From the Guidelines
Amlodipine does not cause hypercalcemia. Amlodipine is a calcium channel blocker that works by preventing calcium from entering the cells of the heart and blood vessels, which helps relax and widen blood vessels to lower blood pressure. Despite its mechanism involving calcium channels, amlodipine does not affect serum calcium levels in the bloodstream. The medication blocks L-type calcium channels in vascular smooth muscle and cardiac muscle, but this action is separate from calcium homeostasis in the body, which is primarily regulated by parathyroid hormone, vitamin D, and calcitonin 1.
Key Points to Consider
- Hypercalcemia (elevated blood calcium levels) is typically caused by conditions such as hyperparathyroidism, certain cancers, excessive vitamin D intake, or medications like thiazide diuretics.
- Calcium channel blockers like amlodipine are not known to contribute to hypercalcemia.
- In fact, in some cases of hypercalcemia caused by certain conditions, calcium channel blockers might be used as part of the treatment approach.
- The subclasses of calcium channel blockers, including dihydropyridines (e.g., amlodipine) and nondihydropyridines, have different selectivities for vascular smooth muscle cells and cardiac cells, but neither subclass is associated with causing hypercalcemia 1.
Clinical Implications
- When managing patients with hypertension or other conditions treated with amlodipine, clinicians do not need to be concerned about the medication causing hypercalcemia.
- Monitoring for hypercalcemia is more relevant when patients are on medications known to affect calcium levels, such as thiazide diuretics, or have underlying conditions that predispose them to hypercalcemia.
- The primary focus for patients on amlodipine should be on monitoring and managing their blood pressure and other cardiovascular risk factors, rather than worrying about the development of hypercalcemia.
From the FDA Drug Label
Serum calcium concentration is not affected by amlodipine.
- Amlodipine does not cause hypercalcemia as it does not affect serum calcium concentration, according to the drug label 2.
From the Research
Amlodipine and Hypercalcemia
- Amlodipine is a calcium channel blocker used to treat hypertension and angina pectoris 3, 4.
- There is no direct evidence that amlodipine causes hypercalcemia as a side effect of its normal use 5, 3, 6, 4.
- However, in a case of amlodipine overdose, treatment with calcium salts can lead to iatrogenic hypercalcemia 7.
- In one reported case, a patient who ingested 450 mg of amlodipine was treated with calcium gluconate, which resulted in a serum calcium level of 26.1 mg/dL and ultimately led to the patient's death 7.
- This suggests that while amlodipine itself may not cause hypercalcemia, its overdose and subsequent treatment with calcium salts can lead to hypercalcemia in certain cases 7.
Mechanism and Treatment
- Amlodipine works by inhibiting the influx of calcium ions into vascular smooth muscle and cardiac muscle 3, 4.
- In cases of amlodipine overdose, treatment with calcium salts is sometimes used to counteract the effects of the overdose, but this can lead to hypercalcemia 7.
- The treatment of hypercalcemia typically involves hydration, intravenous bisphosphonates, and addressing the underlying cause of the hypercalcemia 5.
Important Considerations
- Amlodipine is generally well-tolerated and safe when used as directed 3, 6, 4.
- However, in cases of overdose or certain medical conditions, amlodipine can have serious consequences, including hypercalcemia 7.
- It is essential to carefully monitor patients who are taking amlodipine, especially in cases of overdose or renal failure, to avoid the development of hypercalcemia 7.