Can Norvasc (amlodipine) be stopped or tapered?

Stopping or Tapering Norvasc (Amlodipine)

Norvasc (amlodipine) can be stopped abruptly without tapering in most patients, as it does not cause rebound hypertension or withdrawal symptoms unlike some other antihypertensive medications. 1

Pharmacological Considerations

Amlodipine has several unique pharmacokinetic properties that make abrupt discontinuation generally safe:

• Long elimination half-life of 40-60 hours 2
• Gradual offset of action after discontinuation
• Slow return of blood pressure to baseline over 7-10 days without evidence of rebound effect 2

These properties create a natural "self-tapering" effect when the medication is stopped.

Clinical Recommendations

When Stopping Is Appropriate:

• When switching to another antihypertensive medication
• When addressing medication-related side effects such as:
  • Peripheral edema (most common)
  • Flushing
  • Headache
  • Rare side effects like hyperpigmentation 3 or conjunctival chemosis 4

Stopping Protocol:

1. For most patients: Discontinue amlodipine without tapering
2. Monitor blood pressure for 7-10 days after discontinuation
3. Be aware that blood pressure will gradually return to pre-treatment levels

Special Considerations:

• Patients with severe or unstable hypertension: Consider overlapping with the new antihypertensive medication before completely stopping amlodipine
• Elderly patients: May benefit from closer monitoring after discontinuation
• Patients on multiple antihypertensives: Ensure adequate coverage from remaining medications

Contrast with Other Antihypertensives

Unlike amlodipine, several other antihypertensive medications require careful tapering:

• Beta blockers (metoprolol, propranolol, carvedilol): Must avoid abrupt cessation due to risk of rebound hypertension, tachycardia, and potential cardiac events 1
• Clonidine and other central alpha-2 agonists: Require tapering to avoid rebound hypertension; abrupt discontinuation may induce hypertensive crisis 1

Monitoring After Discontinuation

• Check blood pressure within 1-2 weeks of discontinuation
• Monitor for return of hypertension symptoms
• Be alert for any cardiovascular symptoms that may indicate inadequate blood pressure control

Common Pitfalls to Avoid

• Assuming all antihypertensives require tapering (amlodipine does not)
• Failing to monitor blood pressure after discontinuation
• Not considering the need for replacement therapy if amlodipine was effectively controlling hypertension
• Overlooking the potential for drug interactions with new replacement medications

In summary, amlodipine's pharmacokinetic profile allows for safe discontinuation without tapering in most patients, while ensuring appropriate blood pressure monitoring after stopping the medication.