1 What is Caduet?

Brand: Caduet

Generic: Amlodipine and atorvastatin

Amlodipine and atorvastatin are regarded as anti-anginal and lipid lowering drugs respectively. This drug combination is commonly used to treat angina, hyperlipidaemia, and hypertension.

Amlodipine is a dihydropyridine calcium channel blocker which relaxes peripheral and coronary vascular smooth muscle, it produces coronary vasodilation by inhibiting the entry of calcium ions into the voltage-sensitive channels of the vascular smooth muscle and myocardium during depolarization.

It reduces peripheral vascular resistance and hence resulting in a reduction of blood pressure. It also inhibits coronary spasm in patients with vasospastic angina.

Atorvastatin selectively and competitively inhibits HMG-CoA reductase, the enzyme that catalyses the conversion of HMG-CoA to mevalonate which is a rate-limiting step in cholesterol biosynthesis.

This drug should be taken with a proper diet to lower cholesterol and triglyceride levels in the blood. This medicine may prevent certain medical problems including chest pain, heart attack, or stroke.

2 What to Know Before Using

If you are about to start a drug therapy, the risk and benefit ratio of taking the drug should be considered. This is a decision that your doctor will make with your active participation.

There are some important factors such as drug interaction, metabolic impairment, hypersensitivity reaction, pregnancy, lactation etc. which may alter the drug action.

Sometimes presence of other health disorders affects the beneficial effects of this medicine and even may cause serious complications. Make sure you mention your doctor if you have any other medical problems.

The use of amlodipine is contraindicated in acute liver disease or unexplained persistent elevated hepatic transaminases, pregnancy and lactation.

Studies in animals or humans have demonstrated fatal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

Certain drugs should not be used concurrently with such medications. Rifampicin may increase the metabolism of both amlodipine and atorvastatin. Atorvastatin may increase AUC of norethindrone and ethinyl estradiol.

Increased risk of myopathy when atorvastatin is used concurrently with fibric acid derivatives, lipid-modifying doses of niacin, cyclosporine or strong CYP3A4 inhibitors (eg. clarithromycin, HIV protease inhibitors, itraconazole).

Cyclosporine may significantly increase bioavailability of atorvastatin. Thus, it is always recommended to consult with your doctor if you are in need of some drugs for another health problem in order to avoid unwanted serious complications.

3 Proper Usage

Medicines should be used following the directions given by a doctor. The dose of this medicine will vary according to patient’s condition or requirements. You should follow the doctor's directions and advices.

The amount of medicine that you take should not exceed the maximum therapeutic dose. Also, the frequency of your daily drug administration and the duration of drug therapy depend on the particular medical problem for which you are taking the medicine.

In order to treat angina, hypertension, and hyperlipidemia, an adult should take 5 mg amlodipine once daily at the initial stage.

The dose can be titrated over 1-2 weeks. Maximum therapeutic dose of amlodipine should be within 10 mg/day. Atorvastatin is given initially ranging from 10 to 20 mg once daily (anytime of the day), patients who require >45% reduction in LDL cholesterol may be initiated at 40 mg once daily.

Titrate dose at intervals of at least 4 weeks. Maximum therapeutic dose should not exceed 80 mg/day.

Always try to take your medicine in time. If you miss any dose of this medicine, you should take it as soon as possible. But if it is time for your next dose, then you should skip the missed dose and go back to your regular treatment schedule.

You should store the medicine in a closed container at room temperature away from heat, moisture, and direct light. All kinds of medicines should be kept out of the reach of children. Outdated medicine must be disposed by an appropriate way.

4 Precautions to Take

Regular visits are recommended to make sure this medicine is working properly or not while you are receiving a drug therapy.

Some important measures should be taken if you feel any discomfort following this drug therapy. Although amlodipine is excreted primarily via kidney, mild renal impairment does not appear to have an effect on the plasma concentrations.

Severe renal impairment may however require a dosage reduction. Amlodipine is not dialyzable and its half-life is prolonged in patients with impaired hepatic function.

It should therefore be administered at lower (5mg) initial dose in these patients. An increased number of pulmonary edema has been reported in those who received amlodipine in heart failure.

Atorvastatin may cause myopathy, and rarely rhabdomyolysis with acute renal failure secondary to myoglobinuria especially at high doses or in patients with history of renal impairment.

Atorvastatin should be taken with great care. When atorvastatin is used with CYP3A4 inhibitors, there is increased plasma concentrations of Atorvastatin.

You should withhold/discontinue atorvastatin if symptoms suggestive of myopathy or rhabdomyolysis are observed. Atorvastatin has been associated with biochemical abnormalities of liver, LFT should be monitored prior to and at 12 weeks following treatment initiation and dosage increment.

This drug should be used cautiously in patients who consume large amounts of alcohol or with history of liver disease.

Worsening of angina and/or myocardial infarction has been reported with use of dihydrophyridine calcium channel blockers, especially in patients with severe obstructive coronary artery disease. Amlodipine may cause dose-dependent peripheral oedema.

5 Potential Side Effects

There are some unwanted side-effects associated with each drug that usually do not need medical attention. These side-effects usually go away during the treatment episode as your body adjusts to the medicine.

Additionally, your health care professional may advise you about the ways how to prevent or reduce those unwanted side-effects.

Sometimes you may need to consult with the doctor if you feel any of toxic effects which are common to all members, but the relative propensity differs.

Some adverse effects along with amlodipine are headache, dizziness, fatigue, somnolence, peripheral edema, flushing, palpitations, nausea, abdominal pain, rarely pruritus, rash, dyspnea, asthenia and muscle cramps.

On the contrary, atorvastatin is also responsible for some unwanted adverse effects. Nasopharyngitis, arthralgia, diarrhea, pain in extremity, urinary tract infection, dyspepsia, nausea, musculoskeletal pain, muscle spasms, myalgia, insomnia, increased transaminases, abnormal liver function test, increased creatinine phosphokinase, thrombocytopenia, malaise, hepatitis, cholestasis, bullous rashes, and rhabdomyolysis with acute renal failure are the common side effects.

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