Can amlodipine cause hematuria?

Amlodipine and Hematuria

Amlodipine is not known to cause hematuria based on current clinical guidelines and research evidence. 1 Multiple authoritative guidelines, including those from the Kidney Disease Outcomes Quality Initiative (KDOQI), American College of Cardiology (ACC), American Heart Association (AHA), and the Kidney Disease: Improving Global Outcomes (KDIGO), do not list hematuria among the adverse effects of calcium channel blockers like amlodipine.

Established Side Effects of Amlodipine

Amlodipine, a dihydropyridine calcium channel blocker, has well-documented side effects that include:

• Peripheral edema (most common) 1
• Headache 1
• Flushing 1
• Dizziness 1
• Fatigue 1

In rare cases, more severe side effects may occur:

• Anasarca (generalized edema) has been reported in isolated case reports 2
• Slight elevation of serum creatinine in some patients with pre-existing renal impairment (11.4% in one study) 3

Renal Effects of Amlodipine

Amlodipine generally has a favorable renal profile:

• It may have renoprotective effects and can even increase eGFR in chronic kidney disease patients 1
• Renal impairment has little effect on the pharmacokinetics of amlodipine, and dosage adjustment is not necessary in renal impairment 4
• In studies of hypertensive patients with renal dysfunction, amlodipine effectively controlled blood pressure while causing little or no aggravation of renal function 5, 3

Clinical Implications

If a patient on amlodipine presents with hematuria:

1. Consider other more likely causes of hematuria

   • Urinary tract infection
   • Kidney stones
   • Glomerulonephritis
   • Malignancy
   • Trauma
   • Other medications known to cause hematuria

2. Perform appropriate diagnostic workup:

   • Urinalysis with microscopy
   • Urine culture
   • Renal function tests
   • Imaging studies as indicated

3. Review the patient's complete medication list for other potential causes

Important Considerations

• While calcium channel blockers like amlodipine may exacerbate edema and potentially increase proteinuria, hematuria is not a recognized side effect 1
• The absence of hematuria in the side effect profile is consistent across multiple guidelines and research studies
• If hematuria occurs in a patient taking amlodipine, clinicians should investigate other etiologies rather than attributing it to the medication

In summary, if a patient on amlodipine develops hematuria, the medication is unlikely to be the cause, and alternative diagnoses should be pursued while the patient continues necessary antihypertensive therapy.