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Norvasc Disease Interactions

There are 4 disease interactions with Norvasc (amlodipine).

Major

CCBs (applies to Norvasc) cardiogenic shock/hypotension

Major Potential Hazard, High plausibility.

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. Eibach J, Buss J, Stehle G, et al. "Cardiogenic shock associated with verapamil in a patient with liver cirrhosis." Lancet 336 (1990): 1079
  2. "Product Information. Vascor (bepridil)." McNeil Pharmaceutical (2002):
  3. "Product Information. Cardizem (diltiazem)." Hoechst Marion Roussel (2002):
  4. "Product Information. Calan (verapamil)." Searle (2001):
  5. Pearce GL, Kubota K, 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. Manto A, Guralnik JM, Pedone C, Carbonin P, Carosella L, Pahor M "Age and severe adverse drug reactions caused by nifedipine and verapamil." J Clin Epidemiol 49 (1996): 921-8
View all 6 references
Major

CCBs (applies to Norvasc) coronary artery disease

Major Potential Hazard, Low plausibility. Applicable conditions: 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. Schanzenbacher P, Deeg P, Kochsiek K, Liebau G "Paradoxical angina after nifedipine: angiographic documentation." Am J Cardiol 53 (1984): 345-6
  2. Manga P, Vythilingum "Unstable angina precipitated by nifedipine." S Afr Med J 66 (1984): 144
  3. MacDonald PS, Triester B, Sia STB, et al. "Aggravation of myocardial ischaemia by nifedipine." Med J Aust 142 (1985): 48-50
  4. Myrhed M, Wiholm B-E "Nifedipine: a survey of adverse effects." Acta Pharmacol Toxicol (Copenh) 58 (1986): 133-6
  5. Lambert CR, Feldman RL, Pepine CJ, Hill JA "Myocardial ischemia during intravenous nicardipine administration." Am J Cardiol 55 (1985): 844-5
  6. Bagger JP, Thomassen AR, Nielsen TT "Hemodynamic and cardiac metabolic changes during nicardipine-induced myocardial ischemia." Cathet Cardiovasc Diagn 14 (1988): 41-3
  7. "Product Information. Norvasc (amlodipine)." Pfizer U.S. Pharmaceuticals (2002):
  8. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc (2002):
  9. "Product Information. Procardia (nifedipine)." Pfizer U.S. Pharmaceuticals (2002):
  10. Furberg CD, Psaty BM, Meyer JV "Nifedipine: dose-related increase in mortality in patients with coronary heart disease." Circulation 92 (1995): 1326-31
  11. Kloner RA "Nifedipine in ischemic heart disease." Circulation 92 (1995): 1074-8
  12. Yusuf S "Calcium antagonists in coronary artery disease and hypertension: time for reevaluation?" Circulation 92 (1995): 1079-82
  13. "Product Information. Sular (nisoldipine)." Astra-Zeneca Pharmaceuticals (2001):
  14. Brolmann HAM, Oei SK, Oei SG "Myocardial infarction during nifedipine therapy for preterm labor." N Engl J Med 340 (1999): 154
  15. Abernathy DR, Schwrtz JB "Calcium-antagonist drugs." N Engl J Med 341 (1999): 1447-57
View all 15 references
Major

CCBs (applies to Norvasc) liver disease

Major Potential Hazard, High plausibility.

