Version July 2025
Hypertension:
Note: For initial treatment in patients with BP ≥20/10 mm Hg above goal, may be used in combination with another appropriate agent (eg, angiotensin converting enzyme inhibitor, angiotensin II receptor blocker, thiazide diuretic). For patients <20/10 mm Hg above goal, some experts recommend an initial trial of monotherapy; however, over time, many patients will require combination therapy (Ref).
Oral: Initial: 1.25 to 2.5 mg once daily; titrate every 1 to 2 weeks as needed based on patient response; maximum: 5 mg/day. Antihypertensive effect attenuates with higher doses and adverse effects may become more prominent (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
No dosage adjustment necessary.
Hypertension: Initial: 1.25 mg once daily; titrate slowly in patients with severe hepatic impairment.
Note: Dosing should start at the lower end of dosing range and be titrated to response due to possible increased incidence of hepatic, renal, or cardiac impairment. Elderly patients also show decreased clearance of amlodipine.
Hypertension: Oral: Initial: 1.25 mg once daily.
(For additional information see "Levamlodipine: Pediatric drug information")
Hypertension: Children and Adolescents 6 to ≤17 years: Oral: 1.25 to 2.5 mg once daily.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Children and Adolescents 6 to ≤17 years: No dosage adjustment necessary in kidney impairment.
There are no pediatric-specific recommendations; based on experience in adult patients, dosing adjustment and slow titration are suggested.
All adverse reactions were reported with amlodipine, as levamlodipine is the pharmacologically active isomer of amlodipine.
Peripheral edema is the most common adverse reaction with amlodipine, characterized by ankle and leg swelling independent of fluid retention (Ref). It is a bothersome adverse reaction for patients and may lead to discontinuation (Ref). Peripheral edema can be expected to subside within several days following intervention.
Mechanism: Dose- and time-related; related to the pharmacologic action. Calcium channel blocker-mediated peripheral edema is caused by arteriolar vasodilation that subsequently leads to increased hydrostatic pressure in the precapillary circulation and fluid movement from the capillary vasculature to the interstitial space (Ref). In addition, impaired postural vasoconstriction may contribute (Ref).
Risk factors:
• Dose; generally greater with higher doses (Ref); however, may develop more frequently and at lower doses in patients with impaired postural autoregulation (eg, diabetes, arterial disease) (Ref)
• Duration-related (Ref)
• Females
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. All adverse reactions were reported with amlodipine, as levamlodipine is the pharmacologically active isomer of amlodipine.
>10%: Cardiovascular: Peripheral edema (2% to 11%, dose-related; females: 15%; males: 6%) (table 1)
|
Drug (Levamlodipine) |
Placebo |
Population |
Dose |
Number of Patients (Levamlodipine) |
Number of Patients (Placebo) |
Comments |
|---|---|---|---|---|---|---|
|
15% |
5% |
Females |
N/A |
512 |
336 |
Reported with amlodipine, as levamlodipine is the pharmacologically active isomer of amlodipine |
|
6% |
1% |
Males |
N/A |
1,218 |
914 | |
|
11% |
0.6% |
N/A |
10 mg/day |
268 |
520 | |
|
3% |
0.6% |
N/A |
5 mg/day |
296 |
520 | |
|
2% |
0.6% |
N/A |
2.5 mg/day |
275 |
520 |
1% to 10%:
Cardiovascular: Flushing (≤3%; dose-related, more frequent in females), palpitations (1% to 5%; dose-related, more frequent in females)
