Calcium Channel Blocker (Dihydropyridine) Pregnancy: Limited post-marketing data are not sufficient to inform a drug-associated risk; use in pregnancy only recommended when there is no safer alternative and the disease carries greater risk to mother and foetus.

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: Elderly: start at the lowest available dose (2.5 mg once daily) and titrate with caution

Route: Oral

Frequency: Once daily

Max: 10 mg once daily

Elderly (age >= 65 years): UK combination SPC states caution is required when increasing the dosage and that the lowest available dose of amlodipine monotherapy should be used. US FDA label: small, fragile, or elderly patients may be started on 2.5 mg once daily; usual adult initial dose 5 mg once daily, max 10 mg once daily. For angina the lower end of the 5 to 10 mg range is suggested in the elderly. Elderly patients have decreased amlodipine clearance (AUC increased ~40 to 60%), and a lower initial dose may be required. NOTE: eMC source is an amlodipine/valsartan combination SPC (no standalone amlodipine monotherapy mg dose); the 2.5 mg / 5 mg / 10 mg figures are from the US FDA label (openFDA). Clinician to confirm.

Dose adjustments

Renal

No dosage adjustment required for mild to moderate renal impairment (per combination SPC); no clinical data in severe renal impairment. Elderly patients are more likely to have decreased renal function.

Dose auto-extracted from 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

Known sensitivity to amlodipine (US FDA label)
Hypersensitivity to dihydropyridine derivatives (per combination SPC §4.3)
Severe hypotension (per combination SPC §4.3)
Shock including cardiogenic shock (per combination SPC §4.3)
Obstruction of the outflow tract of the left ventricle (e.g. high grade aortic stenosis) (per combination SPC §4.3)
Haemodynamically unstable heart failure after acute myocardial infarction (per combination SPC §4.3)

Side effects

Oedema (most common; dose related)
Fatigue
Nausea
Abdominal pain
Somnolence

Interactions

CYP3A inhibitors (moderate and strong): increased amlodipine exposure; may require dose reduction; monitor for hypotension and oedema
CYP3A inducers: monitor blood pressure closely
Simvastatin: limit simvastatin dose to 20 mg daily when co-administered
Sildenafil: monitor for hypotension
Immunosuppressants (cyclosporine, tacrolimus): amlodipine may increase their exposure; monitor trough levels

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.

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