What is the use of Felodipine (a calcium channel blocker)?

From the Guidelines

Felodipine should be used with caution in patients with hypertension, particularly in those with heart failure, as it neither improves nor worsens survival, and its use should be considered only after other medications have failed 1.

Key Points

• Felodipine is a calcium channel blocker medication used to treat high blood pressure (hypertension) and angina.
• The typical starting dose is 5 to 10 mg once daily, which can be increased gradually to a maximum of 10 mg daily based on blood pressure response 1.
• Felodipine works by relaxing and widening blood vessels, allowing blood to flow more easily and reducing the workload on the heart.
• Common side effects include headache, edema, and dizziness 1.
• Patients with heart failure should be treated with caution, as felodipine may not provide additional benefits in terms of survival 1.

Considerations

• Felodipine can be used in combination with other medications, such as ACE inhibitors or ARB, and thiazide diuretics, to control hypertension in patients with heart failure 1.
• However, the use of felodipine should be individualized, and patients should be closely monitored for potential side effects and interactions with other medications.
• The American Heart Association recommends that patients with heart failure should be treated with medications that have been proven to reduce mortality, such as ACE inhibitors or ARB, and beta-blockers, before considering the use of calcium channel blockers like felodipine 1.

From the FDA Drug Label

Felodipine Extended-release Tablets, USP are indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure lowers the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including felodipine.

The primary use of Felodipine is for the treatment of hypertension to lower blood pressure and reduce the risk of cardiovascular events such as strokes and myocardial infarctions 2.

From the Research

Mechanism of Action

• Felodipine lowers blood pressure by reducing peripheral vascular resistance through a highly selective action on smooth muscle in arteriolar resistance vessels 3.
• The selective action of felodipine may be considered a safeguard against untoward effects on cardiac contractility and conduction 3.
• Felodipine does not cause orthostatic hypotension since it has no effect in clinical doses on venous smooth muscle 3.

Efficacy and Dosage

• Felodipine has proved more effective than several established antihypertensive drugs in clinical studies 3.
• The combination of felodipine and a beta-adrenergic blocker appears to be a good alternative to standard triple treatment 3.
• Felodipine is often effective in patients with previously "refractory" hypertension 3.
• The antihypertensive effect of felodipine is dose related, with a dose regimen of 5 mg twice a day usually sufficient for patients with moderate hypertension 3.
• Doses greater than 10 mg twice a day are not often required 3.

Comparison with Other Agents

• Felodipine and isradipine are new calcium-channel-blocking agents with FDA-approved labeling for use in the treatment of essential hypertension 4.
• Felodipine and isradipine have similar adverse-effect profiles, and their adverse effects resemble those of other agents in the class 4.
• A study comparing felodipine ER, amlodipine, and nifedipine GITS found no evidence of a difference among the three agents in lowering ambulatory or clinic blood pressure 5.
• Amlodipine and nifedipine GITS have been compared in terms of their effects on sympathetic nervous system activity, with a trend in favor of nifedipine GITS 6.

Adverse Effects

• The most common adverse effects of felodipine are those expected from a potent arteriolar dilator: ankle swelling, headache, dizziness, flushing, etc. 3.
• Adverse effects are usually transient or diminish in intensity with continued treatment 3.
• The overall frequency of adverse effects with felodipine appears to be similar to that for the established antihypertensive drugs, although the adverse effects differ 3.