From the FDA Drug Label
Amlodipine besylate tablets may be used alone or in combination with other antianginal agents Amlodipine besylate tablets is indicated for the symptomatic treatment of chronic stable angina. In patients with recently documented CAD by angiography and without heart failure or an ejection fraction <40%, Amlodipine besylate tablets is indicated to reduce the risk of hospitalization for angina and to reduce the risk of a coronary revascularization procedure.
The provided text does not directly address the management of Amlodipine in the context of STEMI. Key points:
- The label discusses the use of Amlodipine in hypertension and chronic stable angina.
- It does not provide guidance on continuing Amlodipine in patients with STEMI. Therefore, based on the information provided in the drug label, no conclusion can be drawn regarding the continuation of Norvasc (Amlodipine) in a patient with ST-Elevation Myocardial Infarction (STEMI) 1.
From the Research
In patients with ST-Elevation Myocardial Infarction (STEMI), Norvasc (amlodipine) should generally be continued if the patient was previously taking it for hypertension or angina. The standard dose of 5-10 mg daily can be maintained during the acute phase of STEMI management. However, careful monitoring of blood pressure is essential as excessive hypotension could potentially compromise coronary perfusion in the setting of acute myocardial infarction. Amlodipine is a dihydropyridine calcium channel blocker that causes peripheral vasodilation without significant negative inotropic effects, making it relatively safe in the setting of myocardial infarction compared to non-dihydropyridine calcium channel blockers like verapamil or diltiazem.
If the patient develops hypotension (systolic BP <90 mmHg) or cardiogenic shock, amlodipine should be temporarily held. For STEMI patients not previously on amlodipine, it's not typically initiated during the acute phase, as first-line medications would include antiplatelet agents, anticoagulants, beta-blockers, ACE inhibitors/ARBs, and statins as part of guideline-directed medical therapy. According to the most recent study 2, the focus is on optimizing medical therapy for STEMI patients, which may include the use of angiotensin-receptor neprilysin inhibitors (ARNIs) for better outcomes, but this does not directly impact the decision to continue or initiate amlodipine.
Key considerations in managing STEMI patients include:
- Rapid reperfusion strategies, such as primary PCI or thrombolysis, as outlined in guidelines like those discussed in 3.
- Optimal medical therapy, including antiplatelet agents, anticoagulants, beta-blockers, ACE inhibitors/ARBs, and statins, as supported by studies like 4 and 2.
- Monitoring for and managing potential complications, such as hypotension or cardiogenic shock, where the use of certain medications like amlodipine may need to be adjusted.
Given the information from 2, which is the most recent and highest quality study provided, focusing on the management of STEMI and the potential benefits of certain medications in reducing morbidity and mortality, the decision to continue amlodipine in a STEMI patient should be based on the individual patient's clinical context, including their blood pressure and overall cardiovascular status.