LOTREL
Combination product
Pronunciation: am-LOE-di-peen and ben-AY-ze-pril (loe-TREL)
Combination of Amlodipine and Benazepril.
Each component keeps its own pharmacology page; the combination itself adds no new mechanism.
Components (2)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension (not adequately controlled on monotherapy) | Adults | 2.5/10 mg QD | 10/40 mg QD |
Titration Antihypertensive effect largely attained within 2 weeks before up-titration
Renal Severe renal impairment: recommended benazepril dose is 5 mg (not available in this combination) — combination not appropriate.
Hepatic Amlodipine exposure increased in hepatic insufficiency; consider lower doses.
Instructions
- Once daily; use only after failure of/edema on monotherapy or may substitute for titrated components
Available strengths
- cap 2.5/10, 5/10, 5/20, 5/40, 10/20, 10/40 mg
Contraindications
- Do not coadminister with aliskiren in patients with diabetes
- History of angioedema (with or without prior ACE inhibitor use)
- Combination with a neprilysin inhibitor (e.g., sacubitril); do not administer within 36 h of switching to/from sacubitril/valsartan
Cautions
- Angioedema
- Fetal toxicity
- Hypotension
- Hyperkalemia
- Renal impairment / RAS dual blockade
- Hepatic-related amlodipine accumulation
Adverse reactions
- Cough
- Peripheral edema
- Dizziness
- Headache
Pregnancy Can cause fetal harm; RAS inhibitors reduce fetal renal function and increase fetal/neonatal morbidity and death. Discontinue when pregnancy detected.
Lactation Minimal benazepril/benazeprilat excreted into breast milk.
Cost
Clinical profile
Defining liabilityAngioedema, fetal renal toxicity and overdose shock
Part D rank #245.
Self-check
- When is amlodipine–benazepril indicated for hypertension?
When monotherapy does not control it. - What boxed risk applies to amlodipine–benazepril?
Fetal toxicity.