Gastrointestinal: Abdominal pain (2%), nausea (3%)
Nervous system: Dizziness (doses ≥5 mg/day: 3%), drowsiness (1%), fatigue (5%)
<1%:
Cardiovascular: Peripheral ischemia, sinus tachycardia, syncope, vasculitis
Dermatologic: Diaphoresis, erythema multiforme, pruritus, skin rash
Endocrine & metabolic: Hot flash, hyperglycemia, weight gain, weight loss
Gastrointestinal: Anorexia, constipation, dysphagia, flatulence, gingival hyperplasia, pancreatitis, vomiting, xerostomia
Genitourinary: Nocturia, urinary frequency
Hematologic & oncologic: Leukopenia, purpuric disease, thrombocytopenia (Cvetković 2013)
Hypersensitivity: Angioedema, hypersensitivity reaction
Nervous system: Abnormal dreams, anxiety, depersonalization, depression, female sexual disorder, hypoesthesia, insomnia, malaise, male sexual disorder, pain, paresthesia, peripheral neuropathy, rigors, vertigo
Neuromuscular & skeletal: Arthralgia, arthropathy, asthenia, back pain, muscle cramps, myalgia, tremor
Ophthalmic: Conjunctivitis, diplopia, eye pain
Otic: Tinnitus
Respiratory: Dyspnea, epistaxis
Postmarketing:
Dermatologic: Dermatologic disorder (Schamberg's disease) (Schetz 2015), psoriasis (Song 2021), toxic epidermal necrolysis (Baetz 2011)
Endocrine and metabolic: Gynecomastia (Cornes 2001)
Hepatic: Cholestatic hepatitis (Egbuonu 2019; Zinsser 2004), hepatotoxicity (Demirci 2013; Hammerstrom 2015)
Renal: Acute interstitial nephritis (Ejaz 2000)
Hypersensitivity to levamlodipine, amlodipine, or any component of the formulation.
Concerns related to adverse effects:
• Hypotension: Symptomatic hypotension can occur; acute hypotension upon initiation is unlikely due to the gradual onset of action. BP must be lowered at a rate appropriate for the patient's clinical condition.
Disease-related concerns:
• Aortic stenosis: Use with extreme caution in patients with severe aortic stenosis; may cause hypotension or reduce coronary perfusion, resulting in ischemia.
• Heart failure: Calcium channel blockers should be avoided whenever possible in patients with heart failure with reduced ejection fraction (AHA/ACC/HFSA [Heidenreich 2022]).
• Hepatic impairment: Use with caution in patients with hepatic impairment; may require lower starting dose; titrate slowly in patients with severe hepatic impairment.
• Hypertrophic cardiomyopathy with left ventricular outflow tract obstruction: Use amlodipine with caution in patients with hypertrophic cardiomyopathy and left ventricular outflow tract obstruction since reduction in afterload may worsen symptoms associated with this condition (AHA/ACC [Ommen 2024]).
Special populations:
• Older adult: Initiate at a lower dose in elderly patients.
Other warnings/precautions:
• Titration: Peak antihypertensive effect is delayed; dosage titration should occur after 7 to 14 days on a given dose.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Tablet, Oral, as maleate:
Conjupri: 2.5 mg
Conjupri: 2.5 mg [DSC] [scored]
Conjupri: 5 mg
Conjupri: 5 mg [DSC] [scored]
Generic: 2.5 mg, 5 mg
Yes
Tablets (Conjupri Oral)
2.5 mg (per each): $13.14
5 mg (per each): $15.34
Tablets (Levamlodipine Maleate Oral)
2.5 mg (per each): $2.80
5 mg (per each): $2.80
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral: May be administered without regard to food.
Oral: May be administered without regard to food.
Hypertension: Treatment of hypertension, alone or in combination with other antihypertensive agents, in adults and pediatric patients ≥6 years of age.
