia, dysphagia, diarrhea, flatulence, pancreatitis, vomiting, gingival hyperplasia.
  • Nervous System:
    Hypoesthesia, neuropathy peripheral, paresthesia, tremor, vertigo.
  • Skin:
    Angioedema, erythema multiforme, pruritus, rash.
  • Respiratory System:
    Dyspnea, epistaxis.
  • Musculoskeletal System:
    Arthralgia, arthrosis, muscle cramps, myalgia. Skin and Appendages:
  • Hemopoietic:
    Leukopenia, purpura, thrombocytopenia.

Critical Care Drug Manual

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