Adult: Amlodipine 2.5 mg and benazepril 10 mg cap Amlodipine 5 mg and benazepril 10 mg cap Amlodipine 5 mg and benazepril 20 mg cap Amlodipine 5 mg and benazepril 40 mg cap Amlodipine 10 mg and benazepril 20 mg cap Amlodipine 10 mg and benazepril 40 mg cap
Initially, 2.5 mg/10 mg once daily, may increase dose to Max of 10 mg/40 mg once daily. Dosage is individualised and adjusted based on patient's clinical response. Elderly: Initiate at the lower end of the dosing range.
What are the brands available for Amlodipine + Benazepril in Thailand?
Amlodipine + Benazepril May be taken with or without food.
Contraindications
History of angioedema with or without previous ACE inhibitor therapy. Pregnancy. Concomitant use with aliskiren in patients with diabetes; concurrent use with or within 36 hours of switching to or from a neprilysin inhibitor (e.g. sacubitril).
Special Precautions
Patient with volume or salt depletion; severe obstructive CAD, heart failure, severe aortic or mitral stenosis, hypertrophic cardiomyopathy with left ventricular outflow tract obstruction, CHF, ischaemic heart disease, cerebrovascular disease; diabetes mellitus, collagen vascular disease (e.g. SLE); history of airway surgery; unstented unilateral or bilateral renal artery stenosis. Patient undergoing surgery, desensitisation treatment with hymenoptera venom, LDL apheresis with dextran sulfate or haemodialysis with high-flux dialysis membranes. Black race. Renal and hepatic impairment. Elderly. Lactation.
Adverse Reactions
Significant: Worsening angina, acute MI; symptomatic hypotension (with or without syncope); hyperkalaemia; cough; anaphylactic or anaphylactoid reactions; peripheral oedema; renal function deterioration resulting in oliguria, acute renal failure, and progressive azotaemia; increase in serum creatinine. Blood and lymphatic system disorders: Neutropenia. Gastrointestinal disorders: Nausea, dyspepsia, abdominal pain, oesophagitis, dry mouth. General disorders and administration site conditions: Fatigue, asthenia. Musculoskeletal and connective tissue disorders: Muscle cramps. Nervous system disorders: Tremor. Psychiatric disorders: Anxiety, insomnia, nervousness. Reproductive system and breast disorders: Decreased libido. Skin and subcutaneous tissue disorders: Rash, dermatitis, skin nodule. Vascular disorders: Flushing. Potentially Fatal: Angioedema of the head, neck, or intestine. Rarely, cholestatic hepatitis, acute liver failure.
Monitor blood pressure, BUN, serum creatinine, and electrolytes (e.g. serum K). Obtain CBC with differential periodically in patients with renal impairment and/or collagen vascular disease.
Drug Interactions
Amlodipine: Increased serum concentration of simvastatin. Increased serum concentration with moderate or strong CYP3A inhibitors.
Benazepril: Increased risk of angioedema with mTOR inhibitor (e.g. temsirolimus, sirolimus, everolimus). Increased risk of renal function deterioration (e.g acute renal failure) with NSAIDs (including COX-2 inhibitors) or ARBs. Increased risk of hyperkalaemia with K-sparing diuretics, K supplements, and/or K-containing salt substitutes. May increase serum lithium concentration and enhance risk of lithium toxicity. Nitritoid reactions (e.g. facial flushing, nausea, vomiting, hypotension) may occur when used concurrently with injectable gold (Na aurothiomalate). Increased risk of hypoglycaemia with insulin or oral antidiabetics. Potentially Fatal: Benazepril: Increased risk of angioedema with neprilysin inhibitor (e.g. sacubitril). Concomitant use with aliskiren increases the risk of hypotension, hyperkalaemia, and decreased renal function (including acute renal failure).
Action
Description: Mechanism of Action: Amlodipine, a dihydropyridine Ca antagonist, is a peripheral arterial vasodilator. It selectively inhibits Ca ion influx across cell membranes and acts directly on the vascular smooth muscle to produce peripheral vasodilation, thereby causing a reduction in peripheral vascular resistance and blood pressure.
Benazepril, an angiotensin-converting enzyme (ACE) inhibitor, is a prodrug of benazeprilat. It competitively inhibits the conversion of angiotensin I to angiotensin II (a potent vasoconstrictor) through the angiotensin I-converting enzyme activity. The inhibition of ACE lowers angiotensin II levels, thereby resulting in an increase of plasma renin activity and a decrease in aldosterone secretion. Onset: Amlodipine: Antihypertensive effect: 24-48 hours.
Benazepril: Peak effect: 1-2 hours. Duration: Amlodipine: Antihypertensive effect: Approx 24 hours.
Benazepril: Approx 24 hours. Pharmacokinetics: Absorption: Amlodipine: Well absorbed. Bioavailability: 64-90%. Time to peak plasma concentration: 6-12 hours.
Benazepril: Time to peak plasma concentration: Benazepril: 0.5-1 hour. Benazeprilat: 1-2 hours (fasting state); 2-4 hours (nonfasting state). Distribution: Amlodipine: Crosses the placenta and enters breast milk. Volume of distribution: 21 L/kg. Plasma protein binding: Approx 93%.
Benazepril: Enters breast milk (small amounts of benazepril and benazeprilat). Volume of distribution: 8.7 L. Plasma protein binding: Approx 97% (benazepril); approx 95% (benazeprilat). Metabolism: Amlodipine: Extensively metabolised in the liver into inactive metabolites.
Benazepril: Rapidly and extensively metabolised in the liver via enzymatic hydrolysis into benazeprilat (active metabolite); undergoes extensive first-pass effect. Excretion: Amlodipine: Via urine (10% as unchanged drug; 60% as metabolites). Terminal elimination half-life: 30-50 hours.
Benazepril: Via urine (20% as benazeprilat; 12% as other metabolites; trace amounts as benazepril). Elimination half-life: Benazeprilat: 10-11 hours (effective); 22 hours (terminal).
Chemical Structure
Amlodipine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 2162, Amlodipine. https://pubchem.ncbi.nlm.nih.gov/compound/Amlodipine. Accessed Feb. 25, 2025.
Benazepril Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5362124, Benazepril. https://pubchem.ncbi.nlm.nih.gov/compound/Benazepril. Accessed June 27, 2022.
C09BB13 - benazepril and amlodipine ; Belongs to the class of ACE inhibitors and calcium channel blockers. Used in the treatment of cardiovascular diseases.
References
Amlodipine and Benazepril Hydrochloride Capsule (Rising Health, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 03/06/2024.Amlodipine and Benazepril. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 04/06/2024.Amlodipine. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 04/06/2024.Amlodipine; Benazepril. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 03/06/2024.Benazepril. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 04/06/2024.Brayfield A, Cadart C (eds). Amlodipine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/06/2024.Brayfield A, Cadart C (eds). Benazepril Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/06/2024.Lotrel Capsule (Novartis Pharmaceuticals Corporation). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 03/06/2024.
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