Amlodipine 5–10mg

How it works

It blocks L-type calcium channels in vascular smooth muscle, producing peripheral arterial vasodilatation that lowers blood pressure with little direct effect on heart rate.

Prescribing in practice

• Amlodipine is not removed by dialysis and needs no dose change in renal impairment, but ankle oedema is dose-related and may be mistaken for fluid overload in CKD.
• It does not control proteinuria, so a renin-angiotensin blocker remains the preferred first-line agent where albuminuria is present, with amlodipine added for further BP control.
• Avoid potent CYP3A4 inhibitors, which raise amlodipine levels and can cause pronounced hypotension.

Monitoring

Monitor blood pressure and review for peripheral oedema, distinguishing drug-induced ankle swelling from CKD-related fluid retention.

Counselling the patient

• Ankle swelling is a common side effect and is not the same as needing a water tablet.
• Take it at the same time each day; it can be taken with or without food.
• Report flushing or marked dizziness.

Evidence & guidelines

Use of amlodipine as add-on therapy alongside renin-angiotensin blockade in CKD hypertension aligns with NICE hypertension and CKD guidance.