Amlodipine is a calcium channel blocker. It’s main function to cause dilation of the blood vessels to enhance proper flow of blood (Mancia et al, 2015). When the blood vessels are widened, the flow of the blood to and from the heart is greatly improved. This dilation may be particularly important in some disease conditions. The drug is used in treatment of several conditions revolving around the hear and the circulatory system. For instance, it is used to treat angina, the condition that is generally referred to as chest pains. In addition, the drug is usually indicated in other disease conditions caused by coronary artery disease. It follows that the drug is used to manage high blood pressure (hypertension). In most cases of hypertension, the arteries are usually clogged, with fat for example, which makes them narrow. Due to the narrowing, the heart has to exert more force to pump the blood to different parts of the body. This condition may lead to stroke or heart failure. When this drug is used by a person suffering from this condition, it helps widen (dilate) the blood vessels which improves blood flow and lowers the blood pressure. Amlodipine tablet should only be used by adults and children who are more than 6 years old (Morgan et al 2019). The cases of hypertension in children is relatively low and therefore the drug is mostly used by adults.
As with most other drugs, it is very important to consult with a physician before using amlodipine. It is highly inadvisable for a person to use the drug out of self-diagnosis. In addition, when diagnoses with a heart condition, it is very important to notify the doctor whether one has other disease conditions most notably congestive heart failure or liver disease. Extensive evidence has revealed that when a person using the drug drinks alcohol, the blood pressure is lowered even further while some side effects of the drug are expressed with a greater magnitude. It is important to note that amlodipine may greatly improve blood pressure when used in the right dosages (according to the advice of a physician). However, patients with hypertension should continue using the drug even when they feel well. High blood pressure usually presents no symptoms (Kumar, Calhoun, and Dudenbostel, 2013). Therefore, it is not advisable for a person to assume that they have become better just because they are using the drug. In addition to this, hypertension is classified as a lifestyle/ non-communicable disease. A person suffering from this condition may have to use medication (such as amlodipine) for the rest of their lives. Although it is referred to as a lifetime condition, hypertension will pose no health challenges when managed well. It is also important to note that amlodipine cannot be used solely in management of hypertension. Rather, it is used as part of a program to treat the disease. The complete program of treating hypertension should ensure other activities such as observing a healthy diet and engaging in regular body exercises. Diet and exercise are particularly important for the following reasons. One, most of hypertension cases have been associated with excessive body weight. In fact, most people suffering from hypertension are either overweight or obese. Secondly, managing body weight has been found to improve blood pressure. Therefore, diet and exercise should be used together with amlodipine to manage hypertension. The drug is usually administered in two dosages, 5mg and 10 mg. It comes in the form of film-coated tablet (pharmaceutical form).
Contraindications, Special Warnings and Precautions for Use
Most drugs have contraindications which simply refers to the conditions that may make an individual be advised not to take/ use the drug. There are several contraindications for amlodipine. One of the reasons why a patient/ client may be advised not to use this drug despite having hypertension is if they are hypersensitive to any of the components of the drug. Since the drug is made of several components, it is not unusual that an individual may be sensitive to one of the components. The main component of concern when it comes to amlodipine is dihydropyridine derivatives (Poulter et al, 2019). Therefore, the drug may be contraindicated in situations where a person is sensitive to these derivatives. The drug may also be contraindicated in cases of liver impairment. The drug is usually excreted in an unchanged form by the bile. Therefore, when then there is liver impairment, there is a high likelihood that the drug will stay in the body for longer periods without being excreted. This may cause toxicities. It is therefore not wise to indicate the drug to a patient suffering from any from of liver impairment. It is also contraindicated in patients suffering from diabetes and renal conditions and especially those who may be using drugs/products that contain aliskiren. Pregnant mothers especially those who are either in their second or third trimesters should not use the drug.
Following are some of the special warnings and precautions that should be observed while using the drug. Let us first focus on pregnancy. Unless a doctor determines that it is important for this drug to be continued in pregnancy, other antihypertensive medications should be considered. The effects that amlodipine may have on pregnant women has not yet been established. Therefore, it is yet to be established whether the drug affects the developing foetus in a negative way. However, it has been established that use of the drug by lactating mother may lead to presence of the drug in breast milk. Therefore, if a patient on the drug is diagnosed to be pregnant, it is very important that an alternative medical therapy be sought for the patient. In some cases of hypertension, patients may develop excessive hypotension. Placebo controlled studies have shown that this may be the case even in patients who have uncomplicated hypertension. In such cases, it is very important to manage the hypotension first before administering the drug. It is without doubt that a patient administering the drug to such a person will only intensify hypotension which may cause serious complications. In a situation where hypotension occurs, the following approach may be used to manage the condition. The client should be put position. It is also important that where necessary, administration of normal saline be administered intravenously. When the client has regained stability, treatment with amlodipine may be continued. Hyperkalaemia is a detrimental condition and must be avoided when using the drug (Bosworth, Powers and Oddone, 2010). There are several situations that may lead to hyperkalaemia. These include but are not limited to the following: use of diuretics that spare potassium, use of salt substitutes that may contain potassium and also use of medical or medicinal products that have/ may increase the levels of potassium in the blood. An example of such medicinal products is heparin.
