Case 1. Acute hepatitis-like syndrome attributed to amlopidine.
A 76 year old man with diabetes and end-stage renal disease developed jaundice while on long term nifedipine therapy (60 mg daily for
3 years) for hypertension. He was taking insulin, but no other medications. He had no risk factors for viral hepatitis and did not drink alcohol. Serum bilirubin was 2.5 mg/dL and rose over the next few months to 6.2 mg/dL. Tests for acute hepatitis A, B and C were negative and abdominal ultrasonography showed a normal liver and gallbladder. Nifedipine was stopped and he recovered rapidly. Several months later, Vamlo was started (10 mg daily) and within 6 weeks, he developed jaundice and a cholestatic pattern of serum enzyme elevations. Once Vamlo was stopped, liver tests improved and were normal three weeks later.
4. How and when to take it
Take Vamlo exactly as your doctor has told you, and follow the directions on the label. If you're not sure, check with your doctor or pharmacist.
It's usual to take Vamlo once a day. You can take Vamlo at any time of day, but try to make sure it's around the same time every day.
Vamlo (am loe' di peen) belongs to the dihydropyridine class of calcium channel blockers and is used in the treatment of both hypertension and angina pectoris. Like other calcium channel blockers, Vamlo acts by blocking the influx of calcium ions into vascular smooth muscle and cardiac muscle cells during membrane depolarization. This action causes relaxation of vascular and arterial smooth muscle cells, resulting in arterial vasodilation and a decrease in cardiac work and oxygen consumption. Vamlo was approved in the United States in 1992 and it remains in wide use, with several million prescriptions filled yearly. Current indications include hypertension and coronary artery disease (angina pectoris). Vamlo is available generically and under the brand name of Norvasc. Tablet strengths include 2.5, 5, and 10 mg. The recommended dose in adults is 2.5 to 10 mg once daily, usually starting with the lowest dose. Chronic therapy is typical. Recently, multiple fixed dose combinations of Vamlo with other agents have become available including Vamlo (5 or 10 mg) with aliskiren (150 or 300 mg: Tekamlo), aliskiren with hydrochlorothiazide (12.5 and 25 mg: Amturnide), atorvastatin (10, 20, 40 or 80 mg: Caduet and generic), benzapril (10, 20 or 40 mg: Lotrel, Amlobenz, and generic), benzapril and hydrochlorothiazide (12.5 and 25 mg: Tribenzor), olmesaran (20 and 40 mg: Azor), and telmisartan (40 or 80 mg: Twynsta), valsartan (160 and 320 mg: Exforge) and valsartan with hydrochlorothiazide (25 mg: Exforge HCT). Like most calcium channel blockers, Vamlo is generally well tolerated. Side effects are largely due to the vasodilating activities and can include headache, flushing, dizziness, fatigue, nausea, diarrhea, palpitations, peripheral edema and rash.
Drugs that control your immune system
Taking Vamlo with these drugs can cause the levels of these medications to increase in your body. This may lead to more side effects. Examples of these drugs include:
Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
This drug comes with several warnings.
Taking these drugs with Vamlo/benazepril can increase the levels of these medications in your body. This means that you may have more side effects. Examples of these drugs include:
This medication contains Vamlo. Do not take Norvasc if you are allergic to Vamlo or any ingredients contained in this drug.
Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.
How to use Vamlo BESYLATE
Read the Patient Information Leaflet if available from your pharmacist before you start taking Vamlo and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth with or without food as directed by your doctor, usually once daily.
Some brands of the liquid form of this medication should be shaken before use, while other brands should not be shaken before use. Check the manufacturer's information or ask your pharmacist for specific directions. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.
The dosage is based on your medical condition and response to treatment. Your doctor may gradually increase your dose. Follow your doctor's instructions carefully.
Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick.
If used for angina, this medication must be taken regularly to be effective. It should not be used to treat angina when it occurs. Use other medications (such as sublingual nitroglycerin) to relieve an angina attack as directed by your doctor. Consult your doctor or pharmacist for details.
