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Can I Take Lisinopril and Amlodipine Together?

Key Takeaways

  • Yes, lisinopril and amlodipine can be safely taken together and are commonly prescribed as combination therapy for high blood pressure (hypertension).
  • This combination is more effective at lowering blood pressure than either medication alone, so it can be useful for patients with moderate to severe hypertension.
  • Common side effects include dry cough, swelling, and dizziness.
  • The combination works through two different mechanisms – lisinopril blocks ACE enzymes while amlodipine blocks calcium channels.
  • Regular monitoring by your healthcare provider is important to ensure the safety and effectiveness of this treatment.

Are lisinopril and amlodipine safe and effective?

Lisinopril and amlodipine are a safe and effective combination therapy used to manage hypertension. It is typically used in patients who need more aggressive blood pressure control or have a high risk of serious complications.

Many patients require two medications to reach a normal blood pressure below 120/80 mmHg. This is especially true for people with essential hypertension that doesn’t respond adequately to monotherapy (only one medication).

Clinical studies show that over 80% of patients achieve blood pressure control with this combination within 4 weeks of starting treatment. This marked additional effect occurs because amlodipine and lisinopril work through different mechanisms to lower blood pressure. While taking lisinopril blocks the angiotensin converting enzyme, amlodipine is a calcium channel blocker that directly relaxes blood vessels.

Understanding Each Drug

What is Lisinopril?

Lisinopril belongs to a class of drugs called ACE inhibitors that work by preventing the formation of hormones that narrow blood vessels. Specifically, it blocks the angiotensin converting enzyme, which normally converts angiotensin I to angiotensin II. This helps relax blood vessels and reduce your blood pressure.

This medication treats high blood pressure, heart failure and is commonly used after heart attacks to reduce your risk of dying. Lisinopril is available in an oral tablet and solution with a dosage that typically ranges from 2.5mg to 40mg. It is usually taken once daily, with or without food.

How effective lisinopril is may vary based on certain patient factors. Some studies suggest that black patients tend to show reduced blood pressure response to ACE inhibitors alone when compared to caucasian patients. Howevere, this difference largely disappears when combined with other blood pressure medicines like calcium channel blockers.

What is Amlodipine?

Amlodipine is a calcium channel blocker that prevents calcium from entering the cells of the heart and blood vessels. This effectively relaxes blood vessels and improves blood flow throughout your body.

Amlodipine is used to treat high blood pressure and certain types of chest pain. It is an oral tablet strengths of 2.5mg, 5mg, and 10mg. Amlodipine is typically taken once daily for blood pressure control.

Both amlodipine and lisinopril are available as generic medications, making this combination therapy accessible and affordable for most patients.

Common Side Effects

Lisinopril-Related Side Effects

The most common side effects of lisinopril are headache, dizziness, and low blood pressure (hypotension). These symptoms are more likely seen at the beginning of treatment or following a dose increase. They are typically mild and will improve within the first few weeks of starting lisinopril as your body adjusts to the medication. Another common adverse effect of ACE inhibitors like lisinopril is a dry, persistent cough.

Lisinopril can also cause high levels of potassium (hyperkalemia). Your provider will usually perform periodic blood tests to monitor these levels.

And while rare, the most serious side effect is angioedema, which requires immediate medical attention. Symptoms include swelling of the face, lips, tongue, or throat, and trouble breathing.

Amlodipine-Related Side Effects

Ankle and leg swelling (edema) is one of the most common side effects of amlodipine, affecting around 10% of patients. This typically appears gradually and is more common in elderly patients or those taking higher doses.

Like lisinopril, amlodipine can make you feel dizzy or tired, especially when starting treatment or increasing the dose. You may also experience flushing and headaches due to blood vessel dilation, along with nausea and upset stomach.

A rare, but important thing to note is that amlodipine may worsen chest pain or lead to a heart attack, particularly when first starting the medication or increasing the dose.

Combined Therapy Considerations

When both medications are used together, there’s an increased risk of low blood pressure, especially in elderly patients or those taking other medications that lower blood pressure. Studies comparing this combination to alternatives show a higher incidence of cough and edema when compared to some other combinations, such as amlodipine with ARBs.

