Amlodipine and Dizziness
Yes, amlodipine can cause dizziness, and this is a well-documented adverse effect listed in the FDA drug label and multiple clinical guidelines.
Incidence and Clinical Evidence
Dizziness occurs in a dose-dependent manner with amlodipine therapy 1. According to FDA-approved labeling data from controlled clinical trials:
- 2.5 mg dose: 1.1% incidence
- 5 mg dose: 3.4% incidence
- 10 mg dose: 3.4% incidence
- Placebo: 1.5% incidence 1
The incidence of dizziness with amlodipine is consistently reported across multiple clinical contexts 2.
Mechanism and Clinical Characteristics
Dizziness from amlodipine is primarily related to its vasodilatory effects, which can cause systemic hypotension 2. As a dihydropyridine calcium channel blocker, amlodipine has high selectivity for vascular L-type calcium channels, producing marked peripheral vasodilation 2, 3.
The adverse effect profile includes 1, 4:
- Dizziness (dose-related)
- Hypotension
- Flushing
- Headache
- Peripheral edema
Comparative Tolerability
Amlodipine generally has a lower incidence of vasodilatory side effects compared to other dihydropyridines due to its gradual onset and long half-life 4. In comparative trials:
- Amlodipine was better tolerated than nitrendipine with a much lower incidence of vasodilation-related side effects, especially during initial treatment 4
- Compared to losartan, amlodipine showed higher rates of drug-related adverse events, though dizziness upon standing was actually more common with losartan 5
- The most common adverse effects (headache, dizziness, flushing) were generally mild to moderate in severity 6, 3
Special Populations at Higher Risk
Older adults are at increased risk for dizziness and falls with amlodipine 2. European Society of Cardiology guidelines specifically note that calcium channel blockers can increase the risk of:
- Hypotension
- Falls
- Dizziness 2
Monitoring blood pressure (both standing and recumbent) is recommended, particularly in elderly patients 2.
Clinical Management Considerations
Start with lower doses in patients at risk for hypotension-related dizziness 2. Pediatric guidelines recommend starting doses of 2.5 mg daily in children, with careful uptitration 2.
The gradual onset of action with amlodipine (compared to immediate-release dihydropyridines like nifedipine) results in improved tolerability and lower incidence of acute vasodilatory symptoms 4, 3.
Symptomatic hypotension and dizziness often improve with time, though dose reduction of other concurrent hypotensive agents may be necessary 2. Asymptomatic hypotension does not require intervention 2.
Discontinuation Rates
Despite causing dizziness, discontinuation rates due to adverse reactions with amlodipine are low (approximately 1.5% in controlled trials, not significantly different from placebo at 1%) 1. This suggests that while dizziness occurs, it is usually tolerable and does not necessitate stopping the medication in most patients.