Can amlodipine cause hematuria?

Can Amlodipine Cause Hematuria?

Amlodipine is not known to cause hematuria as a common or recognized side effect based on current clinical guidelines and evidence.

Mechanism and Side Effect Profile of Amlodipine

Amlodipine is a dihydropyridine calcium channel blocker that works by selectively blocking calcium channels in vascular smooth muscle, causing vasodilation in peripheral and coronary vascular beds 1. Its primary use is in the management of hypertension and angina.

The most commonly reported side effects of amlodipine include:

• Peripheral edema (most common)
• Headache
• Flushing
• Dizziness
• Fatigue

Renal Effects of Amlodipine

Amlodipine generally has a favorable renal profile:

• Studies indicate that amlodipine may have renoprotective effects and can even increase eGFR in some CKD patients 1
• In hypertensive patients with renal dysfunction, amlodipine effectively reduces blood pressure while causing minimal or no aggravation of renal function 2
• Clinical trials have shown that serum amlodipine does not tend to accumulate in patients with renal impairment, suggesting a favorable pharmacokinetic profile 2

Evidence Regarding Hematuria

None of the major guidelines or clinical studies specifically mention hematuria as a side effect of amlodipine:

• The KDOQI Clinical Practice Guidelines do not list hematuria among the adverse effects of calcium channel blockers 3
• The 2017 ACC/AHA guidelines on hypertension management do not mention hematuria as a side effect of calcium channel blockers 3
• The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure does not include hematuria among calcium channel blocker side effects 3

Monitoring Renal Function with Amlodipine

While hematuria is not a recognized side effect, monitoring of renal function is recommended when using amlodipine:

• In some studies, a small percentage of patients (11.4%) experienced mild elevations in serum creatinine when treated with amlodipine 4
• The KDIGO guidelines for glomerular diseases note that dihydropyridine calcium channel blockers like amlodipine may exacerbate edema and potentially increase proteinuria, but do not mention hematuria 3

Clinical Implications

If a patient on amlodipine presents with hematuria:

1. Consider other more likely causes of hematuria (urinary tract infection, kidney stones, glomerular disease, malignancy)
2. Review the patient's complete medication list for other drugs known to cause hematuria
3. Perform appropriate diagnostic workup for hematuria regardless of medication use
4. Do not automatically attribute hematuria to amlodipine use given the lack of evidence supporting this association

Conclusion

Based on available clinical guidelines and research evidence, amlodipine is not known to cause hematuria. If hematuria occurs in a patient taking amlodipine, clinicians should investigate other potential causes rather than attributing it to the medication.