Amlodipine + Benazepril Hydrochloride

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Generic Name of Amlodipine + Benazepril Hydrochloride - Learn More

Amlodipine + Benazepril Hydrochloride

Amlodipine + Benazepril Hydrochloride Precaution - What You Need to Know

The combination of amlodipine and benazepril hydrochloride is commonly used to treat hypertension, and it can provide a complementary approach by combining a calcium channel blocker (amlodipine) with an angiotensin-converting enzyme (ACE) inhibitor (benazepril). However, there are several important precautions to consider:

Amlodipine can cause vasodilation, potentially leading to hypotension, especially after the first dose. Therefore, it should be used cautiously in patients who are volume-depleted, those with low blood pressure, or in patients who are concurrently taking diuretics. The elderly may be more sensitive to the effects of amlodipine, so a lower starting dose may be recommended.

Benazepril, being an ACE inhibitor, can cause hyperkalemia, particularly in patients with renal impairment, and it can also increase the risk of angioedema, a rare but serious allergic reaction involving swelling of the throat, lips, or tongue. The combination of amlodipine and benazepril should be used with caution in patients with a history of angioedema or those who have previously had an allergic reaction to ACE inhibitors.

Patients with renal dysfunction, particularly those with bilateral renal artery stenosis, should avoid this combination, as ACE inhibitors like benazepril can further impair renal function in these individuals. Monitoring of kidney function, electrolytes (especially potassium), and blood pressure is essential, particularly in the early stages of treatment.

During pregnancy, both amlodipine and benazepril fall under Category D (benazepril) and Category C (amlodipine), meaning they should be avoided unless absolutely necessary, as they can harm the fetus. Both drugs are also contraindicated during breastfeeding due to the potential risks to the infant.

Amlodipine + Benazepril Hydrochloride Indication - Uses and Benefits

The primary indications for the combination of amlodipine and benazepril hydrochloride are the treatment of hypertension and, in some cases, heart failure. Amlodipine, as a calcium channel blocker, works by relaxing the smooth muscle in blood vessels, reducing blood pressure by decreasing vascular resistance. It also helps improve coronary blood flow, which can be beneficial in patients with angina.

Benazepril, as an ACE inhibitor, blocks the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. By inhibiting this conversion, benazepril causes vasodilation, leading to a decrease in blood pressure. Additionally, ACE inhibitors help reduce the workload on the heart by preventing the effects of excessive aldosterone secretion and reducing the risk of fluid retention, which is beneficial for heart failure patients.

The combination of amlodipine and benazepril is particularly useful in patients who require multi-faceted blood pressure control, especially those who have not responded well to monotherapy with either a calcium channel blocker or an ACE inhibitor. In some cases, this combination is also used in patients with chronic kidney disease, as ACE inhibitors have been shown to help protect kidney function, particularly in patients with diabetes or proteinuria.

Amlodipine + Benazepril Hydrochloride Contraindications - Important Warnings

The combination of amlodipine and benazepril hydrochloride is contraindicated in patients with a history of hypersensitivity to either drug or other ACE inhibitors. Additionally, it should not be used in patients with a history of angioedema, particularly if related to previous ACE inhibitor therapy, as benazepril may increase the risk of this serious side effect.

The combination is also contraindicated in patients with bilateral renal artery stenosis, as both amlodipine and benazepril can impair renal function in this setting. In patients with a history of severe renal impairment or those on dialysis, the use of benazepril requires caution, as it may exacerbate renal dysfunction and increase the risk of hyperkalemia.

During pregnancy, this combination is contraindicated, especially during the second and third trimesters, as ACE inhibitors like benazepril can cause fetal harm, including renal failure, hypotension, and even death. Amlodipine is not recommended during pregnancy, though its potential risks are less well-studied.

In breastfeeding, both amlodipine and benazepril should be avoided unless the benefits clearly outweigh the risks, as both medications are excreted in breast milk and may affect the nursing infant.

Amlodipine + Benazepril Hydrochloride Side Effects - What to Expect

The most common side effects of the combination of amlodipine and benazepril include dizziness, headache, fatigue, and peripheral edema (swelling in the ankles or feet) due to amlodipine’s vasodilatory effects. These side effects are generally mild but may require dose adjustment or discontinuation if they are persistent or troublesome.

Benazepril, as an ACE inhibitor, can cause hyperkalemia, particularly in patients with pre-existing kidney issues, so potassium levels should be monitored regularly. Other common side effects include a dry cough (a hallmark of ACE inhibitors), dizziness, and gastrointestinal symptoms such as nausea or abdominal discomfort. ACE inhibitors, including benazepril, are also known to cause angioedema, which is a serious swelling of the face, lips, tongue, or throat, and may require immediate medical intervention.

