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Norvasc (amlodipine) Disease Interactions

There are 4 disease interactions with Norvasc (amlodipine):

Major

Ccbs (Includes Norvasc) ↔ Cardiogenic Shock/Hypotension

Severe Potential Hazard, High plausibility

Applies to: Cardiogenic Shock, Hypotension

In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.

References

  1. "Product Information. Calan (verapamil)." Searle, Skokie, IL.
  2. Stehle G, Buss J, Eibach J, et al "Cardiogenic shock associated with verapamil in a patient with liver cirrhosis." Lancet 336 (1990): 1079
  3. "Product Information. Cardizem (diltiazem)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  4. "Product Information. Vascor (bepridil)." McNeil Pharmaceutical, Raritan, NJ.
  5. Kubota K, Pearce GL, Inman WHW "Vasodilation-related adverse events in diltiazem and dihydropyridine calcium antagonists studied by prescription-event monitoring." Eur J Clin Pharmacol 48 (1995): 1-7
  6. Pahor M, Manto A, Pedone C, Carosella L, Guralnik JM, Carbonin P "Age and severe adverse drug reactions caused by nifedipine and verapamil." J Clin Epidemiol 49 (1996): 921-8
View all 6 references
Major

Ccbs (Includes Norvasc) ↔ Coronary Artery Disease

Severe Potential Hazard, Low plausibility

Applies to: Ischemic Heart Disease

Increased frequency, duration, and/or severity of angina, as well as acute myocardial infarction, have rarely developed during initiation or dosage increase of calcium channel blockers (CCBs), particularly in patients with severe obstructive coronary artery disease and those treated with immediate-release formulations. The mechanism of this effect is not established. Therapy with CCBs should be administered cautiously in patients with significant coronary artery disease.

References

  1. Thomassen AR, Bagger JP, Nielsen TT "Hemodynamic and cardiac metabolic changes during nicardipine-induced myocardial ischemia." Cathet Cardiovasc Diagn 14 (1988): 41-3
  2. Kloner RA "Nifedipine in ischemic heart disease." Circulation 92 (1995): 1074-8
  3. Lambert CR, Hill JA, Feldman RL, Pepine CJ "Myocardial ischemia during intravenous nicardipine administration." Am J Cardiol 55 (1985): 844-5
  4. Myrhed M, Wiholm B-E "Nifedipine: a survey of adverse effects." Acta Pharmacol Toxicol (Copenh) 58 (1986): 133-6
  5. Manga P, Vythilingum "Unstable angina precipitated by nifedipine." S Afr Med J 66 (1984): 144
  6. Furberg CD, Psaty BM, Meyer JV "Nifedipine: dose-related increase in mortality in patients with coronary heart disease." Circulation 92 (1995): 1326-31
  7. Abernathy DR, Schwrtz JB "Calcium-antagonist drugs." N Engl J Med 341 (1999): 1447-57
  8. Oei SG, Oei SK, Brolmann HAM "Myocardial infarction during nifedipine therapy for preterm labor." N Engl J Med 340 (1999): 154
  9. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc, Palo Alto, CA.
  10. Sia STB, MacDonald PS, Triester B, et al "Aggravation of myocardial ischaemia by nifedipine." Med J Aust 142 (1985): 48-50
  11. Schanzenbacher P, Deeg P, Liebau G, Kochsiek K "Paradoxical angina after nifedipine: angiographic documentation." Am J Cardiol 53 (1984): 345-6
  12. "Product Information. Procardia (nifedipine)." Pfizer US Pharmaceuticals, New York, NY.
  13. "Product Information. Sular (nisoldipine)." Zeneca Pharmaceuticals, Wilmington, DE.
  14. Yusuf S "Calcium antagonists in coronary artery disease and hypertension: time for reevaluation?" Circulation 92 (1995): 1079-82
  15. "Product Information. Norvasc (amlodipine)." Pfizer US Pharmaceuticals, New York, NY.
View all 15 references
Major

