From the Guidelines
Amlodipine-induced edema primarily affects the lower extremities, particularly the ankles and feet, due to its vasodilatory action as a calcium channel blocker. This side effect is a result of the medication's effect on blood vessel walls, causing arterioles to dilate more than veins, which creates a pressure imbalance that forces fluid from the vascular space into surrounding tissues, resulting in peripheral edema 1. The edema is typically bilateral, pitting in nature, and tends to worsen with prolonged standing or sitting and in warm weather.
Key Characteristics of Amlodipine-Induced Edema
- Occurs in approximately 5-10% of patients taking amlodipine
- Usually dose-dependent, with higher doses causing more pronounced edema
- Not associated with heart, kidney, or liver dysfunction
- Typically resolves when the medication is discontinued or the dose is reduced
Management Options
- Leg elevation
- Compression stockings
- Reducing salt intake
- Switching to a different antihypertensive medication if the edema becomes bothersome, as suggested in 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 1.
From the FDA Drug Label
Edema 1.8 3.0 10.8 0.6 ... For several adverse experiences that appear to be drug and dose related, there was a greater incidence in women than men associated with amlodipine treatment as shown in the following table: Amlodipine Placebo Male=% (N=1218) Female=% (N=512) Male=% (N=914) Female=% (N=336) Edema 5.6 14.6 1.4 5.1 ... In the CAMELOT and PREVENT studies [see Clinical Studies (14.4)] , the adverse event profile was similar to that reported previously (see above), with the most common adverse event being peripheral edema.
The oedema from amlodipine affects the peripheral areas, with a greater incidence in women than men, and is dose-related, with higher doses associated with a higher incidence of edema 2.
From the Research
Oedema from Amlodipine
- Oedema from amlodipine is a known side effect, particularly pedal edema, which is a type of peripheral edema 3, 4, 5.
- The edema is thought to be caused by vasodilatory effects, which lead to increased intracapillary pressure and fluid volume retention 6.
- Studies have shown that the risk of edema is dose-dependent, with higher doses of amlodipine increasing the likelihood of edema 3, 5.
- The edema is most commonly seen in the lower extremities, particularly in the feet and ankles 3, 7.
Factors Influencing Oedema
- The presence of comorbidities, such as hypertension, can increase the risk of edema 3.
- The duration of amlodipine use can also increase the risk of edema, with longer durations of use associated with a higher risk 3.
- The use of other medications, such as diuretics, may not be effective in reducing edema caused by amlodipine 4.
- The addition of an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) to amlodipine may help reduce the risk of edema 6, 7.