Can You Take Amlodipine With Other Medications?

If you’re taking amlodipine, it’s important to know how it interacts with other medications. Mixing the wrong drugs can lead to unexpected side effects or reduce the effectiveness of your treatment. But with the right combinations, you can enhance blood pressure control and avoid complications.

You might be wondering, “What works best with amlodipine?” That’s a smart question because the answer depends on your health needs. Whether you’re using ACE inhibitors, ARBs, or diuretics, each combination has pros and cons.

In this article, you’ll learn how common drug combinations with amlodipine affect your blood pressure, the potential risks involved, and how to maximize safety while managing your condition.

🔑 Key Takeaways

➤ You can combine amlodipine with ACE inhibitors to lower your blood pressure more effectively, but you might experience a cough.

➤ Mixing amlodipine with ARBs, like losartan, can improve blood pressure control without increasing side effects.

➤ Combining amlodipine with beta-blockers helps your heart pump more efficiently, but it could lead to low blood pressure.

➤ Pairing diuretics with amlodipine can reduce fluid and lower blood pressure, but alcohol use may cause dizziness or fainting.

➤ Some antibiotics and antifungal medicines can make amlodipine stronger, increasing the risk of side effects like swelling or dizziness.

Grapefruit juice and certain supplements, like ginseng or fish oil, can change how amlodipine works, so be cautious.

Common Combinations

Here’s a quick guide to common drug combinations with amlodipine and how they affect your blood pressure. 

ACE Inhibitors

When you take amlodipine with ACE inhibitors, it can help control your high blood pressure better. This combination is a popular choice for many.

Here are some ACE inhibitors you might use with amlodipine:

  • Lisinopril (Prinivil, Zestril)
  • Enalapril (Vasotec)
  • Ramipril (Altace)
  • Captopril
  • Benazepril (Lotensin)
  • Quinapril (Accupril)
  • Fosinopril

Studies show that combining amlodipine with ACE inhibitors like lisinopril works better than taking amlodipine alone. This combo lowers your systolic blood pressure by 5.72 mmHg and diastolic by 3.62 mmHg more than amlodipine therapy alone. You have a 36% higher chance of reaching your target blood pressure (<140/90 mmHg). Swelling decreases by 60%.

The risk of developing a cough increases by 3.28 times compared to taking amlodipine alone. Still, most people find the benefits worth it because the combination offers better blood pressure control.

ARBs

Pairing amlodipine with ARBs, like losartan, can be more effective than using amlodipine alone for stage 2 hypertension. This mix helps lower your blood pressure and gives better results.

Here are some ARBs you might use with amlodipine:

  • Losartan (Cozaar)
  • Valsartan (Diovan)
  • Olmesartan (Benicar)
  • Irbesartan (Avapro)
  • Candesartan (Atacand)
  • Telmisartan (Micardis)
  • Eprosartan (Teveten)

A study found that combining amlodipine and losartan drops systolic blood pressure by 36.5 mmHg compared to 31.6 mmHg with amlodipine alone. After six weeks, 52.1% of people on the combo reached their blood pressure goal (<140 mmHg), versus 33.3% with just amlodipine. 

This combination also means you might not need higher doses or extra medications. It’s safe, with no significant side effect differences.

Beta-Blockers

Taking amlodipine with a beta-blocker can lower your blood pressure more, but it might also increase the risk of low blood pressure. Why? Amlodipine relaxes your blood vessels, while beta-blockers slow your heart rate and reduce the force of each beat.

Here are some beta-blockers you might take with amlodipine:

  • Atenolol
  • Bisoprolol
  • Carvedilol (Coreg, Coreg CR)
  • Metoprolol (Lopressor, Toprol XL)
  • Nebivolol (Bystolic)
  • Propranolol (Inderal LA, Innopran XL)

One study showed that combining atenolol with amlodipine significantly lowers blood pressure in patients whose hypertension isn’t controlled by atenolol alone. The combination helps keep blood pressure down all day without affecting your body’s circadian rhythm. This combo works well because beta-blockers and amlodipine target blood pressure differently, making each other stronger.

