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Amlodipine, Benazepril (Generic Lotrel): Uses, Dosage, Side Effects, and More
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Lotrel is a prescription combination medication used to treat high blood pressure. It combines two proven blood pressure-lowering medicines with different mechanisms of action: amlodipine, a calcium channel blocker, and benazepril, an angiotensin-converting enzyme (ACE) inhibitor. Together, they help relax and widen blood vessels, making it easier for the heart to pump blood. By controlling high blood pressure, Lotrel helps reduce the risk of heart attack, stroke, and kidney complications. It should be taken exactly as directed by a healthcare provider. Sudden discontinuation may cause a rise in blood pressure or worsening of chest pain in patients with coronary artery disease.
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Drug Facts
Generic name
Amlodipine Besylate and Benazepril Hydrochloride
Brand names
Lotrel
Drug type
Combination antihypertensive (calcium channel blocker + ACE inhibitor)
Controlled substance
Not a controlled medication
Dosage forms
Oral capsules
Typical dosage
Amlodipine besylate/benazepril hydrochloride dosing is based on blood pressure response. Treatment commonly starts at 2.5 mg/10 mg once daily, with a maintenance range of 2.5/10 mg to 10/40 mg once daily, using oral capsules as prescribed.
Basics
What Is Amlodipine? What is Benazepril?
Amlodipine and benazepril are prescription medications commonly used together to treat high blood pressure (hypertension). Amlodipine is a long-acting calcium channel blocker that relaxes and widens blood vessels by limiting calcium entry into vascular smooth muscle, which helps lower blood pressure and improve blood flow.
Benazepril is an angiotensin-converting enzyme (ACE) inhibitor that reduces the production of angiotensin II, a hormone that causes blood vessels to constrict. By decreasing angiotensin II levels, benazepril further promotes blood vessel relaxation and lowers blood pressure.
Used together, these medications provide complementary blood-pressure control by targeting vascular resistance through distinct mechanisms.
Note: This medication’s generic and brand-name formulations are used interchangeably throughout this article.
What is Lotrel?
Lotrel is the brand-name combination of amlodipine and benazepril, prescribed for the management of hypertension. By pairing a calcium channel blocker with an ACE inhibitor, Lotrel delivers more consistent blood pressure reduction than either medication alone.
This combination is typically prescribed for patients whose blood pressure is not adequately controlled with single-drug therapy. Effective blood pressure management with medications like Lotrel helps reduce the risk of serious cardiovascular complications, including heart attack, stroke, and kidney damage.
Lotrel should be taken exactly as prescribed and monitored regularly by a healthcare provider to ensure safe and effective blood pressure control.
Indications
What Is Lotrel Used For?
Lotrel is primarily prescribed to manage high blood pressure, a condition characterized by the elevated force exerted by blood against arterial walls. By effectively lowering blood pressure, it lessens the risk of complications associated with hypertension, including strokes, heart attacks, and potential kidney impairment.
Primary Indications
Lotrel is indicated for treating hypertension in patients who may benefit from simultaneous interventions via a calcium channel blocker and an ACE inhibitor. For individuals whose hypertension cannot be controlled with a single class of blood pressure medication, Lotrel provides a dual-action remedy.
The combined effects of its constituents, Amlodipine and Benazepril, target multiple pathways involved in hypertension, making it a potent option for treating hypertension.
Other Uses
Beyond its primary indication for hypertension, Lotrel may occasionally be prescribed for other cardiovascular-related concerns at the discretion of a healthcare provider. This can include scenarios where enhanced vasodilatory or blood pressure-lowering effects are deemed beneficial for patient health.
Mechanism
How Does Lotrel Work?
Lotrel exerts its effects through the synergistic actions of its constituent drugs, amlodipine and benazepril. These medications collectively facilitate vasodilation, lower vascular resistance, and ultimately reduce blood pressure.
Mechanism of Action
- Amlodipine: functions by blocking calcium influx into cardiac and smooth muscle cells. This blockade relaxes and widens blood vessels, allowing blood to flow more freely and with less resistance, thus lowering blood pressure.
- Benazepril: acts by inhibiting the angiotensin-converting enzyme, preventing the formation of angiotensin II, a potent vasoconstrictor. With reduced angiotensin II levels, blood vessels remain relaxed, thereby enhancing the effect of amlodipine.
Pharmacokinetics
Understanding how Lotrel’s components are absorbed, metabolized, and excreted can help appreciate their pharmacologic effects. Both amlodipine and benazepril are well absorbed orally, with peak plasma concentrations achieved within hours of administration.
