Amlodipine Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: IG 239

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: IG 238

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: IG 237

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: U 243

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: 023 logo

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: 210

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2. 5 mg tablet

Color: whiteShape: roundImprint: 211

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: 5 U

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: logo and 22

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: logo 21

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: Z 3

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: NORVASC 10

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: octagonalImprint: NORVASC 5

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: G 1540 10

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: diamondImprint: G 1520 2.5

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: pinkShape: roundImprint: L 28

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: 128 C

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: 127 C

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: 126 C

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: 209

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: diamondImprint: 568

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: logo 55

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: logo and 57

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: logo and 56

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: logo 55

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: L 32

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: oblongImprint: L 29

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: 022 logo

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: U 10

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: U 241

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: Z 5

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: diamondImprint: NORVASC 2.5

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: logo and 56

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: octagonalImprint: 569

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: Z 7

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: logo and 57

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: logo 55

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: U 242

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: light yellowShape: roundImprint: U 2

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: 93 7168

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: 93 7167

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: 93 83

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: blueShape: roundImprint: M A10

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: blueShape: roundImprint: M A9

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: octagonalImprint: G 1530 5

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: blueShape: roundImprint: M A8

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: barrelImprint: C 58

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: C 57

This medicine is a white, round, tablet imprinted with “IG” and “239”.

Amlodipine Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: IG 239

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: IG 238

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: IG 237

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: U 243

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: 023 logo

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: 210

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2. 5 mg tablet

Color: whiteShape: roundImprint: 211

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: 5 U

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: logo and 22

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: logo 21

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: Z 3

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: NORVASC 10

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: octagonalImprint: NORVASC 5

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: G 1540 10

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: diamondImprint: G 1520 2.5

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: pinkShape: roundImprint: L 28

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: 128 C

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: 127 C

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: 126 C

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: 209

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: diamondImprint: 568

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: logo 55

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: logo and 57

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: logo and 56

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: logo 55

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: L 32

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: oblongImprint: L 29

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: 022 logo

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: U 10

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: U 241

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: Z 5

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: diamondImprint: NORVASC 2.5

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: logo and 56

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: octagonalImprint: 569

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: Z 7

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: logo and 57

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: logo 55

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: U 242

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: light yellowShape: roundImprint: U 2

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: whiteShape: roundImprint: 93 7168

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: roundImprint: 93 7167

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: 93 83

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 10 mg tablet

Color: blueShape: roundImprint: M A10

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: blueShape: roundImprint: M A9

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: octagonalImprint: G 1530 5

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: blueShape: roundImprint: M A8

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 5 mg tablet

Color: whiteShape: barrelImprint: C 58

This medicine is a white, round, tablet imprinted with “IG” and “239”.

amlodipine 2.5 mg tablet

Color: whiteShape: roundImprint: C 57

This medicine is a white, round, tablet imprinted with “IG” and “239”.

Amlodipine in the treatment of arterial hypertension: is the generic always equivalent to the original drug? | Podzolkov V.I., Tarzimanova A.I.

Arterial hypertension (AH) remains one of the most important medical and social problems and a leading risk factor for myocardial infarction and stroke [1]. The increase in mortality from cardiovascular diseases determines the high relevance of the problem of treatment of hypertension. Among the groups of drugs used to treat hypertension, calcium antagonists (AC) are widely used. Modern AKs have a high antihypertensive efficacy and organoprotective effect, and are well tolerated.

