DARZALEX 100mg/5ml Price

Overview

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This medicine contains an important and useful components, as it consists of
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Name

Amlodipine + Benazepril Hydrochloride

Precaution

- **Renal Impairment**: Caution is required when using the combination of amlodipine and benazepril in patients with renal impairment. Renal function should be closely monitored, and dose adjustments may be necessary, especially in patients with a history of kidney disease. - **Hyperkalemia**: Benazepril, an ACE inhibitor, can increase potassium levels in the blood (hyperkalemia), which can be dangerous. Regular monitoring of potassium levels is recommended, especially in patients with renal impairment or those taking potassium supplements or potassium-sparing diuretics. - **Hypotension**: Patients who are volume-depleted (e.g., from diuretic use or diarrhea) may experience excessive blood pressure lowering, leading to symptomatic hypotension. Amlodipine can contribute to this effect, especially during the initiation of therapy. Close monitoring of blood pressure is advised. - **Cough and Angioedema**: ACE inhibitors, including benazepril, may cause a persistent dry cough or angioedema (swelling of the lips, face, throat, or tongue). If any of these occur, discontinuation of benazepril is usually required. - **Pregnancy**: The combination is contraindicated during pregnancy, especially in the second and third trimesters, due to the risk of fetal harm. ACE inhibitors can cause injury or death to the developing fetus. If pregnancy is detected, this medication should be discontinued immediately. - **Elderly Patients**: Older adults may be more sensitive to the blood pressure-lowering effects of this combination, and may experience a higher risk of dizziness, fainting, or electrolyte imbalances. Lower starting doses and careful monitoring are recommended. - **Liver Dysfunction**: Benazepril should be used with caution in patients with liver disease as it is metabolized in the liver. Monitoring liver function is advised, particularly during the initial stages of therapy.

Indication

- **Hypertension (High Blood Pressure)**: The combination of amlodipine and benazepril is primarily indicated for the treatment of high blood pressure (hypertension). Amlodipine, a calcium channel blocker, helps relax and widen blood vessels, while benazepril, an ACE inhibitor, lowers blood pressure by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. - **Chronic Kidney Disease (CKD)**: This combination is also used in patients with hypertension and chronic kidney disease, as ACE inhibitors like benazepril can help protect kidney function by reducing the pressure in the kidneys and improving blood flow. - **Congestive Heart Failure**: The combination may be used in patients with heart failure to help reduce the symptoms of fluid retention and to improve heart function. Amlodipine improves blood flow, while benazepril reduces the strain on the heart by lowering blood pressure and decreasing fluid retention. - **Diabetic Nephropathy**: For patients with diabetes and hypertension, this combination can help manage blood pressure while also protecting the kidneys from further damage. Benazepril has renal protective effects, particularly in diabetic patients with proteinuria (excess protein in the urine).

Contra indication

- **Hypersensitivity**: This combination should not be used in patients with a known hypersensitivity to amlodipine, benazepril, or any component of the medication. - **Angioedema**: If a patient has a history of angioedema (swelling of the face, lips, tongue, or throat) associated with ACE inhibitors, they should not use benazepril. The combination is also contraindicated in patients with hereditary or idiopathic angioedema. - **Pregnancy**: The use of amlodipine and benazepril is contraindicated during pregnancy, especially in the second and third trimesters. ACE inhibitors can cause significant harm to the developing fetus, including kidney failure and fetal death. - **Severe Renal Impairment**: In patients with severe renal impairment (creatinine clearance less than 30 mL/min), this combination should be avoided, or the dose adjusted and renal function closely monitored. - **Bilateral Renal Artery Stenosis**: This combination should be avoided in patients with bilateral renal artery stenosis as ACE inhibitors can further impair renal function in such patients.

Side Effect

- **Common Side Effects**: - **Amlodipine**: - Peripheral edema (swelling in the ankles or feet) - Dizziness or lightheadedness - Flushing - Headache - **Benazepril**: - Cough (dry, persistent) - Dizziness or lightheadedness - Fatigue - Nausea or vomiting - **Serious Side Effects**: - **Amlodipine**: - Severe hypotension (very low blood pressure) - Tachycardia (increased heart rate) - Worsening chest pain (angina) or heart attack - **Benazepril**: - Angioedema (swelling of the throat, face, or lips) - Hyperkalemia (high potassium levels in the blood) - Renal dysfunction (kidney damage) - **Combination Side Effects**: - Rhabdomyolysis (muscle breakdown, rare but possible when combined with other risk factors) - Elevated liver enzymes (especially with benazepril) - **Allergic Reactions**: - Rash, pruritus (itching) - Rare cases of anaphylaxis - **Electrolyte Imbalance**: The combination can cause changes in electrolyte levels, such as hypokalemia or hyperkalemia, and should be monitored in patients at risk.

Pregnancy Category ID

4

Mode of Action

- **Amlodipine (Calcium Channel Blocker)**: Amlodipine works by inhibiting the entry of calcium into vascular smooth muscle and cardiac muscle cells. This leads to relaxation of the blood vessels (vasodilation), lowering peripheral resistance and blood pressure. It also helps to improve oxygen delivery to the heart by dilating the coronary arteries, making it effective in treating hypertension and angina. - **Benazepril (ACE Inhibitor)**: Benazepril works by inhibiting the enzyme angiotensin-converting enzyme (ACE), which is responsible for converting angiotensin I into angiotensin II. Angiotensin II is a potent vasoconstrictor that increases blood pressure and fluid retention. By inhibiting ACE, benazepril reduces the levels of angiotensin II, leading to vasodilation, decreased blood pressure, and reduced strain on the heart and kidneys. It also helps prevent the progression of kidney disease in hypertensive patients. - **Synergistic Effect**: The combination of amlodipine and benazepril works synergistically to treat high blood pressure and improve cardiovascular health. Amlodipine provides direct vasodilation, lowering systemic vascular resistance, while benazepril reduces the effects of angiotensin II, enhancing the blood pressure-lowering effect. Together, they improve outcomes in patients with hypertension, heart failure, and chronic kidney disease.

Interaction

- **Diuretics**: When combined with diuretics, especially those that can increase potassium levels (e.g., spironolactone), the risk of hyperkalemia can increase. Careful monitoring of potassium levels is essential. - **Other Antihypertensive Agents**: When used with other antihypertensive medications (e.g., beta-blockers, other ACE inhibitors, or ARBs), there is an increased risk of hypotension, particularly during the initiation phase of therapy. - **NSAIDs**: Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the antihypertensive effects of benazepril and increase the risk of kidney damage when combined with ACE inhibitors. - **Lithium**: The combination of amlodipine and benazepril may increase lithium levels, leading to an increased risk of lithium toxicity. Monitoring of lithium levels is recommended. - **Potassium Supplements**: Potassium supplements or potassium-sparing diuretics may increase the risk of hyperkalemia when taken with benazepril. Potassium levels should be monitored regularly. - **Alcohol**: Alcohol can enhance the blood pressure-lowering effects of this combination, increasing the risk of hypotension.

Pregnancy Category Note

Information not available

Adult Dose

- **Hypertension**: - **Amlodipine**: 5 mg once daily, which may be increased to 10 mg once daily based on response. - **Benazepril**: 10 mg once daily, which may be increased up to 40 mg daily in divided doses based on the patient's blood pressure response. - The combination dosage should be tailored according to the patient's individual needs and response to therapy. - **Heart Failure**: Amlodipine 5 mg and benazepril 10 mg are commonly prescribed in combination, but the doses should be adjusted based on blood pressure and clinical condition.

Child Dose

- **Hypertension in Children (6 years and older)**: - Amlodipine: The recommended starting dose is 2.5 mg once daily, which can be increased to 5 mg or higher if necessary. - Benazepril: The recommended starting dose for children aged 6 years and older is 0.08 mg/kg once daily, not exceeding 10 mg per day. Doses may be adjusted based on response.

Renal Dose

- **Renal Impairment**: - Amlodipine generally does not require dose adjustment for renal impairment, but caution is still advised, especially in patients with severe kidney disease. - Benazepril should be used with caution in patients with renal impairment. In patients with creatinine clearance less than 30 mL/min, lower doses of benazepril should be considered. - **Dialysis**: Both amlodipine and benazepril are dialyzable, but dialysis may not completely remove the drug.

Administration

Information not available