Side Effects, Dosage, Uses, and More

Highlights for amlodipine-benazepril

1. Amlodipine/benazepril oral capsule is available as a brand-name drug and a generic drug. Brand name: Lotrel.
2. Amlodipine/benazepril comes only as a capsule you take by mouth.
3. Amlodipine/benazepril oral capsule is used to treat high blood pressure. It’s given when other drugs by themselves haven’t worked to lower your blood pressure.

FDA warning: Use during pregnancy

• This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
• You shouldn’t take this drug during pregnancy. It can harm or even end your pregnancy. If you become pregnant, you should stop taking this drug right away.

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Other warnings

• Allergic reaction warning: This drug can cause a serious allergic reaction. This can be fatal. Allergic reactions usually happen after one of your first doses, but they sometimes don’t occur until you’ve been taking this drug for months. These allergic reactions are rare, but happen more often in African Americans.
• Low blood pressure warning: This drug may cause low blood pressure. Your risk may be higher if you:
• take water pills
• eat a low-salt diet
• are on dialysis
• have heart problems
• get sick with vomiting or diarrhea
• Heart attack warning: Rarely, this drug can increase your risk of severe chest pain that happens often and lasts for a long time. This may raise your risk of having a heart attack. Your risk may be higher if you have severe heart disease.

Amlodipine/benazepril is a prescription drug. It comes as an oral capsule.

Amlodipine/benazepril is available as the brand-name drug Lotrel. It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, they may not be available in every strength or form as the brand-name drug.

This drug is a combination of two drugs in a single form: amlodipine and benazepril. It’s important to know about all the drugs in the combination because each drug may affect you in a different way.

This drug may be used as part of a combination therapy. That means you need to take it with other drugs.

Why it’s used

This medication contains two drugs in a single form that work together to lower your blood pressure. This drug is given only after other drugs haven’t worked.

How it works

Amlodipine belongs to a class of drugs called calcium channel blockers (CCBs). Benazepril belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Blood pressure is the force of blood in your blood vessels. High blood pressure occurs when the force is too high. This drug can help your blood vessels relax. This lowers your blood pressure.

This drug doesn’t cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects that occur with amlodipine/benazepril include:

• cough
• dizziness
• headache
• swelling of your feet, ankles, and hands

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Serious allergic reaction. Symptoms can include:
• swelling of your face, eyelids, lips, tongue, or throat
• trouble swallowing
• wheezing or other breathing problems
• Low blood pressure (hypotension). Symptoms can include:
• feeling faint or dizzy, especially when you stand up
• tiredness
• lightheadedness
• Liver problems. Symptoms can include:
• nausea
• tiredness
• weakness
• itching
• yellowing of your skin or the whites of your eyes
• pain in your upper right abdomen
• flu-like symptoms, such as:
• fever
• cough
• sore throat
• runny or stuffy nose
• body aches
• chills
• Kidney problems. Symptoms can include:
• tiredness
• swelling, especially of your hands, feet, or ankles
• shortness of breath
• Chest pain and heart attack

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Amlodipine/benazepril oral capsule can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with amlodipine/benazepril are listed below.

Sacubitril

Taking amlodipine/benazepril with sacubitril, which is used with valsartan to treat high blood pressure and heart failure, raises your risk of angioedema (serious swelling). You should not use amlodipine/benazepril within 36 hours of using sacubitril.

Potassium supplements and potassium-sparing diuretics

Taking these drugs with amlodipine/benazepril can increase the amount of potassium in your body. Examples of these drugs include:

• spironolactone
• eplerenone
• amiloride
• triamterene

Mood stabilizers

Taking these drugs with amlodipine/benazepril can increase the levels of these medications in your body. This means that you may have more side effects. Examples of these drugs include:

• lithium

Cholesterol medications

Taking these drugs with amlodipine/benazepril can increase the levels of these medications in your body. This means that you may have more side effects. Examples of these drugs include:

• simvastatin

Diabetes medications

Taking certain diabetes medications with amlodipine/benazepril may result in low blood sugar levels. Examples of these drugs include:

• insulin
• metformin
• glimepiride
• pioglitazone
• sitagliptin

Gold

Taking amlodipine/benazepril with injectable gold may result in flushing, nausea, vomiting, and low blood pressure.