Amlodipine occupies an important place among AKs. Amlodipine is an AA of the dihydropyridine series of the III generation according to the classification of T. Toya-Oka and W. Nayler [2]. It is characterized by high bioavailability, reaching 90%, a long half-life (35-50 hours) and a long duration of action, which allows you to take the drug once a day and control blood pressure (BP) evenly throughout the day [3,4]. Amlodipine is distinguished by high tissue selectivity, its effect on vascular smooth muscle cells is 80 times higher than the effect on cardiomyocytes. Due to this, amlodipine causes a pronounced decrease in total peripheral vascular resistance and has virtually no effect on myocardial contractility, sinus node function and atrioventricular conduction [5]. Amlodipine has a pronounced hypotensive effect on both systolic and diastolic blood pressure. The results of clinical studies indicate a high antihypertensive efficacy of this drug: in elderly patients, the average decrease in systolic blood pressure when using it was 24.1 mm Hg, in patients with isolated systolic hypertension – 25.9mm Hg, in patients with diabetes – 19.8 mm Hg, in patients with chronic renal failure – 19.1 mm Hg. [6]. The drug is well tolerated by patients, with a sudden cessation of its use, there is no withdrawal syndrome [3].
In 1992, Pfizer launched amlodipine besylate in a once-daily tablet form (in Russia, the dosage is 5–10 mg), registering it under the trade names Norvasc. Norvask is one of the most studied representatives of the AK class. Almost all data on the safety and efficacy of amlodipine relate to its non-sylate salt. For the period from 1980 to 2010 conducted 800 clinical trials of amlodipine besylate, which involved more than 600 thousand patients.
ALLHAT, VALUE, PREVENT, CAPARES, CAMELOT should be included among the most interesting and demonstrative studies in which amlodipine besylate was involved. In the ALLHAT study, a comparative analysis of the effect of therapy with three different classes of drugs on the incidence of cardiovascular complications in patients with hypertension was carried out. More than 30 thousand patients were included in the study, the average treatment period was about 5 years. Influence on cardiovascular prognosis amlodipine was comparable to the ACE inhibitor lisinopril, and surpassed the latter in a number of positions [7]. According to the ALLHAT study, amlodipine most effectively reduced the risk of all-cause mortality, the incidence of coronary heart disease (CHD) and its complications. In addition, amlodipine was superior to lisinopril in preventing peripheral vascular disease and stroke [7].
The multicenter VALUE study, which included more than 15,000 AH patients, compared the effectiveness of therapy with amlodipine and the angiotensin receptor blocker valsartan [8]. The results of the study did not reveal statistical differences in the incidence of stroke, myocardial infarction and mortality in the treatment of amlodipine and valsartan. The hypotensive effect (especially the initial one) was more pronounced while taking amlodipine. The data obtained once again emphasize the possibility of achieving the target level of blood pressure in the treatment of amlodipine [8].
In the light of the generally accepted concept of the cardiovascular continuum today, an important criterion for evaluating the effectiveness of an antihypertensive drug is its organoprotective properties. Numerous experimental and clinical studies have shown the ability of AA to cause regression of left ventricular myocardial hypertrophy (LVH) [9,10]. The FOAM study proved that in terms of the ability to cause LVH regression, amlodipine is second only to ACE inhibitors, surpassing drugs of other classes [10].
Numerous experimental and clinical studies indicate the anti-atherosclerotic effect of amlodipine, which is an important point in the treatment of patients with hypertension and coronary artery disease [11-13]. The antiatherogenic effect of AA is due to their antioxidant and antiproliferative properties, which prevents the penetration and deposition of cholesterol esters in the vascular wall. Amlodipine, like other AKs, has the ability to slow down platelet aggregation. In the PREVENT study, in 825 patients with angiographic signs of stenosing atherosclerosis, amlodipine significantly reduced the thickness of the intima of the carotid arteries [11]. In the double-blind, placebo-controlled study CAPARES, the appointment of amlodipine to patients undergoing coronary angioplasty reduced the overall risk of adverse outcomes by 35% [12]. As part of a comparative randomized study CAMELOT using intravascular echography studied the effect of amlodipine on the progression of coronary atherosclerosis. In patients with coronary heart disease, when taking amlodipine, there was a significant trend towards a decrease in the progression of the atherosclerotic process [13].
The high demand for amlodipine explains the emergence of an increasing number of generic drugs (generics) on the world pharmaceutical market. There are dozens of them, but data on bioequivalence, not to mention therapeutic equivalence, are practically absent. There are cases when reproduced drugs were not bioequivalent [14].
