Amlodipine cardiovascular effects

Other sex-related differences in cardiovascular effect include the finding that antihypertensive drugs such as amlodipine exhibit greater antihypertensive effects in women than in men (119). Whether this greater response is due to differences in pharmacokinetics or pharmacodynamics is difficult to determine. Better blood pressure control could be explained by higher plasma drug concentrations in women, but pharmacokinetic differences do not necessarily correlate with the pharmacodynamic effects of antihypertensive drugs. 

Kloner RA, Sowers JR, DiBona GF, Gaffney M, Wein M. Sex- and age-related antihypertensive effects of amlodipine. The Amlodipine Cardiovascular Community Trial Study Group. Am J Cardiol 1996 77 713-22. 

The effects of the prototypical calcium channel blockers are seen most prominently in the cardiovascular system (Table 19.1), although calcium channels are widely distributed among excitable cells. The following calcium channel-blocking drugs are clinically the most widely used compounds in this very extensive class of pharmacological agents amlodipine, diltiazem, isradipine, nifedipine, nicardipine, nimodipine, and verapamil. 

Lefrandt JD, Heitmann J, Sevre K, et al. Contrasting effects of verapamil and amlodipine on cardiovascular stress response in hypertension. Br J Clin Pharmacol 2001 52 687-692. 

There is evidence that most NSAIDs can increase blood pressure in patients treated with antihypertensives, although some studies have not found the increase to be clinically relevant. In various small studies, indometacin appeared not to reduce the hypotensive effects of amlodipine, felodipine, nicardipine, nimodipine or verapamil, but it did in one of two studies with nifedipine, and one study with nitrendipine. Similarly, ibuprofen caused a small reduction in the antihypertensive effects of amlodipine. Diclofenac and sulindac appear not to interact with nifedipine, nor ibuprofen, naproxen, piroxicam or sulindac with verapamil, nor naproxen with nicardipine. Low-dose aspirin did not alter the antihypertensive effect of felodipine or nifedipine in one study, and long-term aspirin did not alter the cardiovascular benefits of nitrendipine in another. Diclofenac reduces verapamil serum levels and raises those of isradipine, but these changes are probably unimportant. 

An isolated report describes acute hyperkalaemia and cardiovascular collapse when dantrolene was given to a patient taking verapamil, but not when he was subsequently given nifedipine. Animal studies have found similar effects with the combination of dantrolene and verapamil or diltiazem, but not with nifedipine or amlodipine. 

Dihydropyridine (DHP) drugs such as nifedipine, nicardipine, amlodipine, and others are effective cardiovascular agents for the treatment of hypertension [63], DHPs have been explored for their calcium charmel activity and are foimd as a constituent in a variety of bioactive compounds which show many biological activities such as vasodilator, bronchodilator, antiatherosclerotic, antitumor, antidiabetic, geroprotec-tive, heptaprotective [64], etc. 

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