Amlodipine Management Before Blepharoplasty
You do not need to stop amlodipine before eyelid surgery. Continue amlodipine through the perioperative period for blepharoplasty, as there is no evidence-based recommendation to discontinue calcium channel blockers for minor ophthalmologic procedures, and the risks of perioperative hypertension from discontinuation outweigh the minimal bleeding risk associated with this surgery.
Rationale for Continuation
The 2022 American College of Chest Physicians guidelines specifically address antiplatelet management for minor ophthalmologic procedures, including eyelid surgery, but do not recommend stopping any medications except antiplatelet agents in select cases. 1 The guideline evidence base included a 42-patient randomized trial of eyelid surgery that found no significant bleeding or thromboembolic complications with aspirin continuation, suggesting that even antiplatelet drugs (which have far greater bleeding risk than calcium channel blockers) can be safely continued. 1
Why Amlodipine is Safe to Continue
Amlodipine is not an anticoagulant or antiplatelet agent and does not increase surgical bleeding risk in the way that aspirin, clopidogrel, or warfarin would. 1
Blepharoplasty is classified as a minor ophthalmologic procedure with minimal bleeding risk, similar to cataract surgery where continuation of antiplatelet therapy shows <1% major bleeding incidence. 1
The pharmacokinetics of amlodipine make acute discontinuation problematic: it has a 40-60 hour elimination half-life and takes 7-10 days to fully clear from the system after discontinuation. 2 Stopping it 1-2 days before surgery provides no meaningful reduction in drug effect while creating risk of rebound hypertension.
Hemodynamic Considerations
The primary perioperative concern with amlodipine is hypotension, not bleeding. One case report documented severe postoperative hypotension requiring vasopressor support in a patient on amlodipine. 3 However, this risk is better managed through:
Continuing the medication to maintain stable baseline blood pressure rather than creating perioperative blood pressure fluctuations from discontinuation. 2
Monitoring blood pressure intraoperatively and postoperatively with vasopressor availability if needed. 3
Recognizing that amlodipine's gradual onset/offset profile (peak effect 6-8 hours, gradual return to baseline over 7-10 days after stopping) means acute discontinuation provides no benefit for a same-day or next-day procedure. 2
Common Pitfalls to Avoid
Do not confuse calcium channel blocker management with antiplatelet or anticoagulant management. The extensive perioperative guidelines for stopping clopidogrel (5 days before), prasugrel (7 days before), or warfarin (5 days before) do not apply to antihypertensive medications like amlodipine. 1, 4, 5
Do not stop amlodipine "just to be safe." This creates actual risk: perioperative hypertension can increase bleeding risk more than the medication itself, and amlodipine's long half-life means stopping it 1-2 days preoperatively leaves substantial drug levels present anyway. 2
Ensure the patient takes their morning dose on the day of surgery with a sip of water, as is standard practice for antihypertensive medications during minor procedures. 1