It is also careful to take precaution when administering the drug to a person who has had a kidney transplant. Until now, there are no studies that have been carried out to show the efficacy of the drug to individuals who have had kidney transplants (Maskell et al, 2017). Therefore, there exists no evidence of the safety of use of amlodipine is such clients. In modern medicine, it is very important to ensure that any action is guided by evidence-based research. Therefore, it is unwise and unrecommended to administer a drug to a client who has had kidney transplant when there exists insufficient evidence on the same (Anderson and Nawarskas, 2010). In addition to this, it is important to take appropriate precaution when the drug is being administered to a patient with any form of hepatic impairment. As observed above, valsartan which is usually a component of amlodipine, is usually excreted in an unchanged from by the bile. Studies have shown that hepatic impairments lead to an increased half-life of the amlodipine drug. In addition, the AUC values for the drug are also relatively high in patients suffering from liver conditions. To date, there are no dosages that have been recommended for persons suffering from such conditions. Therefore, great care and precaution must be undertaken when the drug is being administered to such patients. Particularly, extreme caution must be put in place when the drug is being administered to persons who have mild to moderate hepatic impairment. In cases where the hepatic impairment can be treated, it would be wise to manage the condition first before amlodipine is administered.
For renal impaired patients, there are no any advised dosage adjustments. Therefore, the normal dosages can be administered for patients who may be having mild to moderate impairment (Aljizeeri et al, 2018). However, it is very important that the levels of potassium and creatinine be monitored regularly to avoid any complications. The last condition that will be discussed in this section is heart failure. The section will particularly focus on the condition (post-myocardial infarction). Use amlodipine in such patients may affect the renal system through inhibition of the renin-angiotensin-aldosterone system (Williams et al, 2018). These effects may lead to impaired renal function and sometimes death. It is therefore appropriate when patients with heart failure or post-myocardial infarction are using the drug, renal assessment be done regularly. Regular monitoring would help avert any potential negative side effects of the drug on the renal function.
Pharmacodynamic Properties of Amlodipine
Amlodipine, which is a component of the drug (Amlodipine) has a certain mode of action that makes it effective for use in cases of hypertension. It acts through inhibiting entry of calcium into the membranes of cardiac and vascular smooth muscle (Eguchi et al, 2016). It follows that the drug prevents transmembrane entry of calcium. The inhibition causes the smooth muscle to relax and counteracts the inhibition to blood flow (McLaughlin et al, 2015). The inhibition also reduces the peripheral resistance to flow of blood which accounts for the antihypertensive effect of the drug (Wiysonge et al, 2017). As a result, the dilation of blood vessels is facilitated while constriction is inhibited. Improved dilation of the blood vessels consequently leads to improved blood pressure. Following administration of recommended dosages, an individual who is suffering from hypertension will have their vessels vasodilated and therefore at low risk of developing complications that come from high blood pressure (Berlowitz et al, 2016). It is important to note that the vasodilation does not significantly affect the heart rate. Since the heart rate remains relatively normal, a person who adheres to correct dosages of the drug may regain normal blood pressure. Extensive evidence from experimental data reveals that amlodipine binds to both the sites that have dihydropyridine and those that do not. It has also been shown that the effect of the drug is directly proportional to plasma concentrations. This applies both to the young people and the elderly.
For clients suffering from both high blood pressure and renal related impairment, there are two main effects that are observed when amlodipine is taken. One is that there is a decrease in the vascular resistance to blood flow. This kind of reduction in resistance is very important as it helps improve blood flow. The second main effect is that there is a significant increase in the rate of glomerular filtration (Leung et al, 2017). Despite the increase in the filtration rate, the plasma flow is effective while no changes are observed when it comes to filtration fraction or even proteinuria. It is without doubt therefore that therapeutic doses of the drug are not effective in clients who may have renal impairments. Amlodipine does not cause any change in nodal function (Padwal et al, 2016). The conclusion has been made after various studies were carried out using both animals and humans. Clinical studies have also been carried out to observe whether there is any effect of taking amlodipine together with beta blockers. These studies have shown that there is not significant effect of this combination on the electrocardiographic parameters (Wright, Musini and Gill, 2018). It would be important to note that all the populations that have been used in studies concerning amlodipine are those of hypertensive people. Therefore, no studies have been done to examine the effect of amlodipine in persons suffering from other conditions. Such effects were only studies when populations being studied for hypertension had other disease conditions.
