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What is Levamlodipine and explain in detail?
Levamlodipine (INN), also known as levoamlodipine or S-amlodipine  is a pharmacologically active enantiomer of amlodipine. Amlodipine belongs to the dihydropyridine group of calcium channel blocker used as an antihypertensive and antianginal agent. Levamlodipine is currently marketed in Russia under the brand name EsCordi Cor (Actavis Pharma), in Brazil under the brand name Novanlo (Biolab Sanus) and in India under the trade names Eslo (Zuventus Healthcare Ltd.), Asomex (Emcure Pharmaceutical Ltd.), and Espin (Intas Pharmaceuticals Ltd.).  In December 2019 Levamlodipine received US FDA approval under the name "Conjupri".

Mechanism of action
Amlodipine blocks the transmembrane influx of calcium into the vascular and cardiac smooth muscles resulting in vasodilation and hence a fall in blood pressure. Levamlodipine is an allosteric modulator and acts on the L-type of calcium channels.  Receptor binding studies have shown that out of the two forms only the (S)-enantiomer of amlodipine binds to and blocks L-type calcium channels whereas the (R)-enantiomer has no activity on these channels.The precise mechanisms by which levamlodipine relieves angina have not been fully explored, but are thought to include the following:

Decreases peripheral resistance by arteriolar vasodilatation leading to the reduction in oxygen requirement and energy consumption of cardiac smooth muscles.
Decreases coronary vascular resistance and can lead to an increase in coronary blood flow.

Pharmacokinetics and metabolism
Administration of levamlodipine (2.5 mg) as a single dose gives maximum plasma concentration (Cmax) of 8.3 to 9.3 ng/mL in 2 to 3 hrs (Tmax). It is extensively (about 90%) converted to inactive metabolites via hepatic metabolism with 10% of the parent compound and 60% of the metabolites excreted in the urine. Levamlodipine shows approximately 93% plasma protein binding in hypertensive patients. The mean AUC0–t value (t = 48 hrs) of levamlodipine tablets (2.5 mg) is 95±14 ng·hr/mL. The plasma elimination half-life of levamlodipine has been found to be 31±13 hrs.

Clinical experience
Various clinical studies have shown that levamlodipine has more selectivity and better efficacy than (R)-amlodipine. In pooled data, from three comparative studies conducted in 200 patients with mild to moderate hypertension, 2.5 mg of levamlodipine was found to be equivalent in its blood pressure lowering efficacy to 5 mg of amlodipine. The average reduction in systolic BP was 19±3 vs 19±4, 20±2 vs 19±3 and 20±2 vs 19±3 mm of Hg recorded in standing, supine and sitting position respectively for levamlodipine compared to racemic amlodipine. The studies also reported a significant reduction in total cholesterol and triglyceride levels with levamlodipine, which was not seen with amlodipine.Efficacy and safety of levamlodipine (2.5 mg, once daily) has been evaluated in the patients with isolated systolic hypertension (ISH). Levamlodipine effectively reduced the systolic BP (mean reduction 22±14 mm of Hg) in all grades of ISH. After 28 days of the treatment, overall responder rate was 73%. It significantly reduced the systolic and diastolic BP within 4 weeks with a responder rate of 96.5%.Elderly hypertensives with diabetes mellitus exhibits higher response to levamlodipine therapy than non-diabetic patients