Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
LOTREL vs ALDORIL D30
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Lotrel is a combination of amlodipine (a calcium channel blocker) and benazepril (an ACE inhibitor). Amlodipine inhibits calcium ion influx across cardiac and vascular smooth muscle cells, causing vasodilation and reduced blood pressure. Benazepril inhibits angiotensin-converting enzyme, reducing angiotensin II formation, leading to vasodilation and decreased aldosterone secretion.
Aldoril D30 is a combination of methyldopa, a centrally acting alpha-2 adrenergic agonist that reduces sympathetic outflow, and hydrochlorothiazide, a thiazide diuretic that inhibits the sodium-chloride symporter in the distal convoluted tubule, decreasing plasma volume and peripheral resistance.
Treatment of hypertension,Off-label: chronic kidney disease, heart failure, diabetic nephropathy (as part of combination therapy)
Hypertension
Oral: 1 capsule (amlodipine 2.5 mg/benazepril 10 mg) once daily, titrate to maximum 10 mg/40 mg once daily.
Oral: 1 tablet (hydrochlorothiazide 30 mg / methyldopa 500 mg) twice daily; maximum dose: 2 tablets twice daily.
Amlodipine: 30-50 hours (terminal); steady state in 7-10 days. Benazeprilat: 10-11 hours (terminal); effective half-life 22-24 hours with once-daily dosing.
Terminal elimination half-life of hydrochlorothiazide is 6-15 hours; methyldopa half-life is 1.8 hours (normal renal function). In renal impairment, half-life of both components is prolonged.
Amlodipine is extensively metabolized in the liver via CYP3A4 to inactive metabolites. Benazepril is hydrolyzed in the liver to its active metabolite, benazeprilat, primarily by hepatic esterases; further metabolism is minimal.
Methyldopa is metabolized by conjugation (catechol-O-methyltransferase) and hepatic sulfation; hydrochlorothiazide is not extensively metabolized and is excreted unchanged by the kidney.
Amlodipine: 60% renal, 20-25% fecal. Benazeprilat: 85% renal (as benazeprilat and conjugated metabolites), 15% biliary/fecal.
Renal: approximately 50% as parent drug and metabolites; biliary/fecal: minimal, less than 5%.
Amlodipine: ~93% (plasma proteins). Benazepril: ~96.7%; benazeprilat: ~95.3% (primarily albumin).
Methyldopa: <10% bound to plasma proteins; hydrochlorothiazide: 40-68% bound to albumin.
Amlodipine: 21 L/kg (large Vd indicates extensive tissue distribution). Benazeprilat: 0.11-0.13 L/kg (limited extravascular distribution).
Methyldopa: Vd 0.2-0.3 L/kg (distributes into tissues, crosses placenta); hydrochlorothiazide: Vd 0.75-1.5 L/kg (extensively distributed, does not cross blood-brain barrier significantly).
Amlodipine: 64-90% (oral). Benazepril: >30% (oral; rapidly converted to active benazeprilat).
Oral bioavailability of methyldopa is approximately 25% (variable, influenced by gut metabolism); hydrochlorothiazide bioavailability is 65-75%.
GFR ≥30 m L/min: No adjustment. GFR <30 m L/min: Not recommended. Hemodialysis: Avoid.
GFR 30-60 m L/min: reduce dose by 50%; GFR <30 m L/min: not recommended.
Child-Pugh A: No dose adjustment. Child-Pugh B: Reduce dose or avoid. Child-Pugh C: Contraindicated.
Child-Pugh Class B or C: contraindicated; use not recommended.
Not established in pediatric patients (safety and efficacy not evaluated).
Not recommended for use in pediatric patients due to lack of safety and efficacy data.
Initiate with amlodipine 2.5 mg/benazepril 10 mg daily; titrate slowly due to increased risk of hypotension and renal impairment.
Start with lowest dose; monitor for hypotension, electrolyte imbalance, and CNS effects; consider reduced initial dose.
Fetal toxicity: Drugs acting directly on the renin-angiotensin system can cause injury and death to the developing fetus. Discontinue as soon as possible when pregnancy is detected.
None
Angioedema: Risk of head, neck, or intestinal angioedema,Hypotension: Symptomatic hypotension may occur, especially in volume- or salt-depleted patients,Hepatic impairment: Use with caution; may increase amlodipine exposure,Renal impairment: Monitor renal function; may increase serum creatinine,Hyperkalemia: Risk increases with renal impairment, diabetes, or concomitant potassium-sparing diuretics,Cough: Dry cough is common with ACE inhibitors,Cholestatic jaundice and hepatic failure: Rare but reported with ACE inhibitors
May cause hemolytic anemia, liver disorders, positive Coombs test, sedation, depression, and hypersensitivity reactions. Hydrochlorothiazide may cause electrolyte imbalance, hyperuricemia, photosensitivity, and exacerbation of systemic lupus erythematosus. Use with caution in renal impairment, hepatic disease, and in patients with a history of drug-induced hemolytic anemia.
Hypersensitivity to amlodipine, benazepril, or any component of the formulation,History of angioedema related to previous ACE inhibitor therapy,Hereditary or idiopathic angioedema,Concomitant use with aliskiren in patients with diabetes mellitus,Pregnancy (second and third trimesters)
Active hepatic disease, history of previous methyldopa therapy-associated liver disorders; anuria; hypersensitivity to methyldopa, hydrochlorothiazide, or sulfonamide-derived drugs.
Avoid high-potassium foods (e.g., bananas, oranges, spinach, potatoes) in large amounts. No specific food restrictions beyond maintaining a balanced low-sodium diet. Grapefruit juice may increase amlodipine levels; limit or avoid consumption.
