If amlodipine is discontinued, hydrocodone plasma concentrations will decrease resulting in reduced efficacy of the opioid and potential withdrawal syndrome in a patient who has developed physical dependence to hydrocodone. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Monitor patients for respiratory depression and sedation at frequent intervals. (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. Dextromethorphan; Diphenhydramine; Phenylephrine: (Moderate) Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Acetaminophen; Propoxyphene: (Moderate) Amlodipine is a CYP3A4 substrate. Amlodipine therapy usually does not affect hemodynamic parameters in patients with normal ventricular function. Amlodipine increases the simvastatin exposure by approximately 1.5-fold. Ziprasidone: (Minor) Ziprasidone is a moderate antagonist of alpha-1 receptors and may cause orthostatic hypotension with or without tachycardia, dizziness, or syncope. Decreased calcium-channel blocker doses may be warranted. If indicated, dosage of the antihypertensive agents should be reduced. If coadministration of these drugs is warranted, do so with caution and careful monitoring. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. It is recommended to avoid this combination when hydrocodone is being used for cough. Phenytoin: (Moderate) Hydantoins (phenytoin, fosphenytoin, or ethotoin) may induce the CYP3A4 metabolism of calcium-channel blockers such as amlodipine and thereby reduce their oral bioavailability. Concomitant administration of prazosin with other antihypertensive agents is not prohibited, however. These effects could be more pronounced in patients also receiving a CYP2D6 inhibitor. Vinorelbine: (Moderate) Monitor for an earlier onset and/or increased severity of vinorelbine-related adverse reactions, including constipation and peripheral neuropathy, if coadministration with amlodipine is necessary. Decreased calcium-channel blocker doses may be warranted. Aspirin, ASA; Carisoprodol; Codeine: (Moderate) Monitor for an increase in codeine-related adverse reactions including sedation and respiratory depression if coadministration with amlodipine is necessary; adjust the dose of codeine if necessary. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. Regarding diltiazem, although neurotoxicity was reported after the addition of diltiazem, other drugs were administered concomitantly. Diphenhydramine; Hydrocodone; Phenylephrine: (Moderate) Consider a reduced dose of hydrocodone with frequent monitoring for respiratory depression and sedation if concurrent use of amlodipine is necessary. Caution should be used when CYP3A4 inducers, such as bexarotene, are coadministered with amlodipine. Additive hypotensive effects are possible if ziprasidone is used concurrently with antihypertensive agents. Running one of the largest drug safety studies in the world, eHealthMe is able to enable everyone to run personal clinical trial.The phase IV trial will monitor drug safety outcomes that are personalized to your gender and age (0-99+). Monitor blood pressure and heart rate. Simvastatin; Sitagliptin: (Major) Do not exceed a simvastatin dose of 20 mg/day in patients taking amlodipine due to increased risk of myopathy, including rhabdomyolysis. No information is available on the quantitative effects of CYP3A inducers on amlodipine; however, concomitant use may result in decreased plasma concentrations of amlodipine. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. Caution should be used when CYP3A4 inducers, such as topiramate, are coadministered with amlodipine. Aprepitant, when administered as a 3-day oral regimen (125 mg/80 mg/80 mg), is a moderate CYP3A4 inhibitor and inducer and may increase plasma concentrations of amlodipine. If the antihypertensive cannot be stopped for 24 hours before chemotherapy doses of amifostine, patients should not receive amifostine. Ribociclib is a strong CYP3A inhibitor and amlodipine is a CYP3A substrate. Lovastatin: (Moderate) Carefully weigh the benefits of combined use of amlodipine and lovastatin against the potential risks. If these drugs are used together, monitor for loperamide-associated adverse reactions, such as CNS effects and cardiac toxicities (i.e., syncope, ventricular tachycardia, QT prolongation, torsade de pointes, cardiac arrest). Answers (2) WI. During the first Match Day celebration of its kind, the UCSF School of Medicine class of 2020 logged onto their computers the morning of Friday, March 20 to be greeted by a video from Catherine Lucey, MD, MACP, Executive Vice Dean and Vice Dean for Medical Education. Carbetapentane; Diphenhydramine; Phenylephrine: (Moderate) Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. If amlodipine is discontinued, hydrocodone plasma concentrations will decrease resulting in reduced efficacy of the opioid and potential withdrawal syndrome in a patient who has developed physical dependence to hydrocodone. Posaconazole: (Moderate) Monitor for symptoms of hypotension and edema if coadministration of amlodipine with posaconazole