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Calcium Channel Blocker (Dihydropyridine) Pregnancy: Avoid in pregnancy; limited safety data

Amlodipine

Brand names: Istin

Adult dose

Dose: 5-10 mg once daily
Route: Oral
Frequency: Once daily
Max: 10 mg/day
Start at 5 mg in elderly; increase to 10 mg if tolerated and required

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: Oral
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion

Dose adjustments

Renal

No dose adjustment required

Hepatic

Start at 2.5 mg in hepatic impairment; titrate cautiously

Paediatric weight-based calculator

Seek specialist opinion

Clinical pearls

  • First-line antihypertensive in elderly per NICE NG136 — especially suitable as no reflex tachycardia and once-daily dosing aids adherence
  • Ankle oedema is dose-dependent and common in elderly — distinguish from cardiac or venous oedema; adding ACEi/ARB can reduce CCB-related oedema
  • ASCOT trial: amlodipine-based regimen superior to atenolol-based for cardiovascular outcomes
  • Long half-life (35-50 hours) means missed doses less critical and no rebound hypertension on abrupt withdrawal
  • Suitable in elderly with concurrent angina — provides antianginal benefit alongside antihypertensive effect

Contraindications

  • Cardiogenic shock
  • Significant aortic stenosis
  • Unstable angina (except Prinzmetal)

Side effects

  • Peripheral oedema (ankle swelling — most common, dose-dependent)
  • Flushing
  • Headache
  • Palpitations
  • Gingival hyperplasia (long-term)
  • Hypotension

Interactions

  • CYP3A4 inhibitors (clarithromycin, itraconazole — increase amlodipine levels)
  • Simvastatin (increase simvastatin exposure — limit simvastatin to 20 mg/day)
  • Ciclosporin (increased ciclosporin levels)

Monitoring

  • Blood pressure
  • Heart rate
  • Ankle oedema
  • Gingival hyperplasia (long-term)

Reference: BNFc; BNF 90; NICE NG136 (Hypertension); ASCOT Trial; STOPP/START v3. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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