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Amlodipine + enalapril

CARDIOVASCULAR SYSTEM

ANTIANGINAL - [ CARDIOVASCULAR SYSTEM ]

Amlodipine is a 1,4-dihydropyridine-derivative calcium-channel blocker. Enalapril is a pro-drug; following oral administration, it is bioactivated by hydrolysis of the ethyl ester to enalaprilat, which is the active ACE inhibitor. Combination of the two drugs results in additive antihypertensive action.(1,2,3,4)

It is indicated in refractory hypertension (1,2,3,4)

Hypersensitivity to either component. History of angioedema related to previous exposure to ACE inhibitor. Pregnancy and lactation (1,2,3,4)

Angioneurotic oedema, nausea, headache, cough, dizziness, fatigue, palpitations, chest pain, flushing, rash; Increases in BUN, serum K & creatinine levels may occur; Neutropaenia. (1,2,3,4)

Indometacin and other NSAIDs may blunt antihypertensive effect. Diuretics enhance antihypertensive effect. Potentially Fatal: Increases lithium levels & may cause lithium toxicity: Hyperkalaemia with K & K sparing diuretics. Risk of bone marrow suppression due to enalapril increased with concomitant use of immunosuppressives. (1,2,3,4)

Avoid in pregnant and lactating women. Dose adjustment is necessary renal and hepatic disease, congestive heart failure; concomitant K supplements & potassium-conserving diuretics, hypovolaemic shock, diuretic therapy; Periodic blood count monitoring to preclude neutropaenia or agranulocytosis. (1,2,3,4)

Adult: Per tablet contains enalapril maleate 5 mg and amlodipine besylate 5 mg: Start with 1 tablet daily. Increase dose gradually according to response. Elderly: 1/2 a tab to start with and built up gradually with caution. Diuretics should be withheld for 2-3 days before starting this combination. (1,2,3,4)

1. Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 12th ed. China: McGraw Hill; 2011. 2. National Formulary of India. 4 th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011. 3. Amlodipine. [cited on 2nd september]. Available online from website http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/019787s054lbl.pdf 4. Enalapril maleate. [cited on 2nd september]. Available online from website. http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/018998s077lbl.pdf