Mammalian target of rapamycin (mTOR) inhibitors

Taking mTOR inhibitors with amlodipine/benazepril may result in a serious reaction that causes swelling of your face, eyelids, lips, tongue, or throat. Examples of these drugs include:

• temsirolimus
• sirolimus
• everolimus

Pain medications

Taking certain pain medications with amlodipine/benazepril can decrease your kidney function. Examples of these drugs include:

• nonsteroidal anti-inflammatory drugs (NSAIDs), such as:
• ibuprofen
• naproxen
• indomethacin
• COX-2 inhibitors, such as:
• celecoxib

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

This drug comes with several warnings.

Allergy warning

This drug can cause a severe allergic reaction. Symptoms include:

• trouble breathing
• swelling of your throat or tongue
• hives

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Warnings for people with certain health conditions

For people with liver problems: This drug is broken down by your liver. If you have liver problems, more of this drug may stay in your body. This puts you at risk for more side effects. If you have severe liver problems, you may need a lower dosage or a different dosing schedule.

For people with kidney problems: If you have kidney disease, taking this drug may make your kidney problems worse. Benazepril can cause minor kidney damage. If you already have severe kidney damage, you shouldn’t take this drug.

For people with heart problems or chest pain: Rarely, this drug can cause you to have severe chest pain that happens more often or for a longer period of time. Your risk may be higher if you have severe heart disease. This drug may also increase your risk of having a heart attack. If you have heart failure, you may be at a higher risk of kidney failure if you take this medication.

Warnings for other groups

For pregnant women: This drug is a category D pregnancy drug. That means two things:

1. Studies show a risk of adverse effects to the fetus when the mother takes the drug.
2. The benefits of taking the drug during pregnancy may outweigh the potential risks in certain cases.

Tell your doctor if you’re pregnant or plan to become pregnant. If you get pregnant while taking this drug, stop taking it right away and call your doctor. If it’s taken during pregnancy, this drug can harm or end your pregnancy. This drug should be used during pregnancy only if the potential benefit justifies the potential risk.

For women who are breastfeeding: This drug passes into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: Older adults may process this drug more slowly. A normal adult dosage may cause levels of the drug to be higher than normal in your body. If you’re a senior, you may need a lower dosage or a different dosage schedule.

For children: This drug hasn’t been studied in children and shouldn’t be used in children younger than 18 years.

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

Drug forms and strengths

Generic: Amlodipine/benazepril

• Form: oral capsule
• Strengths:
• 2. 5 mg amlodipine/10 mg benazepril
• 5 mg amlodipine/10 mg benazepril
• 5 mg amlodipine/20 mg benazepril
• 5 mg amlodipine/40 mg benazepril
• 10 mg amlodipine/20 mg benazepril
• 10 mg amlodipine/40 mg benazepril

Brand: Lotrel

• Form: oral capsule
• Strengths:
• 2.5 mg amlodipine/10 mg benazepril
• 5 mg amlodipine/10 mg benazepril
• 5 mg amlodipine/20 mg benazepril
• 5 mg amlodipine/40 mg benazepril
• 10 mg amlodipine/20 mg benazepril
• 10 mg amlodipine/40 mg benazepril

Dosage for high blood pressure

Adult dosage (ages 18 to 64 years)

• Typical dosage: This ranges from 2.5 mg amlodipine/10 mg benazepril to 10 mg amlodipine/40 mg benazepril.
• Dosage increases: Your doctor may change your dosage after 7 to 14 days based on your blood pressure goals.

Child dosage (ages 0 to 17 years)

This medication hasn’t been studied in children. It shouldn’t be used in children younger than 18 years.

Senior dosage (ages 65 years and older)

• Typical starting dosage: 2.5 mg amlodipine/10 mg benazepril.

Special dosage considerations

For people with liver problems: Amlodipine/benazepril is processed by your liver. If your liver isn’t working well, more of the drug may stay in your body longer, putting you at risk for side effects. If you have severe liver problems, your doctor will likely start you on 2.5 mg amlodipine/10 mg benazepril.

For people with kidney problems: Your dosage of amlodipine/benazepril doesn’t need to be adjusted if you have mild or moderate kidney disease. If you have severe kidney disease, you shouldn’t use this drug.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Amlodipine/benazepril oral capsule is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

What to do if you miss a dose: If you miss a dose, take it as soon as you remember. If it’s been more than 12 hours since you missed a dose, skip the missed dose and just take your next dose at the regular time.

If you skip or miss doses: If you skip or miss doses, your blood pressure may get worse. This could lead to serious problems, such as stroke or heart attack.