Another study found that amlodipine and metoprolol together effectively lower high blood pressure. Amlodipine relaxes blood vessels, and metoprolol slows your heart to reduce strain. They help your heart pump blood more efficiently. This combination is also used for chest pain, irregular heartbeats, and heart failure. Common side effects include dizziness, headache, and tiredness.

Remember to avoid grapefruit while on this medication and check your blood pressure and sugar levels regularly.

Diuretics

Amlodipine and diuretics like hydrochlorothiazide are often used together to treat high blood pressure. This combo works well because amlodipine relaxes your blood vessels, and hydrochlorothiazide helps reduce extra fluid in your body.

Here are some diuretics you might use with amlodipine:

  • Hydrochlorothiazide (Microzide)
  • Chlorthalidone
  • Indapamide
  • Metolazone (Zaroxolyn)
  • Furosemide (Lasix)
  • Spironolactone (Aldactone)
  • Bumetanide (Bumex)

Amlodipine and hydrochlorothiazide lower blood pressure more than either drug alone. But take precautions. Mixing these medications with alcohol can cause dizziness, fainting, or changes in your heart rate, especially when starting treatment or adjusting your dose.

If your blood pressure isn’t managed with one medicine, talk to your doctor about trying a combination for better results.

Other Drug Interactions

Here’s what you need to know about other drugs that may interact with amlodipine. These interactions can affect how well the medication works or increases the risk of side effects.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDs are common medicines you might take for pain, fever, or swelling. Drugs like ibuprofen are easy to get without a prescription. But when you take NSAIDs with amlodipine, you need to be careful.

NSAIDs have been shown to potentially elevate blood pressure in certain individuals. The process is somewhat complicated, but involves retaining salt, which ultimately influences blood pressure levels. The effect of blood pressure elevation with NSAIDs may be more noticeable if taking blood pressure pills unrelated to amlodipine. For example, a previous study showed that NSAIDs like indomethacin raised the blood pressure in people taking certain blood pressure medicines, such as enalapril, while the same blood pressure effects were not demonstrated in the population taking amlodipine. Because amlodipine works differently than other blood pressure medications and isn’t affected as much by salt levels, it may not be impacted as much by NSAID use.

But, even with amlodipine, it’s possible the blood pressure lowering effects will be limited. It’s always advised to speak with your provider about using NSAIDs with blood pressure medications.

Here are some NSAIDs that can interact with amlodipine:

  • Ibuprofen (Advil, Motrin)
  • Celecoxib (Celebrex)
  • Diclofenac (Cataflam, Zipsor)
  • Naproxen (Aleve, Naprosyn)
  • Meloxicam

Statins

Statins lower your cholesterol and reduce heart risks. However, taking amlodipine with some statins can cause muscle problems. These issues can be serious, like muscle weakness or even breakdown.

Amlodipine slows the enzyme that breaks down certain statins. This makes more statin stay in your body, raising the risk of muscle problems. It’s important to watch this interaction.

Here are some statins that can interact with amlodipine:

  • Lovastatin (Altoprev)
  • Simvastatin (Zocor)
  • Atorvastatin (Lipitor)

One study found that taking amlodipine with simvastatin increased simvastatin levels in the blood by 43% at peak and 28% overall. Even with higher levels, simvastatin still worked well to lower cholesterol.

Amlodipine slightly raises simvastatin levels because the same liver enzyme, CYP3A4, breaks both down. The increase is mild compared to other enzyme blockers, making amlodipine a safer choice with simvastatin.

Antibiotics

Some antibiotics can interact with amlodipine. These include:

  • Ciprofloxacin (Cipro)
  • Clarithromycin
  • Erythromycin (Ery-Tab and others)

Taking amlodipine with these antibiotics may lower your blood pressure too much or cause swelling. These antibiotics change how your body handles amlodipine, making it stronger or causing fluid retention.