Most side effects of this combination are mild and resolve on their own. The benefits of achieving blood pressure control typically outweigh the risks for most hypertensive patients. Healthcare providers can often manage side effects through dose adjustments or switching to alternative medicines.

Who Should Consider This Combination

Patients with stage 2 hypertension may benefit the most from this combination therapy. Stage 2 hypertension is defined as having a systolic pressure (top number) of 140 mmHg or higher OR a diastolic pressure (bottom number) of 90 mmHg or higher. These patients need aggressive treatment with more than one medication.

The combination is also effective for patients with diabetes, kidney disease, or cardiovascular disease who require tight blood pressure control to prevent complications.

Black patients respond similarly to this combination therapy as other ethnic groups, despite some reduced effectiveness with ACE inhibitor monotherapy. The addition of amlodipine appears to overcome the reduced response sometimes seen with lisinopril alone in certain populations.

However, certain people should avoid this combination. This includes those with a history of angioedema, pregnant women, and patients with severe kidney disease. The doctor will consider individual risk factors, other medications, and medical history to determine if this combination is appropriate.

Monitoring and Safety Considerations

Regular blood pressure monitoring is important to ensure both effectiveness and safety of this therapy. You should take regular blood pressure readings at home and keep all your appointments.

Blood tests every 3 to 6 months should be performed to check your kidney function and potassium levels. You and your doctor should also look for signs of angioedema, especially during the first month of treatment.

Another thing to watch for is ankle swelling, which may be a sign of fluid retention. While mild swelling is common with amlodipine, significant swelling or difficulty breathing could signal more serious complications.

There are also certain dietary considerations while on these medications. Avoid high-potassium foods and salt substitutes while taking lisinopril, as these can increase your potassium levels.

Response to this combination may vary based on patient-specific factors. Age plays a significant role, with elderly patients often requiring a low starting dose to help minimize the risk of side effects.

Pregnant women should not take lisinopril due to potential harm to their unborn baby. Women who can become pregnant should discuss contraception and pregnancy planning with their doctors before starting this combination.

Frequently Asked Questions

How long does it take for the lisinopril and amlodipine combination to work?

Blood pressure begins to decrease within hours of taking the first dose of either medication. However, the full effects typically develop over 2 to 4 weeks of daily use. Clinical studies show that approximately 38% of patients achieve their target blood pressure after 2 weeks, with about 85% reaching goal levels after 4 weeks of combination therapy. Peak and trough levels of both medications provide 24-hour coverage, so they only need to be taken once daily. However, your healthcare provider may adjust doses after 2 to 4 weeks if your blood pressure is still high.

Can I take these medications if I have kidney disease?

Both amlodipine and lisinopril can be used in patients with mild to moderate kidney disease, but you will need monitoring and possible dose adjustments. Lisinopril may actually provide protective effects for kidney function if you have diabetes.

Your healthcare provider will regularly check your kidney function and potassium levels while taking lisinopril. If you have severe kidney disease, you may need to consider an alternative medication.

What should I do if I experience a persistent cough?

A persistent dry cough is a common side effect of ACE inhibitors like lisinopril. This cough typically develops within weeks of starting treatment and may continue as long as you take the medication. The cough is not harmful but can be bothersome.

Contact your healthcare provider rather than stopping the medication abruptly, as sudden discontinuation can cause dangerous blood pressure spikes. Your doctor may switch lisinopril to an ARB like losartan, which provides similar benefits but rarely causes cough. The cough usually resolves within days to weeks after switching medications.

Is it safe to take this combination long-term?

Yes, both lisinopril and amlodipine are designed for long-term use and have excellent safety profiles when taken as directed. Regular monitoring every 3 to 6 months helps ensure the safety and effectiveness of this combination.

Can I stop taking these medications if my blood pressure is normal?

No, you should never stop blood pressure medications without talking to your healthcare provider first. High blood pressure typically returns within days to weeks of stopping medication, even if your readings have been normal for a long time.

While lifestyle changes like improved diet, regular exercise, and weight loss may help you take a lower dose, they rarely take the place of medications in most patients. Any changes to your medication treatment should always be made gradually under medical supervision to be sure your blood pressure remains safely controlled.

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