What happens if I overdose Amlodipine?
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.
Proper storage of Amlodipine:
Store Amlodipine at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Amlodipine out of the reach of children and away from pets.
Overdose of Amlodipine in details
Overdosage might be expected to cause excessive peripheral vasodilation with marked hypotension and possibly a reflex tachycardia. In humans, experience with intentional overdosage of Amlodipine is limited.
Single oral doses of Amlodipine maleate equivalent to 40 mg Amlodipine/kg and 100 mg Amlodipine/kg in mice and rats, respectively, caused deaths. Single oral Amlodipine maleate doses equivalent to 4 or more mg Amlodipine/kg or higher in dogs (11 or more times the maximum recommended human dose on a mg/m2 basis) caused a marked peripheral vasodilation and hypotension.
If massive overdose should occur, initiate active cardiac and respiratory monitoring. Frequent blood pressure measurements are essential. Should hypotension occur, provide cardiovascular support including elevation of the extremities and the judicious administration of fluids. If hypotension remains unresponsive to these conservative measures, consider administration of vasopressors (such as phenylephrine) with attention to circulating volume and urine output. As Amlodipine is highly protein bound, hemodialysis is not likely to be of benefit.
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 warnings
Hypotension
Symptomatic hypotension is possible, particularly in patients with severe aortic stenosis. Because of the gradual onset of action, acute hypotension is unlikely.
Increased Angina or Myocardial Infarction
Worsening angina and acute myocardial infarction can develop after starting or increasing the dose of Amlodipine tablets, particularly in patients with severe obstructive coronary artery disease.
Patients with Hepatic Failure
Because Amlodipine besyaate is extensively metabolized by the liver and the plasma elimination half-life (t1/2) is 56 hours in patients with impaired hepatic function, titrate slowly when administering Amlodipine to patients with severe hepatic impairment.
What should I discuss with my healthcare provider before taking Amlodipine?
Some medical conditions may interact with Amlodipine. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
- if you are pregnant, planning to become pregnant, or are breast-feeding
- if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
- if you have allergies to medicines, foods, or other substances
- if you have low blood pressure
- if you have a history of heart problems (eg, heart failure, aortic stenosis, coronary artery disease), or liver problems
Some MEDICINES MAY INTERACT with Amlodipine. Tell your health care provider if you are taking any other medicines, especially any of the following:
- Sildenafil because the risk of low blood pressure may be increased
- Azole antifungals (eg, itraconazole, ketoconazole), diltiazem, macrolide antibiotics (eg, clarithromycin), protease inhibitors (eg, ritonavir), or vasopressin receptor antagonists (eg, conivaptan) because they may increase the risk of Amlodipine's side effects
- Cyclosporine, simvastatin, or tacrolimus because the risk of their side effects may be increased by Amlodipine
This may not be a complete list of all interactions that may occur. Ask your health care provider if Amlodipine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Amlodipine precautions
Concerns related to adverse effects:
• Angina/MI: Increased angina and/or MI have occurred with initiation or dosage titration of dihydropyridine calcium channel blockers. Reflex tachycardia may occur resulting in angina and/or MI in patients with obstructive coronary disease, especially in the absence of concurrent beta-blockade.
• Hypotension: Symptomatic hypotension can occur; acute hypotension upon initiation is unlikely due to the gradual onset of action. Blood pressure must be lowered at a rate appropriate for the patient's clinical condition.
• Peripheral edema: The most common side effect is peripheral edema; occurs within 2 to 3 weeks of starting therapy.
Disease-related concerns:
• Aortic stenosis: Use Amlodipine with extreme caution in patients with severe aortic stenosis; may reduce coronary perfusion resulting in ischemia.
• Heart failure: With the exception of Amlodipine, calcium channel blockers should be avoided whenever possible in patients with heart failure with reduced ejection fraction (HFrEF). Amlodipine may be used for the treatment of hypertension or ischemic heart disease in patients with HFrEF, but has no effect on functional status or mortality (ACCF/AHA [Yancy 2013]).
• Hepatic impairment: Use with caution in patients with hepatic impairment; may require lower starting dose; titrate slowly in patients with severe hepatic impairment.
• Hypertrophic cardiomyopathy (HCM) with outflow tract obstruction: Use Amlodipine with caution in patients with HCM and outflow tract obstruction since reduction in afterload may worsen symptoms associated with this condition (ACCF/AHA [Gersh 2011]).
Special populations:
•
Elderly: Initiate at a lower dose in the elderly.
Other warnings/precautions:
• Titration: Peak antihypertensive effect is delayed; dosage titration should occur after 7 to 14 days on a given dose.
What happens if I miss a dose of Amlodipine?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
References
- DailyMed. "AMOXICILLIN; CLAVULANATE POTASSIUM: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- DrugBank. "amoxicillin". http://www.drugbank.ca/drugs/DB01060 (accessed September 17, 2018).
- DrugBank. "amlodipine". http://www.drugbank.ca/drugs/DB00381 (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
