| Hypertensive disease
Norvasc vs Inderal LA
Side-by-side clinical, coverage, and cost comparison for hypertensive disease.Deep comparison between: Norvasc vs Inderal with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsInderal has a higher rate of injection site reactions vs Norvasc based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Inderal but not Norvasc, including UnitedHealthcare
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Category
Norvasc
Inderal
At A Glance
Oral
Once daily
Calcium channel blocker
Oral
Once daily
Nonselective beta-blocker
Indications
- Hypertensive disease
- Stable angina
- Angina Pectoris, Variant
- Coronary Artery Disease
- Hypertensive disease
- Coronary Arteriosclerosis
- Migraine Disorders
- Idiopathic hypertrophic subaortic stenosis
Dosing
Hypertensive disease - Adults The usual initial antihypertensive oral dose of NORVASC is 5 mg once daily, and the maximum dose is 10 mg once daily. Small, fragile, or elderly patients, or patients with hepatic insufficiency may be started on 2.5 mg once daily and this dose may be used when adding NORVASC to other antihypertensive therapy. Adjust dosage according to blood pressure goals. In general, wait 7 to 14 days between titration steps. Titrate more rapidly, however, if clinically warranted, provided the patient is assessed frequently.
Hypertensive disease - Pediatric patients The effective antihypertensive oral dose in pediatric patients ages 6-17 years is 2.5 mg to 5 mg once daily. Doses in excess of 5 mg daily have not been studied in pediatric patients.
Stable angina The recommended dose for chronic stable angina is 5-10 mg once daily, with the lower dose suggested in the elderly and in patients with hepatic insufficiency. Most patients will require 10 mg for adequate effect.
Angina Pectoris, Variant The recommended dose for vasospastic angina is 5-10 mg once daily, with the lower dose suggested in the elderly and in patients with hepatic insufficiency. Most patients will require 10 mg for adequate effect.
Coronary Artery Disease The recommended dose range for patients with coronary artery disease is 5-10 mg once daily. In clinical studies, the majority of patients required 10 mg.
Hypertensive disease Initial 80 mg once daily; may increase to 120 mg or higher; usual maintenance 120-160 mg once daily; up to 640 mg may be required.
Coronary Arteriosclerosis Start 80 mg once daily; increase at 3-7 day intervals; average optimal dose 160 mg once daily; maximum established dose 320 mg once daily.
Migraine Disorders Initial 80 mg once daily; usual effective range 160-240 mg once daily; discontinue if no response within 4-6 weeks at maximal dose.
Idiopathic hypertrophic subaortic stenosis Usual dosage 80-160 mg once daily.
Contraindications
- Known sensitivity to amlodipine
- Cardiogenic shock
- Sinus bradycardia and greater than first-degree block
- Bronchial asthma
- Known hypersensitivity to propranolol hydrochloride
Adverse Reactions
Most common adverse reactions (incidence >1%) The most common adverse reaction to amlodipine is edema which occurred in a dose related manner (up to 10.8% at 10 mg dose vs 0.6% placebo). Other adverse experiences not dose related but reported with an incidence >1.0% are fatigue (4.5%), nausea (2.9%), abdominal pain (1.6%), and somnolence (1.4%).
Dose-related adverse reactions Edema: 1.8% (2.5 mg), 3.0% (5 mg), 10.8% (10 mg) vs 0.6% (placebo). Dizziness: 1.1% (2.5 mg), 3.4% (5 mg), 3.4% (10 mg) vs 1.5% (placebo). Flushing: 0.7% (2.5 mg), 1.4% (5 mg), 2.6% (10 mg) vs 0.0% (placebo). Palpitation: 0.7% (2.5 mg), 1.4% (5 mg), 4.5% (10 mg) vs 0.6% (placebo).
Gender differences For several adverse experiences that appear to be drug and dose related, there was a greater incidence in women than men: Edema (14.6% female vs 5.6% male), Flushing (4.5% female vs 1.5% male), Palpitations (3.3% female vs 1.4% male).