If you take too much: You have a higher risk of having side effects caused by this drug. You may also have the following symptoms:

• trouble breathing
• very low blood pressure
• fast heartbeats

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

How to tell if the drug is working: You’ll know whether this drug is working when you check your blood pressure at home. If your blood pressure is at or below the goal your doctor set for you, the medication is working.

Keep these considerations in mind if your doctor prescribes amlodipine/benazepril for you.

General

• You can cut or crush the capsule.

Storage

• Store this drug at room temperature between 59°F and 86°F (15°C and 30°C).
• Don’t freeze this drug.
• Keep this drug away from light.
• Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t harm your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

During your treatment with this drug, your doctor may check your:

• blood pressure: You and your doctor should monitor your blood pressure to make sure this drug is working for you.

Your doctor may do these blood tests to decide if this drug is safe for you to start and if you need a lower dosage:

• liver function test
• kidney function and blood urea nitrogen tests to check how well your kidneys are working
• blood potassium test

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Prior authorization

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Amlodipine/Benazepril: Everything You Need to Know

1. What is the amlodipine & benazepril combination pill, and how does it work?
2. What is the amlodipine & benazepril combination pill used for?
3. Side effects
4. Drug interactions
5. Who should not use the amlodipine & benazepril combination pill (or use it with caution)?
6. Dosing

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

The amlodipine and benazepril combination pill (brand name Lotrel) is a prescription drug that merges two medicines into one capsule. You can take each medication individually, and both are often used to treat high blood pressure. However, by combining them, you get both drugs with fewer pills to swallow.

Both amlodipine and benazepril are antihypertensive medications. Amlodipine is a calcium channel blocker (CCB). It works by encouraging muscles (like those in blood vessels) to relax, thereby dilating or opening the blood vessels. By blocking calcium, amlodipine lowers blood pressure and eases the workload on the heart. CCBs are an effective way to treat high blood pressure. 

Benazepril is an angiotensin-converting enzyme (ACE) inhibitor that lowers blood pressure by interfering with the renin-angiotensin system. This system is a complex interaction of compounds that affect the blood vessels, heart, and kidneys and regulate blood pressure. 

The amlodipine/benazepril combination pill is FDA-approved to treat the following (FDA, 2011):

• High blood pressure (hypertension) in people who have tried amlodipine & benazepril by themselves and are still not well controlled

High blood pressure, or hypertension, is a common condition that affects your blood vessels, heart, brain, kidneys, and other parts of your body. Having high blood pressure increases your risk of suffering from a heart attack or stroke. Treating this condition usually involves lifestyle changes, like a healthy diet, regular physical activity, and smoking cessation. However, this may not be enough. Some people need medications to help keep their blood pressure under control. However, if one drug doesn’t lower the blood pressure enough, combination pills like amlodipine/benazepril may get the job done. 

Amlodipine/benazepril combination pill has a” black box” warning, a serious advisory from the FDA regarding severe side effects: Do not take amlodipine/benazepril combination pills if you are pregnant. If you become pregnant while taking it, stop the amlodipine/benazepril combination pill immediately. Any drug that acts on the renin-angiotensin system can cause injury or death to the developing fetus (DailyMed, 2020).

Common side effects include (DailyMed, 2020):

• Cough
• Headache
• Dizziness
• Edema (swelling of hands, legs, ankles, feet)

Serious side effects include (UpToDate, n. d.):

• Angioedema: swelling of the face, lips, throat, tongue, or intestine
• Worsening chest pain or heart attacks (especially in people with heart disease)
• Jaundice (yellowing of the skin or the whites of the eyes)
• Liver problems
• Kidney problems
• High potassium levels (hyperkalemia)
• Low blood pressure
• Severe allergic reaction—hives, skin rash, trouble breathing, etc.

This list does not include all possible side effects, and others may occur. Seek medical advice from your pharmacist or healthcare provider for more information. 

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Before starting the amlodipine/benazepril combination pill, be sure to seek medical advice regarding your other medications to avoid any potential drug interactions, including prescription and over-the-counter medicines, as well as herbal supplements. Possible drug interactions include (DailyMed, 2020):

