Amlodipine Can Be Safely Combined With Statins
Yes, amlodipine can be given with statins, and this combination is explicitly recommended by the American Heart Association for most statin types without dose adjustment. 1
Amlodipine With Different Statins
No Interaction - Preferred Combinations
- Amlodipine can be coadministered with atorvastatin, pitavastatin, rosuvastatin, fluvastatin, and pravastatin without evidence of significant interaction and without requiring dose adjustments. 1
- The combination of amlodipine and rosuvastatin is generally safe and well-tolerated with no significant pharmacokinetic interactions. 2
- Amlodipine does not interact significantly with rosuvastatin, and no dose adjustment is required. 2
Minor Interaction - Simvastatin Requires Dose Limitation
- The FDA mandates that when amlodipine is combined with simvastatin, the simvastatin dose must be limited to a maximum of 20 mg daily due to increased simvastatin systemic exposure. 3
- Pharmacokinetic data show a minor increase in statin exposure when amlodipine is coadministered with lovastatin or simvastatin, but combination therapy may still be considered. 1
- The American College of Cardiology recommends considering switching to atorvastatin if higher-intensity statin therapy is needed, as it has no significant interaction with amlodipine and requires no dose adjustment. 4
Clinical Evidence Supporting Combination Therapy
- Fixed-dose combinations of amlodipine and atorvastatin have been demonstrated to reduce cardiovascular events in hypertensive patients with concomitant cardiovascular risk factors. 5
- Treatment with a fixed-dose combination of amlodipine 5 mg and atorvastatin 20 mg led to lower risk of composite cardiovascular outcomes compared to lower doses or free combinations. 6
- The combination effectively reduces both blood pressure and LDL cholesterol without modification of either agent's efficacy. 7
Important Caveats
Contrast With Other Calcium Channel Blockers
- Diltiazem and verapamil are NOT interchangeable with amlodipine - they cause much more significant interactions with statins. 1
- Diltiazem increases simvastatin AUC by 5-fold and requires a maximum simvastatin dose of only 10 mg daily (not 20 mg like amlodipine). 4
- Verapamil has similar potent effects and also requires a 10 mg daily simvastatin limit. 4
Monitoring Considerations
- Monitor for symptoms of hypotension and edema when amlodipine is coadministered with any statin, as amlodipine is a CYP3A4 substrate. 3
- Check liver enzymes and CPK to rule out hepatotoxicity or myopathy caused by statins. 2
- If myopathy or muscle weakness occurs with simvastatin/amlodipine combination, reduce simvastatin dose to 20 mg daily or switch to pravastatin, fluvastatin, or rosuvastatin. 8