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1 Interactions
Drug-Drug: Strong CYP3A4 inhibitors, including ketoconazole, itracona- PDF Page #1
amLODIPine (am-loe-di-peen) zole, and ritonavir mayqlevels. Additive hypotension may occur when used con-
Norvasc currently with fentanyl, other antihypertensives, nitrates, acute ingestion of al-
Classification cohol, or quinidine. Antihypertensive effects may be p by concurrent use of
Therapeutic: antihypertensives nonsteroidal anti-inflammatory agents. Mayqrisk of neurotoxicity with lith-
Pharmacologic: calcium channel blockers ium.qrisk of myopathy with simvastatin (do not exceed 20 mg/day of simvastatin).
Pregnancy Category C Mayqcyclosporine levels.
Drug-Food: Grapefruit juiceqserum levels and effect.
Indications Route/Dosage
Alone or with other agents in the management of hypertension, angina pectoris, and PO (Adults): 5– 10 mg once daily; antihypertensive in fragile or small patients or
vasospastic (Prinzmetal’s) angina. patients already receiving other antihypertensives— initiate at 2.5 mg/day,qas
required/tolerated (up to 10 mg/day) as an antihypertensive therapy with 2.5 mg/day
Action in patients with hepatic insufficiency.
Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, PO (Geriatric Patients): Antihypertensive— Initiate therapy at 2.5 mg/day,qas
resulting in inhibition of excitation-contraction coupling and subsequent contrac- required/tolerated (up to 10 mg/day); antianginal— initiate therapy at 5 mg/day,
tion. Therapeutic Effects: Systemic vasodilation resulting in decreased BP. Coro- qas required/tolerated (up to 10 mg/day).
nary vasodilation resulting in decreased frequency and severity of attacks of angina. PO (Children 6– 17 yr): 2.5– 5 mg once daily.
Pharmacokinetics Hepatic Impairment
Absorption: Well absorbed after oral administration (64– 90%). PO (Adults): Antihypertensive— Initiate therapy at 2.5 mg/day,qas required/tol-
Distribution: Probably crosses the placenta. erated (up to 10 mg/day); antianginal— initiate therapy at 5 mg/day,qas required/
Protein Binding: 95– 98%. tolerated (up to 10 mg/day).
Metabolism and Excretion: Mostly metabolized by the liver.
Half-life: 30– 50 hr (qin geriatric patients and patients with hepatic impairment). NURSING IMPLICATIONS
TIME/ACTION PROFILE (cardiovascular effects) Assessment
ROUTE ONSET PEAK DURATION ● Monitor BP and pulse before therapy, during dose titration, and periodically dur-
PO unknown 6–9 24 hr ing therapy. Monitor ECG periodically during prolonged therapy.
● Monitor intake and output ratios and daily weight. Assess for signs of HF (periph-
Contraindications/Precautions eral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).
Contraindicated in: Hypersensitivity; Systolic BP ⬍90 mm Hg. ● Angina: Assess location, duration, intensity, and precipitating factors of patient’s
Use Cautiously in: Severe hepatic impairment (dosage reduction recom- anginal pain.
mended); Aortic stenosis; History of HF; OB, Lactation, Pedi: Children ⬍6 yr ● Lab Test Considerations: Total serum calcium concentrations are not affected
(safety not established); Geri: Dose reduction recommended;qrisk of hypotension. by calcium channel blockers.
Adverse Reactions/Side Effects Potential Nursing Diagnoses
CNS: dizziness, fatigue. CV: peripheral edema, angina, bradycardia, hypotension, Ineffective tissue perfusion (Indications)
palpitations. GI: gingival hyperplasia, nausea. Derm: flushing. Acute pain (Indications)
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
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2 ● Caution patient to discuss exercise restrictions with health care professional be-
fore exertion.
Implementation ● Hypertension: Encourage patient to comply with other interventions for hyper- PDF Page #2
● Do not confuse amlodipine with amiloride. Do not confuse Norvasc with tension (weight reduction, low-sodium diet, smoking cessation, moderation of al-
Navane. cohol consumption, regular exercise, and stress management). Medication con-
● PO: May be administered without regard to meals. trols but does not cure hypertension.
● Instruct patient and family in proper technique for monitoring BP. Advise patient
Patient/Family Teaching to take BP weekly and to report significant changes to health care professional.
● Advise patient to take medication as directed, even if feeling well. Take missed
doses as soon as possible unless almost time for next dose; do not double doses. Evaluation/Desired Outcomes
May need to be discontinued gradually. ● Decrease in BP.
● Advise patient to avoid large amounts (6– 8 glasses of grapefruit juice/day) during ● Decrease in frequency and severity of anginal attacks.
therapy. ● Decrease in need for nitrate therapy.
● Instruct patient on correct technique for monitoring pulse. Instruct patient to con- ● Increase in activity tolerance and sense of well-being.
tact health care professional if heart rate is ⬍50 bpm.
● Caution patient to change positions slowly to minimize orthostatic hypotension. Why was this drug prescribed for your patient?
● May cause drowsiness or dizziness. Advise patient to avoid driving or other activi-
ties requiring alertness until response to the medication is known.
● Instruct patient on importance of maintaining good dental hygiene and seeing
dentist frequently for teeth cleaning to prevent tenderness, bleeding, and gingival
hyperplasia (gum enlargement).
● Instruct patient to notify health care professional of all Rx or OTC medications, vi-
tamins, or herbal products being taken, to avoid alcohol, and to consult health
care professional before taking any new medications, especially cold prepara-
tions.
● Advise patient to notify health care professional if irregular heartbeats, dyspnea,
swelling of hands and feet, pronounced dizziness, nausea, constipation, or hypo-
tension occurs or if headache is severe or persistent.
● Caution patient to wear protective clothing and use sunscreen to prevent photo-
sensitivity reactions.
● Advise patient to inform health care professional of medication regimen before
treatment or surgery.
● Angina: Instruct patient on concurrent nitrate or beta-blocker therapy to con-
tinue taking both medications as directed and to use SL nitroglycerin as needed for
anginal attacks.
● Advise patient to contact health care professional if chest pain does not improve or
worsens after therapy, if it occurs with diaphoresis, if shortness of breath occurs,
or if severe, persistent headache occurs.
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