To prove the equivalence of a generic drug to the original drug, pharmaceutical equivalence data are used, as well as bioequivalence data, which is understood as the pharmacokinetic equivalence of the original and generic drug. Bioequivalence studies are carried out on a limited number of healthy volunteers using a randomized crossover method [15]. As indicators of pharmacokinetics, the maximum concentration of the drug (Cmax) and the time to reach it, as well as the area under the concentration-time curve, the so-called AUC (area under curve), are evaluated. It is believed that 9The 0% AUC values ​​of a generic drug should not exceed 80-125% of those for the original drug. If this condition is met, then a conclusion is made about the bioequivalence of the generic and the original drug [16,17].
The question arises: can therapy with generic drugs really provide the result in terms of improving the prognosis of the life of patients, which has been proven in large controlled trials using original drugs? The formal point of view says that if a generic drug is registered (i.e. there is data on its pharmaceutical and pharmacokinetic equivalence to the original drug), then it is therapeutically equivalent to the original drug [15]. However, many researchers question whether these data are always sufficient to guarantee the real therapeutic equivalence of a generic drug to the originator drug.
In addition to the original brand of amlodipine besylate, protected by a patent, generic drugs containing amlodipine maleate as the active ingredient have appeared in many European countries [18,19]. Since 2007, generic versions of amlodipine besylate have also become available worldwide.
A comparative study of the bioequivalence of amlodipine maleate to the original drug was carried out in several studies. So, in an open randomized crossover study Mignini F. et al. (2007) studied the bioequivalence of amlodipine maleate to the original drug amlodipine besylate in 24 healthy volunteers (aged 24–45 years) [20]. The researchers did not find any statistically significant difference between these substances in terms of AUC and Cmax, it was concluded that amlodipine maleate and amlodipine besylate are bioequivalent.
In the work of Abernethy D.R. et al. (1990) showed that the pharmacokinetics of amlodipine changes with age, so studies to assess the bioequivalence of amlodipine should be carried out in the group of elderly patients [21].
The efficacy and safety of amlodipine besylate and amlodipine maleate was studied in a multicenter randomized clinical trial by Park S. et al., conducted in 2005 in South Korea [22]. The study involved 118 patients with hypertension, who were randomized into two groups. Patients of the first group for the treatment of hypertension took amlodipine besylate, patients of the second group received amlodipine maleate. The evaluation of the results of the study was carried out after 8 weeks of treatment according to a predetermined criterion – a change in the level of diastolic blood pressure by more than 4 mm Hg. According to this criterion, in the amlodipine maleate group, the dynamics of the decrease in diastolic blood pressure was the same as in the amlodipine besilate group. The difference in the decrease in diastolic BP was not statistically significant. The authors concluded that the efficacy of amlodipine maleate is comparable to the antihypertensive effect of amlodipine besylate [22].
However, a detailed analysis of this study found that the achievement of target values ​​of diastolic blood pressure was observed in 91.8% of patients receiving amlodipine besylate and only in 85.7% of patients receiving amlodipine maleate [22] (Fig. 1). In addition, the choice of the magnitude of the change in diastolic blood pressure was arbitrary. In a meta-analysis by Wald D.S. et al. (2009) it was proved that a change in diastolic blood pressure by 4 mm Hg. causes a difference in the incidence of coronary artery disease by 20%, and cerebral stroke by 29% [23]. In this case, leveling the difference in diastolic blood pressure within 4 mm Hg. is a gross violation in the evaluation of the data obtained and makes the statistical reliability of the results of the study doubtful.
It turns out that it is not worth saying that these drugs are interchangeable, since the studies were limited by a small sample size and the absence of long-term follow-up results [14]. In order to talk about the therapeutic equivalence of drugs in terms of their antihypertensive effect, trials are needed in cohorts of at least 600 people, with a follow-up period of at least 6 months, with an assessment of the end points of the study (number of myocardial infarctions, cerebral stroke and overall mortality). The best assessment when studying the therapeutic equivalence of the original and generic drug is to conduct large-scale long-term randomized clinical trials [14].
Thus, amlodipine besylate is the only well-studied amlodipine drug with an antihypertensive effect, organ-protective properties and a good tolerability profile proven in large multicenter international studies, which guarantees the achievement of the goal of patient treatment.

