Amlodipine – Uses, Dosage & Side Effects
Amlodipine is a prescription medication used to treat high blood pressure and angina pectoris. It belongs to the class of calcium channel blockers.
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Amlodipine is a prescription medication used to treat high blood pressure and angina pectoris. It belongs to the class of calcium channel blockers.
What is Amlodipine?
Amlodipine is a medication belonging to the calcium channel blocker class, specifically the dihydropyridine subgroup. It is primarily prescribed for the treatment of high blood pressure (arterial hypertension) and angina pectoris (chest pain caused by reduced blood flow to the heart). Amlodipine is one of the most widely prescribed cardiovascular drugs worldwide.
Indications
Amlodipine is used for:
- Arterial hypertension – for long-term blood pressure reduction
- Stable angina pectoris – to prevent chest pain during physical exertion
- Vasospastic angina (Prinzmetal angina) – caused by spasms of the coronary arteries
Mechanism of Action
Amlodipine selectively blocks voltage-gated L-type calcium channels in vascular smooth muscle and cardiac muscle cells. This reduces the influx of calcium ions into the muscle cells, causing relaxation (vasodilation) of blood vessels. The effects include:
- Reduction of peripheral vascular resistance
- Lowering of blood pressure
- Improved blood supply to the heart muscle
- Decreased oxygen demand of the heart
Unlike some other calcium channel blockers, amlodipine acts predominantly on blood vessels and has minimal effects on heart rate.
Dosage
The usual starting dose for adults is 5 mg once daily. Depending on response and tolerability, the dose may be increased to 10 mg per day. Amlodipine is taken as a tablet and can be administered with or without food. Due to its slow onset of action, it is well suited for long-term maintenance therapy.
Special Patient Populations
- Elderly patients and those with hepatic impairment: A lower starting dose of 2.5 mg is recommended.
- Children (6–17 years): Only under medical supervision, typically 2.5–5 mg daily.
- Renal impairment: No dose adjustment required.
Side Effects
Amlodipine is generally well tolerated. The most common side effects include:
- Peripheral edema (fluid retention, particularly in the ankles and legs)
- Headache
- Flushing (redness of the face)
- Dizziness
- Fatigue
- Palpitations (awareness of the heartbeat)
Rare but serious side effects include excessive blood pressure reduction (hypotension) and, in very rare cases, worsening of angina at the start of therapy.
Drug Interactions
Amlodipine may interact with various medications and substances:
- CYP3A4 inhibitors (e.g., clarithromycin, grapefruit juice): May increase amlodipine blood levels
- Other antihypertensives: Enhanced blood pressure-lowering effect
- Simvastatin: Amlodipine may increase simvastatin levels; a maximum daily dose of 20 mg simvastatin is recommended
- Ciclosporin and tacrolimus: Amlodipine may raise their plasma concentrations
Contraindications
- Severe hypotension (very low blood pressure)
- Cardiogenic shock
- Hemodynamically unstable heart failure following acute myocardial infarction
- Hypersensitivity to amlodipine or other dihydropyridines
References
- European Medicines Agency (EMA): Summary of Product Characteristics (SmPC) for Amlodipine – current version.
- Williams B et al.: 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal, 2018; 39(33): 3021–3104.
- Brunton L, Knollmann B (eds.): Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th edition, McGraw-Hill, 2023.
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Related search terms: Amlodipine + Amlodipin + Amlodipinum