Amlodipine benazepril side effects
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Side Effects of Amlodipine Benazepril Combination Therapy
Introduction to Amlodipine Benazepril Combination Therapy
Amlodipine and benazepril are commonly used together to treat hypertension. Amlodipine is a calcium channel blocker, while benazepril is an angiotensin-converting enzyme (ACE) inhibitor. This combination is effective in lowering blood pressure and reducing cardiovascular events, but it is also associated with certain side effects.
Common Side Effects
Edema
One of the most frequently reported side effects of amlodipine, especially at higher doses, is edema. Studies have shown that the incidence of edema is significantly higher in patients treated with high-dose amlodipine monotherapy compared to those receiving combination therapy with benazepril. Specifically, 24% of patients on high-dose amlodipine monotherapy experienced edema, whereas the incidence was similar to low-dose calcium antagonists when combined with benazepril1 2.
Peripheral Edema
Peripheral edema is another common side effect observed in patients treated with the amlodipine-benazepril combination. In a study comparing benazepril plus amlodipine to benazepril plus hydrochlorothiazide, peripheral edema was more frequent in the benazepril-amlodipine group (33.7%) compared to the benazepril-hydrochlorothiazide group (16.0%)6.
Less Common Side Effects
Cough and Rash
Some patients may develop a cough or rash when switched from high-dose calcium channel blockers to the amlodipine-benazepril combination. In a study involving 75 patients, 4 patients developed new dose-limiting side effects, including cough in three patients and rash in one patient, after switching to the combination therapy7.
Angioedema
Angioedema, although rare, has been reported more frequently in patients with chronic kidney disease treated with the benazepril-amlodipine combination compared to those treated with benazepril plus hydrochlorothiazide6.
Safety and Tolerability
General Tolerability
Overall, the combination of amlodipine and benazepril is well-tolerated. In a study involving hypertensive patients nonresponsive to benazepril monotherapy, the combination therapy was found to be effective, safe, and well-tolerated, with infrequent adverse events comparable to benazepril alone5.
Comparison with Monotherapy
The combination therapy of amlodipine and benazepril has been shown to have fewer dose-dependent adverse experiences compared to high-dose calcium antagonist monotherapy. This includes a lower incidence of vasodilatory edema, making it a preferable option for many patients1 2.
Conclusion
The combination of amlodipine and benazepril is effective in managing hypertension and reducing cardiovascular events. However, it is associated with side effects such as edema, peripheral edema, cough, rash, and, in rare cases, angioedema. Despite these side effects, the combination therapy is generally well-tolerated and offers a safer alternative to high-dose monotherapy with fewer dose-dependent adverse experiences.
Sources and full results
Most relevant research papers on this topic
Comparison of efficacy and side effects of combination therapy of angiotensin-converting enzyme inhibitor (benazepril) with calcium antagonist (either nifedipine or amlodipine) versus high-dose calcium antagonist monotherapy for systemic hypertension.
Combination therapy with a calcium antagonist and an ACE inhibitor provides blood pressure control equal to high-dose calcium antagonist monotherapy but with significantly fewer dose-dependent adverse experiences like vasodilatory edema.
RCT
Large Human Trial
Highly CitedTreatment of patients with essential hypertension: amlodipine 5 mg/benazepril 20 mg compared with amlodipine 5 mg, benazepril 20 mg, and placebo.
Amlodipine 5 mg/benazepril 20 mg is a superior antihypertensive treatment for essential hypertension, well-tolerated, and associated with less edema compared to amlodipine alone.
RCTLarge Human TrialHighly CitedClinical Observation of Amlodipine Combined with Benazepril in Treatment of Senior Patients with Essential Hypertension
Amlodipine combined with benazepril effectively lowers blood pressure in senior patients with essential hypertension, offering better control with minimal side effects.
RCTBenazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients.
The benazepril-amlodipine combination is more effective in reducing cardiovascular events than the benazepril-hydrochlorothiazide combination in high-risk patients with hypertension.
RCTLarge Human TrialHighly CitedAmlodipine/benazepril combination therapy for hypertensive patients nonresponsive to benazepril monotherapy.
High-dose amlodipine/benazepril combination therapy (5 mg/40 mg and 10 mg/40 mg) is an effective, safe, and well-tolerated treatment option for hypertensive patients not responsive to benazepril alone.
RCTRenal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial
Benazepril plus amlodipine is more effective in reducing cardiovascular events than benazepril plus hydrochlorothiazide, but has a higher risk of chronic kidney disease progression.
RCTLarge Human Trial
Rigorous JournalHighly CitedEfficacy and safety of a therapeutic interchange from high-dose calcium channel blockers to a fixed-dose combination of amlodipine/benazepril in patients with moderate-to-severe hypertension
A therapeutic interchange from selected high-dose calcium channel blockers to a fixed-dose combination of amlodipine/benazepril can be successfully accomplished in most patients with moderate to severe hypertension, resulting in cost savings.
Observational StudyEffect of Benazepril plus Amlodipine vs Benazepril Alone on Urinary Albumin Excretion in Hypertensive Patients with Type II Diabetes and Microalbuminuria
Benazepril plus amlodipine tended to produce a greater reduction in urinary albumin excretion and increased creatinine clearance compared to benazepril monotherapy in hypertensive patients with type II diabetes and microalbuminuria.
RCTFixed combination of benazepril and low-dose amlodipine in the treatment of mild to moderate essential hypertension: evaluation by 24-hour noninvasive ambulatory blood pressure monitoring.
The fixed combination of benazepril 10 mg/amlodipine 2.5 mg effectively reduces blood pressure throughout the day and night, with no significant side effects observed.
RCTBlood Pressure Effects of High-Dose Amlodipine-Benazepril Combination in Black and White Hypertensive Patients Not Controlled on Monotherapy
Combination therapy with amlodipine/benazepril 10/40 mg/day effectively lowers blood pressure in both Black and White hypertensive patients, with greater reductions in White patients.
Meta-Analysis