A review of amlodipine in myocardial ischaemia

Amlodipine is a dihydropyridine calcium antagonist with a unique pharmacokinetic profile providing advantages over other therapies of its kind. It has been shown to possess high oral absorption, long elimination half-life, smooth onset of action and long duration of pharmacodynamic activity. These properties result in gradual vasodilation, ensuring a low incidence of vasodilatory side effects and once-daily administration. In randomized, double-blind, placebo-controlled studies a dose of 5-10 mg once daily has been established as the most efficacious dose for the treatment of angina pectoris. Amlodipine was found to increase exercise capacity significantly and reduce electrocardiographic evidence of myocardial ischaemia after treadmill exercise testing 24 h after administration compared with placebo in patients suffering from angina pectoris. Angina attack rate and glyceryl trinitrate consumption were also significantly reduced. Amlodipine was shown to possess comparable anti-anginal efficacy with the calcium antagonist diltiazem and the beta-blocker nadolol. In combination with beta-blockers and/or nitrates the addition of amlodipine was found to produce enhanced anti-anginal efficacy with good tolerability. Amlodipine is also effective in reducing the angina attack rate in patients with vasospastic angina. In conclusion, amlodipine is an effective and well-tolerated therapeutic agent given once daily as monotherapy or in combination with beta-blockers and/or nitrates for the treatment of chronic stable angina pectoris and vasospastic angina.