Amlodipine Interactions: A Comprehensive Guide

Nearly half of adults in the United States have hypertension, the medical term for high blood pressure. 

High blood pressure often doesn’t come with any symptoms, which is why it’s known as “the silent killer.” 

High blood pressure makes your heart work harder to pump blood throughout your body and can contribute to heart disease and related incidents like heart attack and stroke.

If you need medication to help manage your high blood pressure, amlodipine might be one of the first choices your healthcare provider suggests. 

What is amlodipine, and does it have any interactions? Do you have to make any special changes to your lifestyle while taking it? 

We’ll answer those questions and more in this article.

What is Amlodipine?

Amlodipine is a type of calcium channel blocker, a prescription medication most often used to treat high blood pressure and chest pain. 

The common brand name for amlodipine is Norvasc, and it comes in oral tablets. The typical dosage of amlodipine is 5-10 milligrams daily.

Drugs like amlodipine work to lower blood pressure by blocking calcium from entering the smooth muscles of the heart and blood vessels, which helps to relax and dilate blood vessels and reduce blood pressure.

Amlodipine is usually used to treat high blood pressure (hypertension), a common condition that can increase your risk of cardiovascular disease. 

Amlodipine can also help prevent angina (chest pain), which is when blood flow to the heart is reduced. Angina is a symptom of coronary artery disease, which can exist with or without high blood pressure.

Amlodipine is considered the first-line choice for medications to treat high blood pressure. It’s also been proven to help reduce the risks of cardiovascular events like heart attack and stroke.

What are the side effects of Amlodipine?

Some of the more common side effects of amlodipine include:

  • Swelling of your hands, feet, ankles, or lower legs
  • Headache
  • Upset stomach
  • Nausea
  • Stomach pain
  • Dizziness or lightheadedness
  • Drowsiness
  • Excessive tiredness
  • Flushing

If you experience some of the more severe side effects listed below, you should consult medical attention:

  • Increase in frequency or severity of chest pain
  • Rapid, pounding, or an irregular heartbeat
  • Fainting

Some of the side effects of stopping amlodipine include:

  • Rebound high blood pressure
  • Chest pain
  • Hemodynamic problems
  • Dizziness
  • Headaches

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What drugs can Amlodipine interact with? 

Amlodipine is known to have interactions with several medications, which can impact how the drugs work. Ask your healthcare provider or pharmacist about taking any of the following medications while also taking amlodipine.

  • Antibiotics such as clarithromycin, erythromycin, or rifampicin
  • Other drugs in the same drug class as amlodipine, such as diltiazem or verapamil
  • Other medications for high blood pressure
  • Antifungal medications like itraconazole or ketoconazole
  • Medicines to treat HIV or hepatitis C
  • Anti-epilepsy (seizure) medicines such as carbamazepine, phenytoin, phenobarbital (phenobarbitone), and primidone
  • Medications to suppress your immune system (e.g., cyclosporine or tacrolimus)
  • More than 20 milligrams a day of the cholesterol-lowering medicine simvastatin (Zocor)

Amlodipine isn’t known to interact with many herbal supplements or vitamins. It might interact with St. John’s Wort; an herbal supplement used to treat depression. If you’re taking St. John’s Wort, ask your pharmacist if you should discontinue it after starting amlodipine.

Amlodipine disease interactions

If you have certain health conditions, amlodipine might not be a safe choice for you. Some of the health conditions that can interact with amlodipine include:

Cardiogenic shock/hypotension (low blood pressure)

Cardiogenic shock is when your heart can’t pump enough blood to your body, which results in low blood pressure. 

Taking amlodipine when you’re in shock or have low blood pressure can worsen low blood pressure and can be dangerous and even fatal.

Liver disease

Amlodipine is metabolized in your liver. If you have liver disease or liver problems, you might not be able to take amlodipine because it will likely stay in your system much longer than if you didn’t have liver problems.

