Safely Discontinuing Amlodipine
Amlodipine can be stopped abruptly without tapering, as it does not cause rebound hypertension due to its long half-life (40-60 hours) and gradual offset of action over 7-10 days. 1, 2
Key Pharmacologic Principles
Amlodipine differs fundamentally from other antihypertensive classes in its discontinuation profile:
- No rebound hypertension occurs when amlodipine is stopped suddenly, unlike beta-blockers and clonidine which require gradual tapering to prevent hypertensive crisis 1, 2
- Blood pressure returns slowly to baseline over 7-10 days after discontinuation due to the drug's 40-60 hour elimination half-life 2
- The American College of Cardiology explicitly states that ARBs and calcium channel blockers may be stopped abruptly without tapering 1
When to Consider Stopping Amlodipine
Stop or reduce amlodipine by 50% if blood pressure is consistently <100/70 mmHg 3
Additional scenarios warranting discontinuation:
- Symptomatic hypotension with dizziness or orthostatic symptoms 4
- Development of significant ankle edema (a common side effect) 5
- Blood pressure well-controlled with lifestyle modifications alone 3
Discontinuation Protocol
Immediate Action
- Stop amlodipine immediately - no tapering required 1, 2
- Ensure adequate hydration during the transition period 4
Monitoring Schedule
- Home blood pressure monitoring twice daily for 2 weeks after stopping 3
- Office follow-up in 1-2 weeks to assess for return of hypertension 3, 1
- Check for orthostatic blood pressure changes, especially in older adults 4
Blood Pressure Thresholds After Discontinuation
If blood pressure rises after stopping amlodipine:
- 130-139/80-89 mmHg: Implement lifestyle modifications including DASH diet, sodium restriction <1500 mg/day, aerobic exercise 150 minutes/week, and weight loss if BMI >25 3
- ≥140/90 mmHg: Restart antihypertensive therapy, either at a lower dose of amlodipine or with a different agent 3
Important Caveats
Do not confuse amlodipine with medications requiring tapering. Beta-blockers and clonidine absolutely require gradual dose reduction over 7-10 days to prevent rebound hypertension and potential hypertensive crisis 1, 6. The abrupt cessation syndrome seen with centrally-acting agents and beta-blockers does not occur with calcium channel blockers 6.
Have a backup plan ready. Since amlodipine's protective effect is lost within days to weeks, prepare an alternative antihypertensive regimen in case blood pressure rises significantly after discontinuation 1.
Long-term monitoring: If blood pressure remains normal without medication, annual blood pressure checks are sufficient 3.