Amlodipine Vertex Tablets, box, 60 pcs, 10 mg, for oral administration, for adults

Pharmacodynamics and pharmacokinetics

The active component is a dihydropyridine . The principle of action is aimed at blocking slow calcium channels. The drug has a hypotensive and antianginal effect. The main substance binds to dihydropyridine receptors, has a blocking effect on calcium channels, and slows down the transmembrane transition of calcium ions into the cell (there are slightly more vessels in the smooth muscle tissue than in carliomyocytes).

The antianginal effect of amlodipine is achieved by dilating arterioles, peripheral arteries, and coronary arteries, which in angina pectoris can reduce the severity of myocardial ischemia. Under the influence of the active component, the lumen of arterioles and coronary arteries in ischemic and unaffected areas of the myocardium expands, and the formation of constriction of the coronary arteries is prevented (during smoking).

The hypotensive effect of the drug is dose-dependent. A single dose of medication for arterial hypertension allows you to achieve a clinically significant drop in blood pressure within 24 hours. The drug does not affect the ejection fraction in the left ventricle, does not cause a decrease in exercise tolerance, and does not cause a sharp drop in blood pressure.

The medication has cardioprotective and antiatherosclerotic effects in ischemic heart disease. Amlodipine increases the glomerular filtration rate, inhibits platelet aggregation, does not cause a reflex increase in pulse, and has a weak natriuretic effect. The severity of microalbuminuria does not increase in patients with diabetic nephropathy . The drug does not affect plasma lipids or metabolic processes. The effect of taking a single dose of amlodipine is observed after 2 hours and lasts for a day.

Amlodipine: review of clinical studies

Amlodipine is a third-generation dihydropyridine calcium channel antagonist that blocks slow calcium channels (L-type channels) and prevents intracellular hypercalcemia and smooth muscle cell contraction, exerting a vasodilatory effect. Amlodipine has a long-lasting effect, which allows it to be used once a day. Amlodipine effectively lowers blood pressure without affecting heart rate in patients with arterial hypertension. It is also used in the treatment of patients with angina pectoris, including effective in cases of pronounced vasospastic component of ischemia. The drug is well tolerated, causing few side effects. Used in combination with other antianginal and antihypertensive drugs.

Pharmacokinetics

When taken orally, amlodipine is slowly and almost completely absorbed from the gastrointestinal tract, regardless of food intake. The bioavailability of amlodipine is high and ranges from 60 to 80%. The volume of distribution of the drug is on average 20-21 l/kg body weight, which is significantly more than that of other representatives of the dihydropyridine series. In serum, 95-98% of the drug dose is bound to plasma proteins. The maximum concentration of amlodipine in the blood is achieved 6-12 hours after administration. The duration of action of the drug is due to its slow release from connection with receptors.

Table 1. Effect of amlodipine on blood pressure and heart rate

Note: R - randomized, PS - single blind, DS - 'double' blind, PC - placebo-controlled, PG - parallel groups, Per - crossover, MC - multicenter, SBP - systolic blood pressure, DBP - diastolic blood pressure.

The biotransformation of amlodipine to inactive metabolites occurs in the liver. The drug is excreted in the urine (about 10% unchanged and about 60% in the form of inactive metabolites) and in feces. The half-life of amlodipine is 35-50 hours. A stable equilibrium concentration (steady-state) is achieved after 7-8 days of taking the drug. With impaired liver function, the elimination time of amlodipine increases, which is also typical for other dihydropyridine calcium antagonists. When taking amlodipine, there is no impairment of glucose tolerance, so the drug can be used in patients with diabetes mellitus, as well as bronchial asthma and gout.

Pharmacodynamics Effect on blood pressure and heart rate

In table Table 1 shows the effect of amlodipine on the level of systolic and diastolic blood pressure, heart rate and the occurrence of adverse reactions when using the drug.

The effect of amlodipine (in the form of blocking slow calcium channels and reducing intracellular hypercalcemia) is 80 times more pronounced in relation to vascular smooth muscle cells compared to contractile myocardium. Thus, the decrease in blood pressure under the influence of amlodipine occurs precisely due to peripheral vasodilation. Amlodipine has a pronounced hypotensive effect on both systolic and diastolic blood pressure. However, the degree of reduction in blood pressure varies, according to different authors. Thus, in a study by Horwitz LD et al. [2] when using 5-10 mg of amlodipine for 10 weeks. the decrease in systolic pressure was 13.1 mm Hg. Art., diastolic - 12.2 mm Hg. Art., and in the study by Habeler G. et al. [5] when using the same dose of amlodipine for 27 months. systolic blood pressure decreased by 30.5 mmHg. Art., and the decrease in diastolic was 20.7 mm Hg. Art.

