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# Mylod (Amlodipine) ## Overview Amlodipine is a long-acting dihydropyridine calcium channel blocker (CCB) that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle. It exerts its primary therapeutic effect through peripheral arterial vasodilation. ## Primary Indications * Hypertension (HTN) * Chronic stable angina * Vasospastic angina (Prinzmetal’s or variant angina) * Coronary artery disease (CAD) ## Adult Dosing * **Hypertension:** Initial dose is 5 mg orally once daily. Maximum dose is 10 mg daily. * **Angina:** Initial dose is 5 mg orally once daily; may increase to 10 mg daily based on patient response. ## Pediatric Dosing * **Hypertension (≥ 6 years):** 2.5 mg to 5 mg orally once daily. Doses exceeding 5 mg daily have not been studied in pediatric patients. ## Dose Adjustments * **Hepatic Impairment:** Clearance is significantly reduced. Start with the lowest available dose (2.5 mg) and titrate slowly. * **Renal Impairment:** No dosage adjustment is required for patients with renal impairment. * **Geriatric Patients:** Start at the lower end of the dosing range (2.5 mg) due to increased potential for hypotension and decreased clearance. ## Contraindications * Known hypersensitivity to amlodipine or any component of the formulation. ## Adverse Effects * **Common:** Peripheral edema (dose-dependent), dizziness, flushing, palpitations, fatigue. * **Serious:** Hypotension, syncope, exacerbation of angina or myocardial infarction (rare, typically upon initiation or dosage increase). ## Key Drug Interactions * **Simvastatin:** Amlodipine increases exposure to simvastatin; limit simvastatin dose to 20 mg daily when given concomitantly. * **CYP3A4 Inhibitors/Inducers:** Strong inhibitors (e.g., ketoconazole, clarithromycin) may increase amlodipine concentrations; strong inducers (e.g., rifampin) may decrease efficacy. * **Cyclosporine/Tacrolimus:** Amlodipine may increase serum trough levels of these calcineurin inhibitors. ## Monitoring * **Blood Pressure:** Monitor at initiation and after every dose titration. * **Heart Rate:** Observe for reflex tachycardia. * **Fluid Status:** Monitor for signs of peripheral edema, particularly in the lower extremities. ## Clinical Pearls * **Dosing Timing:** May be administered without regard to meals. * **Onset/Duration:** Due to a long half-life (30–50 hours), steady-state plasma levels are achieved after 7–8 days of consecutive dosing. * **Edema:** Peripheral edema is typically not due to fluid retention and does not respond well to diuretics; consider dose reduction or switching to a different antihypertensive class if intolerable. * **Missed Doses:** If a dose is missed, take only if within 12 hours of the scheduled time; otherwise, skip the dose to prevent double dosing. *** *Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors via reliable clinical databases (e.g., Lexicomp, UpToDate) before prescribing or administering medication.*