Ccbs (Includes Norvasc) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Calcium channel blockers (CCBs) are extensively metabolized by the liver. The half-lives of CCBs may be prolonged substantially in patients with severe hepatic impairment, with the potential for significant drug accumulation. In addition, the use of some CCBs has been associated with elevations in serum transaminases, both with and without concomitant elevations in alkaline phosphatase and bilirubin. While these effects may be transient and reversible, several patients have developed cholestasis or hepatocellular injury that was proven by rechallenge. Therapy with CCBs should be administered cautiously and often at reduced dosages in patients with significantly impaired hepatic function. Periodic monitoring of liver function and for excessive pharmacologic effects (e.g., abnormal prolongation of PR interval) is advised, and the dosage adjusted if necessary.

References

  1. "Product Information. Calan (verapamil)." Searle, Skokie, IL.
  2. "Product Information. Procardia (nifedipine)." Pfizer US Pharmaceuticals, New York, NY.
  3. Regardh CG, Edgar B, Olsson R, Kendall M, Collste P, Shansky C "Pharmacokinetics of felodipine in patients with liver disease." Eur J Clin Pharmacol 36 (1989): 473-9
  4. Stern EH, Pitchon R, King BD, Wiener I "Possible hepatitis from verapamil." N Engl J Med 306 (1982): 612-3
  5. Elliott HL, Meredith PA "The clinical consequences of the absorption, distribution, metabolism and excretion of amlodipine." Postgrad Med J 67 (1991): s20-3
  6. Graham D, Dow R, Hall D, Alexander O, Mroszczak E, Freedman A "The metabolism and pharmacokinetics of nicardipine hydrochloride in man." Br J Clin Pharmacol 20 (1985): s23-8
  7. Babany G, Uzzan F, Larrey D, et al "Alcoholic-like liver lesions induced by nifedipine." J Hepatol 9 (1989): 252-5
  8. Giacomini KM, Massoud N, Wong FM, Giacomini JC "Decreased binding of verapamil to plasma proteins in patients with liver disease." J Cardiovasc Pharmacol 6 (1984): 924-8
  9. Ramsch KD, Graefe KH, Scherling D, et al "Pharmacokinetics and metabolism of calcium-blocking agents nifedipine, nitrendipine, and nimodipine." Am J Nephrol 6 (1986): 73-80
  10. "Product Information. DynaCirc (isradipine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  11. Dunselman PH, Edgar B "Felodipine clinical pharmacokinetics." Clin Pharmacokinet 21 (1991): 418-30
  12. Cotting J, Reichen J, Kutz K, Laplanche R, Nuesch E "Pharmacokinetics of isradipine in patients with chronic liver disease." Eur J Clin Pharmacol 38 (1990): 599-603
  13. "Product Information. Plendil (felodipine)." Merck & Co, Inc, West Point, PA.
  14. Brodsky SJ, Cutler SS, Weiner DA, Klein MD "Hepatotoxicity due to treatment with verapamil." Ann Intern Med 94 (1981): 490-1
  15. Rush WR, Alexander O, Hall DJ, Cairncross L, Dow RJ, Graham DJ "The metabolism of nicardipine hydrochloride in healthy male volunteers." Xenobiotica 16 (1986): 341-9
  16. Stopher DA, Beresford AP, Macrae PV, Humphrey MJ "The metabolism and pharmacokinetics of amlodipine in humans and animals." J Cardiovasc Pharmacol 12 (1988): s55-9
  17. McAllister RG Jr, Hamann SR, Blouin RA "Pharmacokinetics of calcium-entry blockers." Am J Cardiol 55 (1985): b30-40
  18. Guarascio P, D'Amato C, Sette P, et al "Liver damage from verapamil." Br Med J 288 (1984): 362-3
  19. Benet LZ "Pharmacokinetics and metabolism of bepridil." Am J Cardiol 55 (1985): c8-13
  20. Toner M, White A, Moriarty J, Clancy L "Allergic urticarial eruption, leukocytosis and abnormal liver function tests following nifedipine administration." Chest 93 (1988): 1320-1
  21. Woodcock BG, Rietbrock N "Verapamil bioavailability and dosage in liver disease." Br J Clin Pharmacol 13 (1982): 240-1
  22. Kumar KL, Colley CA "Verapamil-induced hepatotoxicity." West J Med 160 (1994): 485-6
  23. Raemsch KD, Sommer J "Pharmacokinetics and metabolism of nifedipine." Hypertension 5 (1983): 18-24
  24. Scherling D, Karl W, Ahr G, Ahr HJ, Wehinger E "Pharmacokinetics of nisoldipine. III. Biotransformation of nisoldipine in rat, dog, monkey, and man." Arzneimittelforschung 38 (1988): 1105-10
