Amlodipine

Amlodipine is a calcium channel blocker (dihydropyridine) — antihypertensive and anti-anginal medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

Amlodipine is prescribed for:

• Hypertension (high blood pressure) — as a first-line option, alone or combined with ARBs, ACE inhibitors, diuretics or beta-blockers.
• Chronic stable angina — chest pain on exertion due to narrowed coronary arteries.
• Vasospastic (Prinzmetal's) angina — chest pain from coronary artery spasm.

By keeping blood pressure controlled over the long term, it reduces the risk of stroke, heart attack, heart failure and kidney damage. Your doctor will decide whether it should be used alone or as part of a combination.

Most side effects of Amlodipine are dose-related and often ease with time:

• Ankle and foot swelling (oedema) — the most characteristic effect, caused by widening of small vessels, not by kidney or heart failure; it is more common at the 10 mg dose and in women. Raising the legs helps; tell your doctor if it is bothersome — the dose may be reduced or a combination used.
• Flushing, warmth or headache — usually in the first days.
• Dizziness or tiredness.
• Palpitations.
• Less commonly: gum swelling, stomach upset, muscle cramps or rash.

Seek medical advice for chest pain that worsens, fainting or severe swelling.

Points to remember with Amlodipine:

• Ankle swelling is common and usually harmless, but always mention it to your doctor so other causes can be ruled out and the dose reviewed.
• Rise slowly from sitting or lying in the first days to avoid dizziness.
• Tell your doctor about severe liver disease, severe aortic stenosis or recent heart attack — doses are chosen cautiously in these situations.
• Keep taking the tablet during fasting, travel or minor illness unless your doctor says otherwise.
• Limit excess salt, maintain a healthy weight, walk regularly and avoid tobacco — lifestyle remains half of blood pressure treatment.
• Grapefruit juice in large amounts may slightly increase drug levels; moderation is sensible.

Tell your doctor about all medicines taken with Amlodipine:

• Other blood pressure medicines, nitrates, alpha-blockers and drugs for prostate or erectile dysfunction — combined effect can drop pressure too far, causing dizziness or fainting.
• CYP3A4 inhibitors — clarithromycin, erythromycin, ketoconazole, itraconazole, ritonavir and large amounts of grapefruit juice raise amlodipine levels.
• CYP3A4 inducers — rifampicin, carbamazepine, phenytoin, St John's wort can weaken its effect.
• Simvastatin — amlodipine raises its level; simvastatin doses above 20 mg daily are avoided.
• Ciclosporin and tacrolimus — levels may rise; monitoring needed.
• NSAID painkillers — regular use can blunt blood-pressure control.

Amlodipine should not be used in:

• Allergy to amlodipine, other dihydropyridines or any tablet component.
• Severe hypotension (very low blood pressure, e.g. systolic below 90 mmHg).
• Shock, including cardiogenic shock.
• Severe aortic stenosis — obstruction of the heart's outflow.
• Haemodynamically unstable heart failure after acute heart attack.

Use needs extra care, not necessarily avoidance, in liver disease and in the elderly — lower doses are chosen.

Pregnancy: The safety of amlodipine in pregnancy is not fully established, so Amlodipine is used only if the doctor judges the benefit outweighs the risk; other agents with longer pregnancy track records are often preferred for high blood pressure in pregnancy. Never stop a blood pressure tablet abruptly on discovering pregnancy — uncontrolled hypertension endangers both mother and baby. Contact your doctor promptly for a planned switch.

Breastfeeding: Amlodipine passes into breast milk in small amounts. Available information has not shown harm to breastfed infants, but it should be used during lactation only on a doctor's advice, with the baby observed for unusual sleepiness or poor feeding.

Store Amlodipine below 30°C in a dry place, protected from light and moisture; keep tablets in the original blister until use. As with all medicines, keep it out of the reach and sight of children. Do not use after the expiry date printed on the pack, and return out-of-date tablets to a pharmacy for safe disposal instead of putting them in household waste.