Amlodipine has a long-term hypotensive effect due to its long half-life (35-50 hours), which allows it to control blood pressure evenly throughout the day. This leads to a relatively greater effectiveness of the drug in controlling the early morning rise in blood pressure, regardless of the time of administration (morning or evening once a day) [10, 11, 12]. In a study by Leenen FH et al. during a break in treatment, blood pressure remained within normal limits even on the second day of drug withdrawal [13]. The maximum hypotensive effect during therapy with 5 mg of amlodipine occurs only at the 6th week. use of the drug, which makes early dose increases inappropriate in case of incomplete control of blood pressure levels [14]. The drug has a dose-dependent effect on blood pressure levels and is characterized by a linear dose-concentration relationship in the blood plasma. Thus, in a study on healthy volunteers, diastolic blood pressure decreased when measured while standing by 1.1; 4.8 and 8.0 mm Hg. Art., when using 2.5; 5 and 10 mg of amlodipine, respectively [15].

With the development of the hypotensive effect of amlodipine, there is no change in heart rate, which sets the drug apart from other representatives of the dihydropyridine series. In addition, the drug is well tolerated by patients (Table 1). Side effects include the possibility of developing swelling of the legs and hyperemia, which is typical for all drugs of the dihydropyridine series.

Effect on myocardial ischemia

The antianginal effect is determined by the peculiarity of the mechanism of action and is due to the coronary-lytic effect of the drug, which also determines the most preferable patient population. The effect of the drug is maximum in patients with a pronounced spastic component of coronary obstruction [17]. However, amlodipine is also widely used for the treatment of stable angina pectoris, significantly reducing the frequency, duration and severity of ischemic episodes [18-22]. One of the possible beneficial protective effects of amlodipine on the state of the myocardium after an episode of ischemia is considered to be its ability to reduce calcium overload of cells, which is the cause of myocardial damage [23]. An advantageous difference between amlodipine and earlier calcium antagonists is its lack of influence on heart rate, an increase in which during physical activity is one of the triggers for ischemia.

Table 2. Changes in echocardiographic parameters in groups after 12 months. treatment in the TOMHS study

Note: IVS - interventricular septum, WS - thickness of the posterior wall of the left ventricle, LV - internal volume of the left ventricle, iMLV - left ventricular myocardial mass index (based on body surface area and height), RV - right ventricle.

Table 3. Changes in selected parameters in groups after treatment in the TOMHS study
Indicators

The CAPE study [16] assessed the effect of amlodipine on the duration and frequency of myocardial ischemic episodes in patients with coronary artery disease. During the control 48-hour ECG monitoring, a decrease in the number of ischemic episodes was observed. When assessing the possible proarrhythmogenic effect of the drug in patients with stable angina pectoris, when amlodipine was added to traditional therapy with β-blockers and nitrates, no increase in episodes of arrhythmia was observed.

Effect on the autonomic nervous system

Activation of the sympathetic component of the autonomic nervous system is an undesirable side effect of dihydropyridine calcium antagonists due to their mechanism of action (reflex activation). At the same time, a study of norepinephrine in the blood of patients taking amlodipine did not show changes in its level compared to the baseline [24-26]. During spectral analysis, no increase in LF/HF was observed [27]. Thus, a feature of the action of amlodipine is the absence of activation of the sympathetic nervous system and the development of reflex tachycardia.

Effect on plasma renin activity

Susaguri et al. [28] studied plasma renin activity and norepinephrine levels in patients with arterial hypertension when prescribed amlodipine. The study was conducted 1, 4 and 7 days after the start of therapy. As a result, in response to a decrease in blood pressure when prescribing amlodipine, no activation of the sympathetic nervous and renin-angiotensin systems was observed, and the levels of norepinephrine and plasma renin remained unchanged.

