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Last updated: Oct 06, 2020
6 min read

Amlodipine/benazepril: everything you need to know

The amlodipine/benazepril combination pill is FDA-approved to treat High blood pressure (hypertension) in people who have tried amlodipine & benazepril by themselves and are still not well controlled (FDA, 2011).

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

What is the amlodipine & benazepril combination pill, and how does it work?

The amlodipine and benazepril combination pill (brand name Lotrel) is a prescription drug that merges two medicines into one capsule. You can take each medication individually, and both are often used to treat high blood pressure. However, by combining them, you get both drugs with fewer pills to swallow.

Both amlodipine and benazepril are antihypertensive medications. Amlodipine is a calcium channel blocker (CCB). It works by encouraging muscles (like those in blood vessels) to relax, thereby dilating or opening the blood vessels. By blocking calcium, amlodipine lowers blood pressure and eases the workload on the heart. CCBs are an effective way to treat high blood pressure. 

Benazepril is an angiotensin-converting enzyme (ACE) inhibitor that lowers blood pressure by interfering with the renin-angiotensin system. This system is a complex interaction of compounds that affect the blood vessels, heart, and kidneys and regulate blood pressure. 

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What is the amlodipine & benazepril combination pill used for?

The amlodipine/benazepril combination pill is FDA-approved to treat the following (FDA, 2011):

  • High blood pressure (hypertension) in people who have tried amlodipine & benazepril by themselves and are still not well controlled

High blood pressure (hypertension)

High blood pressure, or hypertension, is a common condition that affects your blood vessels, heart, brain, kidneys, and other parts of your body. Having high blood pressure increases your risk of suffering from a heart attack or stroke. Treating this condition usually involves lifestyle changes, like a healthy diet, regular physical activity, and smoking cessation. However, this may not be enough. Some people need medications to help keep their blood pressure under control. However, if one drug doesn’t lower the blood pressure enough, combination pills like amlodipine/benazepril may get the job done. 

Side effects

Amlodipine/benazepril combination pill has a” black box” warning, a serious advisory from the FDA regarding severe side effects: Do not take amlodipine/benazepril combination pills if you are pregnant. If you become pregnant while taking it, stop the amlodipine/benazepril combination pill immediately. Any drug that acts on the renin-angiotensin system can cause injury or death to the developing fetus (DailyMed, 2020).

Common side effects include (DailyMed, 2020):

  • Cough
  • Headache
  • Dizziness
  • Edema (swelling of hands, legs, ankles, feet)

Serious side effects include (UpToDate, n.d.):

  • Angioedema: swelling of the face, lips, throat, tongue, or intestine
  • Worsening chest pain or heart attacks (especially in people with heart disease)
  • Jaundice (yellowing of the skin or the whites of the eyes)
  • Liver problems
  • Kidney problems
  • High potassium levels (hyperkalemia)
  • Low blood pressure
  • Severe allergic reaction—hives, skin rash, trouble breathing, etc.

This list does not include all possible side effects, and others may occur. Seek medical advice from your pharmacist or healthcare provider for more information. 

Drug interactions

Before starting the amlodipine/benazepril combination pill, be sure to seek medical advice regarding your other medications to avoid any potential drug interactions, including prescription and over-the-counter medicines, as well as herbal supplements. Possible drug interactions include (DailyMed, 2020):

  • Drugs that block the CYP3A4 system: Any drug that interferes with the CYP3A4 system in the liver, which is responsible for breaking down amlodipine, may lead to higher than anticipated levels in your body. Higher levels increase the risk of low blood pressure and other side effects. Drugs that block the CYP3A4 in the liver include ketoconazole, itraconazole, and ritonavir.
  • Simvastatin: Taking simvastatin with the amlodipine/benazepril combination pill raises the levels of simvastatin in your body, increasing the chance of side effects. 
  • Drugs that block the renin-angiotensin system (RAS): Using the amlodipine/benazepril combination pill with other medications that block the RAS, like ACE inhibitors (e.g., lisinopril, captopril), angiotensin receptor blockers (e.g., losartan, valsartan), and aliskiren increases your chance of developing low blood pressure, high potassium levels, and worsening kidney function. Do not take the amlodipine/benazepril combination pill with other drugs that affect the RAS, especially in people with diabetes.
  • Drugs that increase potassium levels: Since the amlodipine/benazepril combination pill may increase your potassium levels, you should be careful when combining it with other medicines that also raise potassium. Otherwise, you may get higher than normal amounts of potassium in your body, which could lead to nausea/vomiting, chest pain, irregular heartbeats, and weakness. Drugs that raise potassium levels include potassium-sparing diuretics (“water pills”) and potassium supplements. Salt substitutes often recommended as part of a low-salt diet, can also increase potassium levels because they replace sodium chloride with potassium chloride.
  • Lithium: Combining lithium (a mood stabilizer often used to treat bipolar disorder) with the amlodipine/benazepril combination pill can lead to higher levels of lithium and increases the risk of lithium toxicity.
  • Non-steroidal anti-inflammatory drugs (NSAIDs): Taking NSAIDs (like ibuprofen and naproxen) with the amlodipine/benazepril combination pill increases the risk of worsening kidney function, including possible kidney failure. Also, NSAIDs may decrease the amlodipine/benazepril combination pill’s ability to lower blood pressure.
  • Mammalian Target of Rapamycin (mTOR) Inhibitors: mTOR inhibitors, used in cancer treatments, increase the risk of developing angioedema if taken with the amlodipine/benazepril combination pill. Examples include temsirolimus, sirolimus, and everolimus. 
  • Neprilysin Inhibitor: Nepriliysin inhibitors (like sacubitril) are used to treat heart failure. They can raise the likelihood of developing angioedema if taken with the amlodipine/benazepril combination pill. Do not take the amlodipine/benazepril combination pill with neprilysin inhibitors.

