Calcium Channel Blocker (Dihydropyridine) Pregnancy: The safety of amlodipine in human pregnancy has not been established; reproductive toxicity was observed at high doses in animals. Use in pregnancy is only recommended when there is no safer alternative and when the disease itself carries greater risk for the mother and foetus. Amlodipine is excreted in human milk (estimated interquartile range 3-7% of the maternal dose, maximum 15%) and the effect on infants is unknown - weigh the benefit of breast-feeding against the benefit of therapy.

Amlodipine

Brand names: Istin

Amlodipine is a long-acting dihydropyridine calcium-channel blocker used for hypertension and stable/vasospastic angina; this page addresses its use in older patients, in whom it is a common first-line antihypertensive.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 5 mg

Route: Oral

Frequency: Once daily

Max: 10 mg once daily

For both hypertension and angina the usual initial dose is 5 mg once daily, which may be increased to a maximum of 10 mg depending on the individual patient's response. ELDERLY PATIENTS: amlodipine used at similar doses in elderly or younger patients is equally well tolerated - normal dosage regimens are recommended in the elderly, but increase of the dosage should take place with care. (The US label in this bundle additionally states that small, fragile, or elderly patients, or patients with hepatic insufficiency, may be started on 2.5 mg once daily - this is US labelling and does not appear in the fetched UK SPC.) Hepatic impairment: dosage recommendations have not been established in mild to moderate impairment, so dose selection should be cautious and start at the lower end of the dosing range; in severe hepatic impairment initiate at the lowest dose and titrate slowly. In hypertension, amlodipine has been used with a thiazide diuretic, alpha blocker, beta blocker or ACE inhibitor, and no dose adjustment is required on concomitant administration of thiazide diuretics, beta blockers or ACE inhibitors. For angina it may be used as monotherapy or with other antianginal medicinal products in angina refractory to nitrates and/or adequate doses of beta blockers. PAEDIATRIC (hypertension, 6 to 17 years): 2.5 mg once daily as a starting dose, up-titrated to 5 mg once daily if the blood pressure goal is not achieved after 4 weeks; doses in excess of 5 mg daily have not been studied in paediatric patients; no data are available in children under 6 years. Verify paediatric dosing against a children's formulary. Fetched source is the amlodipine 1 mg/ml oral solution SPC. Safety and efficacy in hypertensive crisis have not been established.

Dose adjustments

Renal

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.

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

Oedema (very common); ankle swelling and muscle cramps (common)
Somnolence, dizziness, headache, especially at the beginning of treatment (common)
Palpitations (common); flushing (common)
Abdominal pain, nausea, dyspepsia, altered bowel habits including diarrhoea and constipation (common)
Fatigue, asthenia (common); dyspnoea (common); visual disturbance including diplopia (common)
Hypotension (uncommon); arrhythmia including bradycardia, ventricular tachycardia and atrial fibrillation (uncommon)

Interactions

Strong or moderate CYP3A4 inhibitors (protease inhibitors, azole antifungals, macrolides such as erythromycin or clarithromycin, verapamil, diltiazem): significant increase in amlodipine exposure with increased risk of hypotension - may be more pronounced in the elderly; clinical monitoring and dose adjustment may be required
CYP3A4 inducers (e.g. rifampicin, Hypericum perforatum / St John's wort): amlodipine plasma concentration may vary - monitor blood pressure and consider dose regulation during and after concomitant use
Grapefruit or grapefruit juice: not recommended, as bioavailability may be increased in some patients with increased blood-pressure-lowering effect
Dantrolene (infusion): co-administration of calcium channel blockers is not recommended due to the risk of hyperkalaemia (lethal ventricular fibrillation and cardiovascular collapse observed in animals)
Simvastatin: amlodipine increases simvastatin exposure - limit simvastatin to 20 mg daily [US label]
Ciclosporin or tacrolimus: amlodipine may increase systemic exposure - monitor trough levels and adjust dose [US label]

Clinical monograph

How it works

It selectively blocks L-type calcium channels in vascular smooth muscle, causing peripheral arterial vasodilatation that lowers blood pressure and reduces myocardial oxygen demand.

Prescribing in practice

In the elderly, vasodilatation increases the likelihood of ankle oedema, dizziness and postural symptoms, raising falls risk, so review tolerability and standing blood pressure.
Dose-related peripheral oedema is common, does not respond to diuretics, and may need dose reduction or a switch rather than escalation.
Avoid concurrent use with strong CYP3A4 inhibitors and use caution in severe aortic stenosis or significant hepatic impairment.

Monitoring

Monitor blood pressure and, in older patients, standing blood pressure plus tolerability including oedema and dizziness.

Counselling the patient

Ankle swelling can occur; report it rather than stopping treatment yourself.
Rise slowly from sitting or lying to limit dizziness.
Continue the medicine even when you feel well, as it controls blood pressure long term.

Evidence & guidelines

Antihypertensive efficacy and outcome benefit are supported by trials such as ASCOT and NICE hypertension guidance, which favours calcium-channel blockers in older patients.

Reference: NICE NG136 (Hypertension); ASCOT Trial; STOPP/START v3; 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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

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