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

Uses

Amlodipine is used with or without other medications to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Amlodipine belongs to a class of drugs known as calcium channel blockers. It works by relaxing blood vessels so blood can flow more easily.Amlodipine is also used to prevent certain types of chest pain (angina). It may help to increase your ability to exercise and decrease the frequency of angina attacks. It should not be used to treat attacks of chest pain when they occur. Use other medications (such as sublingual nitroglycerin) to relieve attacks of chest pain as directed by your doctor.

How to use Norvasc

Read the Patient Information Leaflet if available from your pharmacist before you start taking amlodipine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor, usually once daily.

If you are using the liquid form of this medication, check the manufacturer’s information or ask your pharmacist for specific directions. Some brands of the liquid form should be shaken before use, while other brands do not need to be shaken before use. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose

The dosage is based on your medical condition and response to treatment. Your doctor may gradually increase your dose. Follow your doctor’s instructions carefully.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. Keep taking this medication even if you feel well. Most people with high blood pressure do not feel sick.

If used for angina, this medication must be taken regularly to be effective. It should not be used to treat angina when it occurs. Use other medications (such as sublingual nitroglycerin) to relieve an angina attack as directed by your doctor. Consult your doctor or pharmacist for details.

Tell your doctor if your condition does not improve or if it worsens (for example, your blood pressure readings remain high or increase, chest pain continues or worsens).

Side Effects

Dizziness, lightheadedness, swelling ankles/feet, or flushing may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

To lower your risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if any of these unlikely but serious side effects occur: fast/irregular/pounding heartbeat, fainting.

Although this medication is effective in preventing chest pain (angina), some people who already have severe heart disease may rarely develop worsening chest pain or a heart attack after starting this medication or increasing the dose. Get medical help right away if you experience: worsening chest pain, symptoms of a heart attack (such as chest/jaw/left arm pain, shortness of breath, unusual sweating).

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking amlodipine, tell your doctor or pharmacist if you are allergic to it; or to other dihydropyridine calcium channel blockers (such as nisoldipine, nifedipine) or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain structural heart problem (aortic stenosis), very low blood pressure, liver disease.

This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the effects of this drug, especially dizziness.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

This drug passes into breast milk. Consult your doctor before breast-feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products have ingredients that could raise your blood pressure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).

Does Norvasc interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: fainting, severe dizziness.

Do not share this medication with others.

Lifestyle changes that may help this medication work better include exercising, stopping smoking, reducing stress, and eating a low-cholesterol/low-fat diet. Consult your doctor for more details.

Lab and/or medical tests (such as blood pressure) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

Check your blood pressure regularly while taking this medication. Learn how to monitor your own blood pressure at home, and share the results with your doctor.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store the tablets at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Different brands of the liquid form of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details.

Images

Norvasc 2.5 mg tablet

Color: whiteShape: diamondImprint: NORVASC 2.5

This medicine is a white, diamond, tablet imprinted with “NORVASC” and “2.5”.

Norvasc 5 mg tablet

Color: whiteShape: octagonalImprint: NORVASC 5

This medicine is a white, diamond, tablet imprinted with “NORVASC” and “2.5”.

Norvasc 10 mg tablet

Color: whiteShape: roundImprint: NORVASC 10

This medicine is a white, diamond, tablet imprinted with “NORVASC” and “2. 5″.

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Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Norvasc – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

Amlodipine belongs to the family of medications known as calcium channel blockers. Amlodipine is used to treat high blood pressure and angina (chest pain). It works to control blood pressure and reduces the number of angina attacks by widening and relaxing blood vessels.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor.  Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

5 mg
Each white, octagonal tablet, scored, debossed with “NRV 5” on one side and “Pfizer” on the other, contains amlodipine besylate equivalent to 5 mg of amlodipine. Nonmedicinal ingredients: dibasic calcium phosphate anhydrous, magnesium stearate, microcrystalline cellulose, and sodium starch glycolate.

10 mg
Each white, octagonal tablet, debossed with “NRV 10” on one side and “Pfizer” on the other, contains amlodipine besylate equivalent to 10 mg of amlodipine. Nonmedicinal ingredients: dibasic calcium phosphate anhydrous, magnesium stearate, microcrystalline cellulose, and sodium starch glycolate.

How should I use this medication?

The recommended adult starting dose of amlodipine is 5 mg taken once daily. Depending on the effectiveness of this medication for your condition, and how well the medication is tolerated, your doctor may suggest a dose between 2.5 mg and 10 mg taken once daily.

For children ages 6 to 17 years, the recommended dose is 2.5 mg to 5 mg once daily.