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. Eichelbaum M, Echizen H "Clinical pharmacokinetics of verapamil, nifedipine and diltiazem." Clin Pharmacokinet 11 (1986): 425-49
  2. Matulewicz TJ, Saracheck NS, London RL, et al. "Diltiazem and granulomatous hepatitis." Gastroenterology 88 (1985): 1260-2
  3. Gibbs DD, Glynn MJ, Padley SP, Shallcross H "Fatal renal and hepatic toxicity after treatment with diltiazem." Br Med J 295 (1987): 1256-7
  4. Colombo G, Grieco A, Zucchella G, Planca E "Intravenous diltiazem in the treatment of unstable angina: a study of efficacy and tolerance." Clin Ther 9 (1987): 536-47
  5. Therkelsen K, Toft E, Vyberg M "Diltiazem-induced granulomatous hepatitis." Histopathology 18 (1991): 474-5
  6. Abramson M, Littlejohn GO "Hepatic reactions to nifedipine." Med J Aust 142 (1985): 47-8
  7. Clancy L, Toner M, Moriarty J, White A "Allergic urticarial eruption, leukocytosis and abnormal liver function tests following nifedipine administration." Chest 93 (1988): 1320-1
  8. Babany G, Larrey D, Uzzan F, et al. "Alcoholic-like liver lesions induced by nifedipine." J Hepatol 9 (1989): 252-5
  9. Brodsky SJ, Cutler SS, Klein MD, Weiner DA "Hepatotoxicity due to treatment with verapamil." Ann Intern Med 94 (1981): 490-1
  10. Albrecht M, Somogyi A, Kliems G, et al. "Pharmacokinetics, bioavailability and ECG response of verapamil in patients with liver cirrhosis." Br J Clin Pharmacol 12 (1981): 51-60
  11. Rietbrock I, Rietbrock N, Vohringer HF, Woodcock BG "Verapamil disposition in liver disease and intensive-care patients: kinetics, clearance, and apparent blood flow relationships." Clin Pharmacol Ther 29 (1981): 27-34
  12. Rietbrock N, Woodcock BG "Verapamil bioavailability and dosage in liver disease." Br J Clin Pharmacol 13 (1982): 240-1
  13. Pitchon R, Wiener I, King BD, Stern EH "Possible hepatitis from verapamil." N Engl J Med 306 (1982): 612-3
  14. Eibach J, Buss J, Stehle G, et al. "Cardiogenic shock associated with verapamil in a patient with liver cirrhosis." Lancet 336 (1990): 1079
  15. Hare DL, Horowitz JD "Verapamil hepatotoxicity: a hypersensitivity reaction." Am Heart J 111 (1986): 610-11
  16. Guarascio P, D'Amato C, Sette P, et al. "Liver damage from verapamil." Br Med J 288 (1984): 362-3
  17. Graham DJM, Dow RJ "A reveiw of the human metabolism and pharmacokinetics of nicardipine hydrochloride." Br J Clin Pharmacol 22 (1986): s195-202
  18. McAllister RG Jr, Blouin RA, Hamann SR "Pharmacokinetics of calcium-entry blockers." Am J Cardiol 55 (1985): b30-40
  19. Kates RE "Calcium antagonists: pharmacokinetic properties." Drugs 25 (1983): 113-24
  20. Finucci GF, Piovan D, Padrini R, et al. "Verapamil pharmacokinetics and liver function in patients with cirrhosis." Int J Clin Pharmacol Res 8 (1988): 123-6
  21. Giacomini JC, Massoud N, Giacomini KM, Wong FM "Decreased binding of verapamil to plasma proteins in patients with liver disease." J Cardiovasc Pharmacol 6 (1984): 924-8
  22. McNeil JJ, Razak TA, Smallwood RA, Conway EL, Drummer OH, Louis WJ, Sewell RB "The effect of hepatic cirrhosis on the pharmacokinetics and blood pressure response to nicardipine." Clin Pharmacol Ther 47 (1990): 463-9
  23. Alexander O, Graham DJ, Cairncross L, Dow RJ, Hall DJ, Rush WR "The metabolism of nicardipine hydrochloride in healthy male volunteers." Xenobiotica 16 (1986): 341-9
  24. Benet LZ "Pharmacokinetics and metabolism of bepridil." Am J Cardiol 55 (1985): c8-13
