Amlodipine
Brand names: Istin, Amlodipine Besilate
Amlodipine is a long-acting dihydropyridine calcium-channel blocker used for hypertension and chronic stable angina.
Adult dose
Dose adjustments
Changes in amlodipine plasma concentrations are not correlated with the degree of renal impairment, therefore the normal dosage is recommended. Amlodipine is not dialysable.
Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.
US labelling (FDA)
Reference — US labelling, may differ from UK•Adult recommended starting dose: 5 mg once daily with maximum dose 10 mg once daily. ( 2.1 ) о Small, fragile, or elderly patients, or patients with hepatic insufficiency may be started on 2.5 mg once daily. ( 2.1 ) •Pediatric starting dose: 2.5 mg to 5 mg once daily. ( 2.2 ) Important Limitation : Doses in excess of 5 mg daily have not been studied in pediatric patients. ( 2.2 ) 2.1 Adults The usual initial antihypertensive oral dose of amlodipine besylate tablet is 5 mg once daily and the maximum dose is 10 mg once daily. Small, fragile, or elderly patients, or patients with hepatic insufficiency may be started on 2.5 mg once daily and this dose may be used when adding amlodipine …
Source: US FDA prescribing information (openFDA / DailyMed), label dated 2026-04-20. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.
Contraindications
- Hypersensitivity to dihydropyridine derivatives, amlodipine or to any of the excipients
- Severe hypotension
- Shock (including cardiogenic shock)
- Obstruction of the outflow tract of the left ventricle (e.g. high grade aortic stenosis)
- Haemodynamically unstable heart failure after acute myocardial infarction
Side effects
- Very common: oedema
- Common: somnolence, dizziness, headache (especially at the beginning of treatment)
- Common: palpitations; flushing
- Common: abdominal pain, nausea, dyspepsia, altered bowel habits (including diarrhoea and constipation)
- Common: ankle swelling, muscle cramps; fatigue, asthenia; dyspnoea; visual disturbance (including diplopia)
- Uncommon / very rare: hypotension, arrhythmia (including bradycardia, ventricular tachycardia and atrial fibrillation), myocardial infarction, hepatitis and jaundice, gingival hyperplasia, angioedema, Stevens-Johnson syndrome, and (not known) toxic epidermal necrolysis
Interactions
- Strong or moderate CYP3A4 inhibitors (protease inhibitors, azole antifungals, macrolides such as erythromycin or clarithromycin, verapamil, diltiazem) — may give a significant increase in amlodipine exposure and an increased risk of hypotension, more pronounced in the elderly; clinical monitoring and dose adjustment may be required
- CYP3A4 inducers (e.g. rifampicin, Hypericum perforatum / St John's wort) — plasma concentration of amlodipine may vary; monitor blood pressure and consider dose regulation during and after concomitant use
- Grapefruit or grapefruit juice — administration with amlodipine is not recommended as bioavailability may be increased in some patients, resulting in increased blood-pressure-lowering effects
- Dantrolene (infusion) — in animals, lethal ventricular fibrillation and cardiovascular collapse were observed in association with hyperkalaemia after verapamil and intravenous dantrolene; because of the risk of hyperkalaemia, co-administration of calcium channel blockers is not recommended (the fetched §4.5 is truncated at this point)
Clinical monograph
How it works
It blocks L-type calcium channels in vascular smooth muscle, causing peripheral arterial vasodilatation and reduced afterload; its long half-life gives smooth 24-hour control.
Prescribing in practice
- Dose-dependent ankle oedema is the commonest reason for stopping and does not respond to diuretics.
- It is a first-line antihypertensive option, particularly useful in older patients.
- Unlike non-dihydropyridine calcium-channel blockers, it is generally acceptable in stable heart failure when needed for blood pressure or angina.
Monitoring
Monitor blood pressure for response and review for peripheral oedema.
Counselling the patient
- Ankle swelling can occur; it is harmless but report it if troublesome.
- Flushing or headache may occur early and usually settles.
- Take it at the same time each day.
Evidence & guidelines
Calcium-channel blockers are a first-line antihypertensive (especially age ≥55, or people of Black African/African-Caribbean family origin) per NICE NG136.
Reference: NICE NG136 Hypertension; ASCOT-BPLA Trial Lancet 2005; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).
Related
Curated clinical cross-links plus same-class fallbacks.
- Calcium Gluconate 10%RecommendedElectrolyte
- GlucagonRecommendedHypoglycaemia Antidote / Endocrine Agent
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines