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Amlodipine, an oral dihydropyridine calcium channel blocker, demonstrates prolonged efficacy by inhibiting voltage-dependent L-type calcium channels. This action interrupts initial calcium influx, distinguishing it within its pharmacological class. With a half-life of 30 to 50 hours, amlodipine affords the convenience of once-daily dosing, contrasting with shorter-acting alternatives like nifedipine. Approved as amlodipine besylate by the United States Food and Drug Administration in 1987, this medication has since become a cornerstone in managing hypertension and related conditions. This activity discusses the indications, contraindications, and nuances of amlodipine therapy essential for interprofessional collaboration. By also discussing off-label uses, monitoring protocols, and pharmacokinetic intricacies, healthcare professionals can tailor treatment regimens to individual patient needs. Armed with a comprehensive understanding of amlodipine's pharmacology, healthcare providers are empowered to optimize therapeutic outcomes while mitigating adverse effects, thereby enhancing patient care and safety. Objectives: Identify the United States Food and Drug Administration-approved and off-label indications of amlodipine. Evaluate the mechanism of action of amlodipine. Assess the adverse drug reactions of amlodipine. Implement effective collaboration and communication among interprofessional team members to improve outcomes and treatment efficacy for patients who might benefit from amlodipine pharmacotherapy. Access free multiple choice questions on this topic.

Signs and Symptoms of Overdose Amlodipine overdose and toxicity can lead to massive vasodilation, hypotension, and reflex tachycardia as compensatory mechanisms. Prolonged systemic hypotension can progress to shock and even death. Management of Overdose Activated charcoal should be administered to patients with amlodipine overdose. The hypotension usually remits intravenous (IV) fluid resuscitation, IV calcium gluconate, and vasopressor therapy with norepinephrine or dopamine. High-dose insulin is also sometimes administered as research has shown it lowers mortality and improves hemodynamics. Electrocardiographic results, vital signs, kidney function, urine output, and electrolytes require continual monitoring during an overdose.[48][53] As amlodipine has high plasma protein binding, hemodialysis is not likely to be beneficial. A recent case report describes successful resin hemadsorption/hemoperfusion treatment for amlodipine overdose, demonstrating its efficacy in resolving severe toxicity and hemodynamic instability.[54]

Amlodipine is a first-line choice among the myriad options of antihypertensive agents. Amlodipine has also shown robust reductions in cardiovascular endpoints (especially stroke). In addition, compared to nifedipine and other medications in the dihydropyridine class, amlodipine has the longest half-life at 30 to 50 hours. The benefit of such a long half-life is having once-daily dosing. Therefore, healthcare providers, including physicians, nurse practitioners, physician assistants, and pharmacists, should be familiar with the indications and contraindications of amlodipine. However, the drug can cause severe hypotension in overdose; it is recommended to titrate the dose with an initial low dose gradually. In addition, long-term patient monitoring is necessary for optimal blood pressure control. The PERSONAL-CovidBP trial demonstrated that smartphone-enabled remote precision dosing of amlodipine effectively lowered blood pressure in individuals with primary hypertension during the COVID-19 pandemic.[55]

Amlodipine is a first-line choice among the myriad options of antihypertensive agents. Amlodipine has also shown robust reductions in cardiovascular endpoints (especially stroke). In addition, compared to nifedipine and other medications in the dihydropyridine class, amlodipine has the longest half-life at 30 to 50 hours. The benefit of such a long half-life is having once-daily dosing. Therefore, healthcare providers, including physicians, nurse practitioners, physician assistants, and pharmacists, should be familiar with the indications and contraindications of amlodipine. However, the drug can cause severe hypotension in overdose; it is recommended to titrate the dose with an initial low dose gradually. In addition, long-term patient monitoring is necessary for optimal blood pressure control. The PERSONAL-CovidBP trial demonstrated that smartphone-enabled remote precision dosing of amlodipine effectively lowered blood pressure in individuals with primary hypertension during the COVID-19 pandemic.[55] Amlodipine therapy requires the participation of the entire interprofessional healthcare team. Clinicians and specialists will typically initiate treatment. The pharmacist should report to the clinician for potential drug interactions (eg, simvastatin or erythromycin). In addition, pharmacists should verify dosing and educate the patient about the common adverse drug reactions. The nurse should assess patient adherence and offer to counsel on medication administration. Both nursing and pharmacy staff should alert the prescriber if they encounter any issues. In an acute overdose of amlodipine, emergency physicians and triage nurses should stabilize the patient with a primary focus on circulation. In a massive overdose of amlodipine, it is important to obtain an emergency consultation with a medical toxicologist. Critical care physician supervision is necessary for patients requiring vasopressor therapy in medical intensive care units. The interprofessional team approach can improve patient outcomes related to amlodipine therapy by maximizing efficacy and minimizing the risk of adverse drug reactions. In addition, a pragmatic randomized controlled trial indicated that team-based care involving community pharmacists and nurses working in an interprofessional manner with clinicians could accomplish long-term blood pressure control related to antihypertensive therapy, including calcium channel blockers.[56]