amlodipine/valsartan

Impact of Amlodipine on Other Drugs Simvastatin Coadministration of simvastatin with amlodipine increases the systemic exposure of simvastatin. Limit the dose of simvastatin in patients on amlodipine to 20 mg daily [see Clinical Pharmacology (12.3)] . If simvastatin is coadministered with amlodipine, do not exceed doses greater than 20 mg daily of simvastatin.

Mechanism: Amlodipine interferes with how the body processes simvastatin, leading to higher amounts of the cholesterol drug in your blood. This can increase your risk of experiencing muscle pain or damage.

What to do: Do not take more than 20 mg of simvastatin per day if you are also taking this medication. Talk to your doctor about adjusting your dose to keep it at a safe level.

Dual Blockade of the Renin-Angiotensin System (RAS): Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy. Do not coadminister aliskiren with valsartan in patients with diabetes. Avoid use of aliskiren with valsartan in patients with renal impairment (GFR < 60 mL/min).

Mechanism: Using these two medicines together can over-block the system that regulates blood pressure and kidney health. This can lead to dangerously low blood pressure, high potassium, or sudden kidney failure.

What to do: Do not use this combination if you have diabetes or existing kidney problems. Your provider will monitor your blood pressure and kidney health very closely if these drugs are used.

Immunosuppressants Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when coadministered. Frequent monitoring of trough blood levels of cyclosporine and tacrolimus is recommended and adjust the dose when appropriate [see Clinical Pharmacology (12.3)] . Cyclosporine: Concomitant treatment with cyclosporine may increase the risk of hyperuricemia and gout-type complications.

Mechanism: Amlodipine can slow down how your body breaks down cyclosporine, which raises the amount of the drug in your system. This combination can also increase your risk of high uric acid and gout.

What to do: Your doctor should check your cyclosporine blood levels frequently and adjust your dose if necessary.

Valsartan – Hydrochlorothiazide Lithium: Increases in serum lithium concentrations and lithium toxicity have been reported during concomitant administration of lithium with angiotensin II receptor antagonists or thiazides. Monitor lithium levels in patients taking Exforge HCT. ( 12.3 ) Lithium: Increased risk of lithium toxicity.

Mechanism: Valsartan can make it harder for your kidneys to clear lithium from your body. This can cause lithium to build up to levels that are poisonous to your system.

What to do: Your doctor should monitor your lithium levels closely to prevent toxicity while you are taking these drugs together.

Amlodipine Impact of Other Drugs on Amlodipine CYP3A Inhibitors Coadministration with CYP3A inhibitors (moderate and strong) results in increased systemic exposure to amlodipine and may require dose reduction. Monitor for symptoms of hypotension and edema when amlodipine is coadministered with CYP3A inhibitors to determine the need for dose adjustment [see Clinical Pharmacology (12.3)] . CYP3A Inducers No information is available on the quantitative effects of CYP3A inducers on amlodipine.

Mechanism: Both of these drugs contain amlodipine, so taking them together results in a double dose. This can cause your blood pressure to drop too low and may cause swelling in your ankles.

What to do: Do not take these two medications together. Your doctor will need to choose one or adjust the dose to keep you safe.