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# 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, causing peripheral arterial vasodilation and reducing total peripheral resistance.
## Primary Indications
* Hypertension
* Chronic stable angina
* Vasospastic (Prinzmetal’s) angina
* Coronary artery disease (CAD) in patients without heart failure or severe left ventricular dysfunction.
## Adult Dosing
* **Hypertension:** Initially 5 mg once daily. Maximum 10 mg once daily.
* **Angina/CAD:** 5 mg to 10 mg once daily.
## Pediatric Dosing
* **Hypertension (Children ≥ 6 years):** 2.5 mg to 5 mg once daily. Doses > 5 mg daily have not been studied in pediatric patients.
## Dose Adjustments
* **Hepatic Impairment:** Clearance is reduced; initiate at 2.5 mg once daily. Titrate slowly.
* **Renal Impairment:** No initial dosage adjustment required.
* **Elderly/Frail Patients:** Consider starting at 2.5 mg once daily due to potential for increased sensitivity.
## Contraindications
* Known hypersensitivity to amlodipine or other dihydropyridines.
## Adverse Effects
* **Common:** Peripheral edema (dose-dependent, more common in women), dizziness, palpitations, flushing, fatigue, abdominal pain, nausea.
* **Serious:** Hypotension, worsening angina or myocardial infarction (upon initiation or dose increase), gingival hyperplasia.
## Key Drug Interactions
* **Simvastatin:** Limit simvastatin dose to 20 mg daily when co-administered with amlodipine to reduce risk of myopathy.
* **CYP3A4 Inhibitors/Inducers:** Strong inhibitors (e.g., clarithromycin, ritonavir) may increase amlodipine levels; inducers (e.g., rifampin) may decrease levels.
* **Cyclosporine/Tacrolimus:** Amlodipine may increase blood concentrations of these immunosuppressants.
## Monitoring
* Monitor blood pressure periodically during dose titration.
* Assess for peripheral edema, particularly in the lower extremities.
* Monitor signs of hypotension or reflex tachycardia.
## Clinical Pearls
* **Onset/Duration:** Slow onset of action; takes 7–14 days to reach steady-state therapeutic effect. Not suitable for acute treatment of hypertensive urgency.
* **Management of Edema:** Peripheral edema is typically unresponsive to diuretics. If intolerable, consider dose reduction or switching to an ACE inhibitor or ARB.
* **Patient Education:** Advise patients to swallow tablets whole and not to discontinue therapy abruptly.
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*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 before administration.*
