How long does it take for amlodipine to work
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How Long Does It Take for Amlodipine to Work?
Amlodipine, a long-acting calcium channel blocker, is commonly prescribed for conditions such as hypertension and chronic stable angina. Understanding the onset of its therapeutic effects is crucial for both patients and healthcare providers.
Onset of Action in Angina Pectoris
Initial Effects in Exercise Testing
In patients with stable exertional angina, amlodipine has been shown to increase total exercise time and delay the onset of angina symptoms. These effects were observed as early as 6 hours after administration and persisted up to 24 hours, although the improvements were more pronounced at the 6-hour mark2. This suggests that amlodipine begins to exert its beneficial effects relatively quickly after dosing.
Long-Term Efficacy
Amlodipine's efficacy in reducing angina attacks and nitroglycerin consumption was evident within the first few weeks of treatment. In a multicenter double-blind crossover trial, significant improvements in exercise duration and reductions in angina frequency were noted after just 4 weeks of treatment1. This indicates that while some benefits are seen within hours, full therapeutic effects may take a few weeks to manifest.
Pharmacokinetics and Steady-State Concentration
Absorption and Half-Life
Amlodipine has a prolonged absorption phase, with peak plasma concentrations occurring approximately 6-8 hours after oral administration6 8. The drug's elimination half-life ranges from 34 to 50 hours, allowing for once-daily dosing3 7. This extended half-life means that steady-state plasma concentrations are typically reached after about 7 days of consistent daily dosing3.
Impact on Blood Pressure
In hypertensive patients, amlodipine begins to lower blood pressure gradually over 4-8 hours after a single dose, with effects lasting up to 24-72 hours8. Continuous daily administration results in a stable reduction in blood pressure, with minimal fluctuations over the 24-hour dosing interval5 9.
Conclusion
Amlodipine starts to work within hours of the first dose, particularly in improving exercise tolerance and delaying angina onset. However, the full therapeutic benefits, including significant reductions in angina attacks and blood pressure, are typically observed after several weeks of consistent daily use. This makes amlodipine a reliable option for long-term management of hypertension and chronic stable angina.
Sources and full results
Most relevant research papers on this topic
Amlodipine in chronic stable angina: results of a multicenter double-blind crossover trial.
Amlodipine effectively increases exercise duration and reduces angina attacks, while maintaining symptom control in chronic stable angina patients.
RCTA four-week double-blind, placebo-controlled, parallel dose-response study of amlodipine in patients with stable exertional angina pectoris.
Amlodipine is an effective and well-tolerated once-daily treatment for chronic stable angina, with no severe adverse reactions compared to placebo.
RCTThe pharmacokinetics of amlodipine in healthy volunteers after single intravenous and oral doses and after 14 repeated oral doses given once daily.
Amlodipine has a 36-hour half-life after intravenous administration and a 45-hour half-life after repeated oral administration, with steady state plasma concentration achieved after seven doses.
Non-RCT
Highly CitedAmlodipine reduces transient myocardial ischemia in patients with coronary artery disease: double-blind Circadian Anti-Ischemia Program in Europe (CAPE Trial).
Once-daily amlodipine significantly reduces both symptomatic and asymptomatic ischemic events over 24 hours in patients with chronic stable angina.
RCT
Large Human TrialHighly Cited24 h blood pressure control with the once daily calcium antagonist, amlodipine.
Amlodipine effectively reduces blood pressure in hypertensive patients over a 24-hour period, with a once-daily dose regimen providing steady state blood levels.
RCTAn assessment of the pharmacokinetics and pharmacodynamics of single doses of amlodipine in elderly normotensives.
Elderly normotensives experience a longer half life and delayed peak plasma concentrations of amlodipine, suggesting reduced drug clearance and potentially higher plasma drug concentrations at steady state.
Observational StudyThe pharmacokinetic profile of amlodipine.
Amlodipine has a unique pharmacokinetic profile with increased oral bioavailability and extended clearance time, making it a promising drug for treating chronic stable angina and cirrhosis.
Non-RCTHighly CitedPharmacokinetics and pharmacodynamics of amlodipine.
Amlodipine effectively treats hypertension and angina pectoris with once-daily dosing, offering a low-clearance, dihydropyridine calcium antagonist with high oral bioavailability.
Highly CitedEffects of amlodipine, a long‐acting dihydropyridine calcium antagonist in aging hypertension: Pharmacodynamics in relation to disposition
Amlodipine administered once daily is an effective antihypertensive agent for both elderly and young patients with essential hypertension, with elderly patients showing greater reductions in systolic and diastolic pressure.
Non-RCTHighly CitedAmlodipine--once-daily monotherapy in systemic hypertension.
Amlodipine, when administered as once-daily monotherapy, effectively controls blood pressure for 48 hours in mild to moderate hypertension patients, with no significant changes in blood pressure or heart rate.
Non-RCT