Food may decrease absorption of methyldopa. Avoid excessive intake of high-potassium foods (e.g., bananas, oranges) unless directed. Hydrochlorothiazide may cause potassium depletion; maintain adequate dietary potassium. Avoid natural licorice as it can worsen hypokalemia.
First trimester: Animal studies suggest possible teratogenicity; human data limited. Second and third trimesters: Exposure to angiotensin II receptor antagonists (valsartan) and calcium channel blockers (amlodipine) is associated with oligohydramnios, fetal renal dysfunction, skull hypoplasia, and hypotension. Risk is highest during second and third trimesters. Contraindicated in pregnancy.
First trimester: Limited data; no clear evidence of major malformations but methyldopa crosses placenta. Second and third trimesters: Associated with reduced placental perfusion; possible fetal bradycardia and neonatal hypotension. Hydrochlorothiazide may cause fetal/neonatal jaundice, thrombocytopenia, and electrolyte disturbances.
No data on excretion in human milk. Amlodipine is excreted in animal milk; valsartan is excreted in animal milk. M/P ratio not determined. Potential for adverse effects in nursing infant includes hypotension, renal impairment. Caution advised; avoid use during breastfeeding.
Methyldopa is excreted in breast milk in low concentrations; M/P ratio approximately 0.2. Hydrochlorothiazide is excreted in minimal amounts; may suppress lactation. Consider risks versus benefits.
Pharmacokinetic changes in pregnancy may alter drug levels but specific dose adjustments not established. Due to fetal risks, use is contraindicated in pregnancy; alternative therapy should be initiated.
Methyldopa: Pregnancy-induced plasma volume expansion may require dose titration; monitor blood pressure and adjust accordingly. Hydrochlorothiazide: Often avoided in pregnancy due to volume depletion risks; if used, monitor electrolytes and renal function, no pharmacokinetic data necessitate routine dose adjustment.
LOTREL is a fixed-dose combination of amlodipine (dihydropyridine calcium channel blocker) and benazepril (ACE inhibitor). Monitor serum potassium and renal function, especially in patients with renal impairment or on potassium-sparing diuretics. Avoid use in pregnancy; discontinue immediately if pregnancy is detected. May cause angioedema; higher risk in Black patients. Use with caution in patients with aortic stenosis or hypertrophic cardiomyopathy. Amlodipine may cause peripheral edema, which is dose-dependent and not relieved by diuretics.
ALDORIL D30 combines methyldopa (central alpha-2 agonist) and hydrochlorothiazide (thiazide diuretic). Monitor for orthostatic hypotension, especially at initiation. Taper not needed for methyldopa but discontinue if fever or liver dysfunction occurs. Interferes with urinary catecholamine measurements (false elevation). Hydrochlorothiazide may cause hyponatremia, hypokalemia, and hyperglycemia; check electrolytes and glucose periodically.
Take exactly as prescribed, usually once daily. Do not stop without consulting your doctor.,Avoid potassium supplements or salt substitutes containing potassium unless directed by your doctor.,Report any swelling of face, lips, tongue, or difficulty breathing immediately (signs of angioedema).,If you become pregnant, stop the medication and contact your doctor right away.,May cause dizziness or lightheadedness; avoid driving until you know how the drug affects you.,Avoid alcohol, which can lower blood pressure further.
Take exactly as prescribed, preferably with food to reduce stomach upset.,Rise slowly from sitting or lying down to prevent dizziness.,This drug may make you drowsy; avoid driving or operating machinery until you know how it affects you.,Report fever, unexplained fatigue, jaundice, or dark urine immediately.,Weigh yourself daily and report rapid weight gain or swelling.,Limit alcohol intake as it can increase side effects.,Do not use salt substitutes containing potassium without consulting your doctor.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about LOTREL vs ALDORIL D30, answered by our medical review team.
LOTREL is a Antihypertensive combination that works by Lotrel is a combination of amlodipine (a calcium channel blocker) and benazepril (an ACE inhibitor). Amlodipine inhibits calcium ion influx across cardiac and vascular smooth muscle cells, causing vasodilation and reduced blood pressure. Benazepril inhibits angiotensin-converting enzyme, reducing angiotensin II formation, leading to vasodilation and decreased aldosterone secretion.. ALDORIL D30 is a Antihypertensive Combination that works by Aldoril D30 is a combination of methyldopa, a centrally acting alpha-2 adrenergic agonist that reduces sympathetic outflow, and hydrochlorothiazide, a thiazide diuretic that inhibits the sodium-chloride symporter in the distal convoluted tubule, decreasing plasma volume and peripheral resistance.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between LOTREL and ALDORIL D30 depend on the specific clinical indication. These are agents from distinct pharmacological classes and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of LOTREL is: Oral: 1 capsule (amlodipine 2.5 mg/benazepril 10 mg) once daily, titrate to maximum 10 mg/40 mg once daily.. The standard adult dose of ALDORIL D30 is: Oral: 1 tablet (hydrochlorothiazide 30 mg / methyldopa 500 mg) twice daily; maximum dose: 2 tablets twice daily.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between LOTREL and ALDORIL D30 in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. LOTREL is classified as Category C. First trimester: Animal studies suggest possible teratogenicity; human data limited. Second and third trimesters: Exposure to angiotensin II receptor antagonists (valsartan) and ca. ALDORIL D30 is classified as Category C. First trimester: Limited data; no clear evidence of major malformations but methyldopa crosses placenta. Second and third trimesters: Associated with reduced placental perfusion; p. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.