benazepril/amlodipine (Rx)

Brand and Other Names:Lotrel
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Dosing & Uses

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Dosage Forms & Strengths

benazepril/amlodipine

capsule

  • 10mg/2.5mg
  • 10mg/5mg
  • 20mg/5mg
  • 20mg/10mg
  • 40mg/5mg
  • 40mg/10mg

Hypertension

1 tablet (2.5-10 mg amlodipine; 10-40mg benazepril) PO qDay; titrate with appropriate dosage combination to control BP; not to exceed 10 mg/day amlodipine, 80 mg/day benazepril

Dosage Modifications

Renal impairment: Decrease dose if CrCl <30 mL/min, severe liver impairment, or coadministered with diuretic

Hepatic impairment: 2.5 mg based on amlodipine initially

Safety and efficacy not established

The recommended initial dose of amlodipine in elderly patients is 2.5 mg

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Interactions

Interaction Checker

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            Contraindicated (3)

            • aliskiren

              benazepril decreases effects of aliskiren by Other (see comment). Contraindicated. Comment: Aliskiren use contraindicated with ACE-inhibitors in patients with diabetes; avoid coadministration with ACE-inhibitors if GFR. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of ACE-inhibitors with drugs that affect RAAS may increase the risk of renal impairment (including acute renal failure) and cause loss of antihypertensive effect. Monitor renal function periodically.

            • dantrolene

              dantrolene, amlodipine. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Contraindicated. Rare incidence of cardiovascular collapse and marked hyperkalemia observed when coadministered; may be higher risk with nondihydropyridine calcium channel blockers.

            • sacubitril/valsartan

              sacubitril/valsartan, benazepril. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment. Increased risk of angioedema. Discontinue ACE Inhibitor therapy for at least 36 hours prior to sacubitril/valsartan administration.

              sacubitril/valsartan, benazepril. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan.

            Serious - Use Alternative (53)

            • abametapir

              abametapir will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

            • allopurinol

              benazepril increases toxicity of allopurinol by unspecified interaction mechanism. Avoid or Use Alternate Drug. May increase risk for allergic or hypersensitivity reactions to allopurinol. Monitor for symptoms of hypersensitivity reactions if both drugs must be used together.

            • apalutamide

              apalutamide will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

            • aspirin

              aspirin, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • aspirin rectal

              aspirin rectal, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • azilsartan

              azilsartan, benazepril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • candesartan

              candesartan, benazepril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • celecoxib

              celecoxib, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • chloramphenicol

              chloramphenicol will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • chloroquine

              chloroquine will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • conivaptan

              conivaptan will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Calcium channel blockers with depressant effects on the sinus and AV nodes could potentiate dronedarone's effects on conduction. Give a low dose of calcium channel blockers initially and increase only ECG is reviewed and tolerated.

            • diclofenac

              diclofenac, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • diflunisal

              diflunisal, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • diltiazem

              diltiazem will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Concomitant use with amlodipine and diltiazem reported an a 60% increase in amlodipine AUC. Monitor increased effects and toxicities (eg, bradycardia, sinus arrest, decreased cardiac output) if amiodarone is concomitantly used with nondihydropyridine calcium channel blocker (ie, diltiazem).

            • enzalutamide

              enzalutamide will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • eprosartan

              eprosartan, benazepril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • etodolac

              etodolac, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • fenoprofen

              fenoprofen, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • fexinidazole

              fexinidazole will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

            • flurbiprofen

              flurbiprofen, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • ibuprofen

              ibuprofen, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • ibuprofen IV

              ibuprofen IV, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • idelalisib

              idelalisib will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

            • indomethacin

              indomethacin, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • irbesartan

              irbesartan, benazepril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • iron dextran complex

              benazepril increases toxicity of iron dextran complex by Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. ACE Inhibitors may enhance adverse/toxic effect of iron dextran complex, specifically anaphylactic reactions.

            • ivosidenib

              ivosidenib will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

            • ketoprofen

              ketoprofen, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • ketorolac

              ketorolac, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • ketorolac intranasal

              ketorolac intranasal, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • linagliptin

              linagliptin increases toxicity of benazepril by Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Increased risk for adverse/toxic effects, specifically, increased risk of angioedema.

            • lofexidine

              lofexidine, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

              lofexidine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

            • lonafarnib

              amlodipine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

              lonafarnib will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

            • losartan

              losartan, benazepril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • meclofenamate

              meclofenamate, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • mefenamic acid

              mefenamic acid, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • meloxicam

              meloxicam, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • nabumetone

              nabumetone, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • naproxen

              naproxen, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • nifedipine

              nifedipine will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • olmesartan

              olmesartan, benazepril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • oxaprozin

              oxaprozin, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • piroxicam

              piroxicam, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • pregabalin

              benazepril, pregabalin. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration results in additive risk of developing angioedema of face, mouth, and neck. Angioedema may result in respiratory compromise.

            • salsalate

              salsalate, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • simvastatin

              amlodipine increases levels of simvastatin by Other (see comment). Avoid or Use Alternate Drug. Comment: Benefits of combination therapy should be carefully weighed against the potential risks of combination. Potential for increased risk of myopathy/rhabdomyolysis. Limit simvastatin dose to no more than 20 mg/day when used concurrently.

            • sodium phosphates, IV

              benazepril increases toxicity of sodium phosphates, IV by pharmacodynamic synergism. Avoid or Use Alternate Drug. ACE Inhibitors may enhance nephrotoxic effects of sodium phosphate.