Congestive heart failure

Some types of calcium channel blockers have worsened outcomes in patients with congestive heart failure.

Does alcohol interact with Amlodipine?

Alcohol isn’t known to interact with amlodipine. However, drinking alcohol while taking amlodipine might increase dizziness, sleepiness, and headaches. 

If you notice these symptoms increasing when you drink alcohol on amlodipine, it would be wise to reduce your alcohol consumption.

Foods to avoid when taking Amlodipine

Amlodipine is meant to treat high blood pressure, which is a major risk factor for developing heart disease. Following a heart-healthy diet while taking amlodipine can help promote healthy blood pressure levels, as well as healthy cholesterol levels.

High-sodium foods

When it comes to your diet, sodium plays a big role in your blood pressure. Sodium (found in table salt) causes your body to retain more fluid, which can increase your blood pressure.

Limiting sodium intake to 1,500 milligrams or less per day is generally recommended if you have high blood pressure. 

The recommended limit for all adults (even without high blood pressure) is 2,300 milligrams and lower, yet the average American consumes 3,400 milligrams of sodium per day. 

Starting with a goal of 2,000 milligrams or less per day would be a great start. To get there, try to limit your portions of or avoid these types of foods while taking amlodipine:

  • Bread and rolls, including quick bread mixes
  • Pizza
  • Sandwiches
  • Cold cuts and cured meats
  • Soups
  • Burritos and tacos
  • Savory snacks (pretzels, jerky, chips, etc.)
  • Cheese
  • Fast food and restaurant food
  • Canned soups
  • Certain condiments (soy sauce, salad dressings, etc.)

Foods high in saturated fat

Diets high in saturated fats might increase your risk of plaque buildup, which can worsen high blood pressure by narrowing your arteries. Eating a lot of saturated fat might also raise your cholesterol, which is another risk factor for heart disease.

Saturated fat is typically found in animal foods like high-fat meat and whole-fat dairy products, but it can also be found in some plant foods, such as coconut and palm fruit.

Eating some saturated fat is okay, but aim to keep your total saturated fat intake to less than 10% of your total calories (less than 22 grams for a 2,000-calorie diet). You should be especially mindful of your saturated fat intake if you have existing heart disease or high cholesterol.

Here is a list of foods high in saturated fat to limit or avoid while taking amlodipine:

  • Beef (especially non-lean cuts)
  • Lamb
  • Pork (non-lean cuts)
  • Poultry with the skin on
  • Lard and cream
  • Butter
  • Cheese
  • Ice cream
  • Coconut (including coconut oil)
  • Palm oil and palm kernel oil
  • Some baked and fried foods

Grapefruit

Grapefruit interacts with several medications and can increase the amount of the drug that stays in your system. This can lead to increased side effects as if you were taking a higher dose.

To be safe, avoid eating large amounts of grapefruit or drinking grapefruit juice while taking amlodipine.

However, a study noted that amlodipine is less impacted by grapefruit juice compared to some other blood pressure medications because it is absorbed more efficiently and rapidly. 

In comparison, grapefruit juice is highly interactive with felodipine, another calcium channel blocker, and can increase the bioavailability of the medication by two- to three-fold.

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Foods to eat when taking Amlodipine

Potassium-rich foods

Potassium is a mineral found in many plant-based foods. Potassium helps to relax and widen your blood vessels, which can help lower your blood pressure.

The recommended amount of potassium for men aged 19 and older is 3,400 milligrams per day and 2,600 milligrams per day for women 19 and older. 

