Dihydropyridine Calcium Channel Blocker — Raynaud's / Peripheral Vascular Disease / Hypertension 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, Amlodip

Amlodipine is a long-acting dihydropyridine calcium-channel blocker used for hypertension and chronic stable and vasospastic angina.

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: 5 to 10 mg once daily (chronic stable or vasospastic angina / coronary artery disease)

Route: Oral

Frequency: Once daily

Max: 10 mg once daily

Chronic stable or vasospastic (Prinzmetal) angina: 5 to 10 mg, with the lower dose suggested in the elderly and in patients with hepatic insufficiency; most patients require 10 mg for adequate effect. Coronary artery disease: 5 to 10 mg once daily; in clinical studies the majority of patients required 10 mg. Hypertension: usual initial 5 mg once daily, max 10 mg once daily. NOTE: eMC source is an amlodipine/valsartan combination SPC and gives no standalone amlodipine monotherapy mg dose; the angina/CAD monotherapy figures above are taken from the US FDA label (openFDA). Clinician to confirm against a UK amlodipine monotherapy SPC.

Dose adjustments

Renal

No dosage adjustment required for mild to moderate renal impairment (per combination SPC); no clinical data in severe renal impairment.

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 blocks L-type calcium channels in vascular smooth muscle, causing peripheral and coronary arterial vasodilatation that lowers blood pressure and reduces myocardial oxygen demand.

Prescribing in practice

Avoid in cardiogenic shock, significant aortic stenosis and unstable angina, and use cautiously in severe hypotension.
Dose-related ankle oedema is common and reflects vasodilatation rather than fluid overload, so diuretics are not the appropriate response.
Exposure is increased in hepatic impairment and by potent CYP3A4 inhibitors, warranting cautious dosing.

Monitoring

Monitor blood pressure and review for peripheral oedema and any anginal symptom change.

Counselling the patient

Ankle swelling and flushing or headache may occur, often easing with time.
Avoid grapefruit juice, which can increase the drug's effect.

Evidence & guidelines

Large outcome trials support dihydropyridine calcium-channel blockers such as amlodipine as effective first-line antihypertensive therapy.

Reference: ACCOMPLISH Trial; BSR/BHPR Guidelines on Raynaud's Phenomenon; 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.

Calculators

Pathways