Calcium Channel Blocker (Dihydropyridine) Pregnancy: The safety of amlodipine in human pregnancy has not been established; reproductive toxicity was observed at high doses in animal studies. 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. Breast-feeding: amlodipine is excreted in human milk (estimated interquartile range of the maternal dose received by the infant 3-7%, maximum 15%) and the effect on infants is unknown — decide whether to continue breast-feeding or therapy taking both benefits into account. Fertility: reversible biochemical changes in the head of spermatozoa have been reported with calcium channel blockers; clinical data on amlodipine are insufficient.

Amlodipine 5–10mg

Brand names: Istin, Amlostin

This entry covers amlodipine used in chronic kidney disease, a long-acting dihydropyridine calcium-channel blocker for hypertension and angina that is a common add-on for blood-pressure control in CKD.

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: Hypertension and angina: usual initial dose 5 mg once daily, which may be increased to a maximum of 10 mg depending on the individual patient's response.

Route: Oral

Frequency: Once daily

Max: 10 mg once daily

Source: UK SPC (eMC) for Amlodipine 1 mg/mL Oral Solution, §4.2 (https://www.medicines.org.uk/emc/product/102452/smpc). PRODUCT FORM: the fetched SPC is the oral solution (supplied with a 5 mL oral syringe graduated in 0.5 mL = 0.5 mg, plus an adaptor); the posology is the same 5-10 mg once daily as for tablets, but the administration wording above refers to the solution. In hypertensive patients amlodipine has been used in combination with a thiazide diuretic, alpha blocker, beta blocker or an 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 combined with other antianginal medicines in angina refractory to nitrates and/or adequate doses of beta blockers. Safety and efficacy in hypertensive crisis have not been established. ELDERLY: normal dosage regimens are recommended but any increase should be made with care. HEPATIC IMPAIRMENT: dosage recommendations have not been established in mild to moderate impairment — start cautiously at the lower end of the range; pharmacokinetics have not been studied in severe impairment — initiate at the lowest dose and titrate slowly. PAEDIATRIC (fixed dose, not per-kg, so not expressed as mg/kg): for children and adolescents with hypertension aged 6 to 17 years the SPC gives a recommended oral starting dose of 2.5 mg once daily, 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, and no data are available in children under 6 years old. Verify any under-18 use against a children's formulary. EXCIPIENT: the oral solution contains liquid maltitol (E965) — patients with rare hereditary problems of fructose intolerance should not take it. §4.4/§4.5 and §4.8 were truncated at the source-fetch limit.

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, to 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 and headache, especially at the beginning of treatment (common)
Palpitations and flushing (common); hypotension (uncommon)
Abdominal pain, nausea, dyspepsia and altered bowel habits including diarrhoea and constipation (common)
Fatigue and asthenia (common); dyspnoea and visual disturbance including diplopia (common)
Rare/very rare but serious: angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis, hepatitis/jaundice, pancreatitis, gingival hyperplasia

Interactions

Strong or moderate CYP3A4 inhibitors (protease inhibitors, azole antifungals, macrolides such as erythromycin or clarithromycin, verapamil, diltiazem) may significantly increase amlodipine exposure and the risk of hypotension — more pronounced in the elderly; clinical monitoring and dose adjustment may be required
CYP3A4 inducers (e.g. rifampicin, Hypericum perforatum/St John's wort) may alter amlodipine plasma concentrations — monitor blood pressure and consider dose regulation during and after concomitant use
Grapefruit or grapefruit juice is not recommended — bioavailability may be increased in some patients, increasing the blood-pressure-lowering effect
Dantrolene (infusion) — risk of hyperkalaemia; the §4.5 text on co-administration with calcium channel blockers was truncated at the source-fetch limit, so verify this entry in the full SPC
US labelling (cross-check, verify vs UK §4.5): limit simvastatin to 20 mg daily in patients on amlodipine; amlodipine may increase systemic exposure to ciclosporin or tacrolimus — monitor trough levels and adjust dose; monitor for hypotension with sildenafil

Clinical monograph

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.

Reference: ALLHAT Trial (JAMA 2002); KDIGO Hypertension in CKD Guidelines 2021; NICE NG136 (Hypertension); 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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