This list does not include all possible drug interactions with the amlodipine & benazepril combination pill, and others may exist. Check with your pharmacist or healthcare provider for more information.

Who should not use the amlodipine & benazepril combination pill (or use it with caution)?

Certain groups of people should not take the amlodipine & benazepril combination pill or use it with caution because of an increased risk of side effects. These groups include (DailyMed, 2020):

  • Pregnant women: Black box warning from FDA: Pregnant women should not take the amlodipine & benazepril combination pill. If you become pregnant while taking it, stop the amlodipine & benazepril combination pill immediately, as it can cause injury or death to the fetus.
  • Nursing mothers: Minimal amounts of amlodipine and benazepril get into the breastmilk. There is no data to suggest that taking the amlodipine & benazepril combination pill while nursing has adverse effects. 
  • History of angioedema: People who have had angioedema (swelling of the face, throat, lips, tongue, or intestine) in the past, whether in response to a drug or not, should not use this medication. 
  • Older people: People older than 65 may want to start at the lowest dose and increase as necessary to prevent side effects.
  • People with liver problems: Since the liver is involved in the breakdown of the amlodipine & benazepril combination pill, abnormal liver function could lead to higher than expected levels. People with liver problems may choose to start at the lowest dose and increase as necessary to prevent side effects. 
  • People with kidney disease: People with severe kidney problems should avoid using the amlodipine & benazepril combination pill as it may worsen their kidney disease.
  • Black people: Black people may be at higher risk for developing angioedema with the amlodipine & benazepril combination pill.
  • People with aortic stenosis: People with a narrowing of their aorta (aortic stenosis) should be careful with the amlodipine & benazepril combination pill. It may decrease blood flow to the coronary arteries and deprive them of necessary oxygen and nutrients.
  • People with renal artery stenosis: People with renal artery stenosis, a narrowing of the artery to the kidney, risk worsening kidney function with the amlodipine & benazepril combination pill.
  • People with heart problems: The amlodipine & benazepril combination pill increases the risk of low blood pressure (hypotension), especially in people with heart failure, hypertrophic cardiomyopathy (enlarged heart), and aortic/mitral stenosis. If you are dehydrated, you are also at a higher risk of low blood pressure with this medication. 

This list does not include all at-risk groups, and others may exist. Talk to your healthcare provider or pharmacist for more information.

Dosing

Amlodipine besylate and benazepril hydrochloride are prescription drugs. Each is available individually or together; the combination pill is available both as a generic medication and under the brand name Lotrel. Capsules come in the following strengths (amlodipine/benazepril): 2.5/10 mg, 5/10 mg, 5/20 mg, 5/40 mg, 10/20 mg, and 10/40 mg.

Most prescription plans cover the amlodipine & benazepril combination pill. The cost for a 30-day supply of generic capsules ranges from $11–$47, depending on the strength (GoodRx.com).

References

  1. DailyMed. (2020). Amlodipine & benazepril capsule. Retrieved on September 21, 2020 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=99ed4927-9a34-4e8d-8eea-60b63c867d46
  2. GoodRx.com. (n.d.). Amlodipine / Benazepril. Retrieved September 21, 2020 from https://www.goodrx.com/amlodipine-benazepril
  3. MedlinePlus. (2019). Amlodipine and Benazepril. Retrieved on September 21, 2020 from https://medlineplus.gov/druginfo/meds/a601018.html
  4. UpToDate. (n.d.). Amlodipine and benazepril: Drug information. Retrieved on September 21, 2020 from https://www.uptodate.com/contents/amlodipine-and-benazepril-drug-information
  5. U. S. Food and Drug Administration (FDA). (2011). Lotrel (amlodipine besylate and benazepril hydrochloride) Capsules. Retrieved on September 21, 2020 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020364s052lbl.pdf