Substrate of CYP3A4 (Major with inhibitors), CYP3A4 (Minor with inducers); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits CYP3A4 (Weak);
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
ALPRAZolam: CYP3A4 Inhibitors (Weak) may increase serum concentration of ALPRAZolam. Risk C: Monitor
Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification
Amphetamines: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor
Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Atosiban: Calcium Channel Blockers may increase adverse/toxic effects of Atosiban. Specifically, there may be an increased risk for pulmonary edema and/or dyspnea. Risk C: Monitor
Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Brigatinib: May decrease antihypertensive effects of Antihypertensive Agents. Brigatinib may increase bradycardic effects of Antihypertensive Agents. Risk C: Monitor
Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid
Calcium Salts: May decrease therapeutic effects of Calcium Channel Blockers. Risk C: Monitor
CarBAMazepine: CYP3A4 Inhibitors (Weak) may increase serum concentration of CarBAMazepine. Risk C: Monitor
Clofazimine: May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor
CycloSPORINE (Systemic): Calcium Channel Blockers (Dihydropyridine) may increase serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase serum concentration of Calcium Channel Blockers (Dihydropyridine). Risk C: Monitor
CYP3A4 Inducers (Moderate): May decrease serum concentration of Levamlodipine. Risk C: Monitor
CYP3A4 Inducers (Strong): May decrease serum concentration of Levamlodipine. Risk C: Monitor
CYP3A4 Inhibitors (Moderate): May increase serum concentration of Levamlodipine. Risk C: Monitor
CYP3A4 Inhibitors (Strong): May increase serum concentration of Levamlodipine. Risk C: Monitor
Dantrolene: May increase hyperkalemic effects of Calcium Channel Blockers. Dantrolene may increase negative inotropic effects of Calcium Channel Blockers. Risk X: Avoid
Dapoxetine: May increase orthostatic hypotensive effects of Calcium Channel Blockers. Risk C: Monitor
Dexmethylphenidate: May decrease therapeutic effects of Antihypertensive Agents. Risk C: Monitor
Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Dofetilide: CYP3A4 Inhibitors (Weak) may increase serum concentration of Dofetilide. Risk C: Monitor
DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor
Finerenone: CYP3A4 Inhibitors (Weak) may increase serum concentration of Finerenone. Risk C: Monitor
Flibanserin: CYP3A4 Inhibitors (Weak) may increase serum concentration of Flibanserin. Risk C: Monitor
Flunarizine: May increase therapeutic effects of Antihypertensive Agents. Risk C: Monitor
Fusidic Acid (Systemic): May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider Therapy Modification
Herbal Products with Blood Pressure Increasing Effects: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor
Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor
Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Indoramin: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor
Inhalational Anesthetics: May increase hypotensive effects of Calcium Channel Blockers. Risk C: Monitor
Isocarboxazid: May increase antihypertensive effects of Antihypertensive Agents. Risk X: Avoid
Ixabepilone: CYP3A4 Inhibitors (Weak) may increase serum concentration of Ixabepilone. Risk C: Monitor
Lemborexant: CYP3A4 Inhibitors (Weak) may increase serum concentration of Lemborexant. Management: The maximum recommended dosage of lemborexant is 5 mg, no more than once per night, when coadministered with weak CYP3A4 inhibitors. Risk D: Consider Therapy Modification
Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor
Lomitapide: CYP3A4 Inhibitors (Weak) may increase serum concentration of Lomitapide. Management: Patients on lomitapide 5 mg/day may continue that dose. Patients taking lomitapide 10 mg/day or more should decrease the lomitapide dose by half. The lomitapide dose may then be titrated up to a max adult dose of 30 mg/day. Risk D: Consider Therapy Modification
Loop Diuretics: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor
Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Lovastatin: Levamlodipine may increase serum concentration of Lovastatin. Risk C: Monitor
Magnesium Sulfate: May increase adverse/toxic effects of Calcium Channel Blockers (Dihydropyridine). Specifically, the risk of hypotension or muscle weakness may be increased. Risk C: Monitor
Melatonin: May decrease antihypertensive effects of Calcium Channel Blockers (Dihydropyridine). Risk C: Monitor
Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor
Methylphenidate: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor
Midazolam: CYP3A4 Inhibitors (Weak) may increase serum concentration of Midazolam. Risk C: Monitor
Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Neuromuscular-Blocking Agents (Nondepolarizing): Calcium Channel Blockers may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor
Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
NiMODipine: CYP3A4 Inhibitors (Weak) may increase serum concentration of NiMODipine. Risk C: Monitor
Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor
Obinutuzumab: May increase hypotensive effects of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider Therapy Modification
Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Perazine: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor
Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor
Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Pimozide: CYP3A4 Inhibitors (Weak) may increase serum concentration of Pimozide. Risk X: Avoid
Prazosin: Antihypertensive Agents may increase hypotensive effects of Prazosin. Risk C: Monitor
Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Red Yeast Rice: Levamlodipine may increase serum concentration of Red Yeast Rice. Risk C: Monitor
Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Simvastatin: Levamlodipine may increase serum concentration of Simvastatin. Management: Limit simvastatin dose to 20 mg daily and monitor closely for signs and symptoms of rhabdomyolysis (eg, creatinine phosphokinase, muscle aches and pains) if coadministering with levamlodipine. Risk D: Consider Therapy Modification
Sincalide: Drugs that Affect Gallbladder Function may decrease therapeutic effects of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Risk D: Consider Therapy Modification
Sirolimus (Conventional): CYP3A4 Inhibitors (Weak) may increase serum concentration of Sirolimus (Conventional). Risk C: Monitor
Sirolimus (Protein Bound): CYP3A4 Inhibitors (Weak) may increase serum concentration of Sirolimus (Protein Bound). Management: Reduce the dose of protein bound sirolimus to 56 mg/m2 when used concomitantly with a weak CYP3A4 inhibitor. Risk D: Consider Therapy Modification
Tacrolimus (Systemic): Calcium Channel Blockers (Dihydropyridine) may increase serum concentration of Tacrolimus (Systemic). Risk C: Monitor
Tacrolimus (Systemic): CYP3A4 Inhibitors (Weak) may increase serum concentration of Tacrolimus (Systemic). Risk C: Monitor
Terazosin: Antihypertensive Agents may increase hypotensive effects of Terazosin. Risk C: Monitor
Triazolam: CYP3A4 Inhibitors (Weak) may increase serum concentration of Triazolam. Risk C: Monitor
Ubrogepant: CYP3A4 Inhibitors (Weak) may increase serum concentration of Ubrogepant. Management: In patients taking weak CYP3A4 inhibitors, the initial and second dose (given at least 2 hours later if needed) of ubrogepant should be limited to 50 mg. Risk D: Consider Therapy Modification
Urapidil: Antihypertensive Agents may increase hypotensive effects of Urapidil. Risk C: Monitor
Amlodipine is a racemic mixture of levamlodipine and dextro amlodipine; levamlodipine is the pharmacologically active isomer. Amlodipine crosses the placenta (Morgan 2017; Morgan 2018).
Refer to the amlodipine monograph for additional information,
Amlodipine is present in breast milk.
Amlodipine is a racemic mixture of levamlodipine and dextro amlodipine; levamlodipine is the pharmacologically active isomer. Refer to the amlodipine monograph for additional information.
Heart rate; blood pressure.
Amlodipine is a 1:1 racemic mixture of levamlodipine and dextro amlodipine; it has been demonstrated that levamlodipine is the pharmacologically active, antihypertensive isomer. Amlodipine is a dihydropyridine calcium channel blocker that exerts its effect by blocking the transmembrane influx of calcium ions primarily into vascular smooth muscle cells and to a lesser extent into cardiac muscle cells. It reduces peripheral vascular resistance and lowers BP by acting directly on vascular smooth muscle.
Note: Amlodipine is a racemic mixture of levamlodipine and dextro amlodipine; levamlodipine is the pharmacologically active isomer. Refer to the amlodipine monograph for additional information.
Onset: Gradual.
Duration: ≥24 hours.
Protein binding: ~93%.
Metabolism: Hepatic (~90%) to inactive metabolites.
Bioavailability: 64% to 90%.
Half-life elimination: Terminal (biphasic): ~30 to 50 hours; increased with hepatic dysfunction.
Time to peak: 6 to 12 hours.
Excretion: Urine (10% of total dose as unchanged drug, 60% of total dose as metabolites).
Clearance: May be decreased in patients with hepatic insufficiency or moderate to severe heart failure; weight-adjusted clearance in children >6 years of age is similar to adults.
Hepatic function impairment: AUC may increase ~40% to 60%.
Elderly: AUC may increase ~40% to 60%.
Moderate to severe heart failure: AUC may increase ~40% to 60%.