Amlodipine can be taken with or without food.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones above, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is less than 12 hours until your next dose, skip the missed dose and continue with your regular dosing schedule.  Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take amlodipine if you:

• are allergic to amlodipine or any ingredients of the medication
• are allergic to other medications of the same class (e.g., felodipine, nifedipine)
• have very low blood pressure
• have narrowing of the aortic valve
• are experiencing shock, including cardiogenic shock
• have unstable heart failure after heart attack
• are breast-feeding

What side effects are possible with this medication?

Many medications can cause side effects.  A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• dizziness
• flushing
• headache
• nausea
• sleepiness or unusual drowsiness
• stomach pain
• swelling of ankles or feet
• tiredness
• unusual tiredness or weakness

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• abnormal heartbeat (e.g., pounding heartbeat, slow heartbeat, fast heartbeat)
• dizziness or fainting when rising from a lying or sitting position
• increased angina symptoms (e.g., more frequent or intense chest pain)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• symptoms of a severe allergic reaction (e.g., hives; difficulty breathing; swelling of the mouth, tongue, face, or throat)
• symptoms of a heart attack (e.g., chest pain, pressure, or heaviness; nausea; shortness of breath; cool, clammy skin; anxiety)
• unexpected muscle stiffness, difficulty moving, or unwanted movements

Some people may experience side effects other than those listed.  Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Chest pain/heart attack: Rarely, this medication may worsen angina (chest pain) or precipitate a heart attack when it is first started or when the dose is increased. People with severe heart disease seem to be more at risk. If you experience worsening chest pain or symptoms of a heart attack (e.g., chest pain, pressure, or heaviness; nausea; shortness of breath; cool, clammy skin; anxiety) while taking this medication, get immediate medical attention.

Grapefruit juice: Grapefruit juice may increase the effects of amlodipine. Avoid grapefruit juice while taking this medication.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver disease or decreased liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may recommend a lower dose.

Low blood pressure: Like other medications for blood pressure, amlodipine may cause a lowering of blood pressure when rising from a sitting or lying position, or a racing heart rate, especially during the first few weeks of treatment. If you feel dizzy or lightheaded or feel your pulse is racing, and this feeling does not go away after a few minutes, call your doctor. If you have heart disease (e.g., heart failure, heart attack) or are taking other medications that lower blood pressure, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are breast-feeding and are taking amlodipine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of amlodipine have not been established for children less than 6 years of age.

Seniors: Seniors may be more sensitive to the side effects of amlodipine. Your doctor may suggest a lower dose.

What other drugs could interact with this medication?

There may be an interaction between amlodipine and any of the following:

• activated charcoal
• aldesleukin
• alpha-blockers (e.g., alfuzosin, doxazosin, tamsulosin)
• amiodarone
• amphetamines (e. g., dextroamphetamine, lisdexamfetamine)
• antipsychotics (e.g., cariprazine, chlorpromazine, clozapine, olanzapine, quetiapine, risperidone)
• apalutamide
• apomorphine
• aprepitant
• “azole” antifungal medications (e.g., fluconazole, itraconazole, ketoconazole)
• barbiturates (e.g., butalbital, phenobarbital)
• certain benzodiazepines (e.g., alprazolam, triazolam)
• bosentan
• brimonidine
• calcium supplements (e.g., calcium carbonate, calcium citrate)
• carbamazepine
• clopidogrel
• cyclosporine
• dabigatran
• darunavir
• dexmedetomidine
• diazoxide
• dinutuximab
• diuretics (water pills; e.g., bumetanide, ethacrynic acid, furosemide)
• dronedarone
• duloxetine
• enzalutamide
• finerenone
• flaxseed oil
• flibanserin
• general anesthetics (medications used to put people to sleep before surgery)
• grapefruit juice
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e. g., efavirenz, etravirine)
• HIV protease inhibitors (e.g., atazanavir, lopinavir, ritonavir)
• lemborexant
• letermovir
• levodopa
• lomitapide
• lovastatin
• lumacaftor and ivacaftor
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• magnesium sulfate
• melatonin
• methylphenidate
• mifepristone
• modafinil
• monoamine oxidase inhibitors (e.g., phenelzine, rasagiline, selegiline, tranylcypromine)
• morphine
• nabilone
• nirmatrelvir
• nitrates (e.g., nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
• obinutuzumab
• other calcium channel blockers (e.g., diltiazem, nifedipine, verapamil)
• pentoxifylline
• phenytoin
• phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
• pramipexole
• protein kinase inhibitors (e.g., ceritinib, imatinib, nilotinib)
• primidone
• rifabutin
• rifampin
• riociguat
• ropinirole
• rotigotine
• sirolimus
• St. John’s wort
• simvastatin
• tacrolimus
• tizanidine
• tretinoin
• tricyclic antidepressants (e.g., clomipramine, imipramine)
• yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2023. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Norvasc

Medicines :: Cardiovascular drugs :: Cardiovascular drugs :: Norvasc 10mg №30 tablets

Pharmacological action

Antianginal, antihypertensive. Norvasc blocks the flow of calcium ions through membranes into smooth muscle cells of the myocardium and blood vessels (calcium channels). Vasodilation leads to a decrease in blood pressure. The antianginal effect is due to both a decrease in O2 consumption due to the expansion of arterioles and a decrease in peripheral vascular resistance (afterload), and an increase in O2 delivery due to dilatation of the main coronary arteries and arterioles in ischemic and unchanged areas of the myocardium.