Rare but severe side effects include liver dysfunction, jaundice, or severe allergic reactions. If a patient experiences significant muscle pain, tenderness, or weakness, particularly in the presence of elevated creatine kinase levels, rhabdomyolysis should be considered, though this is more commonly associated with other medications, such as statins.

Amlodipine + Benazepril Hydrochloride Pregnancy Category ID - Safety Information

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Amlodipine + Benazepril Hydrochloride Mode of Action - How It Works

Amlodipine and benazepril work through complementary mechanisms to reduce blood pressure and improve cardiovascular health. Amlodipine is a calcium channel blocker that inhibits the influx of calcium ions into vascular smooth muscle and cardiac cells. This prevents calcium-induced vasoconstriction, resulting in arterial dilation and a reduction in blood pressure. It also helps reduce the workload on the heart by enhancing blood flow to the myocardium and relieving symptoms of angina.

Benazepril, an ACE inhibitor, blocks the enzyme that converts angiotensin I to angiotensin II, a potent vasoconstrictor. By reducing the levels of angiotensin II, benazepril causes vasodilation, decreasing blood pressure and reducing the effects of aldosterone, which helps prevent fluid retention. ACE inhibitors also help improve endothelial function and reduce the progression of cardiovascular disease by preventing the harmful effects of excessive renin-angiotensin-aldosterone system (RAAS) activation, which can worsen heart failure and chronic kidney disease.

When used together, amlodipine and benazepril address both the vascular and hormonal pathways that contribute to hypertension, making the combination therapy more effective for patients who require more comprehensive control of their blood pressure.

Amlodipine + Benazepril Hydrochloride Drug Interactions - What to Avoid

The combination of amlodipine and benazepril may interact with several other medications, potentially enhancing the risk of side effects or altering the effectiveness of the drugs. Co-administration of other antihypertensive drugs, such as diuretics, beta-blockers, or other ACE inhibitors, may lead to an additive hypotensive effect. Careful monitoring of blood pressure is recommended when starting or adjusting doses of these drugs in combination.

Benazepril’s effect may be potentiated by potassium-sparing diuretics or potassium supplements, increasing the risk of hyperkalemia, which can be life-threatening. Amlodipine has a potential interaction with drugs that inhibit the cytochrome P450 3A4 enzyme, such as ketoconazole, clarithromycin, or HIV protease inhibitors, which could increase amlodipine levels, increasing the risk of hypotension and swelling.

Non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen or naproxen, can reduce the antihypertensive effect of both amlodipine and benazepril. NSAIDs can also increase the risk of kidney damage when used with ACE inhibitors. Caution should also be taken when using amlodipine with other medications that affect heart rate or blood pressure, such as beta-blockers or digoxin.

Grapefruit juice can increase the plasma levels of amlodipine by inhibiting its metabolism through the CYP3A4 enzyme. Patients should be advised to limit their intake of grapefruit juice.

Amlodipine + Benazepril Hydrochloride Adult Dose - Recommended Dosage

The typical starting dose of amlodipine is 5 mg once daily. The dose may be increased to a maximum of 10 mg once daily depending on the patient’s response to therapy and tolerability. The recommended dose for benazepril is usually 10 mg once daily, which can be increased up to 40 mg daily based on the patient’s blood pressure levels and response.

The combination product of amlodipine and benazepril is available in fixed doses (e.g., 5 mg amlodipine + 10 mg benazepril). Dosage should be individualized, and close monitoring of blood pressure is necessary to adjust the dose appropriately. In patients with renal impairment, the starting dose of benazepril should be lower (e.g., 5 mg) to reduce the risk of adverse effects.

Amlodipine + Benazepril Hydrochloride Child Dose - Dosage for Children

The combination of amlodipine and benazepril is not typically recommended for pediatric patients. Amlodipine can be used for pediatric hypertension in children aged 6 years or older, starting at 2.5 mg once daily, with a maximum dose of 5 mg. Benazepril is used off-label in children, particularly those with hypertension or heart failure, but dosing is typically based on the individual child’s weight and renal function, and it should be adjusted accordingly.

Because of the potential for serious side effects, such as hyperkalemia and hypotension, close monitoring is essential when using either drug in pediatric patients.

Amlodipine + Benazepril Hydrochloride Renal Dose - Dosage for Kidney Conditions

In patients with mild to moderate renal impairment (creatinine clearance 30-60 mL/min), the usual dose of amlodipine can be used. However, benazepril should be started at a reduced dose (e.g., 5 mg once daily) to avoid an increased risk of hyperkalemia or further renal dysfunction. In patients with severe renal impairment (creatinine clearance < 30 mL/min), both amlodipine and benazepril should be used with caution, and the dose of benazepril may need to be further reduced, or alternative therapy should be considered.

Frequent monitoring of renal function, electrolytes, and blood pressure is required in patients with renal impairment to prevent complications.