Amlodipine

Amlodipine is one of the most commonly prescribed medications for high blood pressure (hypertension) and chest pain (angina) in Nigeria. It belongs to the calcium channel blocker class and works by relaxing and widening blood vessels, which reduces the effort required by the heart and lowers blood pressure. Amlodipine is taken once daily, has a long duration of action, and is well tolerated by most patients. It is particularly recommended for older adults and patients of African descent, who tend to respond especially well to calcium channel blockers.

• Hypertension (high blood pressure): first-line treatment, often used alone or in combination with other antihypertensives • Stable angina pectoris (chest pain from coronary artery disease) • Vasospastic angina (Prinzmetal's angina) • Coronary artery disease: reduces risk of hospitalisation for chest pain

• Standard dose: 5 mg once daily • Can be increased to 10 mg once daily if blood pressure is not adequately controlled after 2–4 weeks • Take at the same time each day: with or without food • Swallow whole with water • Do not skip doses or stop suddenly without consulting your doctor: stopping antihypertensives abruptly can cause a dangerous rebound rise in blood pressure • Amlodipine can take 1–2 weeks to reach its full blood-pressure-lowering effect after starting or changing dose: be patient and do not stop prematurely • Elderly patients: usually start with 2.5 mg once daily • Liver disease: start at 2.5 mg and titrate slowly

Common side effects: • Ankle and foot swelling (peripheral oedema): the most common side effect; caused by fluid accumulation rather than heart failure; often improves with elevation of the legs • Flushing (feeling of warmth or redness, especially in the face) • Headache • Dizziness • Palpitations • Fatigue Less common: • Nausea and abdominal pain • Skin rash • Excessive gum growth (gingival hyperplasia): with long-term use; maintain excellent dental hygiene Rare but serious: • Severe allergic reaction • Worsening of angina or heart attack (very rare; usually at the start of treatment) • Serious low blood pressure (hypotension)

• Grapefruit and grapefruit juice: significantly increases amlodipine blood levels, potentially causing excessive blood pressure lowering and side effects: AVOID grapefruit and grapefruit juice while taking amlodipine • Simvastatin: amlodipine increases simvastatin levels; maximum simvastatin dose is 20 mg/day when combined • Cyclosporine and tacrolimus: amlodipine increases their blood levels • Other antihypertensives and diuretics: additive blood pressure lowering: monitor for hypotension • Strong CYP3A4 inhibitors (ketoconazole, clarithromycin): increase amlodipine levels and effects • Rifampicin (used in TB treatment): reduces amlodipine effectiveness significantly

• Store at room temperature (15–30°C) away from heat, moisture, and direct sunlight • Keep in original packaging • Keep out of reach of children