ANTIHYPERTENSIVE DRUGS

Antihypertensive Drugs
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Amlodipine
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Generic Name: amlodipine (am LOE di peen)
Brand Names: Norvasc, amlodac, chalchek, nordip, myodipine, amlong, amlor

What is amlodipine?
Amlodipine is in a group of drugs called calcium channel blockers. Amlodipine relaxes (widens) blood vessels and improves blood flow.
Amlodipine is used to treat high blood pressure (hypertension) or chest pain (angina) and other conditions caused by coronary artery disease. This medication is for use in adults and children who are at least 6 years old.
Amlodipine may also be used for other purposes not listed in this medication guide.
Important information about amlodipine
Before taking amlodipine, tell your doctor if you have congestive heart failure or liver disease.
Drinking alcohol can further lower your blood pressure and may increase certain side effects of amlodipine.

Amlodipine is only part of a complete program of treatment that may also include
diet, exercise, weight control, and other medications. Follow your diet, medication, and exercise routines very closely.
Tell your doctor about all other heart or blood pressure medications you are taking.
Your chest pain may become worse when you first start taking amlodipine or when your dose is increased.
Call your doctor if your chest pain is severe or ongoing.
Before taking amlodipine
You should not take this medication if you are allergic to amlodipine.
To make sure you can safely take amlodipine, tell your doctor if you have any of these other conditions:
• a heart valve problem called aortic stenosis;
• congestive heart failure; or
• liver disease.
If you are also taking a beta-blocker drug (such as Betapace, Blocadren, Corgard, Coreg, Inderal, InnoPran, Lopressor, Normodyne, Tenoretic, Tenormin, Toprol, Trandate, Zebeta, and others) do not suddenly stop using the beta-blocker without first talking to your doctor. You may need to use less and less before you stop the medication completely. Stopping a beta-blocker too quickly can cause serious heart problems that will not be prevented by amlodipine.
FDA pregnancy category C. It is not known whether amlodipine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether amlodipine passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are taking amlodipine.

Usual Adult Dose for Hypertension
Initial dose: 5 mg orally once a day
Maintenance dose: 5 to 10 mg orally once a day

Small or fragile patients may be started on 2.5 mg orally once a day.
Usual Adult Dose for Angina Pectoris
Chronic stable or vasospastic angina, or angiographically documented coronary artery disease in patients without heart failure or an ejection fraction less than 40%: 5 to 10 mg orally once a day

Most patients with chronic stable or vasospastic angina require 10 mg for adequate effect. In clinical studies, most patients with coronary artery disease required 10 mg.
Most patients with chronic stable or vasospastic angina require 10 mg for adequate effect. In clinical studies, most patients with coronary artery disease required 10 mg.
Usual Geriatric Dose for Hypertension
Initial dose: 2.5 mg orally once a day
Maintenance dose: 2.5 to 10 mg orally once a day
Usual Geriatric Dose for Angina Pectoris
Chronic stable or vasospastic angina: 5 to 10 mg orally once a day
The lower dose is recommended in the elderly; however, most patients require 10 mg for adequate effect.
Usual Pediatric Dose for Hypertension
6 to 17 years: 2.5 mg to 5 mg orally once a day
Doses in excess of 5 mg daily have not been studied in pediatric patients.
Liver Dose Adjustments
Hypertension: Patients with hepatic insufficiency may be started on 2.5 mg orally once a day.
Precautions
Worsening angina and acute myocardial infarction can develop after initiating or increasing the dosage of amlodipine, especially in patients with severe obstructive coronary artery disease.
Caution is recommended in patients with aortic stenosis, heart failure, and/or hepatic dysfunction.
Monitoring for symptoms of hypotension and edema is recommended when amlodipine is coadministered with CYP450 3A4 inhibitors. Blood pressure should be closely monitored when amlodipine is coadministered with CYP450 3A4 inducers.

Safety and effectiveness have not been established in pediatric patients less than 6 years of age.
Dialysis
Amlodipine is only slightly removed by hemodialysis, if at all, since it is highly protein bound.
Other Comments
When amlodipine is added to other antihypertensive therapy, a 2.5 mg starting dose is often used.

Amlodipine may be administered with or without food.
Overdose symptoms may include rapid heartbeats, severe dizziness, and fainting.
What should I avoid while taking amlodipine?
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.
Drinking alcohol can further lower your blood pressure and may increase certain side effects of amlodipine.

Amlodipine side effects
Get emergency medical help if you have any of these signs of an allergic reaction to amlodipine: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:
• feeling like you might pass out;
• swelling in your hands, ankles, or feet;
• pounding heartbeats or fluttering in your chest; or
• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling.
Less serious amlodipine side effects may include:
• headache;
• dizziness, drowsiness;
• tired feeling;
• stomach pain; or
• flushing (warmth, redness, or tingly feeling).
What other drugs will affect amlodipine?
Tell your doctor about all other medicines you use, especially:
• simvastatin (Zocor, Simcor, Vytorin); or
• any other heart or blood pressure medications.
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Atenolol
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Atenolol (Tenormin) is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).
Atenolol is used to treat angina (chest pain) and hypertension (high blood pressure). It is also used to treat or prevent heart attack.
Atenolol may also be used for purposes other than those listed in this medication guide.
Important information about atenolol
Do not stop taking atenolol without first talking to your doctor. Stopping suddenly may make your condition worse.
If you need to have any type of surgery, you may need to temporarily stop using atenolol. Be sure the surgeon knows ahead of time that you are using atenolol.
Atenolol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol, which could increase drowsiness and dizziness while you are taking atenolol.
Atenolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.
If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.
Store atenolol at room temperature away from moisture and heat.

You should not use this medication if you are allergic to atenolol, or if you have certain heart conditions such as slow heartbeats, or heart block.
Before taking atenolol, tell your doctor if you have:
• asthma, bronchitis, emphysema;
• diabetes;
• low blood pressure;
• a heart problem such as heart block, sick sinus syndrome, slow heart rate, or congestive heart failure;
• depression;
• liver or kidney disease;
• a thyroid disorder;
• myasthenia gravis;
• pheochromocytoma; or
• problems with circulation (such as Raynaud's syndrome).
If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication.
FDA pregnancy category D.
This medication can cause harm to an unborn baby. Do not use atenolol if you are pregnant.
Tell your doctor if you become pregnant during treatment.
Use an effective form of birth control while you are using this medication.
Atenolol can pass into breast milk and may harm a nursing baby.
Do not use this medication without telling your doctor if you are breast-feeding a baby.
Atenolol side effects
Get emergency medical help if you have any of these signs of an allergic reaction:
hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have any of these serious side effects:
• slow or uneven heartbeats;
• feeling light-headed, fainting;
• feeling short of breath, even with mild exertion;
• swelling of your ankles or feet;
• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
• depression; or
• cold feeling in your hands and feet.
Less serious atenolol side effects may include:
• decreased sex drive, impotence, or difficulty having an orgasm;
• sleep problems (insomnia);
• tired feeling; or
• anxiety, nervousness.
Side effects other than those listed here may also occur.
Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
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