From the Guidelines
Dizziness is a more common side effect of nifedipine compared to amlodipine, with an incidence of approximately 10-20% for nifedipine and 3-10% for amlodipine, as reported in the 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction 1.
Key Differences Between Amlodipine and Nifedipine
- Nifedipine has a faster onset of action and more pronounced vasodilatory effects, leading to more rapid drops in blood pressure and a higher incidence of dizziness.
- Amlodipine has a more gradual onset and longer half-life, resulting in smoother blood pressure control and fewer episodes of dizziness.
Management of Dizziness
- Taking the medication at bedtime may help minimize symptoms.
- Starting with a lower dose and gradually increasing it can also reduce side effects.
- For patients particularly sensitive to dizziness, amlodipine might be preferable as a first-line option.
Important Considerations
- Always report persistent or severe dizziness to your healthcare provider, as dosage adjustments or medication changes may be necessary.
- The choice between amlodipine and nifedipine should be based on individual patient factors, including the presence of other medical conditions and the potential for drug interactions.
- As noted in the guidelines, immediate-release nifedipine should be avoided in the absence of concomitant beta blockade due to increased adverse potential 1.
From the Research
Dizziness with Amlodipine and Nifedipine
- The incidence of dizziness with amlodipine and nifedipine can be compared based on several studies 2, 3, 4, 5, 6.
- A study comparing the effectiveness, safety, and tolerability of once-daily nifedipine and amlodipine in patients with mild-to-moderate essential hypertension found that the overall incidence of adverse events was 7.9% in the nifedipine group and 10.1% in the amlodipine group 3.
- Another study found that the incidence of adverse effects considered to be definitely or probably related to nifedipine retard treatment (41%) was significantly higher than for placebo (16%) or amlodipine (27%) 5.
- Specifically, headache, flushing, and dizziness were reported more frequently by patients while on nifedipine retard than on placebo or amlodipine 5.
- Amlodipine was found to have a low incidence of side effects such as headache, flushing, and dizziness, and was not associated with adverse effects on hematologic or biochemical safety parameters 6.
Comparison of Amlodipine and Nifedipine
- Amlodipine and nifedipine have been compared in several studies, with results showing that amlodipine is at least as effective as nifedipine in patients with essential hypertension 4.
- Amlodipine was found to have a favorable safety profile in comparative trials vs. beta-blockers and other calcium antagonists 6.
- The convenience of once-daily dosing, together with a lower incidence of adverse effects, suggests that amlodipine has clinical advantages over nifedipine retard in the treatment of hypertension 5.