Effect on left ventricular myocardial mass

The randomized, double-blind, placebo-controlled TOMHS (Treatment of mild hypertension study) study compared 5 antihypertensive drugs: a diuretic (chlorthalidone), a β-blocker (acebutolol), a calcium channel antagonist (amlodipine), an angiotensin-converting enzyme inhibitor (enalapril maleate) , an α-adrenergic receptor antagonist (doxazosin) and their possible effect on the mass of the left ventricular myocardium. The study was based on a proven connection between an increase in the size of the left ventricle and an increased risk of developing cardiovascular complications. The study followed 902 patients with mild hypertension over a period of more than four years. At the first stage, patients were offered one of 5 antihypertensive drugs (including amlodipine at a dose of 5 mg/day) or placebo, and then at the second stage, if blood pressure control was inadequate, a second drug was added (chlorthalidone in 5 groups of patients and enalapril in the group previously receiving chlorthalidone). All drugs were prescribed once a day in the morning. Control echocardiographic studies were carried out at baseline, 3, 12, 24, 36 and 48 months. During the study, a significant decrease in blood pressure levels was observed, and in the acebutolol and amlodipine groups the percentage of changes in therapy was the smallest, i.e. Adequate blood pressure control was observed throughout the entire four-year observation period at doses of drugs not exceeding the initial ones. When studying the dynamics of changes in left ventricular myocardial mass, it turned out that the most pronounced decrease was observed in the amlodipine and chlorthalidone groups, compared with the acebutolol and placebo groups. During the entire observation, it turned out that amlodipine reduces the mass of the left ventricular myocardium, which may reduce the risk of developing cardiovascular complications in patients with arterial hypertension and left ventricular hypertrophy (Tables 2, 3).

Effect on the progression of vascular atherosclerosis

Due to the presence of a number of reports on the possible beneficial effects of calcium antagonists on the condition of the vascular endothelium, a multicenter, prospective, randomized, double-blind, placebo-controlled PREVENT study was conducted [48]. This study assessed changes in the degree of atherosclerotic lesions of the coronary arteries and the thickness of the intimomedial layer of the carotid arteries during the administration of amlodipine. The study was conducted on 825 patients with coronary artery disease confirmed by coronary angiography. Patients received amlodipine at a dose of 5 mg, which, if well tolerated, was increased to 10 mg. As a result of the study, no significant differences were obtained in both study groups - active treatment and control - in relation to the progression of atherosclerotic stenosis of the coronary vessels. On the contrary, there was a pronounced effect of amlodipine on the progression of atherosclerosis in the carotid arteries, detected using ultrasonography. At the same time, in the amlodipine group, regression of the intima-medial layer was observed by 0.046 mm, and in the control group, thickening by 0.011 mm. Currently, a correlation has been proven between the degree of thickening of the intima-medial layer of the carotid arteries and the incidence of myocardial infarction and cerebral stroke. Also, the PREVENT study showed good tolerability of the drug, which was previously noted by other researchers, with the frequency of adverse reactions comparable to the placebo group (79% for amlodipine and 83% for placebo). Additional prescription of angiotensin-converting enzyme inhibitors in the amlodipine group was observed half as often as in the placebo group.

Clinical application Arterial hypertension

Amlodipine effectively reduces systolic and diastolic blood pressure levels both in monotherapy and as part of combination therapy (Table 1). Amlodipine is a competitive drug when compared with other calcium antagonists and drugs from other classes of antihypertensive drugs (Table 4).

When comparing the effect of amlodipine with the effect of other calcium antagonists, its greater effectiveness in relation to blood pressure levels is shown in comparison with verapamil and diltiazem. Thus, in a study by Watts RW et al. [35] compared amlodipine (5-10 mg) and controlled-release diltiazem (180-360 mg), and mean daily blood pressure decreased with amlodipine to 137/84 mmHg. Art., and when using diltiazem - up to 143/86 mm Hg. Art. According to Lorimer AR et al. When compared with verapamil, amlodipine controlled blood pressure better within 24 hours after the last dose than verapamil within 12 hours after the last dose [39]. In numerous comparisons of amlodipine with other dihydropyridine calcium antagonists, it had a comparable in magnitude, but significantly longer antihypertensive effect [5, 10, 40]. At the same time, the advantageous advantage of the drug over other dihydropyridine calcium antagonists is the lack of its effect on heart rate, which allows it to be prescribed to patients with tachysystole. Only the latest generation calcium antagonists, lacidipine and mibefradil, have a similar effect on blood pressure as amlodipine.

