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Three Rx pill bottles: Amlodipine interactions to avoid
Drug Info

Amlodipine interactions to avoid

Amlodipine interactions typically relate to either magnified amlodipine adverse effects or amplified side effects of the other medication
Chad Shaffer, MD, medical writer and reviewer for SingleCare
By | Jan. 23, 2024

Key takeaways

  • Amlodipine can raise blood levels of the cholesterol-lowering medications simvastatin and lovastatin, putting you at risk of muscle-related adverse effects.

  • Taking the most common prescriptions for impotence, phosphodiesterase inhibitors, along with amlodipine, can lead to steep drops in blood pressure, termed hypotension.

  • Members of the benzodiazepine class of anxiety medications, azole antifungals class, opioid pain relievers, immunosuppressant class, and antipsychotic drugs category all have important interactions with amlodipine.

  • Besides drug interactions, amlodipine can negatively interact with certain health conditions, namely advanced liver disease and heart disease.

  • Whether you are feeling adverse effects from an interaction involving amlodipine or identify that the potential exists on your list of medications, get the medical advice of your healthcare team quickly to determine what action should be taken.

Drug interactions | Food interactions | Other interactions | Avoiding interactions | When to see a doctor

Amlodipine is one of the most frequently used antihypertensives, often chosen because its action as a calcium channel blocker is quite effective for lowering high blood pressure. Unfortunately, it and its brand-name version, Norvasc, are not without their faults, namely side effects like lower leg swelling and constipation and a penchant for drug interactions. You should know some important interactions between amlodipine and other medications and certain health problems. We will cover key ones involving antifungals, erectile dysfunction medications, immunosuppressants, and cholesterol-lowering agents. By gaining this knowledge, you can reach out to your healthcare providers if you find an interaction between amlodipine and one of your other meds or medical conditions.

Amlodipine drug interactions

The issues with drug interactions involving amlodipine relate to either magnified amlodipine adverse effects or amplified side effects of the other medication. Knowing the interaction’s existence and the symptoms to watch for is helpful.

Statins

Statins are a mainstay of hyperlipidemia management, providing lower cholesterol levels and reductions in heart attack and stroke rates. Often, high cholesterol and hypertension coexist, so it is not uncommon to have both a statin and amlodipine on one’s med list. This is perfectly fine most times, but Zocor (simvastatin) and lovastatin are two members of the statin class that can be problematic. In both cases, amlodipine can escalate the risk of muscle pains when taking simvastatin or lovastatin. Talk to your doctor about reducing your statin dose or changing to a different statin.

Phosphodiesterase-5 inhibitors

Inhibiting the enzyme phosphodiesterase-5 (PDE-5) leads to dilated blood vessels and greater penile blood flow, which improves erectile function. If one of these pills for impotence is taken along with amlodipine, a drop in blood pressure can occur, creating a sense of dizziness or fainting. Anyone prescribed this combination should talk to the prescribing professional right away. The PDE-5 inhibitors to watch out for include:

Benzodiazepines

Benzodiazepines, which can offer rapid relief from anxiety and panic symptoms, are frequently utilized, but their habit-forming nature and propensity for sedation restrict their use. Taking some benzodiazepines with amlodipine can be hazardous. Xanax (alprazolam) is one of the better-known members of this drug family. Along with the lesser-known member, midazolam, Xanax interacts with amlodipine, leading to excessive sedation potentially. Before taking the combination, check in with the prescriber or pharmacist about whether avoidance or just caution is advised.

Antipsychotics

You may take an antipsychotic for a mood disorder, like depression or bipolar disorder, or a psychotic disorder. Either way, you should know these drugs can lower blood pressure. Taken alongside amlodipine, the hypotensive effect could progress to syncope or pass out from low blood pressure. Ask your doctor if this concern pertains to you. Antipsychotic class members include:

Opioids

Opioid analgesics relieve pain but often at the expense of feeling drowsy and with the risk of reduced respiration. Amlodipine can compound those problems. If you are feeling these side effects or, better yet, before you run into problems, run it by a healthcare professional if you are taking amlodipine with an opioid like:

CYP3A4 inhibitors

Members of the azole antifungal class are known for their broad use against cutaneous and invasive fungal infections and for their frequent interactions with other drugs. This antifungal class inhibits the CYP3A4 enzyme that metabolizes many common meds. Amlodipine is on the list of meds that azoles can be problematic with. Like the following, Azoles can increase amlodipine levels and lead to hypotension.

