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CARDIOVASCULAR SYSTEM › AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM › ACE INHIBITORS, COMBINATIONS › ACE inhibitors and calcium channel blockers
benazepril and amlodipine
C09BB13
Forms & Strengths
- Benazepril/Amlodipine 2.5/10 mg oral capsule
- Benazepril/Amlodipine 5/10 mg oral capsule
- Benazepril/Amlodipine 5/20 mg oral capsule
- Benazepril/Amlodipine 10/20 mg oral capsule
- Benazepril/Amlodipine 10/40 mg oral capsule
Adult Dosing
- Hypertension: 1 capsule daily, titrated based on clinical response after 1 to 2 weeks
- Maximum recommended dose: Benazepril 20 mg / Amlodipine 10 mg daily
- Renal impairment (CrCl < 30 mL/min): Not recommended as initial therapy; individual component titration preferred
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
Indications
- Treatment of hypertension, alone or in combination with other antihypertensive agents
- Initial therapy for patients likely to need multiple drugs to achieve blood pressure goals
Mechanism of Action
- Benazepril is an ACE inhibitor that blocks conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion
- Amlodipine is a dihydropyridine calcium channel blocker that inhibits transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle
- Combined action produces complementary vasodilatory effects and reduces peripheral vascular resistance
Contraindications
- History of angioedema related to previous ACE inhibitor therapy
- Concomitant use with aliskiren in patients with diabetes mellitus
- Hypersensitivity to benazepril, amlodipine, or other ACE inhibitors/dihydropyridines
- Pregnancy (direct toxicity to developing fetus during second and third trimesters)
Adverse Reactions
- Peripheral edema (primarily from amlodipine)
- Dizziness and orthostatic hypotension
- Dry, persistent cough (from benazepril-induced bradykinin accumulation)
- Fatigue, flushing, and palpitations
- Hyperkalemia and elevated serum creatinine
Drug Interactions
- Potassium-sparing diuretics, potassium supplements, or salt substitutes: Increased risk of severe hyperkalemia
- Lithium: Decreased lithium clearance leading to potential lithium toxicity
- NSAIDs: May attenuate antihypertensive efficacy and increase risk of renal impairment
- Dual blockade of the renin-angiotensin system (e.g., ARBs, aliskiren): Increased risk of hypotension, hyperkalemia, and renal dysfunction
- Strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir): May significantly increase amlodipine plasma concentrations
Curated Content: Needs Vetting Before Put to Clinical Use