Quick facts
| Fact | Amlodipine |
|---|---|
| Drug class[1] | Calcium channel blocker |
| Used for[1] | High blood pressure; chronic stable angina; angina from coronary artery spasm (vasospastic angina); in coronary artery disease recently confirmed by angiography, without heart failure or an ejection fraction below 40%, lowering the risk of hospital stays for angina and of procedures to restore blood flow to the heart |
| Contraindicated with[1] | Known sensitivity to amlodipine |
| Timing[1] | Peak level 6 to 12 hours after a dose; half-life about 30 to 50 hours; blood levels become steady after 7 to 8 days of daily doses |
| Dose-related effects[1] | Edema, dizziness, flushing, and palpitations |
| Food[1] | Can be taken with or without food |
Before giving amlodipine: blood pressure and chest pain
- Check blood pressure. Because amlodipine starts working gradually, a sudden drop is unlikely, but low blood pressure with symptoms can still happen, especially in a patient with severe aortic stenosis (a narrowed aortic valve).[1]
- Ask about chest pain. Worse angina or a heart attack can develop after starting it or raising the dose, especially in severe coronary artery disease.[1]
- The liver breaks down most of the drug. With liver impairment its half-life is about 56 hours, so in severe impairment the dose is raised slowly.[1]
Edema is the side effect to expect, and it rises with the dose
Other side effects and drug interactions
- Jaundice and raised liver enzymes have been reported after marketing, some serious enough for a hospital stay.[1]
- Drugs that block the enzyme CYP3A, such as clarithromycin, itraconazole, and diltiazem, raise amlodipine levels, so watch for low blood pressure and edema.[1]
- Amlodipine raises simvastatin levels, so the simvastatin dose is limited.[1]
- With sildenafil, watch for low blood pressure.[1]
Teach the patient to take it once a day and keep using nitroglycerin
- Take it once a day, with or without food, at about the same time each day.[1]
- Take a missed dose when remembered. If more than 12 hours have passed, skip it and take the next dose at the usual time.[1]
- Nitroglycerin can be used with amlodipine, so a patient who uses nitroglycerin keeps using it. Other blood pressure medicines aren't stopped without talking to the prescriber.[1]
- New or worse chest pain after starting it or raising the dose means calling the prescriber right away or going to an emergency room.[1]
Drill amlodipine in the Cardiovascular and renal medicines flashcard deck.
Browse flashcardsHow it shows up on nursing exams
Practice question
A patient with hypertension started amlodipine 2 weeks ago, and the dose was increased yesterday. Which finding should the nurse report to the health care provider first?
- A. Mild swelling of both ankles since the increase
- B. Facial flushing about an hour after the dose
- C. Blood pressure 128/78 mm Hg this morning
- D. New chest pain while walking to the bathroom
Show the answer and why
Correct answer: D. New chest pain while walking to the bathroom
- A. Incorrect. Edema is an expected, dose-related effect of amlodipine and less urgent than new chest pain.
- B. Incorrect. Flushing is a dose-related side effect. It does not outrank possible worsening angina.
- C. Incorrect. Lower blood pressure is the intended effect, and this reading is not hypotension.
- D. Correct. Worse angina or a heart attack can develop after starting amlodipine or raising the dose. New chest pain after a dose increase is reported first.
Sources for this question: [1]
Memory hook: Amlodipine starts slowly and lasts long. Check the blood pressure, expect some edema, and report new chest pain.