Literature
1. ESH–ESC Guidelines Committee. 2007 guidelines for the management of arterial hypertension.// J Hypertension 2007; 25:1105–87.
2. Toyo-Oka T, Nayler WG. Third generation calcium entry blockers. Blood Press 1996; 5:206–208.
3. Nold G. et al. Morning versus evening amlodipine treatment: Effect of circadian blood pressure profile in essential hypertensive patients. Blood Press Monit 1998 3(1) 17–25.
4. Leenen F.H. et al. Persistence of antihypertensive effect after missed doses of calcium antagonist with long (amlodipine) vs short (diltiazem) elimination half–life. British J Clin Pharmacol 1996 41(2) 83–8.
5. Clavijo GA, de Clavijo IV, Weart CW. Amlodipine: a new calcium antagonist. Am J Hosp Pharm 1994; 51:59–68.
6. Levine CB, Fahrbach KR, Frame D, et al. Effect of amlodipine on systolic blood pressure. Clin Therapeutics 2003;25:35–57.
7. Leenen FH, Nwachuku CE, Black HR et al. Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. Hypertension 2006; 48:374–84.
8. Julius S, Kjeldsen SE, Weber M et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomized trial. Lancet 2004; 363 (9426): 2022–3.
9. Liebson P.R., Grandits G.A., Dianzumba S. et al. Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional–hygienic therapy in the Treatment of Mild Hypertension Study (TOMHS) // Circulation 1995; 91:698–706.
10. Zanchetti A, Ruilope LM, Cuspidi C, Macca G, Verschuren J, Kerselaers W. Comparative effects of the ACE inhibitor fosinopril and the calcium antagonist amlodipine on left ventricular hypertrophy and urinary albumin excretion in hypertensive patients. Results of FOAM, a multicenter European study.// J Hypertens, 2001; 19(Suppl 2):S92.
11. Hernandez RH, Armas–Hernandez MJ, Velasco M. Calcium antagonists and atherosclerosis protection in hypertension.// Am J Ther., 2003; 10(6):409–14.
12. Jorgensen B, Thaulow E; Effects of amlodipine on ischemia after percutaneous transluminal coronary angioplasty: secondary results of the Coronary Angioplasty Amlodipine Restenosis (CAPARES) Study.//Am Heart J., 2003;145(6):1030–5.
13. Nissen SE, Tuzcu EM, Libby P, Thompson PD, Ghali M, Garza D, Berman L, Shi H, Buebendorf E, Topol EJ, CAMELOT Investigators. Effect of antihypertensive agents on cardiorprovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. // JAMA, 2004; 292:2217–2225.
14 Meredith P.A. Potential concerns about generic substitution: bioequivalence versus therapeutic equivalence of different amlodipine salt forms.//Current Medical Research and Opinion, 2009; 25:2179–2189.
15. Martsevich S.Yu., Kutishenko N.P., Deev A.D. Original drugs and generics in cardiology. Is it possible to solve the problem of interchangeability? // Bulletin of Roszdravnadzor, 2009, No. 4 pp. 5–8.
16. Senn S. In the blood: proposed new requirements for registering generic drugs. // Lancet 1998;352:85–86.
17. Meyer G.F. History and regulatory issues of generic drugs. // Transplantation Proceedings 1999;31 (Suppl. 3A):10S–12S.
18. European Medicines Agency (EMEA), Committee for Proprietary Medicinal Products (CPMP), Opinion following an article 29 referral: Amlovita. London 26 April 2004. EMEA/CPMP/539/04.
19. European Medicines Agency (EMEA), Committee for Proprietary Medicinal Products (CPMP), Opinion following an article 29 referral: Talam. London 27 April 2004. EMEA/CPMP/540/04.
20. Mignini F, Tomassoni D, Traini E, et al. Single-dose, randomized, crossover bioequivalence study of amlodipine maleate versus amlodipine besylate in healthy volunteers. // Clin Exp Hypertens 2007;29:539–52.
21. Abernethy DR, Gutkowska J, Winterbottom LM. Effects of amlodipine, a long-acting dihydropyridine calcium antagonist in aging hypertension: pharmacodynamics in relation to disposition. //Clin Pharmacol Ther 1990;48:76–86.
22. Park S, Chung N, Kwon J, et al. Results of a multicenter, 8-week, parallel-group, randomized, double-blind, doubledummy, phase III clinical trial to evaluate the efficacy and tolerability of amlodipine maleate versus amlodipine besylate in Korean patients with mild to moderate hypertension. //Clin Ther 2005;27:441–50.
23. Wald DS, Law M, Morris JK, et al. Combination therapy versus monotherapy in reducing blood pressure: meta–analysis on 11,000 participants from 42 trials. // Am J Med 2009;122:290–300.

