Amlodipine drug interactions

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Contents 1 Drug-drug interactions 2 Drug-food/drug-herb interactions 3 References

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Drug-drug interactions

Severity level	Drug and description of interaction
4	None known
3	general anesthetics, MAOIs: General anesthetics and MAOIs may potentiate the hypotensive effects of amlodipine.[1][2] rifampin: CYP 3A4 inducers may decrease the plasma concentrations of amlodipine due to induction of the CYP3A4 isoenzyme.[3]
2	alpha blockers, antihypertensive agents, beta-blockers: Alpha-blockers, beta-blocker, and other antihypertensives may potentiate the hypotensive effects of amlodipine.[4] amiodarone, aprepitant, clarithromycin, conivaptan, dalfopristin/quinupristin, delavirdine, efavirenz, erythromycin, ethanol, fluconazole, fluoxetine, fluvoxamine, imatinib, itraconazole, ketoconazole, nefazodone, protease inhibitors, telithromycin, voriconazole: CYP 3A4 inhibitors may increase serum concentrations of amlodipine, which may lead to adverse reactions (e.g. hypotension) or toxicity.[1][4][5][6][7][8][9][10][11] barbiturates, bosentan, carbamazepine, phenytoin, rifabutin, rifapentine: CYP 3A4 inducers may decrease the plasma concentrations of amlodipine due to induction of the CYP3A4 isoenzyme.[8][12][13] local anesthetics: Local anesthetics may potentiate the hypotensive effects of amlodipine.[14] NSAIDs: NSAIDs may decrease the effects of amlodipine.[15]
1	mifepristone, zafirlukast, zileuton: CYP 3A4 inhibitors may increase serum concentrations of amlodipine, which may lead to adverse reactions (e.g. hypotension) or toxicity.[8][16][17] photosensitizing agents: Photosensitizing agents may potentiate the hypotensive effects of amlodipine.[18] calcium salts, oral contraceptives: Calcium salts or oral contraceptives may decrease the effects of amlodipine.[15][19]

Drug-food/drug-herb interactions

Severity level	Drug and description of interaction
4	None known
3	St. John's wort: CYP 3A4 inducers may decrease the plasma concentrations of amlodipine due to induction of the CYP3A4 isoenzyme.[4] melatonin, yohimbine: Melatonin or yohimbine may decrease the hypotensive effects of amlodipine.[20][21]
2	ephedra: Ephedra may decrease the hypotensive effects of amlodipine.[22] ginkgo biloba, ginseng, grapefruit juice: CYP 3A4 inhibitors may increase serum concentrations of amlodipine, which may lead to adverse reactions (e.g. hypotension) or toxicity.[23][24][25] hawthorn: Hawthorn may potentiate the hypotensive effects of amlodipine.[26]
1	None known

References

1. ↑ ^1.0 1.1 Norvasc (amlodipine besylate) package insert,Canada;Pfizer:2006 http:/www.pfizer.com/pfizer/download/uspi_norvasc.pdf
2. ↑ Nardil® (phenelzine) package insert. New York, NY: Pfizer; 2003.
3. ↑ Piepho RW, Culbertson VL, Rhodes RS. Drug interactions with the calcium-entry blockers. Circulation 1987;75(6 Pt 2):V181-94.
4. ↑ ^{4.0 4.1 4.2} Klotz U. Interaction potential of lercanidipine, a new vasoselective dihydropyridine calcium antagonist. Arzneimittelforschung 2002;52(3):155-61.
5. ↑ Emend® (aprepitant) package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2006 Aug.
6. ↑ Vaprisol® (conivaptan hydrochloride injection). Deerfield, IL: Astellas Pharma US, Inc.;2005 Dec.
7. ↑ Synercid® (dalfopristin; quinupristin) package insert. Bristol, TN: Monarch Pharmaceuticals, Inc.; 2003 Jul.
8. ↑ ^{8.0 8.1 8.2} Hansten PD, Horn JR. Cytochrome P450 Enzymes and Drug Interactions, Table of Cytochrome P450 Substrates, Inhibitors, Inducers and P-glycoprotein, withFootnotes. In: The Top 100 Drug Interactions - A guide to Patient Management. 2006 Edition. Edmonds, WA: H&H Publications; 2006:160—174.
9. ↑ Sustiva® (efavirenz) package insert. Princeton, NJ: Bristol-Myers Squibb Company; 2006 Mar.
10. ↑ Johnson RH, Eisenhofer G, Lambie DG. The effects of acute and chronic ingestion of ethanol on the autonomic nervous system. Drug Alcohol Depend 1986;18:319—28.
11. ↑ Ketek™ (telithromycin) package insert. Kansas City, MO: Aventis Pharmaceuticals; 2005 Feb.
12. ↑ Tracleer® (bosentan) package insert. South San Francisco, CA: Actelion Pharmaceuticals US, Inc.; 2005 Nov.
13. ↑ Priftin® (rifapentine) package insert. Kansas City, MO: Aventis Pharmaceuticals Inc.; 2003 Feb.
14. ↑ Naguib M, Magboul MMA, Samarkandi AH, et al. Adverse effects and drug interactions associated with local and regional anesthesia. Drug Safety 1998;18:221—50.
15. ↑ ^15.0 15.1 The sixth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure. National Institute of Health publication No. 99—4080. 1997:1—64.
16. ↑ Accolate® (zafirlukast) package insert. Wilmington, DE: AstraZeneca; 2004 Jul.
17. ↑ Zyflo™ Filmtab® (zileuton) package insert. Chicago, IL: Abbott Laboratories; 1998 Mar.
18. ↑ Busch NA, Reiken SR, Toner M, et al. Intracellular calcium dynamics during photolysis. J Biomech Eng 1998;120:570—8. Abstract.
19. ↑ Salhanick SD, Shannon MW. Management of calcium channel antagonist overdose. Drug Safety 2003;26:65—79.
20. ↑ Lusardi P, Piazza E, Fogari R. Cardiovascular effects of melatonin in hypertensive patients well controlled by nifedipine: a 24-hour study. Br J Clin Pharmacol 2000;49:423—7.
21. ↑ Grossman E, Rosenthal T, Peleg E, et al. Oral yohimbine increases blood pressure and sympathetic nervous outflow in hypertensive patients. J Cardiovasc Pharmacol
22. ↑ Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 2000;343:1833—8.
23. ↑ Dergal JM, Gold JL, Laxer DA, Lee MS, Binns MA, Lanctot KL, et al. Potential interactions between herbal medicines and conventional drug therapies used by older adults attending a memory clinic. Drugs Aging 2002;19(11):879-86.
24. ↑ Herbal-drug therapy interactions: a focus on dementia.
25. ↑ Sica DA. Interaction of grapefruit juice and calcium channel blockers. Am J Hypertens 2006;19(7):768-73.
26. ↑ Blesken R. Crataegus in cardiology. Fortschr Med 1992;110:290—2.