            • sulindac

              sulindac, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • telmisartan

              telmisartan, benazepril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • tolmetin

              tolmetin, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • valsartan

              valsartan, benazepril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • voxelotor

              voxelotor will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

            Monitor Closely (289)

            • acebutolol

              acebutolol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • albiglutide

              benazepril increases effects of albiglutide by unknown mechanism. Use Caution/Monitor. ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .

            • aldesleukin

              aldesleukin increases effects of amlodipine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              aldesleukin, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • alfuzosin

              benazepril, alfuzosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

              alfuzosin and amlodipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              alfuzosin increases effects of benazepril by Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypotension.

            • alogliptin

              alogliptin increases toxicity of benazepril by unspecified interaction mechanism. Use Caution/Monitor. May increase risk of angioedema.

            • amifostine

              amifostine, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

            • aluminum hydroxide

              aluminum hydroxide decreases effects of benazepril by unspecified interaction mechanism. Use Caution/Monitor. May decrease absorption.

            • amifostine

              amifostine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

            • amiloride

              benazepril and amiloride both increase serum potassium. Use Caution/Monitor. Risk of hyperkalemia. Enhanced hypotensive effects.

            • aminosalicylic acid

              aminosalicylic acid decreases effects of benazepril by pharmacodynamic antagonism. Use Caution/Monitor. Salicylates may also increase nephrotoxic effects of ACE inhibitors.

            • amiodarone

              amiodarone, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • amobarbital

              amobarbital increases effects of benazepril by Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Enhanced blood pressure lowering.

            • amphotericin B cholesteryl sulfate

              amphotericin B cholesteryl sulfate, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • amphotericin B deoxycholate

              amphotericin B deoxycholate, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • amphotericin B liposomal

              amphotericin B liposomal, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • amphotericin B phospholipid complex

              amphotericin B phospholipid complex, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • amyl nitrite

              amyl nitrite, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • apomorphine

              apomorphine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • aprotinin

              aprotinin decreases effects of benazepril by pharmacodynamic antagonism. Use Caution/Monitor. Aprotinin may diminish antihypertensive effect of ACE Inhibitors.

            • aripiprazole

              aripiprazole, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

            • arsenic trioxide

              arsenic trioxide, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • asenapine

              asenapine and amlodipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              benazepril increases effects of asenapine by pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • aspirin

              benazepril, aspirin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly with high dose aspirin, in elderly or volume depleted individuals.

            • atenolol

              atenolol, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate decreases effects of benazepril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Potential for dangerous interaction. Use with caution and monitor closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

              benazepril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • atogepant

              amlodipine will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • avanafil

              avanafil increases effects of amlodipine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              avanafil increases effects of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • avapritinib

              amlodipine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • azathioprine

              benazepril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.

            • axitinib

              amlodipine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • belzutifan

              belzutifan will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

            • bendroflumethiazide

              bendroflumethiazide, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Thiazide-like diuretics may also enhance the nephrotoxic effects of ACE inhibitors.

            • benperidol

              benperidol, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

            • betaxolol

              betaxolol, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

            • bismuth subsalicylate

              bismuth subsalicylate decreases effects of benazepril by pharmacodynamic antagonism. Use Caution/Monitor. Salicylates may also increase nephrotoxic effects of ACE inhibitors.

            • bisoprolol

              bisoprolol, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

            • bortezomib

              bortezomib, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • bosentan

              bosentan will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for decreased effects of amlodipine (CYP3A4 substrate) if bosentan is initiated/dose increased. Also, monitor toxicities of amlodipine if bosentan is discontinued/dose decreased.

            • bretylium

              benazepril, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

              amlodipine, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

            • brexpiprazole

              brexpiprazole increases toxicity of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • butabarbital

              butabarbital will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • bromocriptine

              bromocriptine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • bumetanide

              benazepril, bumetanide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.

            • bupivacaine

              bupivacaine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • butabarbital

              butabarbital increases effects of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

            • butalbital

              butalbital increases toxicity of benazepril by unspecified interaction mechanism. Use Caution/Monitor.

              butalbital will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • calcium acetate

              calcium acetate decreases effects of amlodipine by pharmacodynamic antagonism. Use Caution/Monitor.

            • calcium carbonate

              calcium carbonate decreases effects of benazepril by unspecified interaction mechanism. Use Caution/Monitor.

            • calcium carbonate

              calcium carbonate decreases effects of amlodipine by pharmacodynamic antagonism. Use Caution/Monitor.

            • calcium chloride

              calcium chloride decreases effects of amlodipine by pharmacodynamic antagonism. Use Caution/Monitor.

            • calcium citrate

              calcium citrate decreases effects of amlodipine by pharmacodynamic antagonism. Use Caution/Monitor.

            • calcium gluconate

              calcium gluconate decreases effects of amlodipine by pharmacodynamic antagonism. Use Caution/Monitor.

            • canagliflozin

              benazepril and canagliflozin both increase serum potassium. Use Caution/Monitor.

            • carbamazepine

              carbamazepine will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • carbidopa

              carbidopa increases effects of amlodipine by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

              carbidopa increases effects of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

            • cariprazine

              cariprazine increases toxicity of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

              benazepril increases toxicity of cariprazine by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • carvedilol

              carvedilol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • celecoxib

              benazepril, celecoxib. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • celiprolol

              celiprolol, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

            • cenobamate

              cenobamate will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

            • chlorothiazide

              benazepril, chlorothiazide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Ehanced hypotensive effects. Increased risk of nephrotoxicity. Monitor blood pressure and renal function.

            • chlorpropamide

              benazepril increases effects of chlorpropamide by pharmacodynamic synergism. Use Caution/Monitor.

