Abrupt Discontinuation of Norvasc (Amlodipine)
Norvasc (amlodipine) should not be stopped abruptly as this may lead to rebound hypertension and increased risk of cardiovascular events. Instead, a gradual tapering approach is recommended to minimize these risks.
Risks of Abrupt Discontinuation
Abruptly stopping amlodipine can lead to:
- Rebound hypertension - sudden elevation in blood pressure
- Increased risk of cardiovascular events including myocardial infarction and stroke
- Exacerbation of angina symptoms in patients with coronary artery disease
Proper Discontinuation Protocol
When discontinuing amlodipine, follow this approach:
Gradual tapering: Reduce the dose by 50% every 1-2 weeks
- For example: 10mg → 5mg → 2.5mg → discontinue
- The tapering schedule may need to be extended for patients who have been on higher doses or long-term therapy
Blood pressure monitoring: Monitor blood pressure regularly during the tapering process
- Check blood pressure at least twice weekly
- If blood pressure increases significantly, slow the tapering process
Medical supervision: Always consult with a healthcare provider before stopping amlodipine
- Never stop based on self-assessment or without medical guidance
Special Considerations
High-Risk Patients
For patients with:
- Coronary artery disease
- History of myocardial infarction
- Heart failure
- Severe hypertension
The tapering process should be even more gradual and closely monitored, as these patients are at higher risk for adverse events with abrupt discontinuation 1.
Medication Switching
If switching to another antihypertensive:
- Begin the new medication while still on amlodipine
- Gradually increase the new medication while tapering amlodipine
- This approach minimizes the risk of uncontrolled hypertension during transition
Pharmacological Rationale
Amlodipine has a long half-life (35-50 hours) compared to other calcium channel blockers 2. This extended duration of action means:
- Its effects persist longer in the body
- Abrupt discontinuation can lead to more pronounced rebound effects
- The long half-life provides some buffer against missed doses, but doesn't eliminate the need for proper tapering when discontinuing
Common Side Effects of Amlodipine
While on amlodipine, patients may experience:
- Peripheral edema (most common)
- Flushing
- Dizziness
- Palpitations
These side effects typically resolve with discontinuation but should not be the sole reason for abruptly stopping the medication 2.
Key Takeaway
The American College of Cardiology recommends that antihypertensive medications that can cause rebound hypertension should always be tapered rather than abruptly discontinued 3. While amlodipine may not cause as severe rebound effects as centrally-acting agents like clonidine, gradual tapering is still the safest approach to minimize cardiovascular risk.