  25. Shallcross H, Padley SP, Glynn MJ, Gibbs DD "Fatal renal and hepatic toxicity after treatment with diltiazem." Br Med J 295 (1987): 1256-7
  26. Gengo FM, Fagan SC, Krol G, Bernhard H "Nimodipine disposition and haemodynamic effects in patients with cirrhosis and age-matched controls." Br J Clin Pharmacol 23 (1987): 47-53
  27. Meredith P, Elliott H "Clinical pharmacokinetics of amlodipine." Clin Pharmacokinet 22 (1992): 22-31
  28. Traverse JH, Swenson LJ, Mcbride JW "Acute hepatic injury after treatment with diltiazem." Am Heart J 127 (1994): 1636-9
  29. Challenor VF, Waller DG, Renwick AG, et al "The trans-hepatic extraction of nifedipine." Br J Clin Pharmacol 24 (1987): 473-7
  30. Abernathy DR, Schwrtz JB "Calcium-antagonist drugs." N Engl J Med 341 (1999): 1447-57
  31. Finucci GF, Padrini R, Piovan D, et al "Verapamil pharmacokinetics and liver function in patients with cirrhosis." Int J Clin Pharmacol Res 8 (1988): 123-6
  32. Razak TA, McNeil JJ, Sewell RB, Drummer OH, Smallwood RA, Conway EL, Louis WJ "The effect of hepatic cirrhosis on the pharmacokinetics and blood pressure response to nicardipine." Clin Pharmacol Ther 47 (1990): 463-9
  33. Colombo G, Zucchella G, Planca E, Grieco A "Intravenous diltiazem in the treatment of unstable angina: a study of efficacy and tolerance." Clin Ther 9 (1987): 536-47
  34. Woodcock BG, Rietbrock I, Vohringer HF, Rietbrock N "Verapamil disposition in liver disease and intensive-care patients: kinetics, clearance, and apparent blood flow relationships." Clin Pharmacol Ther 29 (1981): 27-34
  35. Johnson KE, Balderston SM, Pieper JA, Mann DE, Reiter MJ "Electrophysiologic effects of verapamil metabolites in the isolated heart." J Cardiovasc Pharmacol 17 (1991): 830-7
  36. Hare DL, Horowitz JD "Verapamil hepatotoxicity: a hypersensitivity reaction." Am Heart J 111 (1986): 610-11
  37. Echizen H, Eichelbaum M "Clinical pharmacokinetics of verapamil, nifedipine and diltiazem." Clin Pharmacokinet 11 (1986): 425-49
  38. Kurosawa S, Kurosawa N, Owada E, et al "Pharmacokinetics of diltiazem in patients with liver cirrhosis." Int J Clin Pharmacol Res 10 (1990): 311-8
  39. Saracheck NS, London RL, Matulewicz TJ, et al "Diltiazem and granulomatous hepatitis." Gastroenterology 88 (1985): 1260-2
  40. Somogyi A, Albrecht M, Kliems G, et al "Pharmacokinetics, bioavailability and ECG response of verapamil in patients with liver cirrhosis." Br J Clin Pharmacol 12 (1981): 51-60
  41. "Product Information. Vascor (bepridil)." McNeil Pharmaceutical, Raritan, NJ.
  42. Abramson M, Littlejohn GO "Hepatic reactions to nifedipine." Med J Aust 142 (1985): 47-8
  43. Toft E, Vyberg M, Therkelsen K "Diltiazem-induced granulomatous hepatitis." Histopathology 18 (1991): 474-5
  44. "Product Information. Cardizem (diltiazem)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  45. Kleinbloesem CH, van Harten J, Wilson JP, et al "Nifedipine: kinetics and hemodynamic effects in patients with liver cirrhosis after intravenous and oral administration." Clin Pharmacol Ther 40 (1986): 21-8
  46. Tse FL, Jaffe JM "Pharmacokinetics of PN 200-110 (isradipine), a new calcium antagonist, after oral administration in man." Eur J Clin Pharmacol 32 (1987): 361-5
  47. Kates RE "Calcium antagonists: pharmacokinetic properties." Drugs 25 (1983): 113-24
  48. "Product Information. Norvasc (amlodipine)." Pfizer US Pharmaceuticals, New York, NY.
  49. "Product Information. Sular (nisoldipine)." Zeneca Pharmaceuticals, Wilmington, DE.
  50. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc, Palo Alto, CA.
  51. Stehle G, Buss J, Eibach J, et al "Cardiogenic shock associated with verapamil in a patient with liver cirrhosis." Lancet 336 (1990): 1079
  52. "Product Information. Nimotop (nimodipine)." Bayer, West Haven, CT.
  53. Dow RJ, Graham DJM "A reveiw of the human metabolism and pharmacokinetics of nicardipine hydrochloride." Br J Clin Pharmacol 22 (1986): s195-202
View all 53 references
Moderate