Amlodipine undergoes extensive hepatic metabolism, while benazepril is hydrolyzed to its active form, benazeprilat, primarily in the liver. Amlodipine is eliminated primarily via urine, similarly to benazepril and benazeprilat.
Dosage
Lotrel Dosages & Administration
Lotrel is typically prescribed on a patient-specific basis, with dosages adjusted to optimize therapeutic efficacy and minimize side effects.
Dosage Guidelines
- Initial Dose: The initiation of Lotrel therapy often begins with a lower dose to assess patient response and tolerance.
- Titration: Depending on the therapeutic response and any side effects, the dosage may be adjusted incrementally to achieve desired blood pressure control.
Patients may receive different dosage combinations of amlodipine and benazepril, based on their healthcare provider’s clinical judgment and individual needs.
Administration Guidelines
- Route: Lotrel is administered orally, usually as a once-daily capsule.
- Frequency: Consistent dosing at the same time each day, with or without food, helps maintain stable plasma drug levels and enhances treatment effectiveness.
Patients are advised to follow their prescribed regimen closely, as deviations can affect blood pressure control and overall health outcomes.
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Side Effects
Lotrel Side Effects and Risks
While Lotrel is generally well-tolerated, some individuals may experience side effects. It is crucial to be aware of these potential adverse reactions to manage them effectively and notify a physician when necessary.
Common Side Effects
- Dizziness: Lightheadedness may occur—particularly when standing up quickly—as blood pressure lowers. Rising slowly from seated or lying positions can reduce symptoms.
- Swelling (Peripheral Edema): Amlodipine can cause swelling of the feet, ankles, or lower legs. While usually mild, persistent edema should be evaluated, as dose adjustments or additional therapy may be needed.
- Headache: Headaches may appear as the body adjusts to treatment. These are typically temporary, but should be discussed if severe or persistent.
Serious Side Effects
- Severe Allergic Reactions: Symptoms such as facial or throat swelling, difficulty breathing, rash, or severe dizziness require immediate medical care. These may indicate angioedema, a rare but serious reaction more commonly associated with ACE inhibitors.
- Increased Potassium Levels: Because benazepril can raise potassium levels, some individuals may develop hyperkalemia, which may cause weakness, abnormal heart rhythms, or numbness. Routine blood tests help monitor potassium levels.
- “Salt Substitute” Warning: Many people trying to lower their blood pressure switch to low-sodium salts (like No-Salt). These products replace sodium with potassium chloride. However, combining Lotrel with potassium-based salt substitutes can lead to dangerously high blood potassium (hyperkalemia). This can cause “silent” heart rhythm disturbances that are potentially fatal. Use herbs and spices for flavor instead of potassium-based salt substitutes while taking Lotrel.
- Chest Pain or Heart Attack: Rarely, Lotrel may worsen chest pain initially or contribute to more serious cardiac events such as a heart attack. Any new or worsening chest discomfort should be evaluated promptly.
Kidney Function Changes: ACE inhibitors like benazepril can impact kidney function. Patients with existing kidney issues or taking other kidney-affecting medications may require close monitoring.
Interactions
Lotrel Interactions
Because Lotrel combines two medications—a calcium channel blocker (amlodipine) and an ACE inhibitor (benazepril)—it can interact with a variety of drugs, supplements, and even certain foods.
These interactions may affect blood pressure control or increase the likelihood of adverse effects. Understanding them is essential for safe and effective treatment.
Drug Interactions
- Potassium Supplements: Lotrel can raise potassium levels due to its ACE inhibitor component. Taking additional potassium supplements, salt substitutes containing potassium, or potassium-sparing diuretics (such as spironolactone or triamterene) may further raise potassium levels, increasing the risk of hyperkalemia, which can cause muscle weakness or abnormal heart rhythms. Regular monitoring is recommended.
- Other Antihypertensives: Using Lotrel alongside other blood pressure medications—such as beta-blockers, ARBs, diuretics, or nitrates—can enhance blood-pressure-lowering effects. While this combination can benefit some patients, it may also cause excessive hypotension, leading to dizziness or fainting. Dose adjustments and careful monitoring may be required.
- NSAIDs: Frequent or long-term use of NSAIDs may reduce the blood-pressure-lowering effects of Lotrel and can impair kidney function, especially in older adults or those with pre-existing kidney disease. Healthcare providers may recommend limiting NSAID use or monitoring kidney function more closely.
- Lithium: Concomitant use with ACE inhibitors like benazepril may raise lithium levels and increase the risk of toxicity. If used together, lithium levels should be monitored.