Other potent inhibitors of the CYP3A4 enzyme include the antibiotic clarithromycin and the antiviral ritonavir. One timely note is that ritonavir is one of the components of Paxlovid (nirmatrelvir-ritonavir), an oral antiviral for treating Covid-19. Amlodipine therapy may need adjustment if used concurrently with meds that inhibit CYP3A4 enzymes.

Immunosuppressants

Immunosuppressants are in a broad umbrella category of drugs, and most do not interact with amlodipine. However, some important agents do pose a risk. Amlodipine can increase the levels of Prograf (tacrolimus), Rapamune (sirolimus), and Neoral (cyclosporine), all of which serve vital roles in preventing transplant rejection and have critical adverse effects that are avoided through careful dosing and monitoring. Hence, their interaction with amlodipine is of major importance to recognize and discuss among the healthcare team to determine what adjustments to the regimen are needed.

Amlodipine food interactions

It does not matter if you take amlodipine with food or on an empty stomach. Limiting salt intake with amlodipine helps achieve blood pressure control goals.

Amlodipine and grapefruit

Grapefruit juice inhibits the CYP3A4 enzyme that metabolizes amlodipine, so an interaction exists. A study did not find this to affect amlodipine users who had grapefruit juice once daily negatively.

Other amlodipine interactions

Lowering blood pressure is amlodipine’s main utility, one that stimulants can undo. Conversely, the blood pressure effects of amlodipine can be problematic in certain medical scenarios.

Amlodipine and caffeine

In general, substances with a stimulant effect, like caffeine, can somewhat offset the antihypertensive effect of amlodipine. Still, nothing of great significance, but stimulants like cocaine and amphetamines pose more risk.

Amlodipine and heart disease

Lowering blood pressure too much is always a concern, but in the setting of certain heart diseases, it can be more alarming. Suppose blood pressure quickly drops too low and heart rate spikes upward to compensate for anyone with severe coronary artery disease. In that case, the worsening of angina or chest pain can result, or worse, a myocardial infarction or heart attack can occur. Therefore, long-acting dihydropyridine calcium channel blockers like amlodipine are safer than short-acting types like nifedipine. 

Likewise, according to a review article, compared to the non-dihydropyridine calcium channel blockers verapamil and diltiazem, amlodipine may be a better choice in congestive heart failure. Amlodipine does not stifle the heart’s squeezing action as much. It also may not pose as much risk in severe aortic stenosis, a condition marked by a tightened aortic heart valve. Quick dips in blood pressure from short-acting dihydropyridines are probably more risky than amlodipine. Discuss with your cardiac care provider to carefully determine the safety of using amlodipine in these situations.

Amlodipine and liver disease

The liver metabolizes Amlodipine. In impaired hepatic function, blood levels of amlodipine may accumulate, leading to hypotension. You can discuss with your medical provider how to dose amlodipine safely or whether to avoid it.

Amlodipine and breastfeeding

A conversation is needed between a breastfeeding mom and her medical care team to decide whether taking amlodipine is the best option. Amlodipine is detectable in the breast milk of moms taking the drug. Whether it is harmful to infants is not known.

How to minimize amlodipine interactions

Your best bet to minimize amlodipine interactions is to go from realizing that amlodipine can interact with multiple meds and medical conditions to recognizing that your vigilance can help keep you safe. You must be vigilant in keeping up-to-date lists of your prescription drugs, over-the-counter therapies, supplements, and health conditions. Communicate these lists to every healthcare provider that cares for you. 

It also pays to be open-minded to other options for hypertension management. Inexpensive options like lisinopril and hydrochlorothiazide exist, and the SingleCare discount card can help keep costs down.

When to talk to a healthcare provider about amlodipine interactions

Besides keeping and communicating lists, you should ask about interactions every time you are prescribed a new medication or are about to take an over-the-counter product. Your engagement and honest questions help you choose safer options if an amlodipine interaction is troublesome. While we have reviewed some of the amlodipine interactions here, more certainly exist, so getting medical advice from a professional is advisable even if you do not notice an interaction.