Amlodipine and Hydrochlorothiazide Combination Availability
No, there is no FDA-approved fixed-dose combination pill containing amlodipine and hydrochlorothiazide as a two-drug formulation. However, these two agents are available together in triple-combination pills that also include a renin-angiotensin system blocker.
Available Triple Combinations Containing Both Drugs
The following FDA-approved single-pill triple combinations include both amlodipine and hydrochlorothiazide:
Amlodipine/valsartan/hydrochlorothiazide (Exforge HCT) is the first fixed-dose triple combination containing these agents along with an ARB, available in multiple dose strengths 1, 2
Amlodipine/aliskiren/hydrochlorothiazide (Amturnide) combines these agents with a direct renin inhibitor in five different formulations with escalating dosages 3, 4
Why This Combination Pattern Exists
The pharmaceutical industry has developed triple combinations rather than the amlodipine/HCTZ dual combination because guidelines recommend combining agents from complementary drug classes. The standard approach pairs a calcium channel blocker (amlodipine) and thiazide diuretic (HCTZ) with a renin-angiotensin system blocker to maximize blood pressure reduction through synergistic mechanisms 5, 6.
The 2013 ESH/ESC Guidelines explicitly favor combinations that have been tested in clinical trials, and the triple combination of ARB + calcium antagonist + diuretic represents a preferred, well-validated approach 5
The 2003 JNC 7 Guidelines list multiple ACE inhibitor/diuretic and ARB/diuretic combinations, as well as ACE inhibitor/calcium channel blocker combinations, but notably do not include a calcium channel blocker/diuretic-only fixed-dose combination 5
Clinical Implications for Prescribing
If you need both amlodipine and hydrochlorothiazide for a patient, you must either prescribe them as separate pills or use a triple combination that includes an ARB or ACE inhibitor:
Prescribe amlodipine and hydrochlorothiazide as separate tablets if the patient does not require or cannot tolerate a renin-angiotensin system blocker 5
Consider a triple combination pill (amlodipine/valsartan/HCTZ or amlodipine/aliskiren/HCTZ) if the patient requires all three drug classes, which improves adherence by reducing pill burden 1, 2
Despite amlodipine being the #2 and hydrochlorothiazide being among the most commonly prescribed antihypertensives in the US, pharmaceutical companies have not developed a two-drug fixed-dose combination of these specific agents 7
Evidence for Triple Combination Efficacy
Triple therapy with amlodipine/valsartan/HCTZ produces significantly greater blood pressure reductions than any dual combination of these agents:
In an 8-week randomized trial, the triple combination achieved superior reductions in systolic and diastolic blood pressure compared to valsartan/HCTZ, amlodipine/HCTZ, or amlodipine/valsartan dual therapy 2
The proportion of patients achieving blood pressure control was significantly greater with triple therapy regardless of age, sex, race, ethnicity, or baseline blood pressure severity 2
The triple combination attenuates diuretic-induced hypokalemia, a common adverse effect of HCTZ monotherapy 1