What are the contraindications for amlodipine (Calcium Channel Blocker)?

From the Guidelines

Amlodipine is contraindicated in patients with advanced aortic stenosis. The use of amlodipine in such patients can lead to worsening of their condition due to its vasodilatory effects, which can decrease cardiac output and potentially lead to hypotension, as noted in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.

Key Considerations for Amlodipine Use

• Amlodipine should be used with caution in elderly patients, and no dose adjustment is needed for this population, as stated in the same guideline 1.
• It is also important to consider the potential for interactions with other medications, such as CYP3A4 inhibitors, which can increase the plasma concentration of amlodipine and risk of side effects.
• Patients with known hypersensitivity to amlodipine or other dihydropyridine calcium channel blockers should avoid its use.
• Caution is required when using amlodipine in patients with heart failure, particularly those with reduced ejection fraction, as it may worsen these conditions, although the PRAISE trial suggested that amlodipine appeared to be safe in patients with severe heart failure with reduced ejection fraction 1.

Special Populations

• In pregnant women, amlodipine should be used only if the potential benefit justifies the risk to the fetus.
• During breastfeeding, amlodipine should be avoided when possible due to the potential risk to the infant.
• Patients with severe hepatic impairment require careful consideration and typically lower doses of amlodipine, due to its metabolism in the liver.

Monitoring and Dose Adjustment

• Monitoring for bradycardia and signs of heart failure worsening is necessary, especially in vulnerable populations.
• Dose adjustments may be necessary based on the patient's response to the medication and the presence of any side effects.

Given the potential risks and benefits, the decision to use amlodipine should be made on a case-by-case basis, considering the individual patient's condition, other medications, and potential interactions, with a focus on minimizing morbidity, mortality, and improving quality of life.

From the FDA Drug Label

4 CONTRAINDICATIONS Amlodipine besylate tablets are contraindicated in patients with known sensitivity to amlodipine.

The contraindications for amlodipine are:

• Known sensitivity to amlodipine 2

From the Research

Contraindications for Amlodipine

• Amlodipine is generally well-tolerated, but there are some contraindications to consider:
  • Hypersensitivity to amlodipine or other dihydropyridine calcium channel blockers 3
  • Severe hypotension (low blood pressure) 4
  • Cardiac conduction disturbances, such as second- or third-degree atrioventricular block 4
• Amlodipine should be used with caution in patients with:
  • Congestive heart failure, as it may worsen the condition in some cases 4
  • Coronary artery disease, as it may have a neutral effect on mortality 5
  • Chronic kidney disease or liver disease, as it may affect the drug's pharmacokinetics 6
• There is limited information on the use of amlodipine in pregnant or breastfeeding women, and it should be used with caution in these populations 6

Special Considerations

• Amlodipine may interact with other medications, such as beta-blockers, diuretics, and ACE inhibitors, which may affect its efficacy or increase the risk of side effects 4, 6
• Patients with chronotropic incompetence may benefit from amlodipine treatment, as it may improve exercise tolerance and left ventricular diastolic function 7