            • chlorthalidone

              benazepril, chlorthalidone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects. Increased risk of nephrotoxicity. Monitor blood pressure and renal function.

            • choline magnesium trisalicylate

              benazepril, choline magnesium trisalicylate. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • ciprofloxacin

              benazepril increases toxicity of ciprofloxacin by unknown mechanism. Use Caution/Monitor. ACE Inhibitors may increase arrhythmogenic potential of ciprofloxacin, possibly by increasing serum potassium levels.

            • clarithromycin

              clarithromycin will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased effect of calcium channel blockers may lead to hypotension, edema, decreased HR, and acute kidney injury due to reduced renal blood flow

            • clevidipine

              amlodipine and clevidipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

            • clomiphene

              clomiphene, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • clomipramine

              clomipramine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • clozapine

              clozapine increases toxicity of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

              benazepril increases toxicity of clozapine by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • cobicistat

              cobicistat will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • conivaptan

              conivaptan, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • crizotinib

              crizotinib increases levels of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.

            • cyclosporine

              cyclosporine will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              amlodipine increases levels of cyclosporine by unspecified interaction mechanism. Modify Therapy/Monitor Closely. A prospective study in renal transplant recipients averaged a 40% increase in cyclosporine trough levels.

              benazepril and cyclosporine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. May increase risk of acute renal failure.

            • dabrafenib

              dabrafenib will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • dalteparin

              dalteparin increases toxicity of benazepril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • darunavir

              darunavir will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • deferasirox

              deferasirox will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • dextroamphetamine

              dextroamphetamine decreases effects of benazepril by pharmacodynamic antagonism. Use Caution/Monitor.

            • diazoxide

              diazoxide increases effects of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Diazoxide may enhance the hypotensive effect of antihypertensive agents.

            • dichlorphenamide

              dichlorphenamide and amlodipine both decrease serum potassium. Use Caution/Monitor.

            • diclofenac

              benazepril, diclofenac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • diflunisal

              benazepril, diflunisal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • digoxin

              benazepril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

            • diltiazem

              amlodipine and diltiazem both increase anti-hypertensive channel blocking. Use Caution/Monitor.

            • doxazosin

              doxazosin and amlodipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

            • dronedarone

              dronedarone will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Calcium channel blockers with depressant effects on the sinus and AV nodes could potentiate dronedarone's effects on conduction. Give a low dose of calcium channel blockers initially and increase only ECG is reviewed and tolerated.

            • drospirenone

              benazepril and drospirenone both increase serum potassium. Use Caution/Monitor.

            • duloxetine

              duloxetine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

            • efavirenz

              efavirenz will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • elagolix

              elagolix will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

            • encorafenib

              encorafenib, amlodipine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

            • enoxaparin

              enoxaparin increases toxicity of benazepril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • eplerenone

              benazepril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

            • epoprostenol

              epoprostenol, benazepril. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • erythromycin base

              erythromycin base will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • erythromycin lactobionate

              erythromycin lactobionate will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • erythromycin stearate

              erythromycin stearate will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • eslicarbazepine acetate

              eslicarbazepine acetate will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • esmolol

              esmolol, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

            • ethacrynic acid

              benazepril, ethacrynic acid. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.

            • etodolac

              benazepril, etodolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • everolimus

              benazepril, everolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.

            • exenatide injectable solution

              benazepril increases effects of exenatide injectable solution by Other (see comment). Use Caution/Monitor. Comment: ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .

            • exenatide injectable suspension

              benazepril increases effects of exenatide injectable suspension by Other (see comment). Use Caution/Monitor. Comment: ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor.

            • fedratinib

              fedratinib will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

            • felodipine

              amlodipine and felodipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

            • fenoprofen

              benazepril, fenoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • ferric gluconate

              benazepril increases toxicity of ferric gluconate by unspecified interaction mechanism. Use Caution/Monitor.

            • ferrous gluconate

              benazepril increases toxicity of ferrous gluconate by Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Benazepril may enhance adverse/toxic effects of ferrous gluconate.

            • finerenone

              benazepril and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.

              amlodipine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • flibanserin

              amlodipine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

            • flurbiprofen

              benazepril, flurbiprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • fluconazole

              fluconazole will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fosamprenavir

              fosamprenavir will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • furosemide

              benazepril, furosemide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.

            • glimepiride

              benazepril increases effects of glimepiride by pharmacodynamic synergism. Use Caution/Monitor. Additive hypoglycemic effects.

            • glipizide

              benazepril increases effects of glipizide by pharmacodynamic synergism. Use Caution/Monitor. Additive hypogylcemic effects.

            • glyburide

              benazepril increases effects of glyburide by pharmacodynamic synergism. Use Caution/Monitor. Additive hypoglycemic effects.

            • gold sodium thiomalate

              benazepril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

            • griseofulvin

              griseofulvin will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • heparin

              heparin increases toxicity of benazepril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • hydrochlorothiazide

              benazepril increases toxicity of hydrochlorothiazide by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects; increased risk of nephrotoxicity.

            • ibuprofen

              benazepril, ibuprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • ibuprofen IV

              benazepril, ibuprofen IV. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • icatibant

              icatibant decreases effects of benazepril by pharmacodynamic antagonism. Use Caution/Monitor. Icatibant has potential to have a pharmacodynamic interaction with ACE inhibitors where it may attenuate the antihypertensive effect of ACE inhibitors.

            • iloperidone

              iloperidone increases toxicity of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

              iloperidone and amlodipine both increase additive vasodilation. Use Caution/Monitor. Calcium channel blockers with iloperidone may potentiate the hypotensive effects.

              benazepril increases toxicity of iloperidone by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • iloprost

              iloprost, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

            • isavuconazonium sulfate

              amlodipine will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • indapamide

              indapamide, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Thiazide-like diuretics may also enhance the nephrotoxic effects of ACE inhibitors.

            • indomethacin

              benazepril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • insulin aspart

              benazepril increases effects of insulin aspart by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypoglycemic effects. Monitor blood glucose.

            • insulin degludec

              benazepril, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypoglycemic effects; Monitor blood glucose.

            • insulin degludec/insulin aspart

              benazepril, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypoglycemic effects; Monitor blood glucose.

            • insulin detemir

              benazepril increases effects of insulin detemir by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypoglycemic effects; Monitor blood glucose.

            • insulin glargine

              benazepril increases effects of insulin glargine by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypoglycemic effects; Monitor blood glucose.

            • insulin glulisine

              benazepril increases effects of insulin glulisine by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypoglycemic effects; Monitor blood glucose.

            • insulin inhaled

              benazepril, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypoglycemic effects; Monitor blood glucose.

            • insulin lispro

              benazepril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypoglycemic effects; Monitor blood glucose.

            • insulin NPH

              benazepril increases effects of insulin NPH by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypoglycemic effects; Monitor blood glucose.

            • insulin regular human

              benazepril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypoglycemic effects; Monitor blood glucose.

            • isocarboxazid

              isocarboxazid, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • isoflurane

              isoflurane, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • isosorbide dinitrate

              isosorbide dinitrate, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • isradipine

              amlodipine and isradipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

            • istradefylline

              istradefylline will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

            • itraconazole

              itraconazole will increase the level or effect of amlodipine by Other (see comment). Modify Therapy/Monitor Closely. CCBs elicit negative inotropic effects which may be additive to those of itraconazole; additionally, itraconazole can inhibit the metabolism of calcium channel blockers. Monitor for adverse reactions. Concomitant drug dose reduction may be necessary.

            • ketoconazole

              ketoconazole will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ketoprofen

              benazepril, ketoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • ketorolac

              benazepril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • ketorolac intranasal

              benazepril, ketorolac intranasal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • labetalol

              labetalol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • lanthanum carbonate

              lanthanum carbonate decreases levels of benazepril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.

            • lemborexant

              amlodipine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

            • lesinurad

              lesinurad decreases levels of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • letermovir

              letermovir increases levels of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • levodopa

              levodopa increases effects of amlodipine by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

              levodopa increases effects of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

              benazepril, levodopa. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

            • liraglutide

              benazepril increases effects of liraglutide by unknown mechanism. Use Caution/Monitor. ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .

            • lomitapide

              amlodipine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

            • lisdexamfetamine

              lisdexamfetamine decreases effects of benazepril by pharmacodynamic antagonism. Use Caution/Monitor.

            • lithium

              benazepril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule. Monitor lithium levels.

            • lopinavir

              lopinavir will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lorlatinib

              lorlatinib will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lurasidone

              lurasidone increases effects of amlodipine by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

              lurasidone increases effects of benazepril by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

            • magnesium salicylate

              benazepril, magnesium salicylate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly with high dose aspirin, elderly or volume depleted individuals.

            • magnesium supplement

              magnesium supplement, amlodipine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Calcium channel blockers may increase toxic effects of magnesium; magnesium may increase hypotensive effects of calcium channel blockers.

            • maraviroc

              maraviroc, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

              maraviroc, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

            • meclofenamate

              benazepril, meclofenamate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • mefloquine

              mefloquine increases levels of amlodipine by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

            • mefenamic acid

              benazepril, mefenamic acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • meloxicam

              benazepril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • metformin

              amlodipine decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor. Patient should be closely observed for loss of blood glucose control; when drugs are withdrawn from a patient receiving metformin, patient should be observed closely for hypoglycemia.

              benazepril increases toxicity of metformin by unspecified interaction mechanism. Use Caution/Monitor. Increases risk for hypoglycemia and lactic acidosis.

            • methamphetamine

              methamphetamine decreases effects of benazepril by pharmacodynamic antagonism. Use Caution/Monitor.

            • methylphenidate

              methylphenidate will decrease the level or effect of amlodipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • methohexital

              methohexital increases toxicity of benazepril by unspecified interaction mechanism. Use Caution/Monitor.

            • methyclothiazide

              benazepril, methyclothiazide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects; increased risk of nephrotoxicity.

            • methylphenidate

              methylphenidate will decrease the level or effect of benazepril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • metolazone

              metolazone, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Thiazide-like diuretics may also enhance the nephrotoxic effects of ACE inhibitors.

            • midazolam intranasal

              amlodipine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

            • mifepristone

              mifepristone will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • mitotane

              mitotane decreases levels of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

            • moxisylyte

              moxisylyte and amlodipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

            • nabumetone

              benazepril increases toxicity of nabumetone by unspecified interaction mechanism. Use Caution/Monitor. Combination may result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • nadolol

              nadolol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • naproxen

              benazepril, naproxen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • nebivolol

              nebivolol, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

            • nefazodone

              nefazodone will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • nesiritide

              nesiritide, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

            • nevirapine

              nevirapine will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nicardipine

              amlodipine and nicardipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

            • nifedipine

              amlodipine and nifedipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

            • nilotinib

              nilotinib will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nisoldipine

              amlodipine and nisoldipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

            • nitroglycerin IV

              nitroglycerin IV, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

            • nitroglycerin PO

              nitroglycerin PO, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. monitor blood pressure.

