AmlodipineNursing considerations

Blood pressure

Why

Response and hypotension

When

Each titration step, usually 7 to 14 days apart; frequently if titrating faster

Normal

Below 120/80 mm Hg.

Sources: [1][2]

Heart rate

Why

Palpitations or reflex tachycardia in overdose

When

With symptoms

Normal

60 to 100 beats per minute in adults at rest.

Sources: [1][2][3]

High-alert status

Oral calcium channel blockers are not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

None on the current label.

Sources: [1]

Antidote or reversal

No specific antidote. Overdose causes marked vasodilation, hypotension, and possibly reflex tachycardia. Treat with cardiac monitoring, leg elevation, fluids, and vasopressors such as phenylephrine if needed. Hemodialysis is unlikely to help because the drug is highly protein bound.

Sources: [1]

Patient teaching

• Leg or ankle swelling, tiredness, flushing, and dizziness are the usual side effects
• Get care right away for new or worsening chest pain after starting or raising the dose
• Keep taking nitroglycerin for angina if prescribed
• Do not stop other blood pressure medicines or start new medicines or supplements without checking first
• Tell the prescriber about pregnancy or breastfeeding, since amlodipine passes into milk

Sources: [1]

Sound-alike and look-alike names

• amLODIPine and aMILoride
• Norvasc and Navane

Sources: [1]

Adult dose

Hypertension

Start 5 mg once daily; maximum 10 mg once daily. Use 2.5 mg to start in small, frail, or elderly patients, with hepatic impairment, or when adding to other antihypertensives.

Chronic stable or vasospastic angina

5 to 10 mg once daily. Most patients need 10 mg.

Coronary artery disease

5 to 10 mg once daily.

Sources: [1]

Renal adjustment

None. Renal impairment does not meaningfully change amlodipine levels, so the usual starting dose applies.

Sources: [1]

Hepatic adjustment

Start at 2.5 mg and titrate slowly. Clearance falls and the half-life stretches to about 56 hours in hepatic impairment.

Sources: [1][2]

Mechanism

A dihydropyridine that blocks calcium entry into vascular smooth muscle more than into heart muscle. Arteries dilate and peripheral resistance falls. Onset is gradual, and heart rate changes little with chronic dosing.

Sources: [1][2]