• Drugs that block the CYP3A4 system: Any drug that interferes with the CYP3A4 system in the liver, which is responsible for breaking down amlodipine, may lead to higher than anticipated levels in your body. Higher levels increase the risk of low blood pressure and other side effects. Drugs that block the CYP3A4 in the liver include ketoconazole, itraconazole, and ritonavir.
• Simvastatin: Taking simvastatin with the amlodipine/benazepril combination pill raises the levels of simvastatin in your body, increasing the chance of side effects. 
• Drugs that block the renin-angiotensin system (RAS): Using the amlodipine/benazepril combination pill with other medications that block the RAS, like ACE inhibitors (e.g., lisinopril, captopril), angiotensin receptor blockers (e.g., losartan, valsartan), and aliskiren increases your chance of developing low blood pressure, high potassium levels, and worsening kidney function. Do not take the amlodipine/benazepril combination pill with other drugs that affect the RAS, especially in people with diabetes.
• Drugs that increase potassium levels: Since the amlodipine/benazepril combination pill may increase your potassium levels, you should be careful when combining it with other medicines that also raise potassium. Otherwise, you may get higher than normal amounts of potassium in your body, which could lead to nausea/vomiting, chest pain, irregular heartbeats, and weakness. Drugs that raise potassium levels include potassium-sparing diuretics (“water pills”) and potassium supplements. Salt substitutes often recommended as part of a low-salt diet, can also increase potassium levels because they replace sodium chloride with potassium chloride.
• Lithium: Combining lithium (a mood stabilizer often used to treat bipolar disorder) with the amlodipine/benazepril combination pill can lead to higher levels of lithium and increases the risk of lithium toxicity.
• Non-steroidal anti-inflammatory drugs (NSAIDs): Taking NSAIDs (like ibuprofen and naproxen) with the amlodipine/benazepril combination pill increases the risk of worsening kidney function, including possible kidney failure. Also, NSAIDs may decrease the amlodipine/benazepril combination pill’s ability to lower blood pressure.
• Mammalian Target of Rapamycin (mTOR) Inhibitors: mTOR inhibitors, used in cancer treatments, increase the risk of developing angioedema if taken with the amlodipine/benazepril combination pill. Examples include temsirolimus, sirolimus, and everolimus. 
• Neprilysin Inhibitor: Nepriliysin inhibitors (like sacubitril) are used to treat heart failure. They can raise the likelihood of developing angioedema if taken with the amlodipine/benazepril combination pill. Do not take the amlodipine/benazepril combination pill with neprilysin inhibitors.

This list does not include all possible drug interactions with the amlodipine & benazepril combination pill, and others may exist. Check with your pharmacist or healthcare provider for more information.

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Certain groups of people should not take the amlodipine & benazepril combination pill or use it with caution because of an increased risk of side effects. These groups include (DailyMed, 2020):

• Pregnant women: Black box warning from FDA: Pregnant women should not take the amlodipine & benazepril combination pill. If you become pregnant while taking it, stop the amlodipine & benazepril combination pill immediately, as it can cause injury or death to the fetus.
• Nursing mothers: Minimal amounts of amlodipine and benazepril get into the breastmilk. There is no data to suggest that taking the amlodipine & benazepril combination pill while nursing has adverse effects.  
• History of angioedema: People who have had angioedema (swelling of the face, throat, lips, tongue, or intestine) in the past, whether in response to a drug or not, should not use this medication. 
• Older people: People older than 65 may want to start at the lowest dose and increase as necessary to prevent side effects.
• People with liver problems: Since the liver is involved in the breakdown of the amlodipine & benazepril combination pill, abnormal liver function could lead to higher than expected levels. People with liver problems may choose to start at the lowest dose and increase as necessary to prevent side effects. 
• People with kidney disease: People with severe kidney problems should avoid using the amlodipine & benazepril combination pill as it may worsen their kidney disease.
• Black people: Black people may be at higher risk for developing angioedema with the amlodipine & benazepril combination pill.
• People with aortic stenosis: People with a narrowing of their aorta (aortic stenosis) should be careful with the amlodipine & benazepril combination pill. It may decrease blood flow to the coronary arteries and deprive them of necessary oxygen and nutrients.
• People with renal artery stenosis: People with renal artery stenosis, a narrowing of the artery to the kidney, risk worsening kidney function with the amlodipine & benazepril combination pill.
• People with heart problems: The amlodipine & benazepril combination pill increases the risk of low blood pressure (hypotension), especially in people with heart failure, hypertrophic cardiomyopathy (enlarged heart), and aortic/mitral stenosis. If you are dehydrated, you are also at a higher risk of low blood pressure with this medication. 

This list does not include all at-risk groups, and others may exist. Talk to your healthcare provider or pharmacist for more information.

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Amlodipine besylate and benazepril hydrochloride are prescription drugs. Each is available individually or together; the combination pill is available both as a generic medication and under the brand name Lotrel. Capsules come in the following strengths (amlodipine/benazepril): 2.5/10 mg, 5/10 mg, 5/20 mg, 5/40 mg, 10/20 mg, and 10/40 mg.