The Amlodipine Cardiovascular Community Trial (ACT) [41] examined the comparative effectiveness of amlodipine in patients of different ages, gender and race. It has been established that the drug is equally effective in hypertensive patients of black and white races and is more effective among the female population. The ease of use of the drug also consists in long-term 24-hour control of blood pressure levels and a small number of adverse reactions.

Angina pectoris

Amlodipine has a pronounced coronary effect due to its high selectivity for smooth muscle cells of arterioles. The steal syndrome that occurs when using calcium antagonists is much less pronounced in long-acting drugs, including amlodipine. Amlodipine has the most beneficial effect when used in patients with a pronounced dynamic component of coronary obstruction. In a study by Chahine RA et al. [17] patients with proven vasospastic angina showed a significant reduction in episodes of angina and the frequency of additional use of nitroglycerin.

Table 4. Comparative antihypertensive effect of amlodipine with drugs from other groups
Authors

Note: sBP - systolic blood pressure, dBP - diastolic blood pressure, T/P - through-to-peak coefficient, P/T - peak-to-through coefficient.

However, amlodipine is also widely used for the treatment of stable angina pectoris, both as monotherapy and (more often) as part of combination therapy.

In a study by Van Der Vring JA et al. [42] studied the effectiveness of calcium antagonists when added to β-blocker therapy in the treatment of patients with angina pectoris. The assessment was made based on changes in the performance of the bicycle ergometer test. As a result, although calcium antagonists (including amlodipine at a dose of 5-10 mg) did not increase the duration of exercise, they significantly delayed the onset of ischemic depression of the ST segment, and mibefradil was more effective than amlodipine, and amlodipine - diltiazem. At the same time, the use of mibefradil was limited by a higher incidence of side effects such as dizziness.

The effectiveness of amlodipine monotherapy at a dose of 2.5-10 mg in comparison with the b-blocker nadolol was assessed in a study by Singh S. [43]. At the same time, amlodipine delayed the development of an attack of angina pectoris much longer in comparison with nadolol (+21 and +8%, respectively). When comparing amlodipine with dinitrates, it turned out [19] that amlodipine was significantly more effective in reducing the duration of ischemic episodes, increasing the time to the onset of ST segment depression and angina, and had fewer side effects compared to isosorbide dinitrate. Similarly, a comparison of isosorbide mononitrate with amlodipine in patients with angina pectoris showed a greater protective effect of amlodipine compared with mononitrates in relation to myocardial damage in response to stress ischemia. Such damage occurs in 82% of cases when using mononitrates and only in 48% of cases when using amlodipine [23].

The multicenter CAPE study, conducted in 10 European countries, included patients with at least four episodes of ischemia, as determined by 48-hour ECG monitoring, with a total ischemic duration of more than 20 minutes [49]. Amlodipine significantly reduced the incidence of ST segment depression and total ischemic time (as measured by ECG), as well as the incidence of painful ischemic episodes and the frequency of additional use of short-acting nitrates [50].

The effect of amlodipine therapy on the prognosis of patients with coronary artery disease was assessed in the PREVENT study. There was a decrease in the number of hospitalizations due to destabilization of angina pectoris and chronic heart failure (61 in the amlodipine group and 88 in the placebo group). Also, with the use of amlodipine, a decrease in the number of myocardial revascularization operations was observed (53 compared with 85 in the placebo group), regardless of the use of b-blockers, nitrates or lipid-lowering therapy. The frequency of anginal attacks decreased from 85 to 60.

A comparative assessment of the effect on cardiovascular mortality of the angiotensin receptor antagonist valsartan and the calcium antagonist amlodipine is carried out in the VALUE (Valsartan Antihypertensive Long-tern Use Evaluation) study, which is currently not completed. 14,400 patients with arterial hypertension and additional risk factors (hypercholesteremia >6.5 mmol/l, serum creatinine >1.2 mg/dl, ECG signs of left ventricular hypertrophy, type II diabetes mellitus, coronary artery disease or stroke in history) were randomized. The ALLHAT (Antihypertensive Lipid Lowering Heart Attack Trial) study [44] has also not yet been completed, one of the directions of which is a comparative assessment of the effect of amlodipine on the incidence of non-fatal myocardial infarction and coronary death. The study compares four classes of antihypertensive drugs: diuretic, calcium antagonist, α-blocker, and ACE inhibitor in reducing cardiovascular morbidity and mortality in hypertensive patients with hypercholesterolemia.