            • nitroglycerin rectal

              nitroglycerin rectal, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .

              nitroglycerin rectal, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Marked orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used concomitantly. Observe for possible additive hypotensive effects during concomitant use. .

            • nitroglycerin sublingual

              amlodipine, nitroglycerin sublingual. Either increases toxicity of the other by additive vasodilation. Modify Therapy/Monitor Closely. Marked orthostatic hypotension reported with concomitant use.

            • nitroglycerin transdermal

              nitroglycerin transdermal, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

            • nitroprusside sodium

              amlodipine increases effects of nitroprusside sodium by pharmacodynamic synergism. Use Caution/Monitor.

              nitroprusside sodium, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

            • obinutuzumab

              obinutuzumab increases effects of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Obinutuzumab may enhance the hypotensive effect of blood pressure lowering agents.

            • ombitasvir/paritaprevir/ritonavir & dasabuvir

              ombitasvir/paritaprevir/ritonavir & dasabuvir will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease dose of calcium channel blocker; dose of amlodipine should be decreased by at least 50%; clinical monitoring of patients is recommended for edema and/or signs and symptoms of hypotension. if such events occur, consider further dose reduction of calcium channel blocker or switching to alternative to calcium channel blocker

              ombitasvir/paritaprevir/ritonavir & dasabuvir will increase the level or effect of amlodipine by altering metabolism. Modify Therapy/Monitor Closely. Decrease dose of calcium channel blocker; dose of amlodipine should be decreased by at least 50%; clinical monitoring of patients is recommended for edema and/or signs and symptoms of hypotension. if such events occur, consider further dose reduction of calcium channel blocker or switching to alternative to calcium channel blocker

            • olanzapine

              olanzapine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

            • oxaprozin

              benazepril, oxaprozin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • paliperidone

              paliperidone increases toxicity of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

              benazepril increases toxicity of paliperidone by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • penbutolol

              penbutolol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • pentobarbital

              pentobarbital will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              pentobarbital, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

            • pentoxifylline

              pentoxifylline, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

            • phenobarbital

              phenobarbital will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • phendimetrazine

              phendimetrazine decreases effects of benazepril by pharmacodynamic antagonism. Use Caution/Monitor.

            • phenelzine

              phenelzine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • phenobarbital

              phenobarbital, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

            • phenoxybenzamine

              phenoxybenzamine and amlodipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              benazepril, phenoxybenzamine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • phentermine

              phentermine decreases effects of benazepril by pharmacodynamic antagonism. Use Caution/Monitor.

            • phentolamine

              phentolamine and amlodipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

            • phentolamine

              benazepril, phentolamine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • phenytoin

              amlodipine will increase the level or effect of phenytoin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • pindolol

              pindolol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • piroxicam

              benazepril, piroxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • posaconazole

              posaconazole will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • potassium acid phosphate

              benazepril increases levels of potassium acid phosphate by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.

              potassium acid phosphate and benazepril both increase serum potassium. Use Caution/Monitor. Potassium salts may increase the hyperkalemic effects of ACE inhibitors; the effect may be the result of aldosterone suppression in patients receiving ACE inhibitors

            • potassium chloride

              benazepril increases levels of potassium chloride by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.

              potassium chloride and benazepril both increase serum potassium. Use Caution/Monitor.

            • potassium citrate

              benazepril increases levels of potassium citrate by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.

              potassium citrate and benazepril both increase serum potassium. Use Caution/Monitor. Potassium salts may increase the hyperkalemic effects of ACE inhibitors; the effect may be the result of aldosterone suppression in patients receiving ACE inhibitors

            • potassium citrate/citric acid

              benazepril and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor. Risk of hyperkalemia.

            • potassium iodide

              potassium iodide and benazepril both increase serum potassium. Use Caution/Monitor. Potassium salts may increase the hyperkalemic effects of ACE inhibitors; the effect may be the result of aldosterone suppression in patients receiving ACE inhibitors.

            • potassium phosphates, IV

              benazepril and potassium phosphates, IV both increase serum potassium. Use Caution/Monitor. Increased risk of hyperkalemia.

            • prazosin

              prazosin and amlodipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              benazepril, prazosin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • primidone

              primidone will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • propofol

              propofol, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • propranolol

              propranolol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • quetiapine

              quetiapine increases toxicity of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

              benazepril increases toxicity of quetiapine by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • rasagiline

              rasagiline, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • ribociclib

              ribociclib will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifabutin

              rifabutin will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifampin

              rifampin will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifapentine

              rifapentine will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • riociguat

              riociguat, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • risperidone

              risperidone, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

            • ritonavir

              ritonavir will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ropivacaine

              ropivacaine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • rucaparib

              rucaparib will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

            • salsalate

              benazepril, salsalate. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • saquinavir

              saquinavir increases levels of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .

            • saxagliptin

              saxagliptin increases toxicity of benazepril by Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Increased risk of adverse/toxic effects, specifically increased risk of angioedema.

            • secobarbital

              secobarbital, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

            • selegiline

              selegiline, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • sevoflurane

              sevoflurane, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • sildenafil

              sildenafil, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

            • silodosin

              benazepril, silodosin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

              silodosin and amlodipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

            • sirolimus

              benazepril, sirolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              amlodipine, sodium sulfate/?magnesium sulfate/potassium chloride. Either increases effects of the other by unknown mechanism. Use Caution/Monitor. Monitor for hypotension or muscle weakness in patients receiving calcium channel blockers with elevated serum magnesium concentrations.

            • sitagliptin

              sitagliptin increases toxicity of benazepril by Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Increased risk of adverse/toxic effects, specifically, increased risk of angioedema.

