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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, resulting in peripheral vasodilation and decreased blood pressure.
## Primary Indications
* Hypertension
* Chronic stable angina
* Vasospastic (Prinzmetal’s) angina
## Adult Dosing
* **Hypertension:** Initial dose 5 mg orally once daily. May increase to a maximum of 10 mg once daily based on blood pressure response.
* **Angina:** Initial dose 5 mg once daily. Maximum 10 mg once daily.
## Pediatric Dosing
* **Hypertension (Age ≥ 6 years):** Initial dose 2.5 mg to 5 mg once daily. Doses > 5 mg daily have not been studied in children.
## Dose Adjustments
* **Hepatic Impairment:** Reduce starting dose to 2.5 mg once daily, as the drug is extensively metabolized by the liver.
* **Renal Impairment:** No dose adjustment required.
* **Geriatric Patients:** Start at 2.5 mg once daily due to increased plasma concentrations and slower clearance.
## Contraindications
* Known hypersensitivity to amlodipine.
## Adverse Effects
* **Most Common:** Peripheral edema (dose-dependent), palpitations, flushing, dizziness, fatigue, and abdominal pain.
* **Serious:** Hypotension, syncope, and exacerbation of angina upon initiation or dose increase.
## Key Drug Interactions
* **CYP3A4 Inhibitors:** (e.g., ketoconazole, ritonavir, clarithromycin) may significantly increase amlodipine serum concentrations.
* **Simvastatin:** Limit simvastatin to 20 mg daily when co-administered, as amlodipine increases simvastatin exposure.
* **Cyclosporine/Tacrolimus:** Amlodipine may increase blood levels of these immunosuppressants.
## Monitoring
* Blood pressure (at trough levels).
* Heart rate (less common, but monitor for reflex tachycardia).
* Signs and symptoms of peripheral edema.
## Clinical Pearls
* **Long Half-Life:** The half-life is 30–50 hours, allowing for once-daily dosing.
* **Edema:** Peripheral edema is not typically due to fluid retention and does not respond well to diuretics; it is often dose-related and may improve with a dose reduction.
* **Onset:** Full antihypertensive effect may take up to 2–4 weeks; do not escalate dose prematurely.
* **Administration:** May be taken with or without food.
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*Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Drug protocols may vary by institution. Always consult the most current official prescribing information (package insert) and local formulary policies before administering medication.*