In a meta-analysis, Kloner RA et al. [51] assessed the safety of calcium channel antagonists. Comparative and non-comparative studies of amlodipine and nifedipine GITS were included. It was shown that in patients receiving amlodipine, overall cardiovascular mortality, the incidence of acute myocardial infarction and progression of coronary artery disease were significantly lower than similar indicators for other calcium antagonists.

Chronic heart failure

The randomized, double-blind, placebo-controlled PRAISE I (Prospective Randomized Amlodipine Survival Evaluation Study) study [45] assessed the effect of the new calcium antagonist amlodipine in patients with chronic heart failure. The study included 1153 patients with an ejection fraction of less than 30% and chronic heart failure of ischemic and non-ischemic origin. The result showed a reduction in the total number of cardiovascular complications by 9%, a reduction in the risk of sudden death by 16% in the amlodipine group compared to placebo. Moreover, the change concerned exclusively patients with non-ischemic heart failure, who experienced a 31% reduction in the total number of cardiovascular complications and a 46% reduction in the risk of sudden death when using amlodipine.

The PRAISE II trial is currently being conducted to evaluate the role of amlodipine in the treatment of chronic non-ischemic heart failure (dilated cardiomyopathy). A decrease in clinical symptoms and plasma norepinephrine levels has been shown with the use of amlodipine in patients with dilated cardiomyopathy. A number of authors associate this effect of amlodipine with inhibition of NO hyperproduction and a decrease in myocardial damage.

Directions for use and dosage

Amlodipine is taken once daily due to its long half-life and long-term adequate blood pressure control. For arterial hypertension and angina pectoris, the usual initial dose of the drug is 5 mg once a day. Most patients do not require a dose increase, but the maximum dose is 10 mg/day. You should not increase the dose of the drug during the first week of use if blood pressure levels are insufficiently controlled, since the maximum effect of the drug develops later.

Drug interactions

No adjustment of the drug dose is required with the simultaneous use of thiazide diuretics, β-blockers, and ACE inhibitors. A beneficial effect on blood pressure levels has been shown with simultaneous administration of amlodipine with α-blockers [46].

The study by Schwartz JB [47] assessed the effect of amlodipine on the pharmacological profile of digoxin in healthy volunteers. There is no change in the steady-state concentration of digoxin (steady-state), as well as blood pressure or heart rate when the drugs are used together.

Conclusion

Amlodipine, an antagonist of slow L-type calcium channels from the group of dihydropyridines, is effective in mono- and combination therapy of arterial hypertension, treatment of coronary heart disease with severe coronary spasm, and is also used in the treatment of chronic heart failure of non-ischemic origin. Amlodipine is a long-acting drug, which eliminates the sharp hemodynamic changes characteristic of the initial period of absorption of short-acting calcium antagonists. Another important distinguishing feature of amlodipine from other dihydropyridine calcium antagonists is the lack of effect on heart rate, which expands the possibilities of use of the drug. In numerous studies, amlodipine was well tolerated, and the percentage of adverse reactions when using it did not significantly exceed that in the control group.

Contraindications

Contraindications to the use of the drug are: intolerance to dihydropyridines , pregnancy , severe arterial hypotension , breastfeeding . For aortic stenosis , arterial hypotension , acute myocardial infarction , renal pathology, children under adulthood, CHF, mitral stenosis , elderly patients with CVS, HOCM - Amlodipine is prescribed with caution.

Side effects of Amlodipine

Digestive tract: dry mouth, yellowness of the skin, nausea, increased levels of liver enzymes, vomiting, dyspeptic disorders, pancreatitis , flatulence , diarrhea , constipation , gum hyperplasia, pain in the epigastric region, appetite disturbances.

Nervous system: convulsions, mood changes, drowsiness, headache, depression, nervousness, insomnia, malaise, fatigue, asthenia, tremor, paresthesia, hyperesthesia, amnesia , agitation , apathy , ataxia .

Cardiovascular system: ventricular tachycardia , swelling, blood flow disorders to the face, palpitations, chest pain, drop in blood pressure, migraine, extrasystole, atrial flutter, worsening heart failure, orthostatic hypotension, rise in blood pressure.

