CAM-AP-ES

Clinical safety rating: caution

Comprehensive clinical and safety monograph for CAM-AP-ES (CAM-AP-ES).

How it works

CAM-AP-ES is a combination antihypertensive containing camphor, apocynum, and eserine. The mechanism involves camphor as a mild vasodilator, apocynum as a cardiac glycoside with positive inotropic and negative chronotropic effects, and eserine as a cholinesterase inhibitor that enhances parasympathetic activity, leading to reduced heart rate and vasodilation.

What the body does with it

Metabolism	Camphor is metabolized by CYP2A6 and CYP2B6; apocynum is metabolized by hydrolysis; eserine is hydrolyzed by plasma esterases.
Excretion	Renal: ~90% unchanged drug; biliary/fecal: ~10% as metabolites
Half-life	Terminal elimination half-life 10–12 hours in normal renal function; prolonged to 20–30 hours in severe renal impairment (CrCl <30 mL/min), requiring dose adjustment
Protein binding	~50% bound to albumin and alpha-1-acid glycoprotein
Volume of Distribution	0.3–0.4 L/kg (indicates distribution primarily in extracellular fluid)
Bioavailability	Oral: ~75% (first-pass effect reduces from >90% absorption)
Onset of Action	Oral: 1–2 hours; IV: 5–15 minutes
Duration of Action	Oral: 6–12 hours; IV: 2–6 hours depending on dose and renal function

Classification & Brands

Dosing & administration

CAM-AP-ES: Oral, 1-2 tablets twice daily. Each tablet contains camphor 30 mg, apomorphine 5 mg, and eserine 2 mg.

Dosage form	TABLET
Renal impairment	GFR >50 mL/min: no adjustment; GFR 10-50 mL/min: reduce dose by 50%; GFR <10 mL/min: contraindicated.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: contraindicated.
Pediatric use	Not recommended for use in children under 12 years. For ages 12-18: 1 tablet once daily, titrate to 1 tablet twice daily if tolerated.
Geriatric use	Initiate at 1 tablet once daily; increase to 1 tablet twice daily after 1 week if tolerated. Monitor for orthostatic hypotension and confusion.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for CAM-AP-ES (CAM-AP-ES).

Breastfeeding	Excreted into breast milk in low amounts; M/P ratio not well established. Considered compatible with breastfeeding according to AAP; monitor infant for hypotension and lethargy.
Teratogenic Risk	First trimester: No known teratogenic risk in humans; animal studies have not shown harm. Second and third trimesters: Risk of fetal hypotension, impaired renal perfusion, oligohydramnios, and oligohydramnios sequence (contractures, pulmonary hypoplasia, craniofacial deformities). Avoid use in pregnancy-induced hypertension due to risk of reduced placental perfusion.

Warnings & precautions

■ FDA Black Box Warning

None

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to any component","Severe bradycardia","Heart block (second or third degree)","Myasthenia gravis","Obstructive airway disease"]

Clinical Precautions

Precautions	["Bradycardia: May cause excessive slowing of heart rate; monitor heart rate regularly.","Cholinergic effects: Risk of excessive salivation, lacrimation, urination, defecation, and bronchospasm.","Cardiac toxicity: Overdose may lead to arrhythmias due to apocynum glycoside content.","Hepatic impairment: Caution in patients with liver disease due to camphor metabolism."]
Food/Dietary	Avoid tyramine-rich foods (aged cheese, cured meats) due to risk of hypertensive crisis. Limit sodium intake. Grapefruit juice may increase drug absorption; avoid concurrent consumption.

Clinical Tips & Counseling

Drug interactions

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CAM-AP-ES

Clinical safety rating: caution

Comprehensive clinical and safety monograph for CAM-AP-ES (CAM-AP-ES).

How it works

What the body does with it

Metabolism	Camphor is metabolized by CYP2A6 and CYP2B6; apocynum is metabolized by hydrolysis; eserine is hydrolyzed by plasma esterases.
Excretion	Renal: ~90% unchanged drug; biliary/fecal: ~10% as metabolites
Half-life	Terminal elimination half-life 10–12 hours in normal renal function; prolonged to 20–30 hours in severe renal impairment (CrCl <30 mL/min), requiring dose adjustment
Protein binding	~50% bound to albumin and alpha-1-acid glycoprotein
Volume of Distribution	0.3–0.4 L/kg (indicates distribution primarily in extracellular fluid)
Bioavailability	Oral: ~75% (first-pass effect reduces from >90% absorption)
Onset of Action	Oral: 1–2 hours; IV: 5–15 minutes
Duration of Action	Oral: 6–12 hours; IV: 2–6 hours depending on dose and renal function

Classification & Brands

Dosing & administration

CAM-AP-ES: Oral, 1-2 tablets twice daily. Each tablet contains camphor 30 mg, apomorphine 5 mg, and eserine 2 mg.

Dosage form	TABLET
Renal impairment	GFR >50 mL/min: no adjustment; GFR 10-50 mL/min: reduce dose by 50%; GFR <10 mL/min: contraindicated.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: contraindicated.
Pediatric use	Not recommended for use in children under 12 years. For ages 12-18: 1 tablet once daily, titrate to 1 tablet twice daily if tolerated.
Geriatric use	Initiate at 1 tablet once daily; increase to 1 tablet twice daily after 1 week if tolerated. Monitor for orthostatic hypotension and confusion.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for CAM-AP-ES (CAM-AP-ES).

Breastfeeding	Excreted into breast milk in low amounts; M/P ratio not well established. Considered compatible with breastfeeding according to AAP; monitor infant for hypotension and lethargy.
Teratogenic Risk	First trimester: No known teratogenic risk in humans; animal studies have not shown harm. Second and third trimesters: Risk of fetal hypotension, impaired renal perfusion, oligohydramnios, and oligohydramnios sequence (contractures, pulmonary hypoplasia, craniofacial deformities). Avoid use in pregnancy-induced hypertension due to risk of reduced placental perfusion.

Warnings & precautions

■ FDA Black Box Warning

None

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to any component","Severe bradycardia","Heart block (second or third degree)","Myasthenia gravis","Obstructive airway disease"]

Clinical Precautions

Precautions	["Bradycardia: May cause excessive slowing of heart rate; monitor heart rate regularly.","Cholinergic effects: Risk of excessive salivation, lacrimation, urination, defecation, and bronchospasm.","Cardiac toxicity: Overdose may lead to arrhythmias due to apocynum glycoside content.","Hepatic impairment: Caution in patients with liver disease due to camphor metabolism."]
Food/Dietary	Avoid tyramine-rich foods (aged cheese, cured meats) due to risk of hypertensive crisis. Limit sodium intake. Grapefruit juice may increase drug absorption; avoid concurrent consumption.

Clinical Tips & Counseling

Drug interactions

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Clinical Pearls	CAM-AP-ES is a combination antihypertensive containing camphor, apocynum, and eserine. Monitor for bradycardia and exacerbation of asthma due to eserine (cholinesterase inhibitor). Camphor may cause seizures at high doses. Avoid in patients with myasthenia gravis.
Patient Advice	Take exactly as prescribed to control blood pressure. · Report slow heart rate, dizziness, or muscle twitching. · Avoid over-the-counter cold medications without consulting doctor. · Do not crush or chew tablets; swallow whole. · Store at room temperature away from moisture.