Some potassium-rich foods include:

  • Apricots
  • Bananas
  • Cantaloupe
  • Dried fruit
  • Honeydew melon
  • Kiwi
  • Mango
  • Nectarines
  • Oranges and orange juice
  • Papaya
  • Pomegranate and pomegranate juice
  • Prunes and prune juice
  • Pumpkin
  • Raisins
  • Acorn squash, butternut squash, Hubbard squash
  • Avocado
  • Artichoke
  • Beets
  • Baked beans, black beans, refried beans
  • Broccoli (cooked)
  • Brussels sprouts
  • Kohlrabi
  • Lentils
  • Okra
  • Parsnips
  • Potatoes
  • Rutabagas
  • Spinach (cooked)
  • Tomatoes, tomato sauce, and tomato paste
  • Vegetable juice
  • Bran products
  • Chocolate
  • Coconut
  • Creamed soups
  • French fries
  • Granola
  • Ice cream
  • Milk 
  • Miso
  • Molasses
  • Nuts
  • Peanut butter
  • Potato chips
  • Salt substitutes
  • Seeds
  • Tofu
  • Yogurt

Fiber-rich foods

Diets high in fiber can help lower cholesterol levels (high cholesterol and high blood pressure are often linked), and it might even help reduce your blood pressure.

Diets high in fiber are associated with lower rates of chronic diseases, including cardiovascular disease. All plant-based foods contain fiber, such as grains, fruits, and vegetables.

Aim to get at least 25 grams of fiber daily; some of these foods are the richest in fiber:

  • Beans/lentils
  • Berries (especially raspberries)
  • Apples
  • Whole grains (whole wheat bread, whole wheat pasta, barley, etc.)
  • Dark green leafy vegetables
  • Artichokes
  • Broccoli
  • Cauliflower
  • Nuts and seeds

Magnesium-rich foods

Magnesium is another mineral that can help relax your blood vessels and help naturally lower your blood pressure. Many people don’t get enough magnesium in their diets.

Magnesium is found in many foods that are also high in fiber, such as:

  • Pumpkin seeds
  • Almonds
  • Spinach
  • Cashews
  • Peanuts
  • Soymilk
  • Black beans
  • Edamame
  • Dark chocolate
  • Peanut butter
  • Whole wheat bread

Foods rich in healthy fats

We already discussed how saturated fat might contribute to plaque buildup in your arteries and raise cholesterol levels. Swapping out saturated fat for more heart-healthy unsaturated fats can help promote better heart health.

Omega-3 fatty acids are found in unsaturated fats and are associated with reduced blood pressure levels. Some examples of healthy fats, some of which are high in omega-3 fatty acids, include:

  • Plant-based oils such as olive oil, canola oil, and flaxseed oil
  • Nuts
  • Seeds
  • Avocadoes
  • Fatty fish like salmon, mackerel, and sardines
  • Cod liver oil
  • Algae oil (for vegans/vegetarians)

Conclusion

Amlodipine (Norvasc) is a first-choice medication to treat high blood pressure. It works by blocking calcium from entering smooth muscle and arteries, helping blood vessels to relax and widen.

There are a few medications to avoid while taking amlodipine, such as certain antibiotics, some other blood pressure medications, and higher doses of a cholesterol medication called simvastatin.

While taking amlodipine, it’s recommended to eat a heart-healthy diet, including fiber-rich foods and unsaturated fatty acids. Avoid eating saturated fats as your primary fat source, as well as high-sodium foods that can raise your blood pressure.

Explore More

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High Blood Pressure Diet: Foods To Eat And Avoid.

Sources

  1. Fares H, DiNicolantonio JJ, O’Keefe JH, Lavie CJ. Amlodipine in hypertension: a first-line agent with efficacy for improving blood pressure and patient outcomes. Open Heart. 2016 Sep. 
  2. Domenic A. Sica, Interaction of Grapefruit Juice and Calcium Channel Blockers, American Journal of Hypertension, Volume 19, Issue 7, July 2006, Pages 768–773. 
  3. Filippini T, Naska A, Kasdagli MI, Torres D, Lopes C, Carvalho C, Moreira P, Malavolti M, Orsini N, Whelton PK, Vinceti M. Potassium Intake and Blood Pressure: A Dose-Response Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc. 2020 Jun.

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