Antihypertensive Pregnancy: C — limited data; alternative CCBs (e.g. nifedipine) preferred if needed

Amlodipine

Brand names: Istin, Amlodipine Besilate

Adult dose

Dose: 5–10mg OD

Route: Oral

Frequency: Once daily

Max: 10mg/day

HTN/angina: start 5mg OD, increase to 10mg if needed after 2 weeks. Elderly/hepatic impairment: start 2.5mg OD.

Dose adjustments

Renal

No adjustment required.

Hepatic

Start at 2.5mg OD in hepatic impairment — reduced clearance.

Clinical pearls

Preferred calcium channel blocker for hypertension in diabetic patients and patients with proteinuric CKD (combined with RAAS blockade in ACCOMPLISH trial).
ASCOT-BPLA trial: amlodipine-based regimen superior to atenolol for CV outcomes in hypertension — amlodipine is now preferred first-line CCB.
Ankle oedema is a direct drug effect (local vasodilation) — NOT fluid retention. Diuretics do not help. If troublesome, reduce dose or switch.
Long-acting half-life (~35–50h) — once-daily dosing. Missed doses cause gradual BP rise, not rapid rebound.

Contraindications

Cardiogenic shock
Unstable angina (not vasospastic)
Significant aortic stenosis (severe — relative)
Acute myocardial infarction within 1 month

Side effects

Peripheral oedema (dose-dependent, most common — ankles)
Flushing, headache
Palpitations
Dizziness, fatigue
Gingival hyperplasia (rare, long-term)

Interactions

Simvastatin: increases simvastatin levels — cap simvastatin at 20mg
Ciclosporin / tacrolimus: increased immunosuppressant levels
CYP3A4 inhibitors (diltiazem, azole antifungals): increase amlodipine levels
Rifampicin: reduces amlodipine levels

Monitoring

BP
pulse
ankle oedema

Reference: NICE NG136 Hypertension; ASCOT-BPLA Trial Lancet 2005; NICE BNF 84. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Same class

Pathways

Calcium channel blocker overdoseRecommended
TOXBASE/NPIS; AACT/EAPCCT; ESC; BNF

Same specialty