Does Amlodipine Cause Gout?
No, amlodipine does not cause gout and may actually reduce gout risk compared to other antihypertensive medications, particularly diuretics and beta-blockers.
Evidence Supporting Amlodipine's Protective Effect
Amlodipine demonstrates a protective effect against gout development when compared to other commonly prescribed antihypertensives:
In a large randomized trial (ALLHAT), amlodipine reduced gout risk by 37% compared to chlorthalidone (a thiazide-like diuretic) and by 26% compared to lisinopril (an ACE inhibitor), with this protective effect primarily observed after 1 year of treatment 1.
Amlodipine has demonstrated renoprotective effects in chronic kidney disease patients, which may contribute to improved uric acid handling 2.
In renal transplant recipients with cyclosporin-induced hyperuricemia, amlodipine significantly decreased serum uric acid levels from 483 to 431 μmol/L, while also increasing glomerular filtration rate and uric acid clearance 3.
Mechanism of Benefit
The uric acid-lowering effect of amlodipine appears related to its renal hemodynamic effects:
Amlodipine reduces renal artery smooth muscle contraction, leading to higher renal blood flow even while systemic blood pressure is reduced 2.
It increases the clearance rate of uric acid and reduces fractional proximal tubular reabsorption of sodium, facilitating uric acid excretion 3.
Even a single dose of amlodipine can lead to a demonstrable increase in estimated glomerular filtration rate in chronic kidney disease patients 2.
Clinical Context: Medications That Actually Cause Gout
In contrast to amlodipine, several medication classes are well-established gout triggers:
Thiazide and loop diuretics are the most common medications that contribute to hyperuricemia and gout, reducing uric acid excretion by the kidneys 4.
Beta-blockers, particularly metoprolol, increase serum uric acid levels (by 0.3-0.4 mg/dL) and increase gout-related medication use 5.
Calcineurin inhibitors (cyclosporine, tacrolimus) commonly elevate serum urate levels in organ transplant recipients 4, 6.
Guideline-Recommended Alternatives for Gout Prevention
When selecting antihypertensives for patients with or at risk of gout:
Calcium channel blockers (including amlodipine) are recommended as preferred alternatives to diuretics for patients at risk of gout, as they do not increase serum uric acid levels 7.
Losartan is the single most preferred antihypertensive for gout patients due to its unique uricosuric properties, increasing urinary uric acid excretion by approximately 25% 7.
The American College of Rheumatology conditionally recommends switching hydrochlorothiazide to alternative antihypertensives (such as calcium channel blockers or losartan) in gout patients 4.
Clinical Bottom Line
Amlodipine should be considered a gout-neutral to gout-protective medication choice. When managing hypertension in patients with established gout or hyperuricemia, amlodipine represents a safe and potentially beneficial option, particularly when compared to diuretics or beta-blockers that are known to increase gout risk 1, 6.