From the FDA Drug Label
The pharmacokinetics of amlodipine are not significantly influenced by renal impairment. Patients with renal failure may therefore receive the usual initial dose
Amlodipine dosing in Acute Kidney Injury (AKI):
- The FDA drug label states that the pharmacokinetics of amlodipine are not significantly influenced by renal impairment.
- Therefore, patients with renal failure, including those with AKI, may receive the usual initial dose of amlodipine 1, 1.
- However, it is essential to monitor these patients closely for any potential adverse effects.
- No dose adjustment is recommended in patients with renal impairment, but caution should be exercised when administering amlodipine to these patients.
From the Research
In acute kidney injury (AKI), amlodipine generally does not need to be held or discontinued, as it is primarily metabolized by the liver, with minimal renal elimination, making dose adjustments unnecessary even in patients with impaired kidney function 2.
Key Considerations
- Amlodipine is a calcium channel blocker that helps maintain blood pressure control, which is important for renal perfusion.
- Close monitoring of blood pressure is essential during AKI, as patients may become more sensitive to the hypotensive effects of medications.
- If a patient develops significant hypotension (systolic blood pressure <90 mmHg) while on amlodipine during an AKI episode, temporary dose reduction or holding the medication might be warranted until blood pressure stabilizes 3.
Management Principles
- The usual dosing of amlodipine (typically 2.5-10 mg once daily) can be continued during episodes of AKI.
- General management principles for AKI include determination of volume status, fluid resuscitation with isotonic crystalloid, treatment of volume overload with diuretics, discontinuation of nephrotoxic medications, and adjustment of prescribed drugs according to renal function 2.
- Awareness campaigns and education for health-care professionals on diagnosis and management of AKI can improve outcomes 3.
Outcome Prioritization
- The primary goal is to prioritize morbidity, mortality, and quality of life as the outcome, even if the outcome implied by the question is something else.
- The benefit of continuing amlodipine in AKI is that it provides smooth blood pressure control without abrupt fluctuations that could further compromise renal perfusion 4.