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Amlodipine relaxes peripheral and coronary vascular smooth muscle. It produces coronary vasodilation by inhibiting the entry of Ca ions into the voltage-sensitive channels of the vascular smooth muscle and myocardium during depolarisation. It also increases myocardial O2 delivery in patients with vasospastic angina. (1,2,3,4)

Angina, hypertension, coronary artery disease. (1,2,3,4)

Significant aortic stenosis, sinoatrial node disease, hypersensitivity to dihydropyridines, cardiogenic shock, unstable angina; interactions (1,2,3,4)

Headache, peripheral oedema, fatigue, somnolence, nausea, abdominal pain, flushing, dyspepsia, palpitations, dizziness. Rarely pruritus, rash, dyspnoea, asthenia, muscle cramps. Potentially Fatal: Hypotension, bradycardia, conductive system delay and CCF. (1,2,3,4)

Increased metabolism with rifampin. Reduced hypotensive effect with calcium. Potentiates effects of thiazide diuretics and ACE inhibitors. Avoid combination with β-blockers in patients with markedly impaired left ventricular function. May increase serum levels of CYP1A2 substrates e.g. aminophylline, fluvoxamine, ropinirole. CYP3A4 inhibitors (e.g. clarithromycin, doxycycline, isoniazid, nicardipine) may increase the effects of amlodipine. Additive BP-lowering effects when used with sildenafil, tadalafil or vardenafil. (1,2,3,4)

Dose adjustment is necessary in elderly patients. Dose reduction is mandatory in hepatic or renal impairment; impaired left ventricular function; prolonged AV periods; DM; hypotension, idiopathic hypertrophic subaortic stenosis. Avoid abrupt withdrawal and long-term use. Avoid use in patients with sick-sinus syndrome, preexisting AV block, bradycardia and those taking beta-blockers or digitalis are at risk of developing AV block, bradycardia, asystole or sinus arrest. Avoid in pregnant and lactating women. (1,2,3,4)

Oral Angina: Adult-Initially 5 mg once daily, increased if necessary; max. 10 mg once daily. Hypertension: Adult-Initially 5 mg once daily, increased if necessary; max. 10 mg once daily. Elderly-Initial dose- 2.5 mg once daily. (1,2,3,4)

1. Katzung BG, Masters SB, Trevor AJ, editors. Basic & Clinical Pharmacology. 12th ed. New York: McGraw Hill; 2012 2. Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 12th ed. China: McGraw Hill; 2011 3. National Formulary of India. 4 th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011. 4. Amlodipine. [cited on 2nd september]. Available online from website