Increased angina and/or myocardial infarction has occurred with initiation or dosage titration of calcium blockers.
Because amlodipine is extensively metabolized by the liver and the plasma elimination half-life will be prolonged in patients with impaired hepatic function. The dose should be slowly adjusted in such patients.
Elderly patients and patients with hepatic impairment have decreased clearance of amlodipine with the resulting increase in AUC and half-life of the drug. These patients may be more sensitive to the hypotensive effects amlodipine and may require a lower initial dose.
Symptomatic hypotension with or without syncope can rarely occur; blood pressure must be lowered at a rate appropriate for the patient's clinical condition. However, there is a possibility for hypotension incidence in patients with severe aortic stenosis and/or hypertropic cardiomyopathy.
The safety and efficacy of amlodipine in children less than 6 years of age have not been established.