Mylod%252520at

# Mylod (Amlodipine) ## 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 1. Hypertension. 2. Chronic stable angina. 3. Vasospastic angina (Prinzmetal's or variant angina). ## Adult Dosing * **Initial Dose:** 5 mg orally once daily. * **Titration:** May increase to a maximum of 10 mg daily based on clinical response and tolerability, with at least 7–14 days between dose adjustments. * **Maintenance:** 5–10 mg daily. ## Pediatric Dosing * **Hypertension (Children ≥ 6 years):** 2.5 mg to 5 mg orally once daily. * **Maximum Dose:** 5 mg daily (doses exceeding 5 mg have not been studied in pediatric patients). ## Dose Adjustments * **Hepatic Impairment:** Clearance is significantly reduced. Start with the lowest dose (2.5 mg) and titrate slowly. * **Elderly:** Start with the lowest dose (2.5 mg) due to potential decreased clearance and increased sensitivity to hypotensive effects. * **Renal Impairment:** No dose adjustment required. ## Contraindications * Known hypersensitivity to amlodipine or other dihydropyridines. * Severe hypotension (hypersensitivity to the specific drug class). ## Adverse Effects * **Common:** Peripheral edema (dose-dependent, usually non-pitting, typically occurring 2–4 weeks after initiation), dizziness, palpitations, and flushing. * **Serious:** Hypotension, worsening angina or myocardial infarction (upon initiation or dose increase), and gingival hyperplasia (rare). ## Key Drug Interactions * **CYP3A4 Inhibitors:** May significantly increase amlodipine plasma levels (e.g., clarithromycin, ketoconazole, ritonavir). Monitor for peripheral edema and hypotension. * **Simvastatin:** Amlodipine increases exposure to simvastatin; limit simvastatin dose to 20 mg daily when co-administered. * **Cyclosporine/Tacrolimus:** Amlodipine may increase blood concentrations of these calcineurin inhibitors. ## Monitoring * **Blood Pressure:** Monitor regularly to assess efficacy. * **Peripheral Edema:** Assess at follow-up visits; consider dose reduction or addition of an ACE inhibitor/ARB if edema is bothersome, as these agents may counteract amlodipine-induced edema. ## Clinical Pearls * **Dosing Timing:** Amlodipine has a long half-life (30–50 hours), allowing for once-daily dosing and consistent blood levels if a dose is missed. * **Edema Management:** Edema is caused by precapillary vasodilation rather than fluid overload; diuretics are generally ineffective for this specific side effect. * **Onset:** Full antihypertensive effects may take up to 2 weeks to manifest. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical protocols and prescribing guidelines may vary by institution and patient-specific factors. Always verify current prescribing information, contraindications, and drug interactions using official local pharmacy references or clinical decision support tools before initiating therapy.