What is Norvask?

The raised arterial pressure is marked at more than 50 million Americans and is a major factor of the risk of development of cardiovascular diseases — one of the main reasons of death in the USA. Despite of a significant variety of available preparations, it is not possible to achieve adequate decrease of arterial pressure at the majority of patients. If not to conduct treatment there can be such complications as an insult, an atherosclerosis, heart attack, stagnant cardiac and renal insufficiency, blindness. Norvask is the most advanced representative of the family of dihydropyridines, used in cardiology since 70th years. These medicines are applied at treatment of a high pressure and ischemic illness heart disease. They block calcium pumps in cells, expanding vessels and by that reducing resistance to a blood-groove. The operating basis of Novrask, amlodypine, is remarkable by the fact that it affects the vessels 80 times more effectively, than on a fabric of heart, and owing to it almost does not cause loss of activity of a cardiac muscle.

Indications to application

Amlodypine is designated for treatment of an arterial hypertension as means of the first order and it can be used as monotherapy for the control of a level of arterial pressure at the majority of patients. At the patients not enough reacting on any of the hypotensive preparations, the effect can be received at addition of amlodypine which was appointed in a combination with thiazide diuretic, beta-adrenergic blocking agents or inhibitors of angiotensin converting enzyme. Amlodypine was developed as means of the first order for treatment of a myocardial ischemia caused both by organic impassability (a stable stenocardia), and by a spasm/vasoconstriction of coronary arteries (Prinzmetal's angina or an alternative stenocardia). Amlodypine may be also applied in the cases when the clinical picture allows to assume an opportunity of existence of angiospasm/vasoconstriction though the presence of such spasm is not precisely established. Amlopydine is possible to be prescribed as means of monotherapy or in a combination with other antianginal drugs at patients, refractory to treatment by nitrates and/or beta-adrenergic blocking agents in adequate dozes.

Dosage and method of application

At an arterial hypertension and a stenocardia the usual initial doze of amlopydine is 5 mg once a day which can be increased up to the maximal doze of 10 mg, depending on individual reaction of the patient.

Contra-indications

Amlodypine is counter-indicative to patients at whom the allergy to dihydropyridines is revealed.

Special cautions and safety measures at application

• Application for patients with the infringed function of a liver
The period of semi ejection of amlodypine, as well as all antagonists of calcium, at patients with the infringed function of a liver increases, however any recommendations on dosage of a preparation is not developed yet. Therefore at such patients the preparation should be applied with care.
• Application at renal insufficiency
Amlodypine is exposed to an intensive metabolism with formation of inactive metabolites, thus 10 % of a preparation is deduced with urine in not changed kind. Changes of concentration of amlodypine in plasma do not correlate with a degree of infringement of function of kidneys. Amlodypine may be applied in usual dozes for treatment of such patients. Amlodypine is not eliminated during a dialysis.
• Application at the people of the elderly age
At elderly and younger people the time necessary for achievement of the maximal concentration of amlodypine in the plasma of blood, is almost identical. At people of the elderly age the tendency to decrease the clearance of amlodypine is noted, that leads to increase of AUC (the areas of a zone under a curve concentration-time) and the period of semiejection. At the same dozes amlodypine is equally well transferred both by elderly and young patients. Therefore they are recommended usual modes of reception.

By-effects

Norvask is well transferred. During clinical tests by parallel comparison with placebo, in which the patients suffering from an arterial hypertensia and a stenocardia have participated, the most often marked by-effects were headaches, hypostases, weariness, drowsiness, a nausea, pains in a stomach, inflow, palpitation and dizziness. Much less often there were a skin itch, skin rash, breathlessness, asthenia, spasms of muscles, dyspepsia, hyperplasia of gums and in rare cases multiform erythema. These data are received in marketing researches. As well as at application of other antagonists of calcium, the individual by-effects which cannot be separated from consequences of natural current of the basic disease are described: a heart attack of a myocardium, arrhythmia (including ventricular tachycardia and atrial fibrillation) and pains in a thorax. It has not been noted any clinically significant changes of laboratory parameters at treatment by amlodypine.

How should I take Norvask?

• Take amlodipine exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
• Take each dose with a full glass of water.
• Do not stop taking amlodipine without first talking to your doctor, even if you begin to feel better. If you stop taking the medication, your condition could become worse.
• Store amlodipine at room temperature away from moisture and heat.

What happens if I miss a dose?

• Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose?

• Seek emergency medical attention.
• Symptoms of an amlodipine overdose include dizziness, weakness, chest pain, shortness of breath, fainting, unusually fast or slow heartbeat, coma, slurred speech, and confusion.

What should I avoid while taking amlodipine?

• Follow any recommendations your doctor makes about diet or exercise.
• Use caution when you stand or sit up from a lying position, especially if you wake up during the night. You may become dizzy when changing positions.
• Use alcohol cautiously. Alcohol may further lower blood pressure and increase drowsiness or dizziness while taking amlodipine.

What are the possible side effects of amlodipine?

• If you experience any of the following serious side effects, stop taking amlodipine and contact your doctor immediately or seek emergency medical treatment:
  • an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
  • unusually fast or slow heartbeat;
  • chest pain;
  • severe dizziness or fainting;
  • psychosis;
  • jaundice (yellowing of the skin or eyes); or
  • swelling of the legs or ankles.
• Other, less serious side effects may be more likely to occur. Continue to take amlodipine and talk to your doctor if you experience
  • fatigue or tiredness;
  • headache;
  • insomnia;
  • vivid or abnormal dreams;
  • flushing;
  • abdominal pain;
  • nausea, diarrhea, or constipation; or
  • increased or difficult urination.
• Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What drug(s) may interact with amlodipine?

• antiinflammatory drugs (NSAIDs, such as ibuprofen)
• barbiturates such as phenobarbital
• bosentan
• grapefruit juice
• herbal or dietary supplements such as ginger, gingko biloba, ginseng, hawthorn, ma huang (ephedra), melatonin, St. John's wort, went yeast
• imatinib, STI-571
• local anesthetics or general anesthetics
• medicines for fungal infections (fluconazole, itraconazole, ketoconazole, voriconazole)
• medicines for high blood pressure
• medicines for HIV infection or AIDS
• medicines for prostate problems
• medicines for seizures (carbamazepine, phenobarbital, phenytoin, primidone, zonisamide)
• rifampin, rifapentine, or rifabutin
• some antibiotics (clarithromycin, erythromycin, telithromycin, troleandomycin)
• some medicines for heart-rhythm problems (amiodarone, diltiazem, verapamil)
• some medicines for depression or mental problems (fluoxetine, fluvoxamine, nefazodone)
• water pills (diuretics)
• yohimbine
• zafirlukast
• zileuton

What is the shelf life of the pills?

• The expiry date is mentioned on each blister. It is different for different batches. The shelf life is 2 years from the date of manufacture and would differ from batch to batch depending on when they were manufactured.