Amlodipine tablets 5 mg: instructions, price, analogues | tablets Kyivmedpreparat

• Pharmacological properties
• Readings
• Contraindications
• Interaction with other medicinal products and other forms of interaction
• Dosage and administration
• Overdose
• Adverse reactions
• Expiry date
• Storage conditions
• Diagnosis
• Recommended alternatives
• Trade names

Composition:

active ingredient: amlodipine;

1 tablet contains amlodipine besilate, in terms of amlodipine – 5 mg;

excipients: lactose, monohydrate, potato starch, povidone, calcium stearate.

Dosage form

Tablets.

Basic physical and chemical properties: tablets of white or almost white color with a flat surface, scored and chamfered.

Pharmacotherapeutic group

Selective calcium antagonists with a predominant effect on the vessels. Derivatives of dihydropyridine. ATX code C08C A01.

Pharmacological properties

Pharmacodynamics.

Amlodipine is a calcium antagonist (a derivative of dihydropyridine), which blocks the flow of calcium ions to the myocardium and smooth muscle cells.

The mechanism of the hypotensive action of amlodipine is due to a direct relaxing effect on vascular smooth muscle. The exact mechanism of the antianginal effect of amlodipine is not well defined, but the following effects play a role.

1. Amlodipine dilates peripheral arterioles and thus reduces peripheral resistance (afterload). Since the heart rate remains stable, reducing the workload on the heart leads to a decrease in energy consumption and myocardial oxygen demand.

2. Dilation of the main coronary arteries and coronary arterioles (normal and ischemic) may also play a role in the mechanism of action of amlodipine. This expansion increases myocardial oxygen saturation in patients with coronary artery spasm (Prinzmetal’s or variant angina pectoris).

In patients with arterial hypertension, the use of the drug once a day provides a clinically significant decrease in blood pressure for 24 hours in both the supine and standing positions. Due to the slow onset of action of amlodipine, acute arterial hypotension is usually not observed.

In patients with angina pectoris, a single daily dose of the drug increases the total time of physical activity, the time to the onset of angina pectoris, and the time to achieve 1 mm ST segment depression on the ECG. The drug reduces the frequency of angina attacks and reduces the need for the use of nitroglycerin.

Amlodipine is not associated with any metabolic side effects or plasma lipid changes and may be used in patients with asthma, diabetes mellitus and gout.

Pharmacokinetics.

Absorption/Distribution

After oral administration of therapeutic doses, amlodipine is gradually absorbed into the blood plasma. The absolute bioavailability of the unchanged molecule is approximately 64-80%. The maximum plasma concentration is reached within 6-12 hours after application. The volume of distribution is approximately 21 l/kg; the acid dissociation constant (pKa) of amlodipine is 8.6. Research in vitro demonstrated that the binding of amlodipine to plasma proteins is approximately 97.5%.

Simultaneous food intake does not affect the absorption of amlodipine.

Metabolism/elimination

The plasma half-life is approximately 35-50 hours. Equilibrium concentration in blood plasma is reached after 7-8 days of continuous use of the drug. Amlodipine is mainly metabolized to inactive metabolites. About 60% of the administered dose is excreted in the urine, about 10% of which is unchanged amlodipine.

Elderly patients

The time to reach equilibrium plasma concentrations of amlodipine is similar in elderly patients and in adult patients. The clearance of amlodipine is usually somewhat reduced, which in elderly patients leads to an increase in the area under the concentration / time curve (AUC) and the half-life of the drug.

Patients with impaired renal function

Amlodipine is extensively biotransformed to inactive metabolites. 10% of amlodipine is excreted unchanged in the urine. Changes in the concentration of amlodipine in plasma do not correlate with the degree of impaired renal function. Patients with impaired renal function can use the usual doses of amlodipine. Amlodipine is not excreted by dialysis.

Patients with hepatic impairment

Information on the use of amlodipine in patients with hepatic impairment is very limited. In patients with hepatic insufficiency, the clearance of amlodipine is reduced, which leads to an increase in the duration of the half-life and to an increase in AUC by about 40-60%.

Children

Pharmacokinetic studies of amlodipine were performed in 74 hypertensive children aged 12 to 17 years (also 34 patients aged 6 to 12 years and 28 patients aged 13 to 17 years) who used amlodipine in doses of 1. 25–20 mg per day for 1 or 2 doses. Typically, oral clearance in children aged 6 to 12 years and 13 to 17 years was 22.5 and 27.4 L/h, respectively, for boys and 16.4 and 21.3 L/h, respectively, for girls. There is considerable variability in exposure between patients. Information on patients under 6 years of age is limited.

Clinical characteristics

Indications

• Arterial hypertension.
• Chronic stable angina.
• Vasospastic angina (Prinzmetal’s angina).

