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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 effect via peripheral arterial vasodilation, resulting in a reduction in peripheral vascular resistance and blood pressure.
## Primary Indications
* Hypertension
* Chronic stable angina
* Vasospastic (Prinzmetal's) angina
## Adult Dosing
* **Hypertension:** Initially 5 mg once daily. May increase to a maximum of 10 mg once daily after 7–14 days.
* **Angina:** 5–10 mg once daily. Most patients require 10 mg.
## Pediatric Dosing
* **Hypertension (≥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:** Due to extensive hepatic metabolism (CYP3A4), start at a lower dose (2.5 mg) in patients with severe hepatic impairment.
* **Renal Impairment:** No dosage adjustment is required for renal impairment, as the drug is primarily metabolized by the liver.
## Contraindications
* Known hypersensitivity to amlodipine or other dihydropyridines.
* Severe hypotension.
## Adverse Effects
* **Common:** Peripheral edema (dose-dependent), palpitations, flushing, dizziness, fatigue, and abdominal pain.
* **Serious:** Severe hypotension (rare), worsening of angina or acute myocardial infarction (upon initiation or dose increase), and gingival hyperplasia (rare).
## Key Drug Interactions
* **CYP3A4 Inhibitors:** May significantly increase amlodipine plasma concentrations (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir). Monitor for hypotension.
* **Simvastatin:** Limit simvastatin dose to 20 mg daily when co-administered with amlodipine to reduce risk of myopathy.
* **Cyclosporine/Tacrolimus:** Amlodipine may increase the levels of these immunosuppressants. Monitor trough levels.
## Monitoring
* **Efficacy:** Blood pressure readings; frequency/severity of angina episodes.
* **Safety:** Monitor for peripheral edema (especially in elderly patients) and signs of symptomatic hypotension.
## Clinical Pearls
* **Onset:** The antihypertensive effect is gradual; once-daily dosing provides 24-hour control.
* **Half-life:** Long half-life (30–50 hours) allows for once-daily dosing.
* **Edema:** Peripheral edema is typically non-pitting and dose-related. It is not caused by fluid overload and does not respond well to diuretics, but often improves with dose reduction or addition of an ACE inhibitor/ARB.
* **Administration:** May be taken without regard to meals.
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*Disclaimer: This information is for educational purposes only. Always verify current prescribing information, dosing guidelines, and institutional protocols via official drug references (e.g., Lexicomp, UpToDate, or the FDA-approved product label) before prescribing or administering medication.*
