From the Guidelines
Amlodipine is not specifically contraindicated in subdural hematoma, but its use requires caution due to its potential effects on intracranial pressure and cerebral perfusion pressure. The primary concern with amlodipine in patients with intracranial bleeding, including subdural hematomas, is its vasodilatory and blood pressure-lowering effects, which could potentially complicate management of intracranial pressure or cerebral perfusion pressure in acute subdural hematoma 1.
In patients with acute subdural hematoma requiring blood pressure management, the neurosurgical team should be consulted to establish target blood pressure goals before initiating or continuing amlodipine. For patients with chronic subdural hematoma who require antihypertensive therapy, amlodipine can generally be used safely, but blood pressure should be monitored carefully to avoid hypotension. The standard dosing of amlodipine (2.5-10 mg once daily) applies, but starting at lower doses (2.5 mg) with gradual titration may be prudent in these patients.
Some studies have shown that calcium channel blockers like amlodipine may be safe in patients with hypertension and heart failure 1, but the evidence is limited in the context of subdural hematoma. However, a small study found that moderate reductions in blood pressure with amlodipine were associated with improved short-term outcomes in patients with stroke 1.
Key considerations when using amlodipine in patients with subdural hematoma include:
- Monitoring blood pressure carefully to avoid hypotension
- Establishing target blood pressure goals with the neurosurgical team
- Starting at lower doses (2.5 mg) with gradual titration
- Individualizing the decision to use amlodipine based on the patient's overall clinical condition, the acuity and severity of the subdural hematoma, and other comorbidities. The most recent and highest quality study on this topic is from 2007 1, which highlights the need for caution when using antihypertensive agents in patients with acute ischemic stroke, and by extension, subdural hematoma.
From the Research
Amlodipine Contraindication in Subdural Hematoma
- There is no direct evidence from the provided studies that amlodipine is contraindicated in subdural hematoma 2, 3, 4, 5, 6.
- The studies focus on the management of hypertension, blood pressure control, and the effects of amlodipine on blood pressure variability, but do not specifically address its use in subdural hematoma.
- One study discusses the management of primary hypertensive hemorrhage of the brain, but does not mention amlodipine as a contraindicated medication in subdural hematoma 3.
- Another study highlights the importance of blood pressure control in traumatic subdural hematomas, but does not provide information on the use of amlodipine in this context 2.
- The remaining studies discuss the efficacy and safety of amlodipine in the treatment of hypertension, but do not address its use in subdural hematoma 4, 5, 6.