Contraindications

• Known hypersensitivity to dihydropyridines, amlodipine or any other component of the formulation.
• Severe arterial hypotension.
• Shock (including cardiogenic shock).
• Left ventricular outflow tract obstruction (eg, severe aortic stenosis).
• Hemodynamically unstable heart failure after acute myocardial infarction.

Interaction with other medicinal products and other forms of interaction

.

Effect of other drugs on amlodipine.

There are data on the safe use of amlodipine with thiazide diuretics, alpha-blockers, beta-blockers, angiotensin-converting enzyme inhibitors, long-acting nitrates, sublingual nitroglycerin, non-steroidal anti-inflammatory drugs, antibiotics, oral hypoglycemic drugs.

Data from in vitro studies with human plasma indicate no effect of amlodipine on blood protein binding of investigational drugs (digoxin, phenytoin, warfarin or indomethacin).

CYP3A4 inhibitors.

Concomitant use of amlodipine and strong or moderate CYP3A4 inhibitors (protease inhibitors, azole antifungals, macrolides such as erythromycin or clarithromycin, verapamil or diltiazem) may lead to a significant increase in amlodipine exposure, which may also lead to an increased risk of hypotension . The clinical significance of such changes may be more pronounced in elderly patients. Clinical monitoring of the patient’s condition and dose adjustment may be necessary.

The simultaneous use of amlodipine and grapefruit or grapefruit juice is not recommended, since in some patients the bioavailability of amlodipine may increase, which, in turn, leads to an increase in the hypotensive effect.

CYP3A4 inductors.

There is no information on the effect of CYP3A4 inducers on amlodipine. The simultaneous use of amlodipine and substances that are CYP3A4 inducers (for example, rifampicin, St.

Dantrolene (infusion).

Fatal ventricular fibrillations and cardiovascular collapse associated with hyperkalemia have been observed in animals following intravenous administration of verapamil and dantrolene. Because of the risk of hyperkalemia, it is recommended that calcium channel blockers such as amlodipine be avoided in patients prone to malignant hyperthermia and in the treatment of malignant hyperthermia.

Effect of amlodipine on other medicinal products.

The hypotensive effect of amlodipine potentiates the hypotensive effect of other antihypertensive agents.

Tacrolimus.

There is a risk of increased blood levels of tacrolimus when used concomitantly with amlodipine, but the pharmacokinetic mechanism of this interaction has not been fully established. To avoid tacrolimus toxicity, when amlodipine is used concomitantly in patients taking tacrolimus, blood levels of tacrolimus should be regularly monitored and, if necessary, the dose of tacrolimus should be adjusted.

Cyclosporine.

Interaction studies of cyclosporine and amlodipine in healthy volunteers or in other groups have not been performed, with the exception of use in patients with a transplanted kidney, in which a variable increase in the residual concentration of cyclosporine (up to 40%) was observed to a greater or lesser extent. For kidney transplant patients treated with amlodipine, consideration should be given to monitoring ciclosporin concentrations and, if necessary, reducing the ciclosporin dose.

Simvastatin.

Co-administration of multiple doses of amlodipine 10 mg and simvastatin 80 mg resulted in a 77% increase in simvastatin exposure compared to simvastatin alone. For patients on amlodipine, the dose of simvastatin should be limited to 20 mg daily.

Sildenafil.

A single dose of 100 mg of sildenafil in patients with essential hypertension did not affect the pharmacokinetics of amlodipine. With the simultaneous use of amlodipine and sildenafil as a combination therapy, each of the drugs showed a hypotensive effect independently of the other.

Other drugs.

Clinical drug interaction studies have shown that amlodipine does not affect the pharmacokinetics of atorvastatin, digoxin and warfarin.

Ethanol (alcohol).

Single and multiple doses of 10 mg of amlodipine had no significant effect on the pharmacokinetics of ethanol.

Co-administration of amlodipine with cimetidine had no effect on the pharmacokinetics of amlodipine.

Co-administration of aluminum/magnesium preparations (antacids) with a single dose of amlodipine had no significant effect on the pharmacokinetics of amlodipine.

Laboratory tests.

Effects on laboratory tests are unknown.

Application features.

The safety and efficacy of amlodipine in hypertensive crisis have not been evaluated.

Patients with heart failure.

Amlodipine should be used with caution in this category of patients. In a long-term, placebo-controlled study in patients with severe heart failure (NYHA class III and IV), the incidence of pulmonary edema was higher with amlodipine than with placebo. In patients with congestive heart failure, calcium channel blockers, including amlodipine, should be used with caution as they may increase the risk of future cardiovascular events and death.

Patients with impaired liver function.

Amlodipine half-life and AUC parameters are higher in patients with impaired liver function; There are no recommendations for drug doses. Therefore, this category of patients should start using the drug with the lowest dose. Care should be taken both at the beginning of the use of the drug, and during dose increases. Patients with severe hepatic impairment may require slow dose titration and careful monitoring of the patient’s condition.

Elderly patients.

Increasing the dose of the drug in this category of patients should be done with caution.

Patients with renal insufficiency.

This category of patients should use the usual dose of the drug. Changes in the concentration of amlodipine in plasma do not correlate with the degree of impaired renal function. Amlodipine is not removed by dialysis.

Amlodipine does not interfere with laboratory test results.

It is not recommended to use amlodipine together with grapefruit or grapefruit juice, since in some patients the bioavailability may be increased, which will lead to an increase in the hypotensive effect of the drug.

Patients with hereditary galactose intolerance, lactase deficiency or glucose/galactose malabsorption syndrome should be aware that this medicinal product contains lactose.

Use during pregnancy or lactation.

Fertility

Reversible biochemical changes in the sperm head have been reported in some patients with calcium channel blockers. There is insufficient clinical information regarding the potential effect of amlodipine on fertility.

Use during pregnancy or lactation

The safety of amlodipine in women during pregnancy has not been established.

Use of amlodipine during pregnancy is recommended only when there is no safer alternative and the risk associated with the disease itself outweighs the possible harm from treatment to the mother and fetus.

Reproductive toxicity has been observed in animal studies at high doses.

It is not known whether amlodipine passes into breast milk. When deciding whether to continue breastfeeding or to use amlodipine, it is necessary to evaluate the benefits of breastfeeding for the child and the benefits of using the drug for the mother.

The ability to influence the reaction rate when driving vehicles or operating other mechanisms.

Amlodipine may have minor or moderate effects on the ability to drive or use machines.

The reaction rate may be reduced if symptoms such as dizziness, headache, confusion or nausea are present.

Caution should be exercised, especially at the beginning of therapy.

Dosage and Administration

Adults.

For the treatment of hypertension and angina, the usual starting dose of amlodipine is 5 mg once daily. Depending on the patient’s response to therapy, the dose may be increased to a maximum dose of 10 mg once daily.

In patients with angina pectoris, the drug can be used as monotherapy or in combination with other antianginal drugs with resistance to nitrates and / or adequate doses of beta-blockers.

There is experience with the use of the drug in combination with thiazide diuretics, alpha-blockers, beta-blockers or angiotensin-converting enzyme inhibitors in patients with arterial hypertension.

There is no need to select the dose of the drug when used simultaneously with thiazide diuretics, beta-blockers and angiotensin-converting enzyme inhibitors.

Children over 6 years of age with hypertension.

The recommended initial dose of Amlodipine for this category of patients is 2.5 mg 1 time per day. If the desired level of blood pressure is not reached within 4 weeks, the dose can be increased to 5 mg per day. The use of the drug in doses above 5 mg for this category of patients has not been studied.

Elderly patients.

There is no need to adjust the dose for this category of patients. Increasing the dose should be done with caution.

Patients with impaired renal function.

It is recommended to use the usual doses of the drug, since changes in the concentration of amlodipine in blood plasma are not associated with the severity of renal failure. Amlodipine is not excreted by dialysis.

Patients with impaired liver function.

Doses of the drug for use in patients with mild to moderate hepatic impairment have not been established, so dose selection should be done with caution and start using the drug from the lowest dose in the dose range (see section “Peculiarities of use” and “Pharmacological properties .Pharmacokinetics”). The pharmacokinetics of amlodipine have not been studied in patients with severe hepatic impairment. For patients with severe hepatic impairment, amlodipine should be started at the lowest dose and gradually increased.

Children

The drug can be used in children over 6 years of age.

The effect of amlodipine on blood pressure in patients under 6 years of age is unknown.

Overdose

There is limited experience with intentional drug overdose.

Overdose symptoms: available information suggests that a significant overdose of amlodipine will lead to excessive peripheral vasodilation and possibly reflex tachycardia. There is evidence of the development of significant and possibly prolonged systemic arterial hypotension, including fatal shock.

