Amlodipine Besylate (Page 4 of 5)

14.3 Effects in Vasospastic Angina

In a double-blind, placebo-controlled clinical trial of 4 weeks duration in 50 patients, amlodipine therapy decreased attacks by approximately 4/week compared with a placebo decrease of approximately 1/week (p<0.01). Two of 23 amlodipine and 7 of 27 placebo patients discontinued from the study due to lack of clinical improvement.

14.4 Effects in Documented Coronary Artery Disease

In PREVENT, 825 patients with angiographically documented coronary artery disease were randomized to amlodipine (5 to 10 mg once daily) or placebo and followed for 3 years. Although the study did not show significance on the primary objective of change in coronary luminal diameter as assessed by quantitative coronary angiography, the data suggested a favorable outcome with respect to fewer hospitalizations for angina and revascularization procedures in patients with CAD.

CAMELOT enrolled 1318 patients with CAD recently documented by angiography, without left main coronary disease and without heart failure or an ejection fraction <40%. Patients (76% males, 89% Caucasian, 93% enrolled at US sites, 89% with a history of angina, 52% without PCI, 4% with PCI and no stent, and 44% with a stent) were randomized to double-blind treatment with either amlodipine (5 to 10 mg once daily) or placebo in addition to standard care that included aspirin (89%), statins (83%), beta-blockers (74%), nitroglycerin (50%), anti-coagulants (40%), and diuretics (32%), but excluded other calcium channel blockers. The mean duration of follow-up was 19 months. The primary endpoint was the time to first occurrence of one of the following events: hospitalization for angina pectoris, coronary revascularization, myocardial infarction, cardiovascular death, resuscitated cardiac arrest, hospitalization for heart failure, stroke/TIA, or peripheral vascular disease. A total of 110 (16.6%) and 151 (23.1%) first events occurred in the amlodipine and placebo groups, respectively, for a hazard ratio of 0.691 (95% CI: 0.540–0.884, p = 0.003). The primary endpoint is summarized in Figure 1 below. The outcome of this study was largely derived from the prevention of hospitalizations for angina and the prevention of revascularization procedures (see Table 1). Effects in various subgroups are shown in Figure 2.

In an angiographic substudy (n=274) conducted within CAMELOT, there was no significant difference between amlodipine and placebo on the change of atheroma volume in the coronary artery as assessed by intravascular ultrasound.

Figure 1 — Kaplan-Meier Analysis of Composite Clinical Outcomes for Amlodipine versus Placebo

Figure
(click image for full-size original)

Figure 2 – Effects on Primary Endpoint of Amlodipine versus Placebo across Sub-Groups

Figure
(click image for full-size original)

Table 1 below summarizes the significant composite endpoint and clinical outcomes from the composites of the primary endpoint. The other components of the primary endpoint including cardiovascular death, resuscitated cardiac arrest, myocardial infarction, hospitalization for heart failure, stroke/TIA, or peripheral vascular disease did not demonstrate a significant difference between amlodipine and placebo.

Table 1. Incidence of Significant Clinical Outcomes for CAMELOT
Clinical OutcomesN (%)Amlodipine(N=663)Placebo(N=655)Risk Reduction(p-value)
*
Total patients with these events
Composite CV Endpoint 110(16.6) 151 (23.1) 31% (0.003)
Hospitalization for Angina * 51 (7.7) 84 (12.8) 42%(0.002)
Coronary Revascularization * 78(11.8) 103(15.7) 27%(0.033)

14.5 Studies in Patients with Heart Failure

Amlodipine has been compared to placebo in four 8–12 week studies of patients with NYHA Class II/III heart failure, involving a total of 697 patients. In these studies, there was no evidence of worsened heart failure based on measures of exercise tolerance, NYHA classification, symptoms, or left ventricular ejection fraction. In a long-term (follow-up at least 6 months, mean 13.8 months) placebo-controlled mortality/morbidity study of amlodipine 5–10 mg in 1153 patients with NYHA Classes III (n=931) or IV (n=222) heart failure on stable doses of diuretics, digoxin, and ACE inhibitors, amlodipine had no effect on the primary endpoint of the study which was the combined endpoint of all-cause mortality and cardiac morbidity (as defined by life-threatening arrhythmia, acute myocardial infarction, or hospitalization for worsened heart failure), or on NYHA classification, or symptoms of heart failure. Total combined all-cause mortality and cardiac morbidity events were 222/571 (39%) for patients on amlodipine and 246/583 (42%) for patients on placebo; the cardiac morbid events represented about 25% of the endpoints in the study.

Another study (PRAISE-2) randomized patients with NYHA Class III (80%) or IV (20%) heart failure without clinical symptoms or objective evidence of underlying ischemic disease, on stable doses of ACE inhibitors (99%), digitalis (99%), and diuretics (99%), to placebo (n=827) or amlodipine (n=827) and followed them for a mean of 33 months. There was no statistically significant difference between amlodipine and placebo in the primary endpoint of all-cause mortality (95% confidence limits from 8% reduction to 29% increase on amlodipine). With amlodipine there were more reports of pulmonary edema.

16 HOW SUPPLIED/STORAGE AND HANDLING

16.1 2.5 mg Tablets

Amlodipine – 2.5 mg Tablets, USP (amlodipine besylate equivalent to 2.5 mg of amlodipine per tablet) are supplied as white, diamond shaped tablets engraved with “W59″ on one side and supplied as follows:

Bottle of 30
Bottle of 90
Bottle of 100

16.2 5 mg Tablets

Amlodipine – 5 mg Tablets, USP (amlodipine besylate equivalent to 5 mg of amlodipine per tablet) are white, octagon shaped tablets engraved with “W60″ on one side and supplied as follows:

Bottle of 30
Bottle of 90
Bottle of 100

16.3 10 mg Tablets

Amlodipine – 10 mg Tablets, USP (amlodipine besylate equivalent to 10 mg of amlodipine per tablet) are white, round tablets engraved with “W61″ and supplied as follows:

Bottle of 30
Bottle of 90
Bottle of 100

16.4 Storage

Store bottles at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature]. Dispense in a tight, light-resistant container as defined in the USP.

Patient Information Leaflet

Amlodipine besylate tablets USP, 2.5 mg, 5 mg and 10 mg

Read this information carefully before you start taking amlodipine besylate and each time you refill your prescription. There may be new information. This information does not replace talking with your doctor. If you have any questions about amlodipine besylate , ask your doctor. Your doctor will know if amlodipine besylate is right for you.

What is amlodipine besylate?

Amlodipine besylate is a type of medicine known as a calcium channel blocker (CCB). It is used to treat high blood pressure (hypertension) and a type of chest pain called angina. It can be used by itself or with other medicines to treat these conditions.

High Blood Pressure (hypertension)
High blood pressure comes from blood pushing too hard against your blood vessels. Amlodipine besylate relaxes your blood vessels, which lets your blood flow more easily and helps lower your blood pressure. Drugs that lower blood pressure lower your risk of having a stroke or heart attack.

Angina
Angina is a pain or discomfort that keeps coming back when part of your heart does not get enough blood. Angina feels like a pressing or squeezing pain, usually in your chest under the breastbone. Sometimes you can feel it in your shoulders, arms, neck, jaws, or back. Amlodipine besylate can relieve this pain.

Who should not use amlodipine besylate?

Do not use amlodipine besylate if you are allergic to amlodipine (the active ingredient in amlodipine besylate), or to the inactive ingredients. Your doctor or pharmacist can give you a list of these ingredients.

What should I tell my doctor before taking amlodipine besylate?

Tell your doctor about any prescription and non-prescription medicines you are taking, including natural or herbal remedies.

Tell your doctor if you:

  • ever had heart disease
  • ever had liver problems
  • are pregnant, or plan to become pregnant. Your doctor will decide if amlodipine besylate is the best treatment for you.
  • are breast-feeding. Do not breast-feed while taking amlodipine besylate. You can stop breast-feeding or take a different medicine.

How should I take amlodipine besylate?

  • Take amlodipine besylate once a day, with or without food. You can take amlodipine besylate with most drinks, including grapefruit juice.
  • It may be easier to take your dose if you do it at the same time every day, such as with breakfast, dinner, or at bedtime. Do not take more than one dose of amlodipine besylate at a time.
  • If you miss a dose, take it as soon as you remember. Do not take amlodipine besylate if it has been more than 12 hours since you missed your last dose. Wait and take the next dose at your regular time.
  • Other medicines: You can use nitroglycerin and amlodipine besylate together. If you take nitroglycerin for angina, don’t stop taking it while you are taking amlodipine besylate.
  • While you are taking amlodipine besylate , do not stop taking your other prescription medicines, including any other blood pressure medicines, without talking to your doctor.
  • If you took too much amlodipine besylate , call your doctor or Poison Control Center, or go to the nearest hospital emergency room right away.

What should I avoid while taking amlodipine besylate?

  • Do not breast-feed. It is not known if amlodipine besylate will pass through your milk.
  • Do not start any new prescription or non-prescription medicines or supplements, unless you check with your doctor first.

What are the possible side effects of amlodipine besylate?

Amlodipine besylate may cause the following side effects. Most side effects are mild or moderate:

  • headache
  • swelling of your legs or ankles
  • tiredness, extreme sleepiness
  • stomach pain, nausea
  • dizziness
  • flushing (hot or warm feeling in your face)
  • arrhythmia (irregular heartbeat)
  • heart palpitations (very fast heartbeat)

It is rare, but when you first start taking amlodipine besylate or increase your dose, you may have a heart attack or your angina may get worse. If that happens, call your doctor right away or go directly to a hospital emergency room.

Tell your doctor if you are concerned about any side effects you experience. These are not all the possible side effects of amlodipine besylate. For a complete list, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088 or by visiting www.fda.gov/medwatch.

How do I store amlodipine besylate?

Keep amlodipine besylate away from children. Store amlodipine besylate tablets at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature]. Keep amlodipine besylate out of the light. Do not store in the bathroom. Keep amlodipine besylate in a dry place.

General advice about amlodipine besylate

Sometimes, doctors will prescribe a medicine for a condition that is not written in the patient information leaflets. Only use amlodipine besylate the way your doctor told you to. Do not give amlodipine besylate to other people, even if they have the same symptoms you have. It may harm them.

You can ask your pharmacist or doctor for information about amlodipine besylate , or you can visit the West-ward website at www.west-ward.com.

Distributed by:
West-ward Pharmaceutical Corp.
Eatontown, NJ 07724 USA

Manufactured by:
Hikma Pharmaceuticals
P.O.ox 182400
Amman 11118 — Jordan

Rev. November 2010

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