Is felodipine (a calcium channel blocker) associated with peripheral edema (feet swelling)?

From the Guidelines

Felodipine can cause feet swelling (peripheral edema) as a common side effect, and patients experiencing this should consult their healthcare provider for potential dose reduction, medication switch, or addition of a diuretic like hydrochlorothiazide to manage the condition 1. This occurs because felodipine is a calcium channel blocker that dilates blood vessels, which can lead to fluid leakage into surrounding tissues, particularly in the lower extremities like feet and ankles. The swelling typically worsens with higher doses and when standing or sitting for long periods. Some key points to consider:

• Felodipine is associated with dose-related pedal edema, which is more common in women than men 1.
• To minimize swelling, patients can elevate their feet when sitting, avoid prolonged standing, reduce salt intake, stay physically active, and wear compression stockings.
• The swelling, while uncomfortable, is generally not dangerous but should be monitored.
• If the swelling becomes severe, painful, or is accompanied by shortness of breath, patients should seek medical attention immediately as these could indicate more serious complications. It's also important to note that calcium channel blockers like felodipine are not recommended as routine treatment for patients with heart failure with reduced ejection fraction (HFrEF) due to their potential to worsen outcomes 1. However, in the context of managing hypertension, felodipine may be considered, and its use should be guided by the most recent clinical guidelines and patient-specific factors 1.

From the FDA Drug Label

ADVERSE REACTIONS In controlled studies in the United States and overseas, approximately 3000 patients were treated with felodipine as either the extended-release or the immediate-release formulation. The most common clinical adverse events reported with Felodipine administered as monotherapy at the recommended dosage range of 2. 5 mg to 10 mg once a day were peripheral edema and headache. Peripheral edema was generally mild, but it was age and dose related and resulted in discontinuation of therapy in about 3% of the enrolled patients.

Body System Adverse Events ... Body as a Whole Peripheral Edema 3. 3 (0.0) 2.0 (0.0) 8.8 (2.2) 17.4 (2.5)

Felodipine and feet swelling:

• The most common adverse event related to feet swelling is peripheral edema, which was reported in the studies.
• Peripheral edema was generally mild, but it was age and dose related and resulted in discontinuation of therapy in about 3% of the enrolled patients.
• The incidence of peripheral edema increased with dose, ranging from 2.0% at 2.5 mg to 17.4% at 10 mg once a day 2.

From the Research

Felodipine and Feet Swelling

• Felodipine is a dihydropyridine calcium antagonist that can cause peripheral edema, including feet swelling, as a common side effect 3, 4, 5.
• The incidence of peripheral edema with felodipine can be as high as 70% in some cases 6.
• The etiology of felodipine-related edema is thought to be related to a decrease in arteriolar resistance that is not matched in the venous circulation, leading to increased hydrostatic pressures and fluid shifts into the interstitial compartment 7.
• Strategies to treat felodipine-related edema include switching to a different calcium channel blocker, reducing the dosage, or adding a venodilator such as a nitrate, an angiotensin-converting enzyme inhibitor, or an angiotensin-receptor blocker to the treatment regimen 7.
• Discontinuing felodipine and switching to an alternative antihypertensive therapy can also resolve the edema 7.
• Traditional measures such as limiting the amount of time spent upright and using graduated compression stockings may be useful adjunctive therapies for managing felodipine-related edema 7.