ADMINISTRATION ROUTES:
PO, NG
ALTERNATIVE NAMES:
Apo-amlodipine, Calvasc, Norvasc
ICU INDICATIONS:
-
Hypertension
-
Afterload reduction
-
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 10 mg (white), Calvasc 5mg and 10 mg (white), Norvasc 5mg and 10 mg (white). Tablets may be crushed for NG administration.
DOSAGE:
Hypertension & afterload reduction:
5mg once daily, increasing to maximum 10 mg daily
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
0.05-0.2 mg/kg daily
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 metabolised by the liver and the plasma elimination half-life (T½) 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 IN 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, diarrhoea, flatulence, pancreatitis, vomiting, gingival hyperplasia
Nervous System:
Hypoesthesia, neuropathy peripheral, paraesthesia, tremor, vertigo
Skin:
Angioedema, erythema multiforme, pruritus, rash
Respiratory System:
dyspnoea, epistaxis
Musculoskeletal System:
Arthralgia, arthrosis, muscle cramps, myalgia
Haemopoietic:
Leukopaenia, purpura, thrombocytopaenia