Dosage
There are several factors that influence the appropriate dosage of amlodipine for an individual. It has long been established that a drug can only offer optimum benefits when the corrects dosages are taken. The correct dosage is also referred to as the therapeutic dosage. Underdosage may lead to insufficient management of the condition being managed while an overdose may lead to toxicities (Sander and Giles, 2011). Therefore, both underdose and overdose lead to ineffective treatment and must be avoided with the highest priority. This fact may help explain why it is extremely important to visit a doctor for prescription instead of buying the drug over the counter. Following are some of the factors that are considered while determining the appropriate dose of amlodipine: age, the condition that is being treated/ managed, the severity of the condition/ diseased being treated/ managed, any other medical condition that the patient may be having and the reaction to the first dosage administered. There are two main forms of the drug. One is the generic one (amlodipine). This comes in form of oral tablets and there are three varying strengths of the drug, that is, 2.5 mg, 5 mg and 10 mg. The second form is the brand, Norvasc. Like the generic drug, Norvasc is an oral tablet. Norvasc comes in the same strengths as those of the generic drug. Having identified the main forms and strengths of the drug, focus will be shifted to the parameters that determine dosage. We will focus on each of these parameters (these have been outlined above) and provide brief details of how they influence the dosage. One of the factors affecting dosage is the type of condition that one is suffering from. As we have seen in the previous sections, the drug is mainly used in treatment of hypertension. For hypertension, the dosage of adults (18- 64 years) is as follows. The typical starting dose is 5mg which is taken once every day. Depending on the effect that the drug will have on a patient, the doctor may decide to modify the dosage to suit the unique needs of a patient. For instance, if the drug does not cause a significant improvement in blood pressure within one to two weeks, the doctor may increase the dosage for up to 10 mg per day. The maximum dosage for the drug is 10 milligrams per day. For children (6-17 years), dosages vary between 2- 5 mg per day. There exist no studies to show the effect of dosages above 5mg on children. Therefore, dosages of more than 5 mg should not be administered to children. In addition to this, the drug should never be administered to children who are below the age of 6 years (Mittal and Singh, 2010).
Following is the dosage for patients with coronary heart disease. Just like with hypertension, the typical dosage for adults (18- 64 years) is 5 mg which should only be taken once a day. The maximum dosage for these patients is 10 mg per day. For children (0-17 years) there exists no dosage. This may be due to the fact that children rarely develop coronary heart disease. The dosages for coronary heart disease can also be applied to the condition of angina. For these two conditions, it is important to focus on the dosage for elderly people (65 years or older). The conditions are very common in this age group. The recommended dosage is 5mg which should be administered only once every day (Campbell et al, 2011). It is important to note that the basal metabolic rate of older adults is slow. Therefore, they may process the drug slowly. Therefore, the normal dosage of 5mg per day may cause the drug to stay longer in the body. As such, it is important for the elderly people to consult a doctor about the appropriate dosages. Depending on how the elderly person is processing the drug, the doctor may decide to reduce the dosage. Despite this, the recommended dosage for this category of people has been identified as 5mg taken once per day.
There are special considerations that should be made when it comes to dosages. For people who are suffering from liver disease, a reduced dosage is recommended. 2.5 mg taken once a day is generally the recommended dosage for this category of individuals (Gupta and Yusuf, 2014). As we have already seen a previous section, the liver carries out the central role of processing amlodipine. Therefore, when the function of the liver is impaired, there is an increased likelihood that the drug will stay in the body for a relatively longer period of time. Therefore, if a person continues to take the normal dosages, the drug may accumulate to toxic levels. Such an event would lead to toxicity while increasing the side effects of the drug. Following the information provided in this section about dosages, it is important for a person to seek the advice/ intervention of a pharmacist or a doctor so that they can determine the correct dosages for the drug.
