Can a 50-year-old African American woman with hypertension switch from Nifedipine (Calcium Channel Blocker) 30mg Extended Release (ER) to Amlodipine Besylate (Calcium Channel Blocker) 10mg?

From the Guidelines

A 50-year-old African American woman can switch from nifedipine 30mg ER to amlodipine besylate 10mg for hypertension management, as calcium channel blockers like amlodipine are effective in this population and may offer benefits like consistent 24-hour blood pressure control and potentially fewer side effects 1. When considering this switch, it's crucial to prioritize the patient's comorbid conditions and the specific classes of blood pressure-lowering medications indicated for those conditions, as outlined in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. Key points to consider in this switch include:

• Amlodipine's longer half-life allows for once-daily dosing, which can improve adherence and provide consistent blood pressure control.
• Calcium channel blockers, including amlodipine, have been shown to be effective in preventing stroke and cardiovascular disease in African American patients, making them a suitable choice for this population 1.
• The transition from nifedipine to amlodipine should be done under medical supervision, with the last dose of nifedipine taken and then starting amlodipine the following day.
• Monitoring blood pressure regularly during the transition and reporting any concerning symptoms to the healthcare provider is essential for ensuring the patient's safety and the effectiveness of the new medication regimen. Given the evidence, switching to amlodipine besylate 10mg can be a viable option for managing hypertension in a 50-year-old African American woman, considering its efficacy and potential benefits in this population 1.

From the FDA Drug Label

1 INDICATIONS & USAGE

1. 1 Hypertension Amlodipine besylate tablets is indicated for the treatment of hypertension, to lower blood pressure. Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (e.g., on angina, heart failure, or diabetic kidney disease). These considerations may guide selection of therapy. Amlodipine besylate tablets may be used alone or in combination with other antihypertensive agents.

The patient can switch from nifedipine 30mg ER to amlodipine besylate 10mg to address hypertension, but caution is advised as some antihypertensive drugs have smaller blood pressure effects in black patients. The decision to switch should be made under the guidance of a healthcare professional, considering the patient's individual response to the medication and adjusting the dosage as needed. 2

From the Research

Switching from Nifedipine to Amlodipine

• The decision to switch a 50-year-old African American woman from nifedipine 30mg ER to amlodipine besylate 10mg to address hypertension can be considered based on the pharmacological properties and clinical efficacy of amlodipine 3.
• Amlodipine has been shown to be effective in controlling blood pressure in patients with hypertension, including those with diabetes or chronic kidney disease, without worsening glycemic or kidney function 3, 4.
• A study comparing the effects of amlodipine and nifedipine in hypertensive renal transplant recipients found that both treatments were effective in lowering blood pressure, but amlodipine was more effective in lowering diastolic blood pressure 5.
• However, it is essential to consider the potential risks and benefits of switching medications, including the possibility of side effects or changes in efficacy 6.
• The choice to switch to amlodipine may be justified due to its ability to control blood pressure and protect against stroke and myocardial infarction, particularly in older adults 3.

Considerations for Switching

• When switching between medications, it is crucial to consider the individual patient's clinical status, medical history, and potential interactions with other medications 7, 6.
• The study on switching between β-blockers highlights the importance of considering drug interchangeability, rationale for switching, and necessary initial adjustments to dose/frequency 7.
• In the case of switching from nifedipine to amlodipine, the patient's blood pressure should be closely monitored to ensure that the new medication is effective in controlling hypertension 3, 5.