            • sodium bicarbonate

              sodium bicarbonate decreases effects of benazepril by unspecified interaction mechanism. Use Caution/Monitor.

            • sodium citrate/citric acid

              sodium citrate/citric acid decreases effects of benazepril by unspecified interaction mechanism. Use Caution/Monitor.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of benazepril by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              amlodipine, sodium sulfate/potassium sulfate/magnesium sulfate. Either increases effects of the other by unknown mechanism. Use Caution/Monitor. Monitor for hypotension or muscle weakness in patients receiving calcium channel blockers with elevated serum magnesium concentrations.

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of benazepril by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sotalol

              sotalol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • spironolactone

              benazepril and spironolactone both increase serum potassium. Use Caution/Monitor.

            • St John's Wort

              St John's Wort will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • stiripentol

              stiripentol, amlodipine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

            • sulfasalazine

              sulfasalazine decreases effects of benazepril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Potential for dangerous interaction. Use with caution and monitor closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

              benazepril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • sulindac

              benazepril, sulindac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • synthetic human angiotensin II

              benazepril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.

            • tacrolimus

              amlodipine will increase the level or effect of tacrolimus by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Adjust dose when appropriate.

            • tadalafil

              tadalafil increases effects of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              tadalafil increases effects of amlodipine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • tazemetostat

              tazemetostat will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              amlodipine will decrease the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • temsirolimus

              benazepril, temsirolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.

            • tecovirimat

              tecovirimat will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

            • temsirolimus

              amlodipine increases toxicity of temsirolimus by Other (see comment). Use Caution/Monitor. Comment: Combination of mTOR inhibitors with calcium channel blockers increases risk of angioedema.

            • terazosin

              terazosin and amlodipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              benazepril, terazosin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • timolol

              timolol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

            • tolazamide

              benazepril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

            • tinidazole

              amlodipine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tipranavir

              tipranavir increases levels of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. Tipranavir is used with ritonavir (boosted therapy) which is a potent CYP3A4 inhibitor.

            • tolbutamide

              benazepril increases effects of tolbutamide by pharmacodynamic synergism. Use Caution/Monitor.

            • tolmetin

              benazepril, tolmetin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • torsemide

              benazepril, torsemide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.

            • triamterene

              benazepril and triamterene both increase serum potassium. Use Caution/Monitor.

            • trimagnesium citrate anhydrous

              trimagnesium citrate anhydrous, amlodipine. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Possible additive effect of magnesium and calcium channel blockers on reduction of ionic calcium may increase risk of hypotension or muscle weakness.

            • trimethoprim

              trimethoprim and benazepril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.

            • vardenafil

              vardenafil, benazepril. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

            • verapamil

              amlodipine and verapamil both increase anti-hypertensive channel blocking. Use Caution/Monitor.

            • voclosporin

              voclosporin and benazepril both increase serum potassium. Use Caution/Monitor.

              voclosporin, benazepril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • voriconazole

              voriconazole will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              voriconazole increases levels of amlodipine by decreasing metabolism. Use Caution/Monitor.

            • xipamide

              xipamide increases effects of amlodipine by pharmacodynamic synergism. Use Caution/Monitor.

            • yohimbine

              yohimbine decreases effects of benazepril by pharmacodynamic antagonism. Use Caution/Monitor. Yohimbine may diminish the antihypertensive effect of antihypertensive agents.

            Minor (74)

            • agrimony

              agrimony increases effects of benazepril by pharmacodynamic synergism. Minor/Significance Unknown. Enhanced hypoglycemic and hypotensive effects.

              agrimony increases effects of amlodipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • amobarbital

              amobarbital will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • brimonidine

              brimonidine increases effects of benazepril by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

            • aprepitant

              aprepitant will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • armodafinil

              armodafinil will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • artemether/lumefantrine

              artemether/lumefantrine will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • atazanavir

              atazanavir will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • atracurium

              amlodipine increases effects of atracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

            • brimonidine

              brimonidine increases effects of amlodipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • capsicum

              capsicum, benazepril. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increase ACE inhibitor induced cough.

            • chlorpromazine

              chlorpromazine increases effects of benazepril by unspecified interaction mechanism. Minor/Significance Unknown. Increased risk of hypotension.

            • cisatracurium

              amlodipine increases effects of cisatracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

            • clofarabine

              clofarabine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • cornsilk

              cornsilk increases effects of amlodipine by pharmacodynamic synergism. Minor/Significance Unknown.

              cornsilk increases effects of benazepril by pharmacodynamic synergism. Minor/Significance Unknown.

            • creatine

              creatine, benazepril. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction) Combination may have additive nephrotoxic effects.

            • dasatinib

              dasatinib will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • desflurane

              desflurane, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • dexamethasone

              dexamethasone will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • DHEA, herbal

              DHEA, herbal will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • dinutuximab

              dinutuximab, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • entecavir

              benazepril, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

            • etravirine

              etravirine will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • fluphenazine

              fluphenazine increases effects of benazepril by unspecified interaction mechanism. Minor/Significance Unknown. Enhanced hypotensive effects.

            • fo-ti

              fo-ti increases effects of amlodipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • forskolin

              forskolin increases effects of amlodipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • grapefruit

              grapefruit will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • imipramine

              imipramine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • incobotulinumtoxinA

              amlodipine increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

            • iron sucrose

              iron sucrose, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • lithium

              amlodipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.

            • maitake

              maitake increases effects of benazepril by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              maitake increases effects of amlodipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • mercaptopurine

              benazepril, mercaptopurine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of neutropenia.

