From the Guidelines
Amlodipine should be held in patients with glomerular disease who are at risk of volume depletion, such as those experiencing diarrhea, vomiting, excessive sweating, or inadequate fluid intake, as well as in patients with increasing proteinuria, as it may exacerbate edema and have little impact on proteinuria reduction 1. When considering holding amlodipine, it's essential to weigh the potential benefits of continuing the medication against the risks of adverse effects, particularly in patients with specific conditions.
- In patients with unstable angina or non-ST-elevation myocardial infarction (UA/NSTEMI), amlodipine may be used to control ongoing or recurring ischemia-related symptoms, but its use should be cautious, especially in patients with pulmonary edema or evidence of severe left ventricular dysfunction 1.
- The medication's side effects, including hypotension, worsening heart failure, bradycardia, and AV block, should be carefully monitored, and patients should be advised to report any symptoms promptly.
- In general, amlodipine should not be stopped suddenly without medical guidance, as this could lead to rebound hypertension.
- Patients should document their blood pressure readings and symptoms to share with their healthcare provider, who may need to adjust the dosage or medication regimen.
- It's crucial to consider the properties of different calcium channel blockers, as outlined in Table 16, to make informed decisions about their use in various clinical scenarios 1.
From the Research
Amlodipine Hold Criteria
- Amlodipine is a calcium channel blocker used to treat high blood pressure and coronary artery disease 2.
- There are certain conditions under which amlodipine should be held, including:
- Symptomatic bradycardia resistant to atropine with heart rate in 30s and hypotension resistant to volume expansion, as seen in BRASH syndrome 3.
- Acute kidney injury (AKI) with severe resistant hyperkalemia, where holding amlodipine may be necessary as part of the treatment plan 3.
- Refractory hypotension, noncardiogenic pulmonary edema, and acute kidney injury after an overdose of amlodipine, where treatment with fluids, inotropes, and hemodialysis may be required 4.
Clinical Considerations
- In patients with acute heart failure who develop acute kidney injury, discontinuation or dose reduction of antihypertensive medications, including amlodipine, may be necessary to improve renal outcomes 5.
- The decision to hold amlodipine should be made on a case-by-case basis, taking into account the individual patient's clinical condition and medical history.
- It is essential to monitor patients closely for signs of hypotension, bradycardia, and hyperkalemia when holding or discontinuing amlodipine 3, 4.