Genitourinary system: polyuria , pollakiuria , nocturia , pain during urination, sexual dysfunction, potency disorders, dysuria .

Musculoskeletal system: myasthenia gravis , arthrosis , arthralgia , myalgia .

Skin: alopecia , xeroderma , purpura , dermatitis. It is also possible to develop conjunctivitis , rash, itching, diplopia, visual disturbances, gynecomastia , ringing in the ears, chills, xerophthalmia , accommodation disturbances , parosmia , rhinitis , cough, clammy sweat, nosebleeds, hyperglycemia , thirst , increased sweating, perversion of taste perception.

Reviews of side effects of Amlodipine are quite common.

Amlodipine tablets, instructions for use (Method and dosage)

The drug is taken orally, the initial dosage is 5 mg. The amount of medication is gradually increased over two weeks to a maximum of 10 mg per day once.

The maintenance daily dosage for arterial hypertension is 2.5-5 mg.

For vasospastic angina, exertional angina, a single dose of 5-10 mg per day is prescribed. To prevent angina attacks, a daily dose of 10 mg is indicated.

Patients with kidney pathology, low body weight, and short stature are prescribed 2.5 mg per day, to achieve an antianginal effect - 5 mg.

The initial dosage for CHF is 2.5 mg per day, the dosage is gradually increased to 10 mg per day if the medication is well tolerated.

Instructions for use of Amlodipine Teva, Amlodipine Farmak and Biocom are similar.

What does Amlodipine help with?

The drug is best suited for long-term or lifelong treatment regimens for chronic diseases. It acts smoothly and for a long time. Amlodipine is prescribed for:

• Arterial hypertension.
• Vasospastic angina.
• Angina pectoris.
• Decompensated form of chronic heart failure.
• Myocardial ischemia occurs without pain.

The tablets dilate blood vessels and facilitate the delivery of nutrients to the heart, relieving pain caused by narrowing of the lumen of the arteries. The action lasts for 24 hours, and the maximum effect is achieved 5-6 hours after administration.

Interaction

Indomethacin (blockade of prostaglandin synthesis by the renal system, sodium ion retention), sympathomimetics, estrogens, alpha-adrenergic stimulants, NSAIDs - weaken the severity of the hypotensive effect.

Inhibitors of microsomal oxidation increase the risk of side effects due to an increase in the concentration of the drug in the blood; the opposite effect is observed when taking inducers of microsomal enzymes.

Nitrates, loop diuretics, Verapamil , beta-blockers, thiazide diuretics, ACE inhibitors increase the severity of the hypotensive and antianginal effects.

Antipsychotics, alpha1-blockers, quinidine, amiodarone, BMCC enhance the hypotensive effect of amlodipine.

Warfarin , Cimetidine and Digoxin do not affect pharmacokinetic parameters.

When taking lithium preparations, an increase in neurotoxicity is recorded (tinnitus, ataxia, diarrhea, nausea, tremor, vomiting).

Calcium supplements reduce the effectiveness of BMCC. Quinidine , procainamide enhance the negative inotropic effect.

Description of the drug

The main purpose of Amlodipine is to lower blood pressure and reduce the risk of angina attacks.

The main active ingredient is amlodipine besylate. Auxiliary components are presented: crospovidone, calcium stearate, povidone, lactose monohydrate, microcrystalline cellulose.

Available in the form of white or slightly yellowish tablets with a score. Depending on the concentration of the main active ingredient, Amlodipine is available in pharmacies 5 mg or 10 mg. Packaged in 30, 50 or 90 pieces in cardboard boxes along with instructions. Produced in Russia and Serbia. The drug is stored for 3 years at a temperature not exceeding 25°C.

Has the following positive effects:

• Helps normalize blood pressure.
• Improves the functioning of the cardiovascular system by increasing the supply of oxygen to the heart muscle.
• Reduces blood viscosity.
• Improves cerebral circulation.

Advantages of the drug:

• Does not affect the number of heart contractions.
• Does not cause a rapid decrease in pressure, has a long-term effect due to its effect on vascular tissue.
• Increases resistance to physical activity in people with heart disease.

special instructions

There is no reliable information about the safety of amlodipine for lactating and pregnant women. Therapy requires observation by a dentist for the prevention and timely diagnosis of gum hyperplasia , bleeding and pain.