Ccbs (Includes Norvasc) ↔ Chf/Ami

Moderate Potential Hazard, Moderate plausibility

Applies to: Congestive Heart Failure, Myocardial Infarction

Calcium channel blockers (CCBs) may have varying degrees of negative inotropic effect. Congestive heart failure (CHF), worsening of CHF, and pulmonary edema have occurred in some patients treated with a CCB, primarily verapamil. Some CCBs have also caused mild to moderate peripheral edema due to localized vasodilation of dependent arterioles and small blood vessels, which can be confused with the effects of increasing left ventricular dysfunction. Although some CCBs have been used in the treatment of CHF, therapy with CCBs should be administered cautiously in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, caution is advised in patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened by administration of a CCB.

References

  1. Batlouni M, Armaganijan D, Ghorayeb N, Magliano MF "Clinical efficacy and tolerability of isradipine in the treatment of mild-to-moderate hypertension in young and elderly patients." J Cardiovasc Pharmacol 19 (1992): s53-7
  2. Fagan TC, Haggert BE, Liss C "Efficacy and tolerability of extended-release felodipine and extended-release nifedipine in patients with mild-to-moderate essential hypertension." Clin Ther 16 (1994): 634-46
  3. "Product Information. Procardia (nifedipine)." Pfizer US Pharmaceuticals, New York, NY.
  4. Sleight P "Calcium antagonists during and after myocardial infarction." Drugs 51 (1996): 216-25
  5. Brogden RN, Sorkin EM "Isradipine: an update of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy in the treatment of mild to moderate hypertension." Drugs 49 (1995): 618-49
  6. Batra AK, Segall PH, Ahmed T "Pulmonary edema with nifedipine in primary pulmonary hypertension." Respiration 47 (1985): 161-3
  7. Elkayam U "Calcium channel blockers in heart failure." Cardiology 89 (1998): 38-46
  8. Prigogine T, Waterlot Y, Gottignies P, et al "Acute nonhemodynamic pulmonary edema with nifedipine in primary pulmonary hypertension." Chest 100 (1991): 563-4
  9. Kubota K, Pearce GL, Inman WHW "Vasodilation-related adverse events in diltiazem and dihydropyridine calcium antagonists studied by prescription-event monitoring." Eur J Clin Pharmacol 48 (1995): 1-7
  10. Lorimer AR, Pringle SD "The safety of felodipine." J Cardiovasc Pharmacol 15 (1990): s85-9
  11. Yedinak KC, Lopez LM "Felodipine: a new dihydropyridine calcium-channel antagonist." DICP 25 (1991): 1193-206
  12. "Product Information. Norvasc (amlodipine)." Pfizer US Pharmaceuticals, New York, NY.
  13. Myrhed M, Wiholm B-E "Nifedipine: a survey of adverse effects." Acta Pharmacol Toxicol (Copenh) 58 (1986): 133-6
