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Calcium Channel Blocker (Dihydropyridine)

Amlodipine 5–10mg

Brand names: Istin, Amlostin

Adult dose

Dose: 5mg once daily initially; increase to 10mg once daily after 4 weeks if BP target not achieved
Route: Oral
Frequency: Once daily
Max: 10mg once daily
First-line antihypertensive in CKD — no dose adjustment required regardless of eGFR. Safe in all stages of CKD including dialysis. Does not affect potassium or cause renal deterioration. Does not reduce proteinuria (unlike ACEi/ARB) but controls BP safely.

Paediatric dose

Dose: 0.1 mg/kg
Route: Oral
Frequency: Once daily
Max: 5mg OD (<6 years); 10mg OD (6–17 years)
Concentration: 5 mg, 10 mg tablets; 1 mg/mL oral solution (unlicensed) mg/ml
Paediatric CKD hypertension: 0.1–0.2 mg/kg OD (max 5mg). Specialist paediatric nephrology.

Dose adjustments

Renal

No dose adjustment required in any stage of CKD — hepatically metabolised; safe in dialysis patients

Hepatic

Start at 2.5mg in severe hepatic impairment — reduced hepatic clearance; titrate cautiously

Paediatric weight-based calculator

Paediatric CKD hypertension: 0.1–0.2 mg/kg OD (max 5mg). Specialist paediatric nephrology.

Clinical pearls

  • Preferred CCB in CKD — no renal dose adjustment, no potassium effect, safe in dialysis (unlike ACEi/ARB which may cause hyperkalaemia)
  • Ankle oedema with amlodipine: due to precapillary vasodilatation, not fluid retention — does not respond to diuretics; reduce dose or switch to modified-release isradipine if problematic
  • ALLHAT trial: amlodipine equivalent to ACEi (lisinopril) for reducing CV mortality and total mortality in hypertension
  • Grapefruit juice: inhibits CYP3A4 — significantly increases amlodipine bioavailability; advise avoidance
  • Long half-life (~35–50h) — once daily dosing, smooth BP control, minimal first-dose hypotension

Contraindications

  • Cardiogenic shock
  • Unstable angina (except vasospastic angina)
  • Significant aortic stenosis (relative)
  • Hypersensitivity to dihydropyridine CCBs

Side effects

  • Peripheral oedema (most common — 10–30%, dose-dependent; ankle swelling)
  • Flushing
  • Headache
  • Palpitations
  • Dizziness
  • Gingival hyperplasia (less than diltiazem/verapamil)

Interactions

  • CYP3A4 inhibitors (clarithromycin, ketoconazole, grapefruit juice) — increase amlodipine levels
  • CYP3A4 inducers (rifampicin, carbamazepine) — reduce amlodipine levels
  • Ciclosporin — amlodipine increases ciclosporin levels
  • Simvastatin — amlodipine increases simvastatin exposure (max simvastatin 20mg with amlodipine)

Monitoring

  • Blood pressure
  • Ankle oedema
  • Heart rate

Reference: BNFc; BNF; ALLHAT Trial (JAMA 2002); KDIGO Hypertension in CKD Guidelines 2021; NICE NG136 (Hypertension). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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