Understanding What Should Not Be Taken With Amlodipine

October 7, 2025 •

2 min read

According to research published in Drug Metabolism and Disposition, amlodipine is primarily metabolized by the CYP3A4 enzyme in the liver, a fact critical to understanding its many potential drug interactions. For this reason, knowing what should not be taken with amlodipine is vital for patient safety and treatment effectiveness. This guide covers important drug, food, and supplement interactions to help you use your medication safely.

Quick Summary

Amlodipine interacts with several medications and substances, risking dangerous hypotension, muscle-related issues, or reduced effectiveness. Key interactions include CYP3A4 inhibitors, certain statins, PDE5 inhibitors, NSAIDs, and grapefruit. Awareness is key for managing hypertension or angina safely.

Key Points

CYP3A4 Inhibitors: Certain antifungals (like itraconazole) and macrolide antibiotics (like clarithromycin) can increase amlodipine levels and cause excessively low blood pressure.
Specific Statins: Amlodipine can dangerously increase the levels of simvastatin and lovastatin, raising the risk of muscle damage.
Erectile Dysfunction Drugs: Medications such as sildenafil and tadalafil, when combined with amlodipine, can cause a severe drop in blood pressure.
Grapefruit Caution: Grapefruit and its juice can inhibit the metabolism of amlodipine, potentially increasing its effects and side effects, though the interaction level varies.
NSAIDs and Effectiveness: Chronic use of NSAIDs like ibuprofen can raise blood pressure, undermining the effectiveness of amlodipine.
Herbal Supplements: St. John's wort can decrease the effectiveness of amlodipine by speeding up its breakdown in the body.
Alcohol's Additive Effect: Alcohol consumption can add to amlodipine's blood pressure-lowering effect, increasing the risk of dizziness.

Drug Interactions: Medications to Avoid or Use with Caution

Medications that Increase Amlodipine Levels

Some drugs can increase amlodipine's levels in the bloodstream, potentially raising the risk of low blood pressure and swelling. These include certain antifungals, macrolide antibiotics, and HIV protease inhibitors. Other calcium channel blockers can also impact amlodipine levels.

Medications with an Additive Hypotensive Effect

Combining amlodipine with other medications that lower blood pressure can lead to an excessive drop in blood pressure. This includes drugs for erectile dysfunction like sildenafil and tadalafil, and beta-blockers such as metoprolol or carvedilol. Combining with other antihypertensives like ACE inhibitors requires close monitoring.

Medications Whose Levels Are Increased by Amlodipine

Amlodipine can increase the levels of other drugs. This is particularly important with certain statins like simvastatin and lovastatin, raising the risk of muscle problems. Immunosuppressants such as cyclosporine and tacrolimus may also see increased blood levels.

Medications that Decrease Amlodipine's Effectiveness

Certain medications can reduce amlodipine's ability to lower blood pressure. Long-term use of NSAIDs like ibuprofen can increase blood pressure. Acetaminophen is generally a safer alternative.

Food and Herbal Interactions

Grapefruit and Grapefruit Juice

Grapefruit products can potentially increase amlodipine's levels and the risk of side effects like dizziness. While the interaction level varies, avoiding large amounts is generally advised.

St. John's Wort

This herbal supplement can potentially reduce amlodipine's effectiveness. Consult with a doctor before taking St. John's wort.

Alcohol

Consuming alcohol with amlodipine can lead to an additive blood pressure-lowering effect, increasing the risk of dizziness. Moderate intake is recommended, especially when starting amlodipine.

Comparison of Key Amlodipine Interactions


Substance/Class	Example(s)	Type of Interaction	Resulting Risk/Effect
Statins	Simvastatin, Lovastatin	Increased statin blood levels	Muscle pain (myopathy), rhabdomyolysis
Antifungals	Itraconazole, Ketoconazole	Increased amlodipine blood levels	Low blood pressure (hypotension), swelling (edema)
NSAIDs	Ibuprofen, Naproxen	Reduced amlodipine effectiveness	Increased blood pressure
PDE5 Inhibitors	Sildenafil (Viagra), Tadalafil	Additive hypotensive effect	Excessive drop in blood pressure, dizziness
Beta-Blockers	Metoprolol, Carvedilol	Additive hypotensive effect	Low blood pressure, heart problems
Grapefruit	Grapefruit juice, fresh fruit	Increased amlodipine blood levels	Low blood pressure, dizziness, flushing
St. John's Wort	Herbal Supplement	Decreased amlodipine blood levels	Reduced effectiveness of amlodipine

Important Safety Considerations and Next Steps

It is crucial to discuss all medications, supplements, and herbal products with your doctor or pharmacist when starting amlodipine. Close monitoring is necessary when taking amlodipine with other blood pressure medications. Dosage adjustments may be needed.

Conclusion

Understanding potential interactions with amlodipine is vital for safe and effective treatment. Interactions with certain drugs, foods like grapefruit, and supplements can impact effectiveness or increase side effects. Always maintain open communication with healthcare providers. The {Link: American College of Cardiology https://www.droracle.ai/articles/70338/what-are-the-potential-interactions-with-amlodipine-calcium-channel-blocker} provides clinical guidelines on drug interactions.

Frequently Asked Questions

You should generally avoid regular, long-term use of ibuprofen and other NSAIDs with amlodipine, as they can raise your blood pressure and counteract amlodipine's effects. For occasional pain relief, acetaminophen (Tylenol) is a safer alternative. Always consult your doctor or pharmacist.

Grapefruit juice can increase the level of amlodipine in your blood by inhibiting a key enzyme, which could lead to excessively low blood pressure, dizziness, and flushing. The severity of this interaction can vary, so it is safest to avoid grapefruit products.

Drinking alcohol can cause your blood pressure to drop even further, especially at the start of your treatment or after a dose change. This can increase side effects like dizziness and lightheadedness. It's best to limit or avoid alcohol and discuss safe consumption levels with your doctor.

Yes, but with caution. Taking amlodipine with simvastatin increases the risk of serious muscle-related problems, including myopathy and rhabdomyolysis. Your doctor will assess the appropriate approach for managing cholesterol and blood pressure simultaneously. Other statins, like atorvastatin or rosuvastatin, may be alternatives.

Yes, St. John's wort is a notable herbal supplement that can interact with amlodipine by decreasing its effectiveness. Always inform your doctor or pharmacist about any herbal supplements you plan to take.

Many people take a combination of medications for blood pressure. However, taking amlodipine with other antihypertensives like beta-blockers or other calcium channel blockers can cause an additive effect, leading to excessively low blood pressure. Your doctor will carefully monitor your blood pressure to ensure the combination is safe.

You should aim for a lower salt diet to help manage your blood pressure, as excessive salt intake is a major contributor to hypertension. Otherwise, amlodipine can be taken with or without food.