  14. Taylor SH, Frais MA, Lee P, Verma SP, Jackson N, Reynolds G, Silke B "A study of the long-term efficacy and tolerability of oral nicardipine in hypertensive patients." Br J Clin Pharmacol 20 (1985): s139-42
  15. "Product Information. Sular (nisoldipine)." Zeneca Pharmaceuticals, Wilmington, DE.
  16. Sundstedt CD, Ruegg PC, Keller A, Waite R "A multicenter evaluation of the safety, tolerability, and efficacy of isradipine in the treatment of essential hypertension." Am J Med 86 (1989): 98-102
  17. Blecker D "Antihypertensive therapy with isradipine in patients with special safety concerns." Angiology 45 (1994): 997-1008
  18. Walton T, Symes LR "Felodipine and isradipine: new calcium-channel-blocking agents for the treatment of hypertension." Clin Pharm 12 (1993): 261-75
  19. "Product Information. DynaCirc (isradipine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  20. Scheidt S, LeWinter MM, Hermanovich J, Venkataraman K, Freedman D "Efficacy and safety of nicardipine for chronic, stable angina pectoris: a multicenter randomized trial." Am J Cardiol 58 (1986): 715-21
  21. Schaefer RM, Aldons PM, Burgess ED, Tilvis R, Singh GP, Rehn L, Morgan TO "Improved tolerability of felodipine compared with amlodipine in elderly hypertensives: A randomised, double-blind study in 535 patients, focusing on vasodilatory adverse events." Int J Clin Pract 52 (1998): 381
  22. Johnson BF, Eisner GM, Mcmahon FG, Jain AK, Rudd P, Sowers JR "A multicenter comparison of adverse reaction profiles of isradipine and enalapril at equipotent doses in patients with essential hypertension." J Clin Pharmacol 35 (1995): 484-92
  23. Gillmer DJ, Kark P "Pulmonary oedema precipitated by nifedipine." Br Med J 280 (1980): 1420-1
  24. "Product Information. Plendil (felodipine)." Merck & Co, Inc, West Point, PA.
  25. Dubois C, Blanchard D "Efficacy and safety of nicardipine in 29,104 patients with hypertension." Clin Ther 11 (1989): 452-60
  26. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc, Palo Alto, CA.
  27. Abernathy DR, Schwrtz JB "Calcium-antagonist drugs." N Engl J Med 341 (1999): 1447-57
  28. "Product Information. Nimotop (nimodipine)." Bayer, West Haven, CT.
  29. Ruegg PC, Nelson DJ "Safety and efficacy of isradipine, alone and in combination, in the treatment of angina pectoris." Am J Med 86 (1989): 70-4
View all 29 references

Norvasc (amlodipine) drug Interactions

There are 640 drug interactions with Norvasc (amlodipine)

Norvasc (amlodipine) alcohol/food Interactions

There are 2 alcohol/food interactions with Norvasc (amlodipine)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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