The drug has no effect on plasma concentrations of cholesterol , triglycerides, glucose, uric acid, urea, nitrogen, LDL. The drug is not characterized by a withdrawal syndrome, however, patients are advised to gradually reduce the dosage of the drug before discontinuing it.

The drug is often used in combination with various active substances: valsartan, perindopril, lisinopril, bisoprolol.

Amlodipine analogs

Level 4 ATC code matches:
Lacipil

Cordafen

Azomex

Nimodipine

Felodipin

Nifedipine

Farmadipin

Amlotop

Nimotop

Tenox

Nifecard HL

Cordipin

Felodip

Normodipine

Phenigidine

Norvask

Cordaflex

Lerkamen

Corinfar

Vero-Amlodipine

What can replace the medicine? Analogues of the drug are the following medications:

• Norvask
• Amlotop
• Kalchek
• Tenox
• Amlovas
• Cardilopin
• Amlong
• Amlodak
• Amlocard
• Amlonorm
• Amlodivel

Amlodipine price, where to buy

The price of Amlodipine greatly depends on the manufacturer and has a wide range.

Buy Amlodipine-Teva 5 mg 30 pcs. you can do it for about 120 rubles.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

• Amlodipine-Prana tablets 5 mg 30 pcs. Pranapharm LLC
  40 rub. order
• Amlodipine Sandoz tablets 10 mg 30 pcs. Lek dd

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• Amlodipine-Teva tablets 10 mg 30 pcs R-Pharm Novoselki LLC

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• Amlodipine tablets 10 mg 60 pcs. Canonpharma Production CJSC

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• Amlodipine tablets 10 mg 30 pcs. Ozone LLC

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Pharmacy Dialogue

• Amlodipine-Teva tablets 5 mg No. 30Teva

  117 RUR order

• Amlodipine cardio tablets 5 mg No. 30 Obolenskoe pharmaceutical company.

  100 rub. order

• Amlodipine tablets 5 mg No. 30Canonpharma Production

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• Amlodipine-Teva (tab. 10 mg No. 30)Teva

  182 RUR order

• Amlodipine tablets 10 mg No. 30Ozon LLC

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Pharmacy24

• Amlodipine-Darnitsa 10 mg N20 tablets PrAT" Pharmaceutical company "Darnitsa", Ukraine
  11 UAH. order
• Amlodipine Astrapharm 10 mg N20 tablets TOV Astrapharm, Ukraine

  11 UAH order

• Amlodipine-Darnitsa 5 mg N20 tablets PrAT” Pharmaceutical company “Darnitsa”, Ukraine

  6 UAH order

• Amlodipine Fitofarm 5 mg N20 tablets PRAT "Fitofarm", Ukraine

  5 UAH order

• Amlodipine Farmak 0.005 N20 tablets PAT "Farmak", Ukraine

  12 UAH order

PaniPharmacy

• tablets Amlodipine Sandoz tablets 5 mg No. 30 Ukraine, Lek

  35 UAH order

• Amlodipine tablets Amlodipine tablets 0.05g No. 20 Ukraine, Farmak OJSC

  12 UAH order

• Amlodipine tablets Amlodipine tablets 5 mg No. 20 Ukraine, Fitofarm ChAO

  6 UAH order

• Amlodipine tablets Amlodipine tablets 5 mg No. 30 Ukraine, Kiev Vitamin Plant PJSC

  13 UAH order

• Amlodipine tablets Amlodipine tablets 10 mg No. 30 Ukraine, Astrapharm LLC

  19 UAH order

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Analogs, reviews, price

There are many drugs on the pharmaceutical market with similar main active ingredients. For example, Norvasc, Normodipin, Amlocor, Tenox.

According to doctors, the medicine is considered an effective remedy for heart diseases. It is often prescribed to prevent heart attack and angina. The advantage is that Amlodipine is not contraindicated for people suffering from diabetes and bronchial asthma.

According to patients, Amlodipine reduces blood pressure well and is inexpensive. Some buyers noted side effects, swelling of the legs. The drug and its dosage must be prescribed by a doctor.

The price of the medicine depends on the manufacturer and the number of tablets in the pack, starting from 40 rubles. For example, Amlodipine Teva 5 mg costs from 95 rubles. for 30 tablets, and Amlodipine Prana 5 mg - 105 rubles. for 90 pieces.