Tell your doctor if your condition does not improve or if it worsens (for example, your blood pressure readings remain high or increase, chest pain continues or worsens).
What are the side effects of Vamlo besylate (Norvasc)?
Side effects of Vamlo are generally mild and reversible. The two most common side effects are:
Other side effects include:
More serious side effects include:
Increase in the frequency and severity of angina or heart attack due to Vamlo happens on rare occasions in patients with severe coronary artery disease when first starting Vamlo, or at the time of an increase in dosage. Excessive lowering of blood pressure during initiation of Vamlo treatment can occur, especially in patients already taking other medications that lower blood pressure. In rare instances, congestive heart failure has been associated with Vamlo, particularly in patients already taking a beta blocker.
What Is Vamlo and How Does It Work?
Vamlo a prescription medication that is used with or without other medications to treat high blood pressure. Lowering blood pressure helps prevent strokes, heart attacks, and kidney problems. Vamlo belongs to a class of drugs known as calcium channel blockers. It works by relaxing blood vessels so blood can flow more easily.
Vamlo is also used to prevent certain types of chest pain (angina). It may help to increase your ability to exercise and decrease the frequency of angina attacks. It should not be used to treat attacks of chest pain when they occur. Use other medications (such as sublingual nitroglycerin) to relieve attacks of chest pain as directed by your doctor.
Vamlo is available under the following different brand names: Norvasc.
Dosage of Vamlo Besylate
Dosage for the patients suffering from High blood pressure (hypertension):
Adult Dosage (ages 18-64 years)
- Starting dose: 5 mg taken by mouth once per day.
- Dose increases: Your doctor can change your dose based on your blood pressure levels. If your blood pressure is still not under control after 7–14 days, your doctor may increase your dose.
- Maximum dose: 10 mg per day.
Child Dosage (ages 0-5 years): This medicine hasn’t been studied in children and shouldn’t be used in children younger than 6.
Child Dosage (ages 6-17 years): 2.5–5 mg taken by mouth once per day. Doses above 5 mg haven’t been studied in children and shouldn’t be used.
Senior Dosage (ages 65 years and older):
- The recommended dose is 2.5 mg taken by mouth once per day.
- Older people may course medicines more gradually over time. A regular adult dosage can create amounts of Vamlo to be more than normal level. If you’re a senior, you require a lower dose.
Liver Disease: The Suggested dosage is 2 .5 mg taken by mouth once daily. Vamlo is treated by your liver. If your liver isn’t performing nicely, then more of this drugs may remain in your body for longer. This puts you prone to unwanted side effects. If you have serious liver difficulties, you will need less dose or a separate dosing routine.
What other drugs will affect Vamlo?
Tell your doctor about all your current medicines and any you start or stop using, especially:
- simvastatin (Zocor, Simcor, Vytorin); or
- any other heart or blood pressure medications.
This list is not complete. Other drugs may interact with Vamlo, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
Urgent advice: Call your doctor or go to A&E straight away if you take too much Vamlo
If you need to go to an A&E, do not drive yourself - get someone else to drive you or call for an ambulance.
Take the Vamlo packet or leaflet inside it, plus any remaining medicine, with you.
Like all medicines, Vamlo can cause side effects, although not everyone gets them.
Side effects often improve as your body gets used to the medicine.
Warnings for other groups
For pregnant women: Research in animals has shown negative effects to the fetus when the mother takes Vamlo. However, there haven’t been enough studies done in humans to be certain how the drug might affect a human pregnancy.
Tell your doctor if you’re pregnant or plan to become pregnant. Vamlo should be used during pregnancy only if the potential benefit justifies the potential risk.
For women who are breastfeeding: Some research has shown that Vamlo passes into breast milk. However, it’s not known if Vamlo can cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.
For seniors: As you age, your body may not process this drug as well as it once could. More of this drug may stay in your body longer. This puts you at risk for more side effects.
For children: This drug shouldn’t be used in children younger than 6 years.
All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:
- your age
- the condition being treated
- how severe your condition is
- other medical conditions you have
- how you react to the first dose