Food and Alcohol
Alcohol consumption should be moderated, as it may amplify the blood-pressure-lowering effects and enhance dizziness or drowsiness. Additionally, patients should be cautious of consuming potassium-rich foods to avoid hyperkalemia.
Contraindications
Lotrel Contraindications
While Lotrel can be highly effective for managing high blood pressure, certain medical conditions or risk factors may make its use unsafe. Understanding these contraindications helps ensure that patients receive appropriate therapy with minimal risk.
Absolute Contraindications
- History of ACE Inhibitor-Induced Angioedema: Because Lotrel contains benazepril, an ACE inhibitor, it should not be taken by individuals who have previously experienced angioedema—a serious swelling reaction involving the face, lips, tongue, or throat—related to ACE inhibitor therapy. Recurrence can be life-threatening, requiring immediate avoidance of this medication.
- Pregnancy: Lotrel is contraindicated during pregnancy, especially in the second and third trimesters. ACE inhibitors like benazepril can harm fetal kidney development and increase the risk of birth defects or fetal death. Women who become pregnant while taking Lotrel should stop the medication immediately and consult their healthcare provider for alternative treatment.
- Allergies: Patients with known hypersensitivity to amlodipine, benazepril, or any Lotrel components should not use the medication. Allergic reactions may manifest as rash, itching, swelling, or difficulty breathing and require prompt medical attention.
Additional Considerations
- Severe Kidney Disease: Because benazepril affects kidney function, patients with advanced kidney impairment or renal artery stenosis may face increased risks and need alternative medication.
- Liver Impairment: Amlodipine is metabolized in the liver; therefore, patients with significant liver disease may require dose adjustments or closer monitoring.
Patients should work closely with their healthcare provider to determine whether Lotrel is appropriate, especially if they have underlying health conditions or take other medications that may influence safety or effectiveness.
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Frequently Asked Questions (FAQs)
Didn’t see the answers you’re looking for in this article? Check out this comprehensive FAQ for more details.
Administration & Dosage
Lotrel is administered orally as a capsule and is usually prescribed once daily. You can take it with or without food, but it is best to take it at the same time each day to maintain consistent blood levels. Swallow the capsule whole with a glass of water, and do not crush or chew it as this can release the drug all at once, increasing the risk of side effects. Consistency in the timing helps maximize its benefits and minimize side effects.
The usual starting dose of Lotrel is one capsule daily, containing 5 mg amlodipine and 10 mg benazepril. Depending on your blood pressure response and tolerance, your doctor may adjust the dose. It's essential to follow your prescription instructions and never alter the dose on your own.
Your healthcare provider can adjust the Lotrel dosage based on your response and any side effects you experience. Regular blood pressure assessments and monitoring for adverse reactions are critical. Adjustments are usually made in increments of the individual components—amlodipine or benazepril—and may depend on factors such as kidney function and coexisting medical conditions.
If you forget to take a dose, take it as soon as you remember. If your next dose is coming up soon, skip the missed dose and continue with your regular schedule. Do not double the dose to catch up, as this could increase the risk of side effects.
Lotrel should be stored at room temperature, ideally between 68°F and 77°F (20°C to 25°C). Keep it away from excessive heat, light, and moisture. Store it in a tightly closed container and keep it out of reach of children and pets to prevent accidental ingestion.
Uses & Mechanism of Action
Lotrel is specifically indicated for the treatment of high blood pressure or hypertension. Managing blood pressure effectively is vital to reducing the risk of health complications such as stroke, heart attack, and kidney damage. By appropriately lowering high blood pressure, Lotrel contributes to cardiovascular health and overall well-being.
Lotrel is a combination medication that contains amlodipine and benazepril. Amlodipine, a calcium channel blocker, relaxes blood vessels, allowing blood to flow more easily. Benazepril, an ACE inhibitor, helps lower blood pressure by reducing the production of chemicals that tighten blood vessels. Together, they provide a synergistic effect in managing blood pressure.
By effectively lowering blood pressure, Lotrel helps prevent strokes, myocardial infarctions, and other cardiovascular issues. The dual mechanism of action provides comprehensive vascular benefits, improving overall cardiac function. Additionally, the use of combination therapy can often simplify treatment regimens by reducing the number of pills a patient needs to take.
Lotrel is prescribed for patients whose hypertension cannot be adequately controlled with a single medication alone. It is especially useful for individuals in need of a potent yet balanced medication due to its dual components that target multiple pathways in hypertension management.