  25. Kurosawa N, Kurosawa S, Owada E, et al. "Pharmacokinetics of diltiazem in patients with liver cirrhosis." Int J Clin Pharmacol Res 10 (1990): 311-8
  26. Elliott HL, Meredith PA "The clinical consequences of the absorption, distribution, metabolism and excretion of amlodipine." Postgrad Med J 67 (1991): s20-3
  27. Beresford AP, Macrae PV, Humphrey MJ, Stopher DA "The metabolism and pharmacokinetics of amlodipine in humans and animals." J Cardiovasc Pharmacol 12 (1988): s55-9
  28. Wilson JP, van Harten J, Kleinbloesem CH, et al. "Nifedipine: kinetics and hemodynamic effects in patients with liver cirrhosis after intravenous and oral administration." Clin Pharmacol Ther 40 (1986): 21-8
  29. Sommer J, Raemsch KD "Pharmacokinetics and metabolism of nifedipine." Hypertension 5 (1983): 18-24
  30. Graefe KH, Ramsch KD, Scherling D, et al. "Pharmacokinetics and metabolism of calcium-blocking agents nifedipine, nitrendipine, and nimodipine." Am J Nephrol 6 (1986): 73-80
  31. Challenor VF, Renwick AG, Waller DG, et al. "The trans-hepatic extraction of nifedipine." Br J Clin Pharmacol 24 (1987): 473-7
  32. Dunselman PH, Edgar B "Felodipine clinical pharmacokinetics." Clin Pharmacokinet 21 (1991): 418-30
  33. Collste P, Edgar B, Olsson R, Regardh CG, Kendall M, Shansky C "Pharmacokinetics of felodipine in patients with liver disease." Eur J Clin Pharmacol 36 (1989): 473-9
  34. Laplanche R, Nuesch E, Cotting J, Reichen J, Kutz K "Pharmacokinetics of isradipine in patients with chronic liver disease." Eur J Clin Pharmacol 38 (1990): 599-603
  35. 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
  36. Alexander O, Dow R, Mroszczak E, Freedman A, Graham D, Hall D "The metabolism and pharmacokinetics of nicardipine hydrochloride in man." Br J Clin Pharmacol 20 (1985): s23-8
  37. Bernhard H, Gengo FM, Krol G, Fagan SC "Nimodipine disposition and haemodynamic effects in patients with cirrhosis and age-matched controls." Br J Clin Pharmacol 23 (1987): 47-53
  38. Meredith P, Elliott H "Clinical pharmacokinetics of amlodipine." Clin Pharmacokinet 22 (1992): 22-31
  39. "Product Information. Norvasc (amlodipine)." Pfizer U.S. Pharmaceuticals (2002):
  40. "Product Information. Vascor (bepridil)." McNeil Pharmaceutical (2002):
  41. "Product Information. Cardizem (diltiazem)." Hoechst Marion Roussel (2002):
  42. "Product Information. Plendil (felodipine)." Merck & Company Inc (2002):
  43. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc (2002):
  44. "Product Information. Procardia (nifedipine)." Pfizer U.S. Pharmaceuticals (2002):
  45. "Product Information. Nimotop (nimodipine)." Bayer (2002):
  46. "Product Information. Calan (verapamil)." Searle (2001):
  47. Balderston SM, Johnson KE, Mann DE, Reiter MJ, Pieper JA "Electrophysiologic effects of verapamil metabolites in the isolated heart." J Cardiovasc Pharmacol 17 (1991): 830-7
  48. "Product Information. DynaCirc (isradipine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  49. Colley CA, Kumar KL "Verapamil-induced hepatotoxicity." West J Med 160 (1994): 485-6
  50. Mcbride JW, Swenson LJ, Traverse JH "Acute hepatic injury after treatment with diltiazem." Am Heart J 127 (1994): 1636-9
  51. Ahr G, Ahr HJ, Karl W, Wehinger E, Scherling D "Pharmacokinetics of nisoldipine. III. Biotransformation of nisoldipine in rat, dog, monkey, and man." Arzneimittelforschung 38 (1988): 1105-10
  52. "Product Information. Sular (nisoldipine)." Astra-Zeneca Pharmaceuticals (2001):
  53. Abernathy DR, Schwrtz JB "Calcium-antagonist drugs." N Engl J Med 341 (1999): 1447-57
View all 53 references
Moderate