Most prescription plans cover the amlodipine & benazepril combination pill. The cost for a 30-day supply of generic capsules ranges from $11–$47, depending on the strength (GoodRx.com).

1. DailyMed. (2020). Amlodipine & benazepril capsule. Retrieved on September 21, 2020 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=99ed4927-9a34-4e8d-8eea-60b63c867d46
2. GoodRx. com. (n.d.). Amlodipine / Benazepril. Retrieved September 21, 2020 from https://www.goodrx.com/amlodipine-benazepril
3. MedlinePlus. (2019). Amlodipine and Benazepril. Retrieved on September 21, 2020 from https://medlineplus.gov/druginfo/meds/a601018.html
4. UpToDate. (n.d.). Amlodipine and benazepril: Drug information. Retrieved on September 21, 2020 from https://www.uptodate.com/contents/amlodipine-and-benazepril-drug-information
5. U. S. Food and Drug Administration (FDA). (2011). Lotrel (amlodipine besylate and benazepril hydrochloride) Capsules. Retrieved on September 21, 2020 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020364s052lbl.pdf

Dr. Mike is a licensed physician and the Director, Medical Content & Education at Ro.

Amlodipine and Benazepril | Memorial Sloan Kettering Cancer Center

Adult Medication

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Provided by Lexicomp ^® , this document contains all the information you need to know about this medicine, including indications, directions for use, side effects, and when your healthcare provider should be contacted.

Trade names: USA

Lotrel

Warning

• Not to be taken by pregnant women. The use of the drug during pregnancy may cause birth defects or intrauterine death of the child. If you become pregnant or plan to become pregnant while taking this drug, contact your doctor immediately.

What is this drug used for?

• Used to treat high blood pressure.
• This drug may also be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

• If you have an allergy to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergies and how they have manifested.
• If you have ever had a serious allergic reaction called angioedema (angioedema). Symptoms include swelling of the hands, face, lips, tongue, or throat; respiratory failure; swallowing disorder; uncharacteristically hoarse voice.
• If you have kidney disease.
• If you are dehydrated or have electrolyte disturbances.
• If you are taking a medicine containing aliskiren if you have diabetes or kidney disease.
• If you have taken a medicine containing sacubitril in the past 36 hours.

This list of drugs and conditions that may interact with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural medicines and vitamins) and any health problems you have. You need to make sure that this drug is safe for your conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s advice.

What do I need to know or do while taking this drug?

• Tell all your health care workers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
• It may take several weeks for full results to be seen.
• Avoid driving and other activities that require increased attention until you see how this drug affects you.
• To reduce the risk of dizziness or loss of consciousness, get up slowly from a lying or sitting position. Walking up and down stairs should be done with care.
• If you are allergic to tartrazine (FD&C Yellow No. 5), talk to your doctor. Some products contain tartrazine.
• Check your blood pressure as directed.
• Perform blood tests as directed by your doctor. Consult with your doctor.
• If you are using a salt substitute containing potassium, a potassium-sparing diuretic, or a potassium supplement, check with your doctor.
• If you are on a salt-free or low-salt diet, please consult your doctor.
• In rare cases, after the first use of this drug or after increasing the dose, chest pain may first occur or worsen. Myocardial infarction may also occur. The risk may be increased in people with very severe heart blood vessel disease. Consult your doctor.
• With the use of captopril (a drug similar to this drug), there was a low level of leukocytes. This may lead to an increased risk of infection. Most of the time this happened in people with kidney problems, mostly in the presence of some other health problem. Call your doctor right away if you have symptoms of an infection, such as a high fever, chills, or sore throat.
• Talk to your doctor before taking an over-the-counter drug that can raise blood pressure. These drugs include cough and cold medicines, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, and some natural products.
• Consult your doctor before drinking alcohol.
• Caution should be exercised in hot weather and during vigorous activity. Drink plenty of fluids to prevent dehydration.
• Tell your doctor if you have excessive sweating, fluid loss, vomiting, or loose stools. This can lead to a decrease in blood pressure.
• There was a serious and sometimes fatal reaction called angioedema. The risk of developing angioedema may be increased in blacks.
• If you are 65 years of age or older, use this drug with caution. You may experience more side effects.
• Tell your doctor if you are breastfeeding. It is necessary to consult whether the drug poses any risk to the child.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, this drug can cause serious and sometimes deadly side effects in some patients. Call your doctor right away or get medical help if you have any of the following signs or symptoms that could be associated with serious side effects:

• Signs of an allergic reaction, such as rash, hives, itching, red and swollen skin with blisters or peeling, possibly accompanied by fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue or throat.
• Signs of kidney problems, including not passing urine, changes in the volume of urine, blood in the urine, or rapid weight gain.
• Signs of elevated potassium levels such as feeling of an abnormal heartbeat, confusion, feeling weak or dizzy, feeling faint, feeling numb or tingly, or short of breath.
• Severe dizziness or fainting.
• With the appearance or aggravation of chest pain.
• Swelling of the hands or feet.
• Severe pain in the abdomen.
• Severe nausea or vomiting.
• The use of drugs like this has been associated with liver problems. In some cases, this has led to death. Call your doctor right away if you develop signs of liver problems such as dark urine, fatigue, lack of appetite, nausea or abdominal pain, light-colored stools, vomiting, yellowing of the skin or eyes.

What are some other side effects of this drug?

Any medicine can have side effects. However, for many people, side effects are either minor or non-existent. Contact your doctor or seek medical attention if these or any other side effects bother you or do not go away:

• Dizziness.
• Cough.

This list of possible side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Board.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your doctor. Read all the information provided to you. Strictly follow all instructions.

• Take this drug with or without food.
• Take this drug at about the same time of day.
• Keep taking this drug as instructed by your doctor or other health care professional, even if you feel well.
• Drink plenty of non-caffeinated fluids, unless your doctor tells you to drink less fluids.

What if I miss a dose of a drug?

• Take the missed dose as soon as you can.
• If it has been 12 hours or more since a dose was missed, skip that dose and return to your regular schedule.
• Do not take 2 doses or an additional dose at the same time.

How do I store and/or discard this drug?

• Store at room temperature in a dry place. Do not store in the bathroom.
• Keep all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into a toilet or sewer unless instructed to do so. If you have any questions about disposing of medicines, ask your pharmacist. Drug disposal programs may be in place in your area.

General information about medicines

• If your health does not improve or even worsens, see your doctor.
• Do not give your medicine to anyone and do not take other people’s medicines.
• Some medicines may come with other patient information leaflets. If you have any questions about this drug, talk with your doctor, nurse, pharmacist, or other health care professional.
• Some medicines may come with other patient information leaflets. Check with your pharmacist. If you have any questions about this drug, talk with your doctor, nurse, pharmacist, or other health care professional.
• If you think you have overdosed, call a poison control center or get medical help right away. Be prepared to tell or show what drug you took, how much, and when it happened.

Consumer Use of Information and Limitation of Liability

This summary information includes a summary of the diagnosis, treatment, and/or drug product. It is not intended to be a comprehensive source of data and should be used as a tool to help the user understand and/or evaluate potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a particular patient. It should not be considered medical advice or a substitute for medical advice, diagnosis or treatment provided by a physician based on a medical examination and assessment of the patient’s specific and unique circumstances. Patients should consult with their physician for full information about their health, medical issues, and treatment options, including any risks or benefits regarding the use of medications. This information is not a guarantee that a treatment or drug is safe, effective, or approved for a particular patient. UpToDate, Inc. and its subsidiaries disclaim any warranties or liabilities related to this information or its use. The use of this information is subject to the Terms of Use found at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms.

Last revision date

2023-02-22

Copyright

© UpToDate, Inc. and its affiliates and/or licensors, 2023. All rights reserved.

Date last updated

Monday, December 12, 2022

Amlodipine / Benazepril: what you need to know

Disclaimer

If you have any medical questions or concerns, contact your doctor. Articles in the Health Guide are based on peer-reviewed research and information from medical societies and government agencies. However, they are not a substitute for professional medical advice, diagnosis or treatment.

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What is amlodipine and benazepril combination tablet and how does it work?

Amlodipine and benazepril combination tablet (brand name Lotrel) is a prescription drug that combines two drugs into one capsule. You can take each medication individually, and both are often used to treat high blood pressure. However, by combining them, you get both drugs with fewer pills to swallow.

Vitals

• FDA black box warning: Do not take amlodipine/benazepril combination tablets if you are pregnant. If you become pregnant while taking it, stop taking the amlodipine/benazepril combination tablets immediately. Any drug that acts on the renin-angiotensin system can cause injury or death to the developing fetus.
• Amlodipine and benazepril combination tablet (brand name Lotrel) is a prescription drug that combines two drugs into one capsule. It is used to treat people who have been unable to control their blood pressure with just one medication.
• Amlodipine is a calcium channel blocker (CCB) and benazepril is an angiotensin-converting enzyme (ACE) inhibitor.
• Common side effects include cough, headaches, dizziness, and swelling (swelling) of the legs, ankles, feet, and hands.

