Lotrel (Amlodipine and Benazepril) - Oral

What Is Lotrel?

Lotrel (amlodipine and benazepril) is a prescription capsule taken orally to treat high blood pressure. It is a combination medication with two components: a calcium channel blocker (amlodipine) and an angiotensin-converting enzyme (ACE) inhibitor (benazepril).

Drugs that have an ACE inhibitor as an active ingredient should not be used during pregnancy; therefore, this medication must be immediately discontinued if you become pregnant while on it.

To understand how Lotrel works, it is important to know how its individual parts work. Benazepril acts as an ACE inhibitor. Throughout the body, there are specific proteins (enzymes) that speed up reactions that happen in your body. ACE is one of many enzymes in what is known as the renin-angiotensin (RAS) pathway. This pathway results in the production of an important molecule called angiotensin II, a molecule that can cause your blood pressure to increase. Benazepril reduces the production of angiotensin II,  which results in less squeezing of the blood vessels; this helps decrease your blood pressure.

Amlodipine, the other active ingredient in Lotrel, acts as a calcium channel blocker. Proteins called channels and ions (like calcium) are responsible for different bodily functions. In the heart and blood vessels, the entry of calcium in the calcium channels causes the heart and blood vessels to squeeze tighter, increasing your blood pressure. Calcium channel blockers block the entry point of calcium, which allows the blood vessels and heart to relax more, lowering your blood pressure.

Lotrel is available in capsule form to be taken by mouth.

What Is Lotrel Used For?

The Food and Drug Administration (FDA) has approved Lotrel to treat high blood pressure (hypertension). A healthcare provider may prescribe Lotrel if either amlodipine or benazepril alone does not control your blood pressure.

High blood pressure is diagnosed by consistently high blood pressure readings, namely consistent systolic readings of 130 millimeters of mercury (mm Hg) or higher or diastolic readings of 80 millimeters of mercury or higher. It's possible for hypertension to go unrecognized, as people don't typically experience symptoms. Left untreated, it can lead to serious health issues, such as heart attack and stroke.

Blood pressure–lowering medications, such as Lotrel, are sometimes prescribed to help control hypertension. However, lifestyle adjustments such as diet modifications and regular exercise should always be adopted.

How to Take Lotrel

Follow the directions given by your prescribing healthcare provider. Generally, Lotrel is taken once a day, with or without food. This medication, and other medications for blood pressure, should be taken even if you are feeling well. This is because high blood pressure often doesn't have any symptoms. Uncontrolled blood pressure can lead to further health complications, including heart disease.

Storage

Store Lotrel capsules in a cool, dry place. Medications should be kept away from areas exposed to heat, like the kitchen, or humidity, like the bathroom. These environments can affect how well medicines work. Keep your medication away from and out of reach of children and pets to prevent accidental consumption.

There are no specific travel requirements set by the Transportation Security Administration for Lotrel. Since this is not a controlled substance, getting refills should be fairly easy. Contact your pharmacist for a refill request before running out of the medication.

What Are the Side Effects of Lotrel?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

You may not feel any side effects from taking this drug or have only minor effects. Talk to your healthcare provider if these common side effects continue to bother you:

• Dry cough
• Edema (swelling)
• Headache 
• Dizziness

Severe Side Effects

Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and symptoms can include the following:

• Allergic reaction: Rash, hives, difficulty breathing, or swelling of the face, tongue, lips, or throat
• Edema: Swelling of the feet, hands, ankles, or face

Rarer side effects that can be severe include:

• Hypotension (low blood pressure)
• Neutropenia, a condition caused by low levels of neutrophils (a type of white blood cell)
• Hyperkalemia (high potassium levels)
• Thrombocytopenia, or low platelet count
• Agranulocytosis, a blood condition caused by too few white blood cells called granulocytes
• Pancreatitis, or inflammation of the pancreas
• Stevens-Johnson syndrome, a rare type of hypersensitivity reaction
• Pemphigus, a rare group of autoimmune diseases affecting the skin and mucous membranes
  

Dosage: How Much Lotrel Should I Take?

Modifications

Due to the possible effects of this medication, there may be changes to how it is used. Therefore, it is important for users to be aware of the following when taking Lotrel:

• Kidney function: Lotrel is not recommended for people with a creatinine clearance of less than 30 milliliters per minute (mL/min), which would indicate low kidney function.
• Liver impairment: Liver problems may necessitate a lower starting dose since amlodipine is primarily removed from the body by the liver.
• Age: Adults 65 and older may have greater sensitivity to certain medications and are more likely to have problems like liver impairment.
• Pregnancy: Discontinue Lotrel if you become pregnant while on this medication and immediately contact your healthcare provider.

Missed Dose

If you miss a dose of Lotrel, take it as soon as you remember. If it's too close to the next scheduled dose, take only the scheduled dose and skip the missed one. You should not take more than one dose at a time. Missing one dose of this medication is not harmful, but it is important to take it daily to control your blood pressure.

Overdose: What Happens If I Take Too Much Lotrel?

There have been no reports of human overdoses with Lotrel, although a few cases have been reported with amlodipine alone. If you take too much of this medication, you may experience severe low blood pressure and a fast heart rate. Get medical help immediately if you think you've overdosed on Lotrel.

Precautions

What Are Reasons I Shouldn’t Take Lotrel?

You should not take Lotrel if:

• You are pregnant or think you are pregnant: Lotrel has an active ingredient that is part of a drug class with teratogenic effects, which can cause injury or death to the developing fetus.
• You have a history of angioedema or allergy to benazepril or amlodipine
• You are also taking a neprilysin inhibitor, another class of medications used to treat high blood pressure and heart failure

This medication can be present in breast milk, but no bad side effects have been observed in nursing infants. Talk with your healthcare provider about the risks and benefits of being on this medication while breastfeeding.

What Medications Interact With Lotrel?

One of Lotrel's active ingredients is an ACE inhibitor, which can increase potassium levels in the blood. Potassium is a sensitive element and needs to be tightly controlled, as levels that are too high or too low can be deadly. Therefore, Lotrel should be used with caution with potassium supplements or potassium-containing medications, such as diuretics (water pills). Examples of diuretics include:

• Aldactone (spironolactone)
• Lasix (furosemide)
• Microzide (hydrochlorothiazide)

Lotrel also interacts with lithium. Taking these medications together can increase lithium levels in the blood, raising the risk of toxicity. Frequent monitoring of lithium blood levels is recommended if both drugs are taken together.

Lotrel—and other ACE inhibitors—should not be taken with drugs in the nonsteroidal anti-inflammatory drug (NSAID) class. NSAIDs are commonly used for the management of mild to moderate pain and osteoarthritis. Taking Lotrel with NSAIDs can also increase the risk of kidney problems and lower Lotrel's blood pressure–lowering effects.

Examples of NSAIDs include:

• Advil (ibuprofen)
• Mobic (meloxicam)
• Naprosyn or Aleve (naproxen)

One alternative to NSAIDs is Tylenol, which can also be used for mild to moderate pain relief and is safe to take with Lotrel.

Other drug interactions associated with Lotrel are:

• Injectable gold
• Zocor (simvastatin)
• mTOR inhibitors, such as Afinitor (everolimus), and neprilysin inhibitors, such as sacubitril, can increase the risk of angioedema

This is not a complete list of all the drugs that may interact with Lotrel. Always keep an up-to-date list of all the medicines you take and share this information with your healthcare provider and pharmacist any time there are changes.

What Medications Are Similar?

Lotrel is a unique blood pressure medication that combines two common drug classes for blood pressure medications: an ACE inhibitor and a calcium channel blocker. Another combination ACE inhibitor/calcium channel blocker is Prestalia (perindopril and amlodipine).

Angiotensin II receptor blockers are also commonly combined with thiazide diuretics to treat high blood pressure. Examples of these combination treatments include:

• Hyzaar (losartan and hydrochlorothiazide) 
• Benicar-HCT (olmesartan and hydrochlorothiazide) 
• Micardis-HCT (telmisartan and hydrochlorothiazide) 
• Diovan-HCT (valsartan and hydrochlorothiazide)

This is a list of drugs that are also prescribed for blood pressure control. It is NOT a list of drugs recommended to take with Lotrel. In fact, you should not take these drugs together. Discuss any questions or concerns about your treatment regimen with a healthcare provider or pharmacist.

How Can I Stay Healthy While Taking Lotrel?

To stay healthy, it is important to take this medication exactly as prescribed. Get your blood pressure checked regularly at a healthcare provider's office or pharmacy. You can also practice home blood monitoring with a home blood pressure device.

Along with taking Lotrel daily, adopt healthy lifestyle practices, such as a heart-healthy diet and regular exercise. Healthcare providers recommend following the Dietary Approaches to Stop Hypertension (DASH) eating plan, which involves reducing sodium (salt) intake. The DASH eating plan includes:

• Fruits and vegetables
• Low- or fat-free dairy products
• Whole grains
• Fish
• Poultry
• Beans
• Seeds
• Nuts

Even if you're feeling well, that doesn't mean your blood pressure is being adequately controlled. Continue taking other prescribed medications as directed and follow up with your healthcare provider to check your blood pressure.