Indications

Hypertension (first-line agent for monotherapy or in combination with other antihypertensive drugs), stable angina, vasospastic angina (Prinzmetal’s angina or variant angina), vasospasm/vasoconstriction iction, as well as sick, refractory to treatment with nitrates or beta-blockers (monotherapy or in combination with other antianginal drugs).

Contraindications

Hypersensitivity (including to other dihydropyridines).

Use during pregnancy and lactation is not recommended.

Special instructions

Norvasc is used with caution in renal failure, impaired liver function. Do not administer to children (there is no experience of use).

Composition

1 tablet contains amlodipine (as besilate) 10 mg.

Dosage and administration

Norvasc is taken orally. With arterial hypertension and angina pectoris, the initial dose is 5 mg 1 time per day. It is possible to increase it to a maximum dose of 10 mg, depending on the individual response of the patient.

Side effects

Headache, swelling, fatigue, drowsiness, nausea, abdominal pain, flushing, palpitations and dizziness; less often – dyspepsia, arthralgia, asthenia, shortness of breath, gingival hyperplasia, gynecomastia, impotence, increased frequency of urination, mood changes, muscle cramps, myalgia, pruritus, rashes, visual disturbances; rarely – erythema multiforme, jaundice and increased levels of hepatic transaminases.

Drug interactions

It can be expected that inhibitors of microsomal oxidation will increase the plasma concentration of amlodipine, increasing the risk of side effects, and inducers of microsomal liver enzymes – to reduce.

Cimetidine: with the simultaneous use of amlodipine with cimetidine, the pharmacokinetics of amlodipine does not change.

Grapefruit juice: the simultaneous single dose of 240 ml of grapefruit juice and 10 mg of amlodipine orally is not accompanied by a significant change in the pharmacokinetics of amlodipine.

Unlike other BMCs, no clinically significant interaction of Norvasc (3rd generation BMC) was found when co-administered with non-steroidal anti-inflammatory drugs (NSAIDs), especially indomethacin.

It is possible to increase the antianginal and hypotensive action of BMCC when used together with thiazide and “loop” diuretics, verapamil, ACE inhibitors, beta-blockers and nitrates, as well as an increase in their hypotensive action when used together with alpha1-blockers, antipsychotics.

Although no negative inotropic effect has generally been observed with Norvasc, some CBCAs may increase the negative inotropic effect of QT prolonging antiarrhythmic drugs (eg, amiodarone and quinidine).

With the combined use of BMCC with lithium preparations (data are not available for Norvasc), it is possible to increase the manifestation of their neurotoxicity (nausea, vomiting, diarrhea, ataxia, tremor, tinnitus).

Amlodipine does not affect in vitro the degree of binding to plasma proteins of digoxin, phenytoin, warfarin and indomethacin.

Aluminum/Magnesium containing antacids: their single dose does not significantly affect the pharmacokinetics of amlodipine.

Sildenafil (Viagra): a single dose of 100 mg of sildenafil in patients with essential hypertension does not affect the pharmacokinetic parameters of amlodipine.

Atorvastatin: Repeated use of amlodipine at a dose of 10 mg and atorvastatin at a dose of 80 mg is not accompanied by significant changes in the pharmacokinetics of atorvastatin.

Digoxin: Co-administration of amlodipine with digoxin in healthy volunteers does not alter serum levels and renal clearance of digoxin.

Ethanol (alcohol-containing beverages): with a single and repeated use at a dose of 10 mg, amlodipine does not significantly affect the pharmacokinetics of ethanol.

Warfarin: Amlodipine does not affect changes in prothrombin time caused by warfarin.

Cyclosporine: Amlodipine does not cause significant changes in the pharmacokinetics of cyclosporine.

Overdose

Symptoms: pronounced decrease in blood pressure with the possible development of reflex tachycardia and excessive peripheral vasodilation (there is a possibility of severe and persistent arterial hypotension, including the development of shock and death).

Treatment: administration of activated charcoal (especially in the first 2 hours after an overdose), gastric lavage (in some cases), giving an elevated position to the limbs, active support of the function of the cardiovascular system, monitoring of indicators of heart and lung function, control of circulating volume blood and diuresis.

To restore vascular tone and blood pressure, if there are no contraindications, it may be useful to use vasoconstrictor drugs. Use intravenous administration of calcium gluconate. Since amlodipine is largely bound to serum proteins, hemodialysis is not effective.