Since amlodipine is a long-term treatment drug, it may lead to serious health consequences if not used in the correct dosages. For instance, if a person does not take the drug or starts and the stops taking it, it may lead to exacerbation of the illness at hand, for instance hypertension. Serious consequences such heart failure or stroke may follow. It is important to point out that the drug is not used to completely cure hypertension. Therefore, the drug should be continually used unless advised otherwise by the doctor. In case of any complications, it is important to see the doctor also. In situations where a patient skip or misses some doses, the blood pressure of heart pain may increase. This skipping has the potential of leading to stroke or heart attack (Lüders et al, 2010). If a dose is missed, the best practice is to take that dose as soon as one remembers. However, if 12 hours have already elapsed, that dose can be skipped and the next one taken during the regular time. Taking too much dose of the drug may lead to complications such as dizziness, fainting, a rapid heart rate and/ or shock.
Side Effects of Amlodipine
Along with the intended effects, a drug may cause other effects that are undesirable. It is important to note that it is not necessarily that all the identified side effects will automatically be observed in any person who uses the drug. In fact, it is possible that amlodipine will cause different side effects on different individuals. When some side effects occur, it may be advisable to check with a pharmacist or a doctor so that the best action can be taken. When it comes to amlodipine, the most common side effect is swelling in the feet and ankle areas (Angell, De Cock and Frieden, 2015). There are also some side effects that are referred to as less common, for although there are potential side effects, they are not seen in most cases. Following are the less common side effects: experiencing difficulties while breathing, feeling dizzy, experiencing irregular/ fast heart beat or even pulse, redness of the face or other areas of the body and having a congested/ tight chest (Krause et al, 2011). In addition to the side effects that are less common, there are others that are referred to as rare. The rare side effects are including the following: stools that are black in colour (which is usually an indicator of blood in stool), bleeding in the gums, blood could be observed in stool or in urine, feeling numb, experiencing chest pain or discomfort, diarrhoea and extreme fatigue.
Some of the side effects that occur may require medical attention while others may not require any such attention. The reason why some of the side effects may not require the attention of a medical professional is that they usually disappear as the body gets used to the medication. The adjustment process is therefore important to the treatment process. The health care professional administering the drug could also provide some important ways that can be used to reduce some of the side effects. Sometimes, it is very important that a client/ patient inform the health care professional about the kind of side effects that they are experiencing for appropriate help and advice. There is also a side effect that has been observed in both male and female patients, that is, swelling of the breasts (Aronova, Fahey and Zarnegar, 2014). The incidence of this side effect has not yet been established. A patient may also experience a side effect that has not been listed in this section. The most important thing to keep in mind is that, a health care professional, especially a doctor or a pharmacist, is the best source of information when it comes to any issues regarding the use of amlodipine and the side effects.
In addition to the information provide above, following are some important precautions and tips to consider while using the drug. For a child using the drug, it is important that regular blood checks be do determine progress. The best way to check whether or not there are unwanted effects of the drug is through carrying out some blood tests on the same (Kotchen, 2010). As such, regular visits to a health care professional are important. In some cases, the amlodipine may cause angina or heart attack. While this is not common, such cases have been observed in patients whose blood vessels are severely damaged by conditions such as arteriosclerosis. Immediate medical attention should be sought when the drug causes such side effects. The drug may cause dizziness or even fainting who have used the drug gets up suddenly from either a sitting position or that of lying. The best thing to do when feeling dizzy is to lay down. This decreases the chance that one will faint.
Interaction with Other Medications
It is common for drug-drug interactions to occur. There are also other kinds on interactions that may occur such as drug-nutrient interactions. An interaction can be described as an instance that changes the way a drug normally works (Nguyen et al, 2010). These interactions may cause a drug to be ineffective and stop working as it should. To ensure that there are no adverse interactions, it is always advisable that a client/ patient inform their doctor/ pharmacist about all the drugs or medications that they are using. When this information is provided, appropriate advice is given to avoid any adverse interactions. When the client/ patient may have doubt about whether some special diet/ medication they are taking have some influence on their drugs, it is important to seek medical advice (Uhlig et al, 2013). In the following discussion, some examples of drugs that may interact with amlodipine to cause adverse effects will be outlined. One of the drugs that interacts with amlodipine is diltiazem. This is a heart medication. When the two drugs are used together, the level of amlodipine in the body is increased (Falaschetti et al, 2014). As a result, the side effects of amlodipine are increased. It follows that if the drugs are used together for a long period of time, toxicity may occur.
There are some antifungal medications that interact with amlodipine. Examples of these drugs are ketoconazole and voriconazole (Ibrahim and Damasceno, 2012). Using these drugs together with amlodipine causes an increased level of amlodipine in the body. The result is greater side effects and a risk for toxicity. Another drug that may cause increased levels of amlodipine in the body is clarithromycin, which is an antibiotic (Kaplan, 2010). There are some other drugs that when used together with amlodipine increases the risk for hypotension. Examples are avanafil and sildenafil (Easterling, 2014). On the other hand, using amlodipine with other drugs may cause an increased level of the other drug. A great example here is the cholesterol medication simvastatin.
