What are the dermatological side effects of Amlodipine (calcium channel blocker)?

Dermatological Side Effects of Amlodipine

Common Dermatological Side Effects

Amlodipine can cause several dermatological side effects, with rash being the most commonly reported cutaneous adverse reaction. According to FDA drug labeling, dermatological side effects of amlodipine include 1:

• Rash (maculopapular rash being most common)
• Erythema multiforme
• Pruritus
• Angioedema
• Flushing
• Peripheral edema (most common overall side effect)

The incidence of these reactions varies, with peripheral edema being dose-dependent and occurring in up to 10.8% of patients taking 10mg of amlodipine, while flushing occurs in approximately 2.6% of patients at the same dosage 1.

Rare but Serious Dermatological Side Effects

Several rare but potentially serious dermatological adverse effects have been reported:

1. Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

   • Case reports have documented SJS and TEN associated with amlodipine use 2, 3
   • One study found that 6.2% of patients with cutaneous reactions to amlodipine developed SJS 2
   • These are life-threatening conditions requiring immediate drug discontinuation

2. Hyperpigmentation

   • Oral mucosal and cutaneous hyperpigmentation has been reported with long-term amlodipine use 4
   • This may be more pronounced in photoexposed areas

3. Generalized Edema

   • While peripheral edema is common, rare cases of anasarca (generalized edema) have been reported 5
   • Bilateral upper extremity edema has also been documented 6

Risk Factors and Monitoring

Certain factors may increase the risk of dermatological reactions:

• Female patients appear to have a higher incidence of edema (14.6% vs 5.6% in males) and flushing (4.5% vs 1.5% in males) 1
• Patients with abnormal arterial circulation may be at higher risk for unusual patterns of edema 6
• Higher doses (10mg) are associated with increased risk of dermatological side effects compared to lower doses 1

Management of Dermatological Side Effects

When dermatological side effects occur:

1. For mild to moderate reactions (simple rash, peripheral edema):

   • Consider dose reduction if clinically appropriate
   • Provide symptomatic treatment
   • Monitor for progression

2. For severe reactions (SJS, TEN, anasarca):

   • Immediately discontinue amlodipine
   • Provide appropriate supportive care
   • Consider alternative antihypertensive medications

3. For persistent peripheral edema:

   • Consider switching to another calcium channel blocker or different class of antihypertensive

Clinical Considerations

When prescribing amlodipine, clinicians should:

• Inform patients about potential dermatological side effects
• Advise patients to report any skin changes promptly
• Monitor for development of edema, particularly in female patients
• Be aware that dermatological side effects are often dose-related
• Consider that while amlodipine has renoprotective effects in CKD patients 7, the peripheral edema it causes is not related to fluid retention but rather to arteriolar dilation

In patients with psoriasis, calcium channel blockers including amlodipine are generally considered safe, with no evidence supporting avoidance of these medications 7.