            • metipranolol ophthalmic

              metipranolol ophthalmic increases effects of amlodipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • mirabegron

              mirabegron decreases effects of benazepril by pharmacodynamic antagonism. Minor/Significance Unknown. Monitor blood pressure.

            • modafinil

              modafinil will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • morphine

              morphine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • nabilone

              nabilone, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • nelfinavir

              nelfinavir will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • nitric oxide gas

              nitric oxide gas, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • octacosanol

              octacosanol increases effects of amlodipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • onabotulinumtoxinA

              amlodipine increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

            • oxcarbazepine

              oxcarbazepine will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • paclitaxel

              paclitaxel, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • pancuronium

              amlodipine increases effects of pancuronium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

            • perphenazine

              perphenazine increases effects of benazepril by unspecified interaction mechanism. Minor/Significance Unknown.

            • porfimer

              amlodipine decreases levels of porfimer by unspecified interaction mechanism. Minor/Significance Unknown.

            • probenecid

              probenecid increases levels of benazepril by Other (see comment). Minor/Significance Unknown. Comment: Probenecid may decrease the renal excretion of benazepril; monitor blood pressure.

            • prochlorperazine

              prochlorperazine increases effects of benazepril by unspecified interaction mechanism. Minor/Significance Unknown. Enhanced hypotensive effects.

            • promazine

              promazine increases effects of benazepril by unspecified interaction mechanism. Minor/Significance Unknown. Enhanced hypotensive effects.

            • promethazine

              promethazine increases effects of benazepril by unspecified interaction mechanism. Minor/Significance Unknown. Enhanced hypotensive effects.

            • quinupristin/dalfopristin

              quinupristin/dalfopristin will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • rapacuronium

              amlodipine increases effects of rapacuronium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

            • reishi

              reishi increases effects of amlodipine by pharmacodynamic synergism. Minor/Significance Unknown.

              reishi increases effects of benazepril by pharmacodynamic synergism. Minor/Significance Unknown. Enhanced hypotensive and hypoglycemic effects.

            • remifentanil

              remifentanil, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • rocuronium

              amlodipine increases effects of rocuronium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

            • ropinirole

              ropinirole, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • rotigotine

              rotigotine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • rufinamide

              rufinamide will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • ruxolitinib

              amlodipine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • salicylates (non-asa)

              salicylates (non-asa) decreases effects of benazepril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • secobarbital

              secobarbital will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • shepherd's purse

              shepherd's purse, amlodipine. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

            • sotalol

              sotalol, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • succinylcholine

              amlodipine increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

            • tamsulosin

              tamsulosin, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • thalidomide

              thalidomide, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • thioridazine

              thioridazine, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • tizanidine

              tizanidine increases effects of benazepril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              tizanidine increases effects of amlodipine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

            • tolfenamic acid

              tolfenamic acid decreases effects of benazepril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • treprostinil

              treprostinil increases effects of amlodipine by pharmacodynamic synergism. Minor/Significance Unknown.

            • treprostinil

              treprostinil increases effects of benazepril by pharmacodynamic synergism. Minor/Significance Unknown. Enhanced hypotensive effects.

            • tretinoin

              tretinoin, benazepril. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. May increase risk of hypotension.

            • trifluoperazine

              trifluoperazine increases effects of benazepril by unspecified interaction mechanism. Minor/Significance Unknown. Enhanced hypotensive effects.

            • vecuronium

              amlodipine increases effects of vecuronium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

            Previous
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            Adverse Effects

            >10%

            Amlodipine

            • Peripheral edema (2-15%)
            • Pulmonary edema (7-15%)

            Benazepril

            • None indicated

            1-10%

            Amlodipine

            • Abdominal pain (1.6%)
            • Dizziness (1.1-3.4%)
            • Dyspepsia (1-2%)
            • Fatigue (4.5%)
            • Flushing (0.7-2.6%)
            • Headache (7.3%)
            • Male sexual dysfunction (1-2%)
            • Muscle cramps (1-2%)
            • Nausea (2.9%)
            • Palpitation (0.7-4.5%)
            • Rash (1-2%)
            • Somnolence (1-2%)
            • Weakness (1-2%)

            Benazepril

            • ARF if renal artery stenosis
            • Cough (1-10%)
            • Dizziness (4%)
            • Fatigue (2%)
            • Headache (6%)
            • Nausea (1%)
            • Postural dizziness (2%)
            • Serum creatinine increased (2%)
            • Somnolence (2%)

            Postmarketing Reports

            Amlodipine

            • Gingival hyperplasia
            • Tachycardia
            • Jaundice
            • Hepatic enzyme elevations
            • Diplopia
            • Gynecomastia
            • Cholestasis
            • Acute interstitial nephritis
            • Depression
            • Leukopenia

            Benazepril

            • Stevens-Johnson syndrome
            • Pancreatitis
            • Hemolytic anemia
            • Pemphigus
            • Thrombocytopenia
            • Arthralgia
            • ECG changes
            • Gastritis
            • Flushing
            • Hemolytic anemia
            • Neutropenia
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            Warnings

            Black Box Warnings

            Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system, causing oligohydramnios, which may result in fetal injury and/or death

            Contraindications

            Hypersensitivity

            History of angioedema with or without previous ACE inhibitor therapy

            Hereditary or idiopathic angioedema

            Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan

            Concomitant use with Aliskiren in patients with diabetes mellitus

            Cautions

            Use with caution in CHF

            Use with caution in patients with aortic stenosis, ischemic heart disease or cerebrovascular disease

            Use with caution in patients with unstented unilateral/bilateral renal artery stenosis; avoid use due to elevated risk of deterioration in renal function

