What is amlodipine used for?

Amlodipine Uses and Indications

Amlodipine is primarily indicated for the treatment of hypertension and coronary artery disease, including chronic stable angina, vasospastic angina, and angiographically documented CAD. 1

Hypertension

• Amlodipine is FDA-approved for the treatment of hypertension, to lower blood pressure and reduce the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions 1
• It can be used alone or in combination with other antihypertensive agents for effective blood pressure control 1
• In the ALLHAT study, amlodipine was equally effective as chlorthalidone (a thiazide diuretic) and lisinopril (an ACE inhibitor) in preventing coronary heart disease mortality and morbidity 2
• Amlodipine works by inhibiting calcium influx through "slow" channels in peripheral vascular smooth muscle cells, producing vasodilation in peripheral vascular beds 3

Coronary Artery Disease

Chronic Stable Angina

• Amlodipine is indicated for the symptomatic treatment of chronic stable angina, either as monotherapy or in combination with other antianginal agents 1
• It is considered an alternative to beta-blockers in patients who cannot tolerate them 2
• The European Society of Cardiology recommends amlodipine as a second-line agent when angina persists despite treatment with a beta-blocker 2
• Clinical trials have shown that amlodipine provides good anti-anginal and anti-ischemic efficacy for a full 24 hours with once-daily dosing 4

Vasospastic Angina (Prinzmetal's or Variant Angina)

• Amlodipine is indicated for the treatment of confirmed or suspected vasospastic angina 1
• It has been shown to be consistently effective in patients with vasospastic angina 4
• It can be used as monotherapy or in combination with other antianginal agents 1

Angiographically Documented CAD

• In patients with recently documented CAD by angiography and without heart failure or ejection fraction <40%, amlodipine is indicated to reduce the risk of hospitalization for angina and to reduce the risk of coronary revascularization procedures 1

Heart Failure Considerations

• Amlodipine is one of the few calcium channel blockers that can be safely used in patients with compensated heart failure when other therapies are insufficient 2
• Unlike non-dihydropyridine calcium channel blockers (diltiazem and verapamil), amlodipine does not have significant negative inotropic effects 5
• In the ALLHAT study, amlodipine was associated with a higher risk of heart failure compared to chlorthalidone, but this did not translate to increased mortality 2

Pharmacological Properties

• Amlodipine belongs to the dihydropyridine subclass of calcium channel blockers 5
• It has a long elimination half-life of 36-45 hours, allowing for once-daily dosing 5, 6
• Absorption after oral administration is slow with peak plasma concentration occurring 6-8 hours after dosing, which contributes to its gradual onset of action 6
• This gradual onset reduces the incidence of side effects such as reflex tachycardia and headache, which can be troublesome with other calcium antagonists 4
• Amlodipine has high selectivity for vascular smooth muscle with minimal effect on myocardial contractility or cardiac conduction 5

Common Side Effects and Precautions

• The most common adverse effects are related to vasodilation: peripheral edema, headaches, and flushing 7
• Unlike some other calcium channel blockers, amlodipine does not cause significant postural hypotension, reflex tachycardia, or cardiac conduction disturbances 7
• Amlodipine has not shown unfavorable effects on serum glucose or lipid levels 5
• When combined with statins, amlodipine has minimal drug interactions compared to other calcium channel blockers like diltiazem and verapamil 2

Dosing Considerations

• The usual starting dose is 5 mg once daily, which can be increased to 10 mg daily if required to control symptoms 4
• Amlodipine can be taken with or without food 1
• For patients with angina, clinical studies have confirmed that once-daily dosing provides anti-anginal efficacy for a full 24 hours 4

Amlodipine's unique pharmacokinetic profile, efficacy in both hypertension and various forms of coronary artery disease, and favorable side effect profile make it a versatile and valuable medication in cardiovascular disease management.