Atorvastatin Amlodipine

A 63-year-old female was on treatment with double antiplatelet medication, bisoprolol, amlodipine, atorvastatin and ranolazine due to a previous medical history of hypertension and unstable angina with no signs of myocardial damage. At 3 months, she began to experience malaise and insomnia. A biochemical study showed an increase in liver function parameters. The most common viral and autoimmune causes were ruled out. Laboratory results pointed towards a hepatocellular toxic-medication source. After cessation of ranolazine the patient was asymptomatic and normalisation of liver function tests was achieved [35]. 

Atorvastatin 40 mg PO once daily Hydrochlorothiazide 25 mg PO once daily Amlodipine 5 mg PO once daily Lantus insulin 30 units per day Multivitamin 1 tablet daily Pantoprazole 40 mg PO once daily Maalox 15 mL PO 4 times daily as needed for heartburn/stomach upset... 

Tablets 5 mg amlodipine besylate/10 mg atorvastatin calcium (as base), 5 mg amlodipine besylate/20 mg atorvastatin calcium (as base), 5 mg amlodipine besylate/40 mg atorvastatin calcium (as base), 5 mg amlodipine besylate/80 mg atorvastatin calcium (as base), 10 mg amlodipine besylate/10 mg atorvastatin calcium (as base), 10 mg amlodipine besylate/20 mg atorvastatin calcium (as base), 10 mg amlodipine besylate/40 mg atorvastatin calcium (as base), 10 mg amlodipine besylate/80 mg atorvastatin calcium (as base) Rx)...

Abbreviations AM, amlodipine AT, atorvastatin DS, diclofenac sodium EZ, ezetimibe FB, fenofibrate HAT, hydroxy atorvastatin IS, internal standard o-HAT, ortfio-hydroxy atorvastatin p-HAT, para-hydroxy atorvastatin HPLC-ESI-MS, high-performance liquid chromatography with electrospray tandem mass spectrometry LV, lovastatin NA, nicotinic acid NB, novobiocin FV, pravastatin RV, rosuastatin SV, simvastatin RT, roxethromycin UPLC, ultra performance liquid chromatography. 

R. Sahu, V.B. Patel, Simultaneous spectrophotometric determination of amlodipine besylate and atorvastatin calcium in binary mixture, Indian J. Pharm. Sci. 69 (2007) 110-111. 

G.B. Chaudhari, N. Patel, P.B. Shah, Stability indicating RP-HPLC method for simultaneous determination of atorvastatin and amlodipine from their combination drug products, Chem. Pharm. Bull. 55 (2007) 241-246. 

While that particular combination isn t currently on the market, one product (Caduet) combines Lipitor (atorvastatin) for cholesterol lowering and Norvasc (amlodipine) for blood pressure reduction. Caduet is available in a wide variety of dosages of both agents, allowing physicians to choose the one that would best suit a particular patient. That s much better than a fixed combination, since typically one size does not fit all. 

Clinically important, potentially hazardous interactions with amlodipine, anisindione, anticoagulants, aprepitant, atorvastatin, barbiturates, benzodiazepines, butabarbital, carbamazepine, chlordiazepoxide, clarithromycin, clonazepam, dorazepate, corticosteroids, cyclosporine, dexamethasone, diazepam, dicumarol, erythromycin, ethotoin, felodipine, flurazepam, fluvastatin, fosphenytoin, isradipine, itraconazole, ketoconazole, lorazepam, lovastatin, mephenytoin, mephobarbital, midazolam, nicardipine, nifedipine, nimodipine, nisoldipine, oxazepam, pentobarbital, phenobarbital, pimozide, pravastatin, primidone, quazepam, rifampin, secobarbital, simvastatin, St John s wort, temazepam, warfarin... 

Atorvastati n/amlod ip ine Pfizer Atorvastatin/amlodipine 10 mg/5 mg Atovastatin/amlodipine Atovastatin/amlodipine... 

Atorvastatin is marketed in combination with the Ca2+-channel blocker amlodipine (Caduet) for patients with hypertension or angina as well as hypercholesterolemia. Atorvastatin is an HMG-CoA reductase inhibitor that increases the rate at which the body removes cholesterol from blood and reduces the production of cholesterol by inhibiting enzymes that catalyze early rate-limiting steps in cholesterol synthesis increases HDL reduces LDL, VLDL, and triglycerides. 

The manufacturers of amlodipine state that it does not affect the pharmacokinetics of atorvastatin. They also note that no clinically significant interactions were seen in clinical studies in which atorvastatin was used with antihypertensives, including unspecified calcium-channel blockers. However, they do warn that drugs that are metabolised by the cytochrome P450 isoenzyme CYP3A4 (e.g. calcium-channel blockers) do have the potential to interact. ... 

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