What can be given to a patient with left ear pain who is taking amlodipine (calcium channel blocker) 10 pills of 100mg and [MEDICATION] 0.4?

Management of Left Ear Pain in a Patient on Amlodipine

For left ear pain in this patient, initiate acetaminophen or NSAIDs (ibuprofen or naproxen) immediately as first-line analgesic therapy, and if the pain is moderate to severe, prescribe a fixed-combination product containing acetaminophen or ibuprofen with an opioid (oxycodone or hydrocodone) limited to a 48-72 hour supply. 1

Immediate Pain Management

• NSAIDs demonstrate superior efficacy compared to placebo in reducing pain during acute otitis externa and should be the preferred first-line agent. 1
• Acetaminophen is an acceptable alternative if NSAIDs are contraindicated. 1
• For moderate to severe pain, use fixed-combination products (acetaminophen/oxycodone or ibuprofen/hydrocodone) with opioids limited to 48-72 hours to mitigate misuse risk. 1
• Administer analgesics at fixed intervals rather than as-needed (PRN) when frequent dosing is required, as pain is easier to prevent than treat. 1

Diagnostic Assessment Required

• A normal otoscopic exam with ear pain indicates secondary (referred) otalgia until proven otherwise. 1
• Perform tragus tenderness and pinna traction test—these findings are pathognomonic for acute otitis externa (AOE). 1
• Inspect the canal for edema, erythema, debris, or purulent material to confirm AOE. 1
• Evaluate the tympanic membrane for color, position, translucency, perforation, and mobility to assess for acute otitis media or middle ear effusion. 1
• Pain with chewing suggests temporomandibular joint (TMJ) syndrome or AOE. 1

Definitive Treatment Based on Diagnosis

If Acute Otitis Externa is Confirmed:

• Prescribe topical antibiotics active against Pseudomonas aeruginosa and Staphylococcus aureus as first-line therapy—NOT systemic antibiotics. 1
• Systemic antibiotics should NOT be prescribed for uncomplicated acute otitis externa. 1
• Use non-ototoxic topical preparations if there is any concern for tympanic membrane perforation or tympanostomy tubes. 1

If Secondary (Referred) Otalgia:

• Investigate TMJ dysfunction, dental pathology, pharyngeal sources, or cervical spine issues as potential causes. 1

Critical Safety Considerations with Amlodipine

NSAID Use Warning:

• NSAIDs should be avoided in patients taking amlodipine for hypertension, as they worsen blood pressure control and may precipitate heart failure. 2
• This creates a clinical dilemma since NSAIDs are superior for ear pain but contraindicated with amlodipine therapy.
• In this situation, prioritize acetaminophen as the primary analgesic to avoid NSAID-amlodipine interaction. 1, 2

Amlodipine Dosing Concern:

• The stated dose of "10 pills of 100mg" appears to be an error, as amlodipine is not available in 100mg tablets and maximum dosing is 10mg daily. 3
• Standard amlodipine dosing is 5-10mg once daily. 3
• If this patient is actually taking 1000mg total daily (10 x 100mg), this represents a massive overdose requiring immediate emergency evaluation for hypotension, pulmonary edema, and renal complications. 4, 5, 6

Follow-Up Requirements

• Reassess within 48-72 hours to confirm clinical improvement; complete resolution may take up to 2 weeks, but improvement should be evident within 72 hours. 1
• Lack of improvement by day 5 warrants reassessment for treatment failure, poor adherence, canal obstruction, fungal co-infection, contact dermatitis, or misdiagnosis. 1

What NOT to Use

• Benzocaine otic solution should be avoided as it is NOT FDA-approved for safety, effectiveness, or quality, and may mask progression of underlying disease. 1
• There is no specific indication for topical anesthetic drops in treating acute otitis externa. 1