The full blood pressure-lowering effects of Lotrel might not be apparent for 2 weeks after starting treatment. Even if you feel well, continue taking Lotrel as prescribed. Blood pressure management is a long-term commitment, and Lotrel plays a critical role in sustaining healthy numbers.
Side Effects & Safety
Common side effects include dizziness, headache, and cough. Other side effects might be swelling of the ankles or feet due to fluid retention. These side effects are generally mild and temporary. If they persist or worsen, inform your healthcare provider of appropriate management. The ACE-Inhibitor Dry Cough: Up to 20% of patients taking ACE inhibitors like benazepril develop a persistent, dry, hacking cough. This is not due to an infection or allergies; it is caused by the accumulation of a substance called bradykinin in the lungs. This cough will not respond to cough syrups or antibiotics. If it becomes bothersome, your doctor may need to switch you from Lotrel to a different combination medication (such as an ARB/CCB combo like Exforge), which does not affect bradykinin levels.
Serious side effects are uncommon but may include signs of kidney problems, such as changes in the amount of urine, or signs of high potassium levels in the blood, such as muscle weakness or an irregular heartbeat. Besides, severe allergic reactions, including rash, itching, and swelling, require immediate medical attention.
If you experience dizziness, rise slowly from sitting or lying down to minimize the risk of falls. Ensuring adequate hydration and avoiding alcohol can also help manage this side effect. Persistent dizziness should be discussed with your healthcare provider to explore further solutions.
Certain people, such as those with a history of angioedema associated with ACE inhibitors or who have severe renal impairment, should be cautious about using Lotrel. If you have allergies to any of its components, consider alternative treatments. Increased Risk for African American Patients: Black/African American patients have a 3–4× higher risk of angioedema when taking ACE inhibitors like benazepril in Lotrel, which can cause sudden swelling of the face, lips, tongue, or throat and requires immediate emergency care. While ACE inhibitors alone may be less effective for blood pressure control in this population, adding amlodipine improves efficacy, making Lotrel a strong option when patients are closely monitored.
Lotrel is not recommended for use during pregnancy because of potential risks to the developing fetus, such as fetal toxicity. If you are pregnant or plan to become pregnant, discuss alternative antihypertensive treatments with your doctor. FDA Boxed Warning: Lotrel must be discontinued immediately if pregnancy is detected. Drugs that act on the renin–angiotensin system can cause serious fetal injury or death, especially during the second and third trimesters. Exposure may lead to oligohydramnios (low amniotic fluid), resulting in fetal skull hypoplasia, underdeveloped lungs, and neonatal kidney failure.
Interactions & Contraindications
Lotrel may interact with medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, or potassium supplements, which could alter its effects on blood pressure. Always inform your healthcare provider about all the medications and supplements you are currently taking.
Alcohol consumption can increase the blood pressure-lowering effects of Lotrel, potentially causing dizziness or fainting. It is advisable to limit alcohol intake and discuss any concerns with your healthcare provider.
Lotrel is contraindicated in patients with a history of angioedema related to ACE inhibitors and in those who have hypersensitivity to any of its components. Individuals with significant kidney dysfunction should also consider alternative therapies.
No specific food interactions have been noted with Lotrel. However, maintaining a balanced, low-salt diet can enhance the drug’s efficacy. Patients are advised to avoid potassium-heavy salt substitutes to prevent complications related to high potassium levels.
Conditions such as severe kidney or liver disease and certain heart conditions might dictate careful monitoring or dosage adjustments when taking Lotrel. Consult with your healthcare provider for a thorough health assessment before beginning treatment.
Generic & Alternatives
A generic version of amlodipine and benazepril is available and usually costs less than the brand-name Lotrel. It offers the same therapeutic benefits by combining two potent antihypertensives.
The cost of Lotrel without insurance can vary by pharmacy and location. Generally, generic versions are more affordable, making it important to shop around or ask your healthcare provider about affordable options.
Numerous alternatives exist for managing hypertension, including single-agent medications like lisinopril or amlodipine, or other combination drugs. The choice depends on the individual patient profile and the effectiveness of current therapy.
Lotrel has not been discontinued. However, availability can vary, and it’s wise to check with your pharmacist or healthcare provider for the most current information.
Disclaimer
The information provided on this page is for general informational purposes only and is not intended as medical advice. Always consult with a licensed healthcare provider before starting, stopping, or changing any medication regimen. While Invictus strives to provide accurate and up-to-date information, individual health conditions and circumstances vary. The prices, availability, and descriptions of all medications on this page are subject to change.
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