Both amlodipine and benazepril are antihypertensive drugs. Amlodipine is a calcium channel blocker (CCB). It works by prompting muscles (such as those in the blood vessels) to relax, thereby dilating or opening up the blood vessels. By blocking calcium, amlodipine lowers blood pressure and reduces the workload on the heart. CCB is an effective way to treat high blood pressure.

Benazepril is an angiotensin-converting enzyme (ACE) inhibitor that lowers blood pressure by acting on the renin-angiotensin system. This system is a complex interplay of compounds that affect blood vessels, the heart, and kidneys and regulate blood pressure.

What are amlodipine and benazepril combination tablets used for?

Amlodipine/benazepril combination tablet FDA approved for the following conditions (FDA, 2011):

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• High blood pressure (hypertension) in people who have tried amlodipine and benazepril but are still poorly controlled

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High blood pressure (hypertension)

High blood pressure or hypertension is a common disease that affects your blood vessels, heart, brain, kidneys and other parts of your body. High blood pressure increases the risk of a heart attack or stroke. Treatment for this condition usually includes lifestyle changes such as a healthy diet, regular physical activity, and quitting smoking. However, this may not be enough. Some people need medications to help control their blood pressure. However, if one drug does not lower blood pressure enough, combination pills such as amlodipine/benazepril may help.

Side effects

Amlodipine/benazepril combination tablet has a black box warning, a strong FDA warning regarding serious side effects: Do not take amlodipine/benazepril combination tablets if you are pregnant. If you become pregnant while taking it, stop taking the amlodipine/benazepril combination tablets immediately. Any drug that acts on the renin-angiotensin system can cause injury or death to the developing fetus (DailyMed, 2020).

Common side effects include (DailyMed, 2020):

• Cough
• Headache
• Dizziness
• Edema (swelling of arms, legs, ankles, feet)

Serious side effects include (UpToDate , n. d.):

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• Angioedema: swelling of the face, lips, throat, tongue, or intestines.
• Increasing chest pain or heart attacks (especially in people with heart disease)
• Jaundice (yellowing of the skin or whites of the eyes)
• Liver problems
• Kidney problems
• High potassium levels (hyperkalemia)
• Low blood pressure
• Severe allergic reaction – hives, skin rash b, difficulty breathing, etc.

This list does not include all possible side effects that you may experience. For more information, ask your pharmacist or health care provider for medical advice.

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Drug Interactions

Before you start taking amlodipine/benazepril combination tablets, be sure to check with your doctor about your other medicines to avoid any potential drug interactions, including prescription and over-the-counter medicines and herbal supplements. Possible drug interactions include (DailyMed, 2020):

• Drugs that block the CYP3A4 system : Any drug that affects the CYP3A4 system in the liver, which is responsible for breaking down amlodipine, may result in higher than expected levels in your body. Higher levels increase the risk of low blood pressure and other side effects. Drugs that block CYP3A4 in the liver include ketoconazole, itraconazole, and ritonavir.
• Simvastatin : Taking simvastatin with the amlodipine/benazepril combination tablet increases the levels of simvastatin in the body, increasing the chance of side effects.
• Medicines that block the renin-angiotensin system (RAS) : Use of amlodipine/benazepril combination tablets with other medicines that block the RAS, such as ACE inhibitors (eg lisinopril, captopril), angiotensin receptor blockers (eg losartan, valsartan) and aliskiren, increases the likelihood of developing low blood pressure, high blood pressure. potassium levels and deterioration of kidney function. Do not take amlodipine/benazepril combination tablets with other drugs that affect the RAS, especially in people with diabetes.
• Medicines that increase potassium levels : Because the amlodipine/benazepril combination tablet can increase potassium levels, you should be careful when taking it with other medicines that also increase potassium levels. Otherwise, the amount of potassium in the body may be higher than normal, which can lead to nausea/vomiting, chest pain, irregular heartbeat, and weakness. Medications that increase potassium levels include potassium-sparing diuretics (water tablets) and potassium supplements. Salt substitutes, often recommended as part of a low-salt diet, can also increase potassium levels by replacing sodium chloride with potassium chloride.
• Lithium : Combining lithium (a mood stabilizer often used to treat bipolar disorder) with an amlodipine/benazepril combination tablet may result in higher lithium levels and increase the risk of lithium poisoning.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) : Taking NSAIDs (such as ibuprofen and naproxen) with the amlodipine/benazepril combination tablet increases the risk of worsening kidney function, including possible kidney failure. In addition, NSAIDs may reduce the ability of amlodipine/benazepril combination tablets to lower blood pressure.
• Mammalian target of rapamycin (mTOR) inhibitors : mTOR inhibitors used in cancer treatment increase the risk of angioedema with amlodipine/benazepril combination tablets. Examples include temsirolimus, sirolimus and everolimus.
• Neprilysin inhibitor : Neprilysin inhibitors (eg sacubitril) are used to treat heart failure. They may make you more likely to develop angioedema if taken with an amlodipine/benazepril combination tablet. Do not take amlodipine/benazepril combination tablets with neprilysin inhibitors.