Treatment: clinically significant hypotension due to amlodipine overdose requires active cardiovascular support, including frequent monitoring of cardiac and respiratory functions, elevation of the lower extremities, monitoring of circulating fluid volume and urinary output.

To restore vascular tone and blood pressure, you can use vasoconstrictor drugs, making sure that there are no contraindications to their use. The use of intravenous calcium gluconate may be useful in counteracting the effects of calcium channel blockade.

Gastric lavage may be helpful in some cases. The use of activated charcoal to healthy volunteers within 2 hours after the administration of 10 mg of amlodipine significantly reduced the level of its absorption.

Since amlodipine is highly protein bound, the effect of dialysis is negligible.

Adverse reactions

The most commonly reported adverse reactions with amlodipine are: drowsiness, dizziness, headache, palpitations, hot flashes, abdominal pain, nausea, leg swelling, edema and fatigue.

Adverse reactions reported during the use of amlodipine are listed below by system and class of organs and by frequency of occurrence: very often (≥ 1/10), often (from ≥ 1/100 to < 1/10), infrequently ( from ≥ 1/1000 to ≤ 1/100), rarely (from ≥ 1/10000 to ≤ 1/1000), very rarely (≤ 1/10000).

From the blood and lymphatic system.

Very rare: leukocytopenia, thrombocytopenia.

From the side of the immune system.

Very rare: allergic reactions.

From the side of metabolism and alimentary disorders.

Very rare: hyperglycemia.

Mental disorders.

Uncommon: depression, mood changes (including anxiety), insomnia.

Rare: confusion.

From the side of the nervous system.

Often: drowsiness, dizziness, headache (mainly at the beginning of treatment).

Uncommon: tremor, dysgeusia, syncope, hypesthesia, paresthesia.

Very rare: hypertonicity, peripheral neuropathy.

From the side of the organs of vision.

Often: visual impairment (including diplopia).

From the side of the hearing organs and the labyrinth.

Uncommon: ringing in the ears.

From the side of the heart.

Often: increased heartbeat.

Uncommon: arrhythmia (including bradycardia, ventricular tachycardia and atrial fibrillation).

Very rare: myocardial infarction.

Unknown: pain behind the sternum.

Vessel side.

Often: hot flashes.

Uncommon: arterial hypotension.

Very rare: vasculitis.

Respiratory, thoracic and mediastinal disorders.

Often: dyspnea.

Uncommon: cough, rhinitis.

From the gastrointestinal tract.

Common: Abdominal pain, nausea, dyspepsia, impaired intestinal motility (including diarrhea and constipation).

Uncommon: vomiting, dry mouth.

Very rare: pancreatitis, gastritis, gingival hyperplasia.

From the hepatobiliary system.

Very rare: hepatitis, jaundice, elevated liver enzymes (most often associated with cholestasis).

From the side of the skin and subcutaneous tissue.

Uncommon: alopecia, purpura, discoloration of the skin, increased sweating, pruritus, rash, exanthema, urticaria.

Very rare: angioedema, erythema multiforme, exfoliative dermatitis, Stevens-Johnson syndrome, angioedema, photosensitivity.

From the musculoskeletal and connective tissues.

Often: swelling of the legs, muscle cramps.

Uncommon: arthralgia, myalgia, back pain.

From the side of the kidneys and urinary tract.

Uncommon: urinary disorders, nocturia, increased frequency of urination.

From the reproductive system and mammary glands.

Uncommon : impotence, gynecomastia.

General disorders and conditions at the injection site.

Very common: edema.

Often: increased fatigue, asthenia.

Uncommon: chest pain, pain, malaise.

Research.

Uncommon: increase or decrease in body weight.

Exceptional cases of extrapyramidal syndrome have been reported.

Children.

Amlodipine is well tolerated in children. The adverse reaction profile is similar to that in adults. In a study of amlodipine in 268 children, the most commonly reported adverse reactions were: headache, dizziness, vasodilation, epistaxis, abdominal pain, asthenia.

Most of the adverse reactions were mild or moderate. Severe adverse reactions (mainly headache) were observed in 7.2% when taking 2.5 mg of amlodipine, in 4.5% when using 5 mg of amlodipine, and in 4.6% in the placebo group. The most common reason for exclusion from the study was uncontrolled hypertension. At no time were withdrawals from the study due to laboratory abnormalities. There were no significant changes in heart rate.