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Amlodipine Besylate

October 2018

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Amlodipine Besylate

Calcium Channel Blocker (Systemic Drug)

Prescriber Highlights

  • Dihydropyridine calcium channel blocker is often used for treating hypertension, especially in cats
  • Use with caution in patients with heart disease and hepatic dysfunction because it is a slight negative inotrope
  • Hypertension can reoccur rapidly if doses are missed
  • Has the potential to cause anorexia and hypotension in cats, and gingival hyperplasia in dogs
Uses, Indications
  • The treatment of choice for cats with hypertension, according to the International Society of Feline Medicine
  • Can lower blood pressure in dogs with hypertension secondary to renal disease; however, efficacy in lowering blood pressure in dogs due to other causes is not well established
Precautions, Warnings
  • Precautions
    • Patients with heart failure, cardiogenic shock, or hepatic disease, because amlodipine is a slight negative inotrope
    • Use cautiously in patients at risk of hypotension
  • Warnings
    • Not recommended for dogs with pulmonary hypertension because systemic hypotension can occur
    • Shown to activate renin-angiotensin-aldosterone system (RAAS) when used alone in healthy dogs at higher doses
      • Use of amlodipine combined with ACE inhibitors may partially block this effect but routine use together is controversial
Side Effects
  • Hypotension, bradycardia, and inappetence
  • Cats may develop azotemia, lethargy, hypokalemia, reflex tachycardia, and weight loss
  • Dogs may develop reversible gingival hyperplasia
  • Diffuse peripheral edema has been reported in dogs 
Drug Interactions
  • May decrease the antithrombotic effect of clopidogrel
  • May increase cyclosporine and tacrolimus levels
  • Amlodipine levels may be increased with CYP3A4 inhibitors (eg, ketoconazole, itraconazole)
  • Amlodipine levels may be decreased with CYP3A4 inducers (eg, rifampin)
  • Other drugs causing decreased blood pressure may have an additive effect
Monitoring
  • Blood pressure (ie, maintaining systolic blood pressure less than 160mmHg) is recommended in cats
  • Fundic examinations
  • Potassium levels, especially in cats with chronic kidney disease
Client Information
  • May be given with or without food
  • Not skipping doses is very important because hypertension can quickly reoccur
  • Side effects are uncommon, but can include reduced appetite and low blood pressure, especially early in treatment
  • In dogs, overgrowth of the gums can occur
  • Patients will need frequent rechecks with the veterinarian to ensure the medication is working properly 
Dosage Forms
  • Amlodipine oral tablets: 2.5 mg, 5 mg, 10 mg tablets

Compiled and summarized from Plumb’s® Veterinary Drugs by Shannon Palermo, VMD

Information about this drug was adapted from Plumb’s® Veterinary Drugs. Further details and more therapeutics can be found with a subscription at plumbsveterinarydrugs.com

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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