It is also important to note that amlodipine may cause allergic reactions in certain people. Some of the reactions include experiencing trouble in breathing, swelling of the tongue and hives. Research involving animals have shown that the drug may cause negative effects to the developing foetus (Hoeper et al, 2013). Although this is the case, there is not enough evidence to show the effects that the drug on human beings. It is very important to inform the health professional whether one id pregnant or they plant to become pregnant. In such situations, the drug should only be used when the benefits of doing so exceed the potential risks (American College of Obstetricians and Gynecologists, 2013). There also exists research to show that amlodipine can be passed to breastmilk. However, the effect of breastfeeding a child when on amlodipine is not known. The following section will provide some important considerations that should be made while using the amlodipine drug.
Considerations for Use
Some of the considerations that should be put in place are general in nature. One is that it is important to form a routine of taking the drug at the same time every day. Doing so does not only increase the effectiveness of the drug but also helps ensure that one rarely forgets to take the drug. It is easier to remember to take the drug when it is done at the same time every day than when the drug is taken at different times each day. The other general consideration is that one may either cut or crush the tablet. Let us now look at the storage conditions of the drug. It is important to store the drug at the right temperature. The drug should be stored at room temperature (Shimamoto et al, 2014). Room temperature is defined as a temperature range between 15 and 30 degrees Celsius. It is also advisable that this drug be stored in its original container. The container should be kept airtight well closed. In case, there are children around, it is important to ensure that the drug is kept out of their reach. The drug should not be exposed to light. In addition, this medication should always be kept away from moist areas such as bathrooms. When it comes to refills, amlodipine is refillable (Kotsis et al, 2015). Therefore, a person can refill the medication without requiring a new prescription from the doctor. The doctor should authorize on the prescription the number of times that the drug should be refilled. Therefore, in case drugs one has run low, they can simply buy more from an authorized dealer. When travelling, there are some considerations that should be made concerning the medication. One of these is that one should always carry with them their medication. In case of a flight, it is not advisable to put the drugs in a checked bag. Rather, the medication should be put on the bag that one is carrying. Another important consideration to make while travelling concerns airport X-ray machines. One should not worry about these machines for they cannot harm the drug (Gradman et al, 2010). Since it may be important to show the airport attendant the pharmacy label of the medication, it is always advisable to carry with you the original prescription labelled container. In addition, amlodipine should never be left in the glove compartment of a car. This should be particularly avoided when the weather is either too hot or cold.
Self-Management Practices to be Used Together with Amlodipine to Increase Positive Health Outcomes
There are some self-management practices that a person suffering from hypertension should ensure so that the treatment process becomes effective. One of these practices is that blood pressure should be checked regularly (Parati and Omboni, 2010). As we have seen in a previous section, hypertension may have no signs or symptoms. Therefore, the best way to monitor progress of blood pressure is to have regular checks. Regular checks will help inform consequent decisions. For instance, if the pressure is not improving, one may visit the physician to know what is happening. If there is improvement, proper management practices should be continued. Therefore, it is a very important practice to keep check of blood pressure while at home. After monitoring, it is important to keep a log of the pressure readings in a diary. This diary should be carried during doctor appointments. To be able to do this, it may be important to purchase a blood pressure monitor. It is also important to ensure that other lifestyle factors are monitored if blood pressure is to be effectively controlled. For example, a healthy diet should be ensured at all times. A registered nutritionist/ dietitian can offer appropriate nutritional advise. There exists extensive evidence to show that when proper nutrition habits are combined with appropriate drug therapy, positive health outcomes are maximized (Rebholz et al, 2016). One of the nutritional goals may be loss of weight especially in situations where the patient is either overweight or obese. Generally, dietary approaches to stop hypertension (DASH diet) has been found to be effective in managing blood pressure. This diet is mainly composed of a variety of whole foods, vegetables and fruits. It is low in saturated fats, refined foods, sodium and high energy drinks. Another important aspect of lifestyle is exercise. There exists evidence to show that exercise, in and of itself, provides great benefits to a person suffering from hypertension. Exercise has been found to improve cardio strength and blood flow (Ghadieh and Saab, 2015). It is recommended that a person with hypertension engage in moderate exercise, such as walking, for at least 30 minutes every day (Larsson, Wallin and Wolk, 2016). In a nutshell, while amlodipine is a drug therapy aimed at managing hypertension, it should be combined with other lifestyle practices such as good nutrition and regular exercises to increase positive health outcomes.
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