Storage conditions

In a place protected from light, at a temperature not exceeding 20 °C.

Conditions for dispensing from pharmacies: Available on prescription

Norvasc® tablets, 10 mg, 30

Drug interactions

Amlodipine can be safely used to treat hypertension with thiazide diuretics, alpha-blockers, beta-blockers, or ACE inhibitors. In patients with stable angina, amlodipine can be combined with other antianginal agents, such as long-acting or short-acting nitrates, beta-blockers.

Unlike other BMCs, no clinically significant interaction of amlodipine (III generation BMC) was found when used together with NSAIDs, incl. with indomethacin.

It is possible to enhance the antianginal and antihypertensive action of BMCC when used together with thiazide and “loop” diuretics, ACE inhibitors, beta-blockers and nitrates, as well as to enhance their antihypertensive action when used together with alpha ₁ -blockers, neuroleptics.

Although no negative inotropic effects have generally been observed with amlodipine, some CBCAs may potentiate the negative inotropic effects of QT prolonging antiarrhythmic agents (eg, amiodarone and quinidine).

Amlodipine can also be used safely with oral antibiotics and hypoglycemic agents.

A single dose of sildenafil at a dose of 100 mg in patients with essential hypertension does not affect the pharmacokinetic parameters of amlodipine.

Repeated use of amlodipine at a dose of 10 mg and atorvastatin at a dose of 80 mg is not accompanied by significant changes in the pharmacokinetics of atorvastatin.

Co-administration of multiple doses of amlodipine 10 mg and simvastatin 80 mg resulted in a 77% increase in exposure to simvastatin. In such cases, the dose of simvastatin should be limited to 20 mg.

Amlodipine at a single and repeated use at a dose of 10 mg does not affect the pharmacokinetics of ethanol.

Antiviral drugs (eg, ritonavir) increase plasma concentrations of BMCC, incl. amlodipine.

Antipsychotics and isoflurane enhance the antihypertensive effect of dihydropyridine derivatives.

Calcium supplements may reduce the effect of BMCC.

With the combined use of BMCC with lithium preparations (data are not available for amlodipine), it is possible to increase the manifestations of neurotoxicity of the latter (nausea, vomiting, diarrhea, ataxia, tremor, tinnitus).

Co-administration of amlodipine and cyclosporine in healthy volunteers and in all patient populations, except for patients after kidney transplantation, has not been studied. Various studies of the interaction of amlodipine with cyclosporine in patients after kidney transplantation show that the use of this combination may not lead to any effect, or increase the minimum concentration of cyclosporine to varying degrees up to 40%. These data should be taken into account and the concentration of cyclosporine in this group of patients should be monitored while the use of cyclosporine and amlodipine.

Amlodipine does not affect the serum concentration of digoxin and its renal clearance.

Norvasc ^® does not significantly affect the action of warfarin (prothrombin time).

Cimetidine does not affect the pharmacokinetics of amlodipine.

In in vitro studies, amlodipine does not affect plasma protein binding of digoxin, phenytoin, warfarin and indomethacin.

Simultaneous single dose of 240 ml of grapefruit juice and 10 mg of amlodipine orally is not accompanied by a significant change in the pharmacokinetics of amlodipine. However, it is not recommended to use grapefruit juice and amlodipine at the same time, because. with genetic polymorphism of the CYP3A4 isoenzyme, it is possible to increase the bioavailability of amlodipine and, as a result, increase the hypotensive effect.

A single dose of aluminum/magnesium antacids does not significantly affect the pharmacokinetics of amlodipine.

With the simultaneous use of diltiazem (an inhibitor of the CYP3A4 isoenzyme) at a dose of 180 mg and amlodipine at a dose of 5 mg in elderly patients (from 69 to 87 years old) with arterial hypertension, an increase in the systemic exposure of amlodipine by 57%. The simultaneous use of amlodipine and erythromycin in healthy volunteers (from 18 to 43 years old) does not lead to significant changes in the exposure of amlodipine (increase in AUC by 22%). Although the clinical significance of these effects is not entirely clear, they may be more pronounced in elderly patients.

Strong CYP3A4 inhibitors (eg, ketoconazole, itraconazole) may increase amlodipine plasma concentrations to a greater extent than diltiazem. Amlodipine and inhibitors of the CYP3A4 isoenzyme should be used with caution.

Patients taking both clarithromycin (a CYP3A4 inhibitor) and amlodipine are at increased risk of lowering blood pressure. Patients taking this combination are advised to be under close medical supervision.

There are no data on the effect of inducers of the CYP3A4 isoenzyme on the pharmacokinetics of amlodipine. Blood pressure should be carefully monitored while using amlodipine and inducers of the CYP3A4 isoenzyme.

When used simultaneously with amlodipine, there is a risk of increasing the concentration of tacrolimus in the blood plasma.