Can Norvasc (Amlodipine) and Benapril (Benazepril) be given together?

Amlodipine (Norvasc) and Benazepril (Benapril) Combination for Hypertension Management

Yes, amlodipine (Norvasc) and benazepril (Benapril) can be given together and are considered an effective and recommended combination for hypertension treatment. This combination pairs a calcium channel blocker (amlodipine) with an ACE inhibitor (benazepril) to provide complementary mechanisms of action for blood pressure control.

Evidence Supporting This Combination

The 2024 ESC guidelines for hypertension management specifically recommend combination therapy using a renin-angiotensin system (RAS) blocker (such as an ACE inhibitor like benazepril) with a calcium channel blocker (like amlodipine) as one of the preferred combinations for hypertension treatment 1. This combination is supported by strong evidence for efficacy in blood pressure reduction and cardiovascular event prevention.

The pharmacokinetic profile of benazepril specifically notes that it has been used concomitantly with calcium channel blockers without evidence of clinically important adverse interactions 2. Additionally, studies have confirmed that the pharmacokinetics of benazepril are not affected by amlodipine 2.

Benefits of This Combination

1. Complementary Mechanisms of Action:

   • Amlodipine blocks calcium channels, causing vasodilation
   • Benazepril inhibits the renin-angiotensin-aldosterone system

2. Enhanced Efficacy:

   • The combination provides greater blood pressure reduction than either agent alone
   • Research shows that combining drugs from two different classes results in approximately five times greater BP reduction than doubling the dose of one drug 1

3. Improved Adherence:

   • Available as a fixed-dose combination in a single pill
   • Simplifies treatment regimen and improves patient compliance 3

4. Reduced Side Effects:

   • The combination may allow for lower doses of each individual component
   • May reduce the incidence of peripheral edema associated with amlodipine monotherapy 3

Clinical Application

The 2018 ACC/AHA guidelines recommend considering starting with 2 drugs of different classes for patients with stage 2 hypertension (≥140/90 mmHg) 1. For most patients with confirmed hypertension, combination BP-lowering treatment is recommended as initial therapy, with a RAS blocker (ACE inhibitor or ARB) with a dihydropyridine CCB being one of the preferred combinations 1.

Important Considerations

1. Dosing:

   • Start with appropriate doses based on patient characteristics
   • Fixed-dose combinations are available and preferred to improve adherence 1

2. Monitoring:

   • Monitor blood pressure response
   • Check renal function and electrolytes, particularly potassium, as ACE inhibitors can cause hyperkalemia

3. Contraindications:

   • Avoid in pregnancy
   • Use with caution in patients with severe renal impairment
   • Benazepril dose adjustment may be needed in patients with creatinine clearance ≤30 mL/min 2

4. Drug Interactions:

   • While this specific combination is safe, avoid adding another RAS blocker (such as an ARB) to this regimen
   • The 2013 ESH/ESC guidelines explicitly state that combining two different blockers of the RAS is not recommended 1

Conclusion

The combination of amlodipine and benazepril represents an evidence-based approach to hypertension management that aligns with current guidelines. This combination offers complementary mechanisms of action, enhanced efficacy, and the potential for improved adherence through fixed-dose formulations.