Contraindications of Amlodipine
The only absolute contraindication to amlodipine is known hypersensitivity to the drug itself. 1
Absolute Contraindication
- Known sensitivity/hypersensitivity to amlodipine is the sole FDA-labeled absolute contraindication 1
- This includes patients with documented allergic reactions to amlodipine in the past 1
Clinical Situations Where Amlodipine Should NOT Be Used
Heart Failure with Reduced Ejection Fraction (HFrEF)
- Amlodipine is NOT recommended as treatment for heart failure, though it is not contraindicated for blood pressure control in these patients 2
- Among calcium channel blockers, amlodipine is actually one of the few that can be safely used in heart failure patients when needed for hypertension or angina, as demonstrated in the PRAISE trials 2, 3
- Non-dihydropyridine calcium channel blockers (diltiazem, verapamil) are absolutely contraindicated in HFrEF due to negative inotropic effects and increased mortality risk 2
Pediatric Age Restrictions
- Amlodipine is contraindicated in children under 1 year of age 2
- For children 6-17 years, dosing should start at 2.5 mg daily with a maximum of 5 mg daily 2
Relative Contraindications and Cautions
Advanced Aortic Stenosis:
- Amlodipine is contraindicated in advanced aortic stenosis 2
- The vasodilatory effects can cause dangerous hypotension in patients who depend on preload to maintain cardiac output 2
Severe Hepatic Impairment:
- While not an absolute contraindication, dosage adjustments are necessary but not yet fully established 4
- Amlodipine undergoes extensive hepatic metabolism, requiring careful monitoring in liver disease 4
Important Clinical Distinctions
What Amlodipine Does NOT Require Avoidance For:
- Renal impairment: No dosage modifications necessary 4
- Conduction abnormalities: Amlodipine does not cause cardiac conduction disturbances and is well tolerated 4, 5
- Elderly patients: Well tolerated without specific contraindications, though closer monitoring for hypotension is prudent 4
Key Differentiating Point from Other Calcium Channel Blockers:
- Unlike non-dihydropyridines (verapamil, diltiazem), amlodipine does NOT cause bradycardia, heart block, or worsen heart failure through negative inotropic effects 2, 5
- This makes amlodipine's contraindication profile much narrower than other calcium channel blockers 2
Common Pitfalls to Avoid
- Do not confuse amlodipine's contraindications with those of non-dihydropyridine calcium channel blockers - verapamil and diltiazem have extensive contraindications including heart failure, bradycardia, and heart block that do NOT apply to amlodipine 2
- Do not withhold amlodipine in heart failure patients who need blood pressure control - while not indicated FOR heart failure treatment, it can be safely used when hypertension management is needed 2, 3
- Vasospastic angina is a contraindication for beta-blockers, not for amlodipine - calcium channel blockers like amlodipine are actually preferred in this condition 2