Dihydropyridine Calcium Channel Blocker — Raynaud's / Peripheral Vascular Disease / Hypertension Pregnancy: Use with caution — limited data; some animal teratogenicity; nifedipine preferred in pregnancy

Amlodipine

Brand names: Istin, Amlodip

Adult dose

Dose: Raynaud's: 5–10 mg once daily; Hypertension/PAD: 5 mg once daily, may increase to 10 mg

Route: Oral

Frequency: Once daily

Max: 10 mg/day

Preferred CCB for Raynaud's phenomenon — long half-life (35–50 hours) ensures consistent vasodilation without peaks and troughs. Start at 5 mg, uptitrate after 2–4 weeks if tolerated. Take at same time each day. Slow onset of hypotensive effect (days–weeks).

Paediatric dose

Dose: 0.1–0.3 mg/kg mg/kg

Route: Oral

Frequency: Once daily

Max: 5 mg/day (child 6–17 years)

BNFc: licensed for hypertension in children ≥6 years

Dose adjustments

Renal

No dose adjustment required

Hepatic

Start at 2.5 mg in severe hepatic impairment — reduced clearance

Paediatric weight-based calculator

Patient weight (kg)

BNFc: licensed for hypertension in children ≥6 years

Clinical pearls

First-line pharmacological treatment for Raynaud's phenomenon — vasodilates cutaneous and digital vasculature; reduces frequency and severity of attacks
Long half-life (35–50 hours) is clinical advantage — once-daily dosing with minimal peak-trough variability, no rebound vasoconstriction on missed dose
Peripheral oedema is caused by preferential arteriolar dilation (increasing capillary hydrostatic pressure) — not fluid retention; diuretics ineffective; switching to ACE inhibitor/ARB combination reduces oedema
ACCOMPLISH trial: amlodipine + benazepril superior to HCTZ + benazepril for CV outcomes — amlodipine now preferred add-on in hypertension

Contraindications

Cardiogenic shock
Unstable angina (unless combined with beta-blocker)
Significant aortic stenosis
Hypersensitivity to dihydropyridines

Side effects

Peripheral oedema (dose-dependent — ankle oedema very common)
Flushing
Headache
Palpitations
Fatigue
Gingival hyperplasia (long-term)

Interactions

Cyclosporine — increased cyclosporine levels (CYP3A4 inhibition)
Simvastatin — amlodipine increases simvastatin AUC (limit simvastatin to 20 mg/day)
CYP3A4 inhibitors (diltiazem, erythromycin) — increase amlodipine levels
Tacrolimus — increased tacrolimus levels

Monitoring

Blood pressure
Heart rate
Ankle oedema
Gingival inspection (long-term use)

Reference: BNFc; BNF 90; ACCOMPLISH Trial; BSR/BHPR Guidelines on Raynaud's Phenomenon; NICE NG136 (Hypertension). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways