From the Guidelines
Norvac, or amlodipine, should be used with caution in patients with hypertension, particularly in diabetic patients, as it may not offer significant advantages over other antihypertensive agents like ACE inhibitors or thiazide diuretics in reducing cardiovascular events or mortality, as suggested by the ALLHAT trial 1. When considering the use of Norvac, it's essential to weigh its benefits against potential risks, especially in specific patient populations. The ALLHAT trial, which compared the effectiveness of different antihypertensive therapies, found that amlodipine did not significantly differ from lisinopril (an ACE inhibitor) or chlorthalidone (a thiazide diuretic) in terms of primary outcomes like combined fatal coronary heart disease or nonfatal myocardial infarction, or all-cause mortality 1. Key points to consider when prescribing Norvac include:
- Starting dose: Typically 5 mg once daily, with potential increases to 10 mg daily for blood pressure control.
- Mechanism of action: Relaxation of blood vessels to reduce blood pressure and workload on the heart.
- Administration: Consistent daily use, with or without food, at the same time each day.
- Side effects: Common effects include swelling, dizziness, flushing, and headache, which may diminish over time.
- Importance of continuous use: Necessary for maintaining blood pressure control, as hypertension is often asymptomatic but can lead to severe health issues if untreated.
- Caution with dosage changes: Abrupt cessation or changes should be supervised by a healthcare provider to avoid sudden blood pressure increases. Given the findings from the ALLHAT trial 1, the choice of Norvac as a first-line agent should be made considering the individual patient's profile, including the presence of diabetes or other cardiovascular risk factors, and weighing the potential benefits against the lack of significant advantages over other antihypertensive medications.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Norvac (Amlodipine) Studies
- The CAMELOT study 2 found that amlodipine reduced adverse cardiovascular events in patients with coronary artery disease and normal blood pressure.
- A literature review 3 indicated that the fixed combination of perindopril and amlodipine may have a positive impact on cardiovascular mortality and morbidity in hypertensive individuals.
- A study on patients with coronary heart disease 4 found that the combination of atorvastatin and amlodipine was effective in reaching recommended lipid and blood pressure targets.
- The PREVENT Investigators study 5 found that amlodipine slowed the progression of carotid artery atherosclerosis, but had no effect on the angiographic progression of coronary atherosclerosis.
- A review paper 6 concluded that amlodipine is a first-line agent with efficacy for improving blood pressure and patient outcomes in hypertension.
Key Findings
- Amlodipine has been shown to reduce adverse cardiovascular events in patients with coronary artery disease and normal blood pressure 2.
- The combination of amlodipine with other medications, such as perindopril and atorvastatin, may have additional benefits in managing hypertension and coronary heart disease 3, 4.
- Amlodipine has been found to slow the progression of carotid artery atherosclerosis, but its effect on coronary atherosclerosis is less clear 5.
- Amlodipine is considered a first-line antihypertensive agent due to its efficacy and safety profile 6.