This list does not include all possible drug interactions with amlodipine and benazepril combination tablet and others may exist. For more information, contact your pharmacist or health care provider.

Who should not take amlodipine and benazepril combination tablets (or use them with caution)?

Some groups of people should not take amlodipine and benazepril combination tablets or use them with caution due to an increased risk of side effects. These groups include (DailyMed, 2020):

• Pregnant women : FDA black box warning: Pregnant women should not take amlodipine and benazepril combination tablets. If you become pregnant while taking it, stop taking amlodipine and benazepril combination tablets immediately, as this may result in injury or death to the fetus.
• Nursing mothers : Amlodipine and benazepril pass into breast milk in minimal amounts. There is no evidence to suggest that taking amlodipine and benazepril combination tablet while breastfeeding has side effects.
• History of angioedema : People who have had angioedema (swelling of the face, throat, lips, tongue, or intestines) in the past, whether or not this medicine has responded, should not use this medicine.
• Elderly : People over 65 are advised to start at the lowest dose and increase it as needed to prevent side effects.
• People with liver problems: Since the liver is involved in the breakdown of the amlodipine and benazepril combination tablet, abnormal liver function may result in higher than expected levels. People with liver problems may start at the lowest dose and increase as needed to prevent side effects.
• People with kidney disease : People with severe kidney disease should avoid taking amlodipine and benazepril combination tablets as they may aggravate kidney disease.
• Black people : Black people may be at a higher risk of developing angioedema when taking amlodipine and benazepril combination tablets.
• People with aortic stenosis : People with narrowing of the aorta (aortic stenosis) should be careful when taking amlodipine and benazepril combination tablets. This can reduce blood flow to the coronary arteries and deprive them of essential oxygen and nutrients.
• People with renal artery stenosis : People with renal artery stenosis, narrowing of the artery to the kidney, are at risk of worsening kidney function when taking amlodipine and benazepril combination tablets.
• People with heart problems : Amlodipine and benazepril combination tablet increases the risk of low blood pressure (hypotension), especially in people with heart failure, hypertrophic cardiomyopathy (enlarged heart), and aortic/mitral stenosis. If you are dehydrated, you are also at a higher risk of low blood pressure while taking this medicine.

This list does not include all risk groups, but other risk groups may exist. Talk to your doctor or pharmacist for more information.

Dosage

Amlodipine besylate and benazepril hydrochloride are available by prescription. Each is available individually or together; The combination tablet is available both as a generic and under the brand name Lotrel. The capsules come in the following dosages (amlodipine/benazepril): 2.5/10mg, 5/10mg, 5/20mg, 5/40mg, 10/20mg and 10/40mg.

Most prescription plans cover amlodipine and benazepril combination tablets. A 30-day supply of Universal Capsules ranges from $11 to $47 depending on strength (GoodRx.com).

Recommendations

1. DailyMed – amlodipine and benazepril capsules. (2020) Retrieved September 21, 2020 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=99ed4927-9a34-4e8d-8eea-60b63c867d46
2. GoodRx.com – Amlodipine / Benazepril (n.d. ) Retrieved 21 September 2020 from https://www.goodrx.com/amlodipine-benazepril
3. MedlinePlus – Amlodipine and Benazepril (2019). Retrieved September 21, 2020 from https://medlineplus.gov/druginfo/meds/a601018.html
4. UpToDate – Amlodipine and Benazepril: Medication Information (no data available). Retrieved September 21, 2020 from https://www.uptodate.com/contents/amlodipine-and-benazepril-drug-information
5. US Food and Drug Administration (FDA): Lotrel (amlodipine besylate) capsules and benazepril hydrochloride) (2011).