Mylod%2520at

# Mylod (Amlodipine Besylate) ## Overview Amlodipine is a long-acting dihydropyridine calcium channel blocker (CCB). It inhibits transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle, resulting in peripheral arterial vasodilation and reduced blood pressure. ## Primary Indications * Hypertension (HTN) * Chronic Stable Angina * Vasospastic (Prinzmetal’s or Variant) Angina * Coronary Artery Disease (CAD) ## Adult Dosing * **Initial:** 5 mg orally once daily. * **Titration:** May increase to a maximum of 10 mg daily based on response and tolerability. * **Geriatric/Hepatic Impairment:** Start at 2.5 mg once daily. ## Pediatric Dosing * **HTN (Ages 6 to 17 years):** * Initial: 2.5 mg once daily. * Maximum: 5 mg once daily. * *Note: Safety and efficacy have not been established in children <6 years of age.* ## Dose Adjustments * **Hepatic Impairment:** Clearance is decreased; start at the lowest available dose (2.5 mg). * **Renal Impairment:** No dosage adjustment indicated; drug is minimally cleared renally. * **Dialysis:** Not removed by hemodialysis. ## Contraindications * Known hypersensitivity to amlodipine. ## Adverse Effects * **Common:** Peripheral edema (dose-dependent), dizziness, flushing, palpitations, fatigue. * **Serious:** Hypotension, worsening angina or myocardial infarction (upon initiation or dose increase), reflex tachycardia. ## Key Drug Interactions * **CYP3A4 Inhibitors:** May increase amlodipine plasma levels (e.g., clarithromycin, ritonavir, ketoconazole). * **Simvastatin:** Limit simvastatin dose to 20 mg daily when co-administered with amlodipine to reduce risk of myopathy. * **CYP3A4 Inducers:** May decrease amlodipine efficacy (e.g., rifampin, St. John’s Wort). * **Cyclosporine/Tacrolimus:** Amlodipine may increase serum levels of these calcineurin inhibitors via CYP3A4 competition. ## Monitoring * **Blood Pressure:** Check at baseline and during titration. * **Physical Exam:** Monitor for signs of peripheral edema (ankles/legs). * **Angina:** Monitor for increased frequency or severity of angina during titration. ## Clinical Pearls * **Edema:** Peripheral edema is typically non-pitting and occurs more frequently in women; it is often dose-dependent and does not respond well to diuretics. * **Onset:** Amlodipine has a slow onset and long half-life (30–50 hours), making it unsuitable for acute hypertensive emergencies. * **Administration:** May be taken without regard to meals. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and local protocols vary. Always verify current prescribing information, dose calculations, and drug compatibility via official resources (e.g., Lexicomp, Micromedex, or the FDA-approved product label) before administration.