            Persistent, progressive dermatologic reactions

            Exacerbation of angina (during initiation of treatment, after dose increase, or withdrawal of beta blocker)

            Use caution in hepatic impairment (may require lower starting dose)

            Excessive hypotension if concomitant diuretics, hypovolemia, hyponatremia

            Risk of hyperkalemia, especially with renal impairment or DM or in patients taking concomitant K+-elevating drugs; assess for hypotension and hyperkalemia

            Dual blockade of the renin-angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure), compared with monotherapy; most patients receiving combination of two renin-angiotensin system (RAS) inhibitors do not obtain additional benefit compared to monotherapy; in general, avoid combined use of RAS inhibitors

            Titrate slowly with hepatic impairment; amlodipine extensively metabolized by liver (half-life is 56 hr with hepatic impairment)

            Rare reports of cholestatic hepatitis and acute liver failure (some fatal)

            Myocardial infarction or increased angina in patients with obstructive coronary artery disease may occur

            Avoid with severe renal impairment (ie, CrCl <30 mL/min); avoid in patients with severe heart failure, whose renal function may depend on the activity of the renin-angiotensin-aldosterone system; treatment with ACE inhibitor causes oliguria or progressive azotemia and (rarely) with acute renal failure and/or death

            Hypotension

            • Therapy can cause symptomatic hypotension, sometimes complicated by oliguria, progressive azotemia, acute renal failure, or death
            • Symptomatic hypotension is most likely to occur in patients who have heart failure, severe aortic or mitral stenosis, obstructive hypertrophic cardiomyopathy or have been volume or salt depleted as a result of diuretic therapy, dietary salt restriction, dialysis, diarrhea, or vomiting;
            • Correct volume and salt depletion before starting therapy with benazepril; if hypotension occurs, place patient in supine position and give physiological saline intravenously if needed; continue treatment with therapy once blood pressure and volume have returned to normal

            Angioedema

            • Angioedema may occur at any time during treatment; angioedema associated with edema of the larynx, tongue, or glottis can compromise the airway and be fatal; if laryngeal stridor or angioedema of face, tongue, or glottis occurs, discontinue treatment with Lotrel and treat immediately
            • Patients with a history of angioedema may be at increased risk for angioedema while receiving therapy
            • Black patients receiving ACE inhibitors have higher incidence of angioedema compared with nonblacks
            • Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (eg, temsirolimus, sirolimus, everolimus) therapy may be at increased risk for angioedema
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            Pregnancy & Lactation

            Pregnancy

            Therapy can cause fetal harm when administered to a pregnant woman; use of drugs that act on RAS during second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death

            Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in the first trimester have not distinguished drugs affecting the RAS from other antihypertensive agents;

            When pregnancy is detected, discontinue therapy as soon as possible; the estimated background risk of major birth defects and miscarriage for indicated population is unknown; all pregnancies have a background risk of birth defect, loss, or other adverse outcomes

            Hypertension in pregnancy increases maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (e.g., need for cesarean section, and post-partum hemorrhage); hypertension increases fetal risk for intrauterine growth restriction and intrauterine death; pregnant women with hypertension should be carefully monitored and managed accordingly

            Reactions oligohydramnios in pregnant women who use drugs affecting renin-angiotensin system in second and third trimesters of pregnancy can result reduced fetal renal function leading to anuria and renal failure, fetal lung hypoplasia, skeletal deformations, including skull hypoplasia, hypotension and death

            Perform serial ultrasound examinations to assess intra-amniotic environment; fetal testing may be appropriate, based on week of gestation

            Patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained irreversible injury

            If oligohydramnios is observed, consider alternative drug treatment;

            closely observe neonates with histories of in utero exposure to drug for hypotension, oliguria, and hyperkalemia

            In neonates with a history of in utero exposure to therapy, if oliguria or hypotension occurs, support blood pressure and renal perfusion

            Exchange transfusions or dialysis may be required as a means of reversing hypotension and replacing renal function

            Lactation

            Minimal amounts of unchanged benazepril and of benazeprilat are excreted into the breast milk of lactating women treated with benazepril, so that a newborn child ingesting nothing but breast milk would receive less than 0.1% of maternal doses of benazepril and benazeprilat

            Limited available data from a published clinical lactation study reports that amlodipine is present in human milk at an estimated median relative infant dose of 4.2%; no adverse effects of amlodipine on breastfed infant have been observed; there is no available information on effects of amlodipine or benazepril on milk production

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Amlodipine: Ca channel blocker; inhibits the transmembrane influx of extracellular Ca ions across the membranes of myocardial cells and vascular smooth muscle cells without changing serum calcium concentrations, resulting in inhibition of cardiac and vascular smooth muscle contraction, thereby dilating the main coronary and systemic arteries

            Benazepril: Competitively inhibits angiotensin-converting enzymes, resulting in decreased plasma angiotensin II concentrations; consequently, blood pressure may be reduced in part through decreased vasoconstriction, increased renin activity, and decreased aldosterone secretion

            Absorption

            Bioavailability: Benazepril (37%); amlodipine (64-90%)

            Peak plasma time: Benazepril (0.5-2 hr); amlodipine (6-12 hr)

            Distribution

            Protein bound: >90% for each component

            Vd: Benazepril (0.7 L/kg); amlodipine (21 L/kg)

            Metabolism

            Benazepril by hepatic metabolism to active metabolite (benazeprilat)

            Amlodipine is extensively metabolized in liver

            Elimination

            Half-life, elimination: Benazeprilat (10-11 hr); amlodipine (~48 hr)

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            Images

            No images available for this drug.
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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.