From the Guidelines
Yes, a person with chronic kidney disease (CKD) can generally take amlodipine, and it is often a preferred blood pressure medication for these patients. Amlodipine is a calcium channel blocker that does not typically require dose adjustment in kidney disease since it is primarily metabolized by the liver rather than excreted by the kidneys. The standard dosing ranges from 2.5 to 10 mg once daily, with many CKD patients starting at 5 mg daily. Amlodipine is particularly beneficial for CKD patients because it effectively lowers blood pressure without worsening kidney function, and it can help reduce proteinuria (protein in urine) in some cases, as noted in a study published in the British Journal of Pharmacology 1.
Some key points to consider when prescribing amlodipine to CKD patients include:
- Monitoring for potential side effects such as peripheral edema (swelling in the legs or ankles), which may be more problematic in CKD patients who already have fluid retention issues.
- Regular monitoring of kidney function and blood pressure, as with any medication in CKD.
- The medication should be prescribed and monitored by a healthcare provider familiar with managing CKD.
- Amlodipine can be used in combination with other medications, such as angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs), to achieve optimal blood pressure control, as discussed in the American Journal of Kidney Diseases 1.
- 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 provides further guidance on the use of amlodipine and other antihypertensive medications in patients with CKD 1.
Overall, amlodipine is a valuable treatment option for CKD patients with hypertension, offering effective blood pressure control and potential renoprotective effects, as supported by the evidence from the British Journal of Pharmacology 1.
From the FDA Drug Label
The pharmacokinetics of amlodipine are not significantly influenced by renal impairment. Patients with renal failure may therefore receive the usual initial dose
- Key Point: Amlodipine pharmacokinetics are not significantly affected by renal impairment.
- Clinical Decision: A person with CKD can take amlodipine, as the drug's pharmacokinetics are not significantly influenced by renal impairment 2.
From the Research
Amlodipine Use in CKD Patients
- Amlodipine is a calcium channel blocker that can be used to treat hypertension in patients with chronic kidney disease (CKD) 3, 4, 5.
- Studies have shown that amlodipine can help achieve blood pressure goals and reduce stroke risk in CKD patients 4.
- When used with a renin-angiotensin system blocker, amlodipine does not detract from the benefits of this blockade on slowing progression of kidney disease 4.
- Amlodipine has been compared to angiotensin-converting enzyme inhibitors (ACEIs) in terms of its effects on renal function, and no statistically significant difference was found in true glomerular filtration rate (GFR) decline between the two treatments 3.
Safety and Efficacy of Amlodipine in CKD
- Amlodipine is considered safe and necessary to achieve blood pressure goals in people with CKD 4.
- However, dihydropyridine calcium antagonists like amlodipine may not significantly slow the progression of kidney disease among patients with established nephropathy and macroalbuminuria when compared to agents that block the renin-angiotensin system 4.
- A study found that adding amlodipine to a renin-angiotensin system inhibitor resulted in greater improvements in augmentation index and urinary protein excretion compared to adding a diuretic 5.
Clinical Considerations
- The use of amlodipine in CKD patients should be individualized and based on the patient's specific clinical needs and circumstances 3, 4, 5.
- Patients with CKD should be closely monitored for changes in renal function and proteinuria when taking amlodipine or any other antihypertensive medication 3, 4, 5.