One study showed that antibiotics like ampicillin can make your body absorb more amlodipine by affecting gut bacteria. In rats, those given antibiotics had higher levels of amlodipine than those who didn’t.

This means antibiotics can change how amlodipine works, possibly causing side effects. Your doctor may need to monitor you closely if you take both.

Antifungals

Amlodipine can interact with certain antifungal medicines, such as:

  • Itraconazole (Sporanox, Tolsura)
  • Ketoconazole
  • Posaconazole (Noxafil)
  • Voriconazole (Vfend)
  • Fluconazole (Diflucan)

These antifungals stop your liver from breaking down amlodipine. This causes higher levels of amlodipine in your blood, increasing the risk of side effects like:

  • Swelling
  • Flushing
  • Dizziness
  • Low blood pressure

In severe cases, it can lead to toxicity. If you take amlodipine with an antifungal, your doctor might lower your amlodipine dose and watch your blood pressure and swelling closely. Be alert for dizziness, fainting, or swelling, and tell your doctor right away.

Immunosuppressants

Some immunosuppressants can interact with amlodipine. These include:

  • Cyclosporine (Neoral, others)
  • Sirolimus (Rapamune)
  • Tacrolimus (Prograf, others)

Taking amlodipine with these drugs can increase side effects from the immunosuppressants. Studies show that amlodipine can raise tacrolimus levels in the blood by about 45.57%. This is crucial for kidney transplant patients, who need precise dosing to avoid problems.

The interaction depends on your genes. Patients without the CYP3A5 enzyme have much higher tacrolimus levels when taking amlodipine. Your doctor should monitor tacrolimus levels to prevent side effects. Talk to your doctor about adjusting doses if you take both medications.

Rifampin

Rifampin is an uncommon medication typically used to treat tuberculosis (TB) and other resistant or uncommon infections. That said, rifampin can lower the levels of amlodipine in your blood, making amlodipine less effective for high blood pressure. This is a major interaction, and very important to consider if placed on rifampin therapy. 

If you take rifampin and amlodipine together, you might need a dose change, closer monitoring, or a different blood pressure treatment. Rifampin is also affected by food, so take it on an empty stomach—at least 30 minutes before or 2 hours after eating

Phosphodiesterase Inhibitors

Some PDE5 inhibitors can interact with amlodipine. These include:

  • Avanafil (Stendra)
  • Sildenafil (Viagra, Revatio)

One study found that amlodipine made a PDE5 inhibitor (mirodenafil) relax rabbit tissue more. At a certain concentration, relaxation increased to 64%, more than other drugs tested.

This means amlodipine might combine with PDE5 inhibitors, helping treat erectile dysfunction while managing high blood pressure. Using these drugs together could help patients dealing with both conditions, making treatment more effective. But, caution also needs to be taken to avoid low blood pressure scenarios.

Other Interactions

Certain supplements, foods, and substances can interact with amlodipine and affect its effectiveness or increase side effects

Supplements

Be cautious with certain supplements when taking amlodipine. For example, high doses of fish oil can lower your blood pressure too much, which might be dangerous.

St. John’s wort, an herbal supplement used for depression, can make your body break down amlodipine faster. This means the medicine might not work as well. 

Supplements like ginkgo biloba, which is used for memory and anxiety, and ginseng, used for energy and cholesterol, can slow down how your body breaks down amlodipine. This can cause too much amlodipine in your system, increasing the risk of side effects.

Food

Watch what you eat when you’re on amlodipine. Grapefruit juice can raise the amount of amlodipine in your blood, which might lead to more side effects like dizziness or swelling. Also, try to avoid foods high in sodium (salt). High-sodium foods can limit the effects of blood pressure medications.

Alcohol

Drinking alcohol while taking amlodipine can make its blood pressure-lowering effects stronger. This can lead to:

  • Dizziness
  • Lightheadedness
  • Headaches
  • Fainting
  • Changes in your heart rate

These symptoms are most common when you first start taking amlodipine, increase your dose, or restart it after a break. To stay safe, avoid alcohol or drink it very carefully.

Cannabis

Using cannabis with amlodipine can lower your blood pressure even more. You might feel:

  • Dizziness
  • Headaches
  • Lightheadedness
  • Fainting
  • Changes in your heart rate

These effects are more likely when you start amlodipine, increase your dose, or restart it after a break. Avoid driving or using machines until you know how this combination affects you.

When Not to Use Amlodipine

Amlodipine helps manage high blood pressure and heart disease, but there are times you shouldn’t use it.

Allergic Reaction

Don’t take amlodipine if you’re allergic to it or any of its ingredients. Using it again could cause a severe allergic reaction. Amlodipine is a calcium channel blocker, effective for controlling blood pressure, but rare allergic reactions can be dangerous.

Studies show amlodipine can influence central aortic pressure and biomarkers like high-sensitivity C-reactive protein (hsCRP) and adiponectin. These effects indicate potential long-term vascular benefits beyond blood pressure control. 

However, if you’re allergic to amlodipine, these benefits can’t outweigh the risk of a severe allergic response.

Severe Heart Problems

If you have serious heart issues like aortic stenosis or severe coronary artery disease (CAD), amlodipine might not be safe. It could cause:

  • Low blood pressure
  • Chest pain
  • Heart attacks

For example, patients with severe aortic stenosis are at higher risk of low blood pressure from amlodipine. While studies like CAMELOT showed benefits for some heart patients, those with severe obstructive coronary conditions might experience worsened chest pain or heart attacks when starting or increasing the dose.

Liver Conditions

If you have liver problems, be careful with amlodipine. Your liver might not process the medicine well, leading to more side effects. In people with liver disease, especially cirrhosis, amlodipine stays in the body longer—about 60 hours compared to 34 hours in healthy individuals. This means the medication can build up, increasing the chance of adverse effects.

Amlodipine is designed for once-daily dosing with a typical half-life of around 34 hours. However, in those with liver impairment, this clearance slows dramatically. Always have your liver checked before starting amlodipine.

Pregnancy

If you are pregnant or planning to become pregnant, use amlodipine carefully. Animal studies show risks like fewer babies, more miscarriages, and longer labor. Although human data is limited, the FDA classifies amlodipine as a pregnancy category C drug. This means you should only use it if the benefits outweigh the risks to your baby.

Wrap Up

Pairing amlodipine with ACE inhibitors or ARBs can give you better results than using it alone. Diuretics are another option to combine amlodipine with, helping to reduce fluid and improve blood pressure control. However, not every combination is perfect.

You need to watch for risks, like cough with ACE inhibitors or dizziness with diuretics. NSAIDs, statins, and certain antibiotics can also interfere with amlodipine’s effectiveness. Even foods like grapefruit juice and supplements like ginseng might cause problems.

To stay safe, talk to your doctor before trying new combinations. Make sure you know what works for you. 

Frequently Asked Questions

What should I avoid while taking amlodipine?

Avoid grapefruit or grapefruit juice as it can increase side effects. Also, be cautious with alcohol, as it may worsen dizziness.

What are the common side effects of amlodipine?

Side effects include swelling (especially in the ankles), dizziness, headaches, and flushing. 

Can I stop taking amlodipine if I feel better?

No. Stopping suddenly may cause your condition to worsen. Talk to your doctor before making any changes.

Is amlodipine safe during pregnancy?

Amlodipine is generally not recommended for blood pressure treatment during pregnancy. There are other first line agents that are more commonly used. 

Can I take herbal supplements with amlodipine?

Some herbal remedies, like St. John’s wort can interfere with amlodipine. Any herbal supplement use should be discussed with your provider.

What should I do if I miss a dose?

Take it as soon as you remember. If it’s close to your next dose, skip the missed one. Don’t double your dose.

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