From the Guidelines
Amlodipine can cause angioedema, although it is considered a rare side effect. Angioedema is characterized by swelling beneath the skin, particularly affecting the face, lips, tongue, throat, and sometimes the extremities or genitals. This reaction typically occurs within the first few weeks of starting amlodipine therapy but can occasionally develop after longer periods of use. Amlodipine is a calcium channel blocker commonly prescribed for hypertension and angina at doses ranging from 2.5 to 10 mg daily, as stated in the guidelines 1. The mechanism behind amlodipine-induced angioedema likely involves alterations in vascular permeability and inflammatory mediators.
Patients taking amlodipine should be aware of warning signs including facial swelling, difficulty breathing, or swelling of the tongue or throat, which require immediate medical attention. If angioedema occurs, the medication should be discontinued and an alternative antihypertensive from a different drug class would typically be prescribed. Patients with a history of angioedema with other medications may have an increased risk and should discuss this with their healthcare provider before starting amlodipine. It's worth noting that while the provided guidelines 2, 1, 3 discuss various antihypertensive medications and their potential side effects, they do not specifically highlight amlodipine as a common cause of angioedema, suggesting its occurrence is rare. However, given the potential severity of angioedema, caution and monitoring are advised.
From the FDA Drug Label
Skin and Appendages: angioedema, erythema multiforme, pruritus, 1 rash, 1 rash erythematous, rash maculopapular Amlodipine can cause angioedema, as it is listed as a possible side effect in the drug label 4.
- The incidence of angioedema is not specified, but it is mentioned as an event that occurred in less than 1% of patients in controlled clinical trials or under conditions of open trials or marketing experience.
From the Research
Amlodipine and Angioedema
- Amlodipine, a dihydropyridine calcium channel blocker, has been associated with angioedema in several case reports and studies 5, 6, 7, 8.
- Angioedema is a rare but potentially life-threatening adverse effect of amlodipine, characterized by localized swelling of the dermis, subcutaneous tissues, and/or submucosal tissues 9.
- The exact mechanism of amlodipine-induced angioedema is unclear, but it is thought to be related to the drug's effect on bradykinin levels or other vasoactive molecules 6, 9.
Clinical Presentation
- Patients with amlodipine-induced angioedema typically present with swelling of the face, lips, tongue, or larynx, which can be severe and potentially life-threatening 5, 7, 8.
- The onset of symptoms can occur at any time during treatment with amlodipine, from shortly after initiation to months or even years later 6, 7.
- Discontinuation of amlodipine and treatment with glucocorticoids and antihistamines can lead to resolution of symptoms 5, 7.
Risk Factors and Associations
- The risk of angioedema associated with amlodipine may be increased when the drug is used in combination with other medications, such as renin-angiotensin-aldosterone system inhibitors (RAAS-i) 6.
- Certain patient populations, such as those with a history of angioedema or allergic reactions, may be at increased risk of developing amlodipine-induced angioedema 9.
- Further studies are needed to fully elucidate the risk factors and mechanisms underlying amlodipine-induced angioedema 6, 9.