CCBs (applies to Norvasc) CHF/AMI

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: 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. Kark P, Gillmer DJ "Pulmonary oedema precipitated by nifedipine." Br Med J 280 (1980): 1420-1
  2. Ahmed T, Batra AK, Segall PH "Pulmonary edema with nifedipine in primary pulmonary hypertension." Respiration 47 (1985): 161-3
  3. Myrhed M, Wiholm B-E "Nifedipine: a survey of adverse effects." Acta Pharmacol Toxicol (Copenh) 58 (1986): 133-6
  4. Gottignies P, Prigogine T, Waterlot Y, et al. "Acute nonhemodynamic pulmonary edema with nifedipine in primary pulmonary hypertension." Chest 100 (1991): 563-4
  5. Armaganijan D, Batlouni M, Magliano MF, Ghorayeb N "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
  6. Freedman D, Scheidt S, LeWinter MM, Venkataraman K, Hermanovich J "Efficacy and safety of nicardipine for chronic, stable angina pectoris: a multicenter randomized trial." Am J Cardiol 58 (1986): 715-21
  7. Frais MA, Silke B, Jackson N, Lee P, Reynolds G, Taylor SH, Verma SP "A study of the long-term efficacy and tolerability of oral nicardipine in hypertensive patients." Br J Clin Pharmacol 20 (1985): s139-42
  8. Dubois C, Blanchard D "Efficacy and safety of nicardipine in 29,104 patients with hypertension." Clin Ther 11 (1989): 452-60
  9. Lopez LM, Yedinak KC "Felodipine: a new dihydropyridine calcium-channel antagonist." DICP 25 (1991): 1193-206
  10. Lorimer AR, Pringle SD "The safety of felodipine." J Cardiovasc Pharmacol 15 (1990): s85-9
  11. Keller A, Ruegg PC, Waite R, Sundstedt CD "A multicenter evaluation of the safety, tolerability, and efficacy of isradipine in the treatment of essential hypertension." Am J Med 86 (1989): 98-102
  12. 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
  13. "Product Information. Norvasc (amlodipine)." Pfizer U.S. Pharmaceuticals (2002):
  14. "Product Information. Plendil (felodipine)." Merck & Company Inc (2002):
  15. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc (2002):
  16. "Product Information. Procardia (nifedipine)." Pfizer U.S. Pharmaceuticals (2002):
  17. "Product Information. Nimotop (nimodipine)." Bayer (2002):
  18. "Product Information. DynaCirc (isradipine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  19. Symes LR, Walton T "Felodipine and isradipine: new calcium-channel-blocking agents for the treatment of hypertension." Clin Pharm 12 (1993): 261-75
  20. 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
  21. Blecker D "Antihypertensive therapy with isradipine in patients with special safety concerns." Angiology 45 (1994): 997-1008
  22. 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
  23. Pearce GL, Kubota K, 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
  24. Eisner GM, Rudd P, Mcmahon FG, Jain AK, Johnson BF, 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
  25. "Product Information. Sular (nisoldipine)." Astra-Zeneca Pharmaceuticals (2001):
  26. Sleight P "Calcium antagonists during and after myocardial infarction." Drugs 51 (1996): 216-25
  27. Elkayam U "Calcium channel blockers in heart failure." Cardiology 89 (1998): 38-46
  28. Aldons PM, Burgess ED, Tilvis R, Morgan TO, Rehn L, Schaefer RM, Singh GP "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
  29. Abernathy DR, Schwrtz JB "Calcium-antagonist drugs." N Engl J Med 341 (1999): 1447-57
View all 29 references

Norvasc drug interactions

There are 452 drug interactions with Norvasc (amlodipine).

Norvasc alcohol/food interactions

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


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.