From the Guidelines
Amlodipine can be used in patients with a history of angioedema, but with caution, particularly if the previous angioedema was drug-induced, as the most recent and highest quality study suggests that calcium channel blockers have a lower incidence of angioedema compared to ACE inhibitors 1. When considering the use of amlodipine in patients with a history of angioedema, it is essential to assess the risk of recurrence and potential cross-reactivity with other calcium channel blockers.
- The mechanism of CCB-induced angioedema differs from ACE inhibitor-induced cases, likely involving altered calcium-dependent mediator release rather than bradykinin accumulation, which explains the lower incidence with CCBs compared to ACE inhibitors.
- Patients with a history of ACE inhibitor-induced angioedema may be at higher risk, and amlodipine may be a reasonable alternative after careful risk assessment.
- If the patient has experienced angioedema with another CCB, amlodipine should be avoided due to potential cross-reactivity.
- When initiating amlodipine in these patients, start with a low dose (typically 2.5 mg daily) and monitor closely for signs of facial, lip, tongue, or throat swelling, especially during the first few weeks of treatment.
- Patients should be educated about angioedema symptoms and instructed to seek immediate medical attention if they develop difficulty breathing, swallowing, or significant facial swelling, as recommended by the most recent guidelines 1.
From the FDA Drug Label
Skin and Appendages: angioedema, erythema multiforme, pruritus, 1 rash, 1 rash erythematous, rash maculopapular The use of amlodipine in patients with a history of angioedema should be approached with caution, as angioedema is listed as a possible adverse event in the drug label 2.
- Key considerations:
- Amlodipine has been associated with angioedema in postmarketing experience, although the frequency is uncertain.
- Patients with a history of angioedema should be closely monitored for signs and symptoms of angioedema when taking amlodipine.
- The benefits and risks of using amlodipine in these patients should be carefully weighed.
From the Research
Considerations for Using Amlodipine in Patients with a History of Angioedema
- Amlodipine, a calcium channel blocker, has been associated with angioedema, although it is a rare adverse effect 3, 4.
- The incidence of angioedema in patients taking amlodipine is lower compared to those taking angiotensin-converting enzyme (ACE) inhibitors 5.
- Patients who develop angioedema while taking amlodipine may present with severe swelling, often isolated to a specific area such as the upper lip 3.
- Discontinuation of amlodipine and treatment with IV glucocorticoids and diphenhydramine may be effective in resolving the angioedema 3.
- Clinicians should consider amlodipine as a potential cause of angioedema, especially in patients with a history of this condition 4.
- The Naranjo probability scale can be used to determine the likelihood of amlodipine-induced angioedema 4.
- Upper airway obstruction can occur in patients with angioedema, including those taking amlodipine, and requires prompt medical attention 6.
- Patients with a history of angioedema should be closely monitored while taking amlodipine, and alternative antihypertensive medications should be considered if necessary 7, 6.