What are the contraindications for amlodipine (calcium channel blocker)?

Contraindications for Amlodipine

Amlodipine is contraindicated in patients with known sensitivity or allergy to amlodipine. 1

Primary Contraindications

1. Known hypersensitivity to amlodipine - The FDA label explicitly states this as the only absolute contraindication 1

Relative Contraindications and Precautions

Cardiovascular Conditions

• Heart failure:

  • Non-dihydropyridine calcium channel blockers (diltiazem, verapamil) are contraindicated in heart failure with reduced ejection fraction (HFrEF) 2
  • Amlodipine specifically appears to be safe in patients with severe HFrEF based on the PRAISE trial 2
  • Unlike other calcium channel blockers, amlodipine is one of the few that can be considered in heart failure patients 2

• Severe aortic stenosis: Calcium channel blockers should be avoided in advanced aortic stenosis 2

• Hypotension: Caution should be exercised in patients with existing hypotension due to amlodipine's vasodilatory effects 3

Age-Related Considerations

• Children under 1 year of age: Contraindicated in this population 2
• Elderly patients: Lower starting doses recommended but not contraindicated 2

Pregnancy and Breastfeeding

• Unlike ACE inhibitors and ARBs which are absolutely contraindicated in pregnancy, amlodipine does not carry the same level of contraindication, though caution is still advised

Special Populations Requiring Dose Adjustment (Not Contraindications)

• Hepatic impairment: Amlodipine is metabolized by the liver, so dosage adjustment may be needed in patients with hepatic dysfunction 3

• Elderly patients: Should start with the low end of the dosing range 2

Important Clinical Considerations

Drug Interactions

• Cytochrome P450 3A4 interactions: Amlodipine is metabolized by CYP3A4, so caution should be exercised when used with other drugs metabolized by this enzyme 2

• Ivabradine: Diltiazem and verapamil should not be used with ivabradine due to risk of severe bradycardia, though this specific warning does not apply to amlodipine 2

Common Side Effects to Monitor

• Peripheral edema
• Headache
• Flushing
• Dizziness 3

Clinical Advantages of Amlodipine

• Unlike non-dihydropyridine calcium channel blockers, amlodipine:
  • Does not cause significant cardiac conduction disturbances
  • Does not typically cause postural hypotension
  • Does not cause reflex tachycardia at therapeutic doses 4
  • Has a gradual onset of action that minimizes activation of physiological reflexes 5

Key Differences from Other Calcium Channel Blockers

It's important to note that many contraindications that apply to non-dihydropyridine calcium channel blockers (verapamil, diltiazem) do not apply to amlodipine. Specifically, amlodipine:

1. Can be used in heart failure patients (while verapamil and diltiazem are contraindicated)
2. Has minimal effects on cardiac conduction
3. Has once-daily dosing due to its long half-life (40-60 hours) 5

This distinction is critical as physicians sometimes incorrectly apply the contraindications of the entire class to all calcium channel blockers.