Hypertension: Amlodipine is indicated for the treatment of hypertension. It may be used alone or in combination with other antihypertensive agents.
Stable angina: Amlodipine is indicated for the treatment of chronic stable angina. It may be used alone or in combination with other antianginal agents.
Vasospastic angina: Amlodipine is indicated for the treatment of confirmed or suspected vasospastic angina. The drug may be used as single therapy or in combination with other antianginal drugs.
Calcium-channel blockers
Amlodipine is a calcium ion influx inhibitor of the dihydropyridine group (slow channel blocker or calcium ion antagonist) and inhibits the transmembrane influx of calcium ions into cardiac and vascular smooth muscle.The mechanism of the antihypertensive action is due to a direct relaxant effect on vascular smooth muscle. The precise mechanism by which amlodipine relieves angina has not been fully determined but Amlodipine reduces total ischemic burden by the following two actions:
1. Amlodipine dilates peripheral arterioles and thus, reduces the total peripheral resistance (afterload) against which the heart works. Since the heart rate remains stable, this unloading of the heart reduces myocardial energy consumption and oxygen requirements.
2. The mechanism of action of Amlodipine also probably involves dilatation of the main coronary arteries and coronary arterioles, both in normal and ischemic regions. This dilation increases myocardial oxygen delivery in patients with coronary artery spasm (prinzmetals or variant angina).
The dose should be individualized according to the goal of therapy and patient response. The usual initial oral dose for stable or vasospastic angina and hypertension is 5 mg once daily with a maximum dose of 10 mg once daily.
Use of Amlodipine together with thiazide diuretics or angiotensin-converting-enzyme inhibitors in the treatment of hypertension is additive. There are no hazardous interaction of Amlodipine with Digoxin, Cimetidine, Warfarin and food.
Amlodipine is contraindicated in patients with–1. Hypersensitivity to amlodipine, dihydropyridine derivatives or any of the excipients
2. Shock (including cardiogenic shock)
3. Obstruction of the outflow-tract of the left ventricle (e.g. high grade aortic stenosis)
4. Unstable angina
5. Hemodynamically unstable heart failure after acute myocardial infarction (during the first 28 days)
6. Severe hypotension
Peripheral oedema may occasionally be severe but is fully reversible. As with other calcium antagonist drugs, peripheral oedema and skin erythema occur in a proportion of patients (5-10%) and facial flushing in 2-5% of patients. Complain of fatigue was also reported more frequently than in placebo treated patients. There is evidence that these effects are more common in patients treated with doses greater than 10 mg daily.
Pregnancy Category C. The safety of amlodipine in human pregnancy has not been established. In animal studies, reproductive toxicity was observed at high doses. Use in pregnancy is only recommended when there is no safer alternative and when the disease itself carries greater risk for the mother and fetus.Lactation: It is not known whether amlodipine is excreted in breast milk. A decision on whether to continue/discontinue breast-feeding or to continue/discontinue therapy with amlodipine should be made taking into account the benefit of breast-feeding to the child and the benefit of amlodipine therapy to the mother.
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