is necessary; adjust the dose of amlodipine as clinically appropriate. (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Adjust dose every 5 to 7 days; it may require several weeks for the maximum hypotensive effect to fully manifest. Lidocaine: (Moderate) Concomitant use of systemic lidocaine and amlodipine may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life. When these drugs are given together, however, hypotension and impaired cardiac performance can occur, especially in patients with left ventricular dysfunction, cardiac arrhythmias, or aortic stenosis. Small decreases in blood pressure have been observed in some patients treated with pentoxifylline; periodic systemic blood pressure monitoring is recommended for patients receiving concomitant antihypertensives. Chloramphenicol: (Moderate) Amlodipine is a CYP3A4 substrate. Doses of antihypertensive medications may require adjustment in patients receiving concurrent NSAIDs. In addition, calcium channel blockers may cause peripheral edema and clinically significant constipation; some agents may cause generalized aching, headache, and muscle pain. Antihypertensives may cause dizziness, postural hypotension, fatigue, and there is an increased risk for falls. Telaprevir: (Moderate) Close clinical monitoring is advised when administering amlodipine with telaprevir due to an increased potential for amlodipine-related adverse events. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Specific guidelines for dosage adjustments in pediatric patients with hepatic impairment are not available. Meclofenamate Sodium: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Apomorphine: (Moderate) Use of calcium-channel blockers and apomorphine together can increase the hypotensive effects of apomorphine. If amlodipine is discontinued, alfentanil plasma concentrations will decrease resulting in reduced efficacy of the opioid and potential withdrawal syndrome in a patient who has developed physical dependence to alfentanil. Cyclosporine: (Moderate) Caution should be used when cyclosporine is coadministered with amlodipine; therapeutic response should be monitored, including cyclosporine levels as necessary. Because CYP3A plays a significant role in the metabolism of eliglustat in CYP2D6 PMs, coadministration with CYP3A inhibitors may increase eliglustat exposure and the risk of serious adverse events (e.g., QT prolongation and cardiac arrhythmias) in these patients. (Moderate) Olanzapine may induce orthostatic hypotension and thus enhance the effects of antihypertensive agents. When these drugs are given together, however, hypotension and impaired cardiac performance can occur, especially in patients with left ventricular dysfunction, cardiac arrhythmias, or aortic stenosis. Adult Max dose: 10 mg/day. Nilotinib: (Moderate) Coadministration of CYP3A4 inhibitors with amlodipine can theoretically decrease the hepatic metabolism of amlodipine (a CYP3A4 substrate). NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Amlodipine is a CYP3A4 substrate and bosentan is a moderate CYP3A4 inducer. Benzhydrocodone is a prodrug for hydrocodone. Acetaminophen; Guaifenesin; Phenylephrine: (Moderate) Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. Lonafarnib is a sensitive CYP3A4 substrate and strong CYP3A4 inhibitor; amlodipine is a CYP3A4 substrate and weak CYP3A4 inhibitor. This effect is most significant in patients receiving concurrent antihypertensive agents and long-term NSAID therapy. Chlorpheniramine; Codeine: (Moderate) Monitor for an increase in codeine-related adverse reactions including sedation and respiratory depression if coadministration with amlodipine is necessary; adjust the dose of codeine if necessary. No information is available on the quantitative effects of CYP3A inducers on amlodipine; however, concomitant use may result in decreased plasma concentrations of amlodipine. When these drugs are given together, however, hypotension and impaired cardiac performance can occur, especially in patients with left ventricular dysfunction, cardiac arrhythmias, or aortic stenosis. Amlodipine is a CYP3A4 substrate and cenobamate is a moderate CYP3A4 inducer. Aldesleukin, IL-2: (Moderate) Calcium channel blockers may potentiate the hypotension seen with aldesleukin, IL 2. Ibuprofen; Pseudoephedrine: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Amlodipine is a CYP3A4 substrate; efavirenz induces CYP3A4. Monitor blood pressure and heart rate. Discontinuation of amlodipine could decrease dihydrocodeine plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to dihydrocodeine. Dosage adjustments of the antihypertensive medication may be required. Ceritinib: (Moderate) Monitor for symptoms of hypotension and edema if coadministration of amlodipine with ceritinib is necessary; adjust the dose of amlodipine as clinically appropriate. Taking these drugs together may increase ethosuximide plasma concentrations, potentially resulting in adverse events. Well-controlled hypertensive patients receiving decongestant sympathomimetics at recommended doses do not appear to be at high risk for significant elevations in blood pressure; however, increased blood pressure (especially systolic hypertension) has been reported in some patients. When these drugs are given together, however, hypotension and impaired cardiac performance can occur, especially in patients with left ventricular dysfunction, cardiac arrhythmias, or aortic stenosis. Patients who rely upon renal prostaglandins to maintain renal perfusion may have acute renal blood flow reduction with NSAID usage. Overdose symptoms may include extreme weakness or lack of energy, very slow heart rate, shortness of breath, or fainting. Lasmiditan has been associated with lowering of heart rate. Well-controlled hypertensive patients receiving decongestant sympathomimetics at recommended doses do not appear to be at high risk for significant elevations in blood pressure; however, increased blood pressure (especially systolic hypertension) has been reported in some patients. It is possible that additive reductions in blood pressure may be seen when fish oils are used in a patient already taking antihypertensive agents. Brompheniramine; Carbetapentane; Phenylephrine: (Moderate) Phenylephrine's cardiovascular effects may reduce the antihypertensive effects of calcium-channel blockers. Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) The cardiovascular effects of pseudoephedrine may reduce the antihypertensive effects produced by calcium-channel blockers. NSAIDs cause a dose-dependent reduction in prostaglandin formation, which may result in a reduction in renal blood flow leading to renal insufficiency and an increase in blood pressure that are often accompanied by peripheral edema and weight gain. Amlodipine inhibits the influx of extracellular calcium across the myocardial and vascular smooth muscle cell membranes. Litter size for rats was decreased by about 50% and the number of intrauterine deaths was increased approximately 5-fold. Theoretically, CYP3A4 inhibitors, such as anti-retroviral protease inhibitors, may increase the plasma concentration of amlodipine via CYP3A4 inhibition; this effect might lead to hypotension in some individuals. Patients should be monitored more closely for hypotension if nitroglycerin, including nitroglycerin rectal ointment, is used concurrently with a calcium-channel blocker. Azithromycin may be preferred if the use of a macrolide antibiotic is necessary in a patient receiving amlodipine therapy. If use together is necessary, obtain an ECG prior to lacosamide initiation and after treatment has been titrated to steady-state. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. False study results are possible in patients with drug-induced hyper- or hypo-responsiveness; thorough patient history is important in the interpretation of results. Amlodipine is a weak inhibitor of CYP3A4. Asenapine: (Moderate) Secondary to alpha-blockade, asenapine can produce vasodilation that may result in additive effects during concurrent use of antihypertensive agents. If coadministration of these drugs is warranted, do so with caution and careful monitoring. If used together, monitor blood pressure closely; the dosage requirements of amlodipine may be increased. If amlodipine is discontinued, consider increasing the oxycodone dose until stable drug effects are achieved and monitor for evidence of opioid withdrawal. A non-controlled pharmacokinetic study in healthy volunteers found that the concurrent administration of ginkgo with nifedipine resulted in a 53% increase in nifedipine peak concentrations. Sofosbuvir; Velpatasvir: (Moderate) Use caution when administering velpatasvir with amlodipine. Decreased calcium-channel blocker doses may be warranted. Fosaprepitant 150 mg IV as a single dose increased the AUC of midazolam (given on days 1 and 4) by approximately 1.8-fold on day 1; there was no effect on day 4. NSAIDs, to varying degrees, have been associated with an elevation in blood pressure. Less than a 2-fold increase in the midazolam AUC is not considered clinically important. Etomidate: (Major) The depression of cardiac contractility, conductivity, and automaticity as well as the vascular dilation associated with general anesthetics may be potentiated by calcium-channel blockers. Lithium: (Moderate) Lithium neurotoxicity has been reported during co-administration of lithium and verapamil or diltiazem, and is possible during concurrent use of other calcium-channel blockers with lithium. A non-controlled pharmacokinetic study in healthy volunteers found that concurrent administration of St. John's wort with nifedipine resulted in a 53% decrease in nifedipine peak concentrations. An ergot alkaloid dose reduction may be necessary if these drugs are used together. If these drugs are used together, monitor for loperamide-associated adverse reactions, such as CNS effects and cardiac toxicities (i.e., syncope, ventricular tachycardia, QT prolongation, torsade de pointes, cardiac arrest). Amlodipine is approximately 93% bound to plasma proteins. Oxaprozin: (Moderate) If nonsteroidal anti-inflammatory drugs (NSAIDs) and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Codeine; Promethazine: (Moderate) Monitor for an increase in codeine-related adverse reactions including sedation and respiratory depression if coadministration with amlodipine is necessary; adjust the dose of codeine if necessary. What to avoid. Ethinyl Estradiol; Ethynodiol Diacetate: (Minor) Estrogen containing oral contraceptives can induce fluid retention and may increase blood pressure in some patients. Sildenafil: (Moderate) Monitor for additive hypotension if amlodipine is administered concurrently with sildenafil, as both agents act independently to reduce blood pressure. A retrospective, case crossover study, found the risk of hospitalization due to hypotension or shock to be significantly increased in geriatric patients exposed to clarithromycin during concurrent calcium-channel blocker therapy (OR 3.7, 95% CI 2.3-6.1). Dihydroergotamine: (Moderate) Be alert for symptoms of ergot toxicity if using dihydroergotamine and amlodipine together is medically necessary. Serum calcium levels remain unchanged. As with other calcium-channel blockers of the dihydropyridine class, amlodipine exerts its effects mainly on arteriolar vasculature. Isocarboxazid: (Moderate) Additive hypotensive effects may be seen when monoamine oxidase inhibitors (MAOIs) are combined with antihypertensives. Photosensitizing agents (topical): (Minor) Preclinical data suggest that calcium-channel blockers could decrease the efficacy of photosensitizing agents used in photodynamic therapy. Lumacaftor is a strong CYP3A inducer. If amlodipine is discontinued, monitor the patient carefully and consider increasing the opioid dosage if appropriate. Caution should be used when anti-retroviral protease inhibitors are coadministered with amlodipine; therapeutic response should be monitored. An ergot alkaloid dose reduction may be necessary if these drugs are used together. Maraviroc is a CYP3A substrate and amlodipine is a weak CYP3A4 inhibitor. Methadone is a CYP3A4 substrate; coadministration with a weak CYP3A4 inhibitor like amlodipine can increase methadone exposure resulting in increased or prolonged opioid effects including fatal respiratory depression, particularly when an inhibitor is added to a stable dose of methadone. Hydrocodone is a CYP3A4 substrate, and coadministration with CYP3A4 inhibitors like amlodipine can increase hydrocodone exposure resulting in increased or prolonged opioid effects including fatal respiratory depression, particularly when an inhibitor is added to a stable dose of hydrocodone. It is recommended to avoid this combination when hydrocodone is being used for cough. If you have been using this medicine regularly for several weeks, do not suddenly stop using it. When these drugs are given together, however, hypotension and impaired cardiac performance can occur, especially in patients with left ventricular dysfunction, cardiac arrhythmias, or aortic stenosis. Elderly patients may be at increased risk of adverse effects from combined long-term NSAID therapy and antihypertensive agents, especially diuretics, due to age-related decreases in renal function and an increased risk of stroke and coronary artery disease. Ritonavir also prolongs the PR interval in some patients; however, the impact on the PR interval of coadministration of ritonavir with other drugs that prolong the PR interval (including calcium channel blockers) has not been evaluated. Verteporfin is a light-activated drug used in photodynamic therapy; all patients treated with verteporfin will be photosensitive. Amlodipine is a CYP3A4 substrate; efavirenz induces CYP3A4. Close monitoring of blood pressure is recommended until the full effects of the combination therapy are known. Clopidogrel: (Moderate) Monitor for reduced therapeutic response to clopidogrel when it is coadministered with amlodipine. For patients chronically receiving simvastatin 80 mg/day who need to be started on amlodipine, consider switching to an alternative statin with less potential for interaction. Closely monitor for seizures, serotonin syndrome, and signs of sedation and respiratory depression. Amlodipine is a weak inhibitor of CYP3A4, an isoenzyme partially responsible for the metabolism of dihydrocodeine. If coadministration is necessary, monitor patients closely at frequent intervals and consider a dosage reduction of dihydrocodeine until stable drug effects are achieved. Monitor blood pressure and heart rate. Hydrocodone is a CYP3A4 substrate, and coadministration with CYP3A4 inhibitors like amlodipine can increase hydrocodone exposure resulting in increased or prolonged opioid effects including fatal respiratory depression, particularly when an inhibitor is added to a stable dose of hydrocodone. Letermovir: (Moderate) Amlodipine dose reductions may be required during concurrent administration with letermovir; monitor for symptoms of hypotension and edema to determine the need for dose adjustment.

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