Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Amlodipine
See also Calcium channel blockers
General information
Amlodipine is a long-acting dihydropyridine calcium channel blocker. It has an adverse effects profile similar to those of other dihydropyridines, but at a lower frequency [ ]. Along with felodipine [ ], but unlike other calcium channel blockers, it may also be safer in severe chronic heart failure when there is concurrent angina or hypertension [ ].
The effects of amlodipine and isosorbide-5-mononitrate for 3 weeks on exercise-induced myocardial stunning have been compared in a randomized, double-blind, crossover study in 24 patients with chronic stable angina and normal left ventricular function [ ]. Amlodipine attenuated stunning, evaluated by echocardiography, significantly more than isosorbide, without difference in anti-ischemic action or hemodynamics. Amlodