What is amlodipine used for?

Amlodipine: Primary Clinical Uses

Amlodipine is used to treat hypertension (high blood pressure) and chronic stable angina, with FDA-approved indications also including vasospastic angina. 1

FDA-Approved Indications

Amlodipine besylate is a calcium channel blocker with three primary approved uses 1:

• Hypertension: Lowers blood pressure by relaxing blood vessels, allowing blood to flow more easily and reducing the risk of stroke and heart attack 1
• Chronic stable angina: Relieves chest pain that occurs when part of the heart doesn't receive adequate blood flow 1
• Vasospastic angina: Effective for angina caused by coronary artery spasm 1, 2

Mechanism and Pharmacological Properties

Amlodipine is a dihydropyridine calcium channel blocker that selectively inhibits calcium influx through L-type channels in vascular smooth muscle 3:

• Peripheral vasodilation: Produces marked relaxation of peripheral arterial vessels with minimal effects on cardiac contractility, AV conduction, or heart rate 4, 5
• Coronary vasodilation: Dilates coronary arteries and arterioles, improving myocardial blood flow 4
• Long duration of action: Half-life of 35-50 hours allows once-daily dosing with sustained 24-hour blood pressure control 6

Role in Specific Clinical Scenarios

Angina Management

Amlodipine is recommended as an alternative or add-on therapy for angina when beta-blockers are contraindicated, not tolerated, or insufficient 4:

• Can be used as first-line therapy in patients unable to tolerate beta-blockers (Class IIa recommendation) 4
• Effective as add-on therapy when angina persists despite beta-blocker treatment (Class I recommendation) 4
• Safe in patients with mild left ventricular dysfunction, unlike verapamil or diltiazem 4

Hypertension in Special Populations

Amlodipine offers specific advantages in certain patient groups 6:

• Older adults: Wise choice due to stroke and myocardial infarction protection 6
• Diabetes or chronic kidney disease: Controls blood pressure without worsening glycemic or kidney function 6
• Heart failure patients: Reasonably well tolerated in patients with mild LV dysfunction (NYHA class II-III), unlike non-dihydropyridine calcium channel blockers 4, 2

Combination Therapy

Amlodipine can be safely combined with beta-blockers, unlike rapid-release nifedipine which requires concomitant beta-blockade 4:

• No significant drug interactions with statins, though minor increases in statin exposure may occur with lovastatin or simvastatin 4
• Can be used with nitrates for additional angina control 1
• Appropriate for combination with ACE inhibitors or ARBs in hypertension management 4

Dosing and Administration

Standard dosing regimen 1, 7:

• Starting dose: 5 mg once daily
• Maximum dose: 10 mg once daily
• Can be taken with or without food 1
• Provides effective 24-hour control with once-daily administration 7, 6

Common Adverse Effects

The most frequent side effects are vasodilator-related 1, 8:

• Peripheral edema (swelling of legs or ankles) 1, 8
• Headache 1
• Flushing (hot or warm feeling in face) 1
• Dizziness 1

Important: Unlike non-dihydropyridine calcium channel blockers (verapamil, diltiazem), amlodipine does not cause bradycardia, AV block, or worsen heart failure in most patients 4, 5.

Critical Contraindications and Cautions

Avoid amlodipine in patients with known allergy to amlodipine or its inactive ingredients 1:

• Unlike verapamil and diltiazem, amlodipine can be used cautiously in patients with mild-to-moderate heart failure 4, 2
• Does not require dose adjustment for missed doses if more than 12 hours have passed; simply resume at next scheduled time 1
• No postural hypotension or reflex tachycardia typically observed, unlike short-acting nifedipine 8