Less common adverse reactions (<1% but >0.1%) Cardiovascular: arrhythmia (including ventricular tachycardia and atrial fibrillation), bradycardia, chest pain, peripheral ischemia, syncope, tachycardia, vasculitis. Central and Peripheral Nervous System: hypoesthesia, neuropathy peripheral, paresthesia, tremor, vertigo. Gastrointestinal: anorexia, constipation, dysphagia, diarrhea, flatulence, pancreatitis, vomiting, gingival hyperplasia. General: allergic reaction, asthenia, back pain, hot flushes, malaise, pain, rigors, weight gain, weight decrease. Musculoskeletal: arthralgia, arthrosis, muscle cramps, myalgia. Psychiatric: sexual dysfunction, insomnia, nervousness, depression, abnormal dreams, anxiety, depersonalization. Respiratory: dyspnea, epistaxis. Skin: angioedema, erythema multiforme, pruritus, rash, rash erythematous, rash maculopapular. Special Senses: abnormal vision, conjunctivitis, diplopia, eye pain, tinnitus. Urinary: micturition frequency, micturition disorder, nocturia. Autonomic: dry mouth, sweating increased. Metabolic: hyperglycemia, thirst. Hemopoietic: leukopenia, purpura, thrombocytopenia.
Postmarketing experience Gynecomastia has been reported infrequently. Jaundice and hepatic enzyme elevations (mostly consistent with cholestasis or hepatitis), in some cases severe enough to require hospitalization, have been reported in association with use of amlodipine. A possible association between extrapyramidal disorder and amlodipine has been reported.
Cardiovascular Bradycardia, congestive heart failure, intensification of AV block, hypotension, paresthesia of hands, thrombocytopenic purpura, arterial insufficiency (Raynaud type)
Central Nervous System Light-headedness, mental depression, insomnia, lassitude, weakness, fatigue, catatonia, visual disturbances, hallucinations, vivid dreams, disorientation, short-term memory loss, emotional lability
Gastrointestinal Nausea, vomiting, epigastric distress, abdominal cramping, diarrhea, constipation, mesenteric arterial thrombosis, ischemic colitis
Allergic Hypersensitivity reactions including anaphylactic/anaphylactoid reactions, pharyngitis, agranulocytosis, erythematous rash, fever with aching and sore throat, laryngospasm, respiratory distress
Respiratory Bronchospasm
Hematologic Agranulocytosis, nonthrombocytopenic purpura, thrombocytopenic purpura
Autoimmune Systemic lupus erythematosus
Skin and Mucous Membranes Stevens-Johnson Syndrome, toxic epidermal necrolysis, dry eyes, exfoliative dermatitis, erythema multiforme, urticaria, alopecia, SLE-like reactions, psoriasisiform rashes
Genitourinary Male impotence, Peyronie's disease
Pharmacology
Amlodipine is a dihydropyridine calcium antagonist (calcium ion antagonist or slow-channel blocker) that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle. Amlodipine binds to both dihydropyridine and nondihydropyridine binding sites. The contractile processes of cardiac muscle and vascular smooth muscle are dependent upon the movement of extracellular calcium ions into these cells through specific ion channels. Amlodipine inhibits calcium ion influx across cell membranes selectively, with a greater effect on vascular smooth muscle cells than on cardiac muscle cells. Amlodipine is a peripheral arterial vasodilator that acts directly on vascular smooth muscle to cause a reduction in peripheral vascular resistance and reduction in blood pressure. In patients with exertional angina, NORVASC reduces the total peripheral resistance (afterload) against which the heart works and reduces the rate pressure product, and thus myocardial oxygen demand, at any given level of exercise. In vasospastic angina, NORVASC blocks constriction and restores blood flow in coronary arteries and arterioles, inhibiting coronary spasm. Following administration of therapeutic doses to hypertensive patients, NORVASC produces vasodilation resulting in a reduction of supine and standing blood pressures. These decreases in blood pressure are not accompanied by a significant change in heart rate or plasma catecholamine levels with chronic dosing. With chronic once daily oral administration, antihypertensive effectiveness is maintained for at least 24 hours. Plasma concentrations correlate with effect in both young and elderly patients.
Propranolol is a nonselective beta-adrenergic receptor-blocking agent that competitively blocks beta-receptor-stimulating agents, reducing chronotropic, inotropic, and vasodilator responses to beta-adrenergic stimulation; at doses greater than required for beta blockade, it also exerts a quinidine-like membrane action affecting the cardiac action potential.
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Most Common Insurance
Anthem BCBS
Norvasc
- Covered on 5 commercial plans
- PA (0/12) · Step Therapy (0/12) · Qty limit (9/12)
Inderal
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (0/12) · Qty limit (5/12)
UnitedHealthcare
Norvasc
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Inderal
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Norvasc
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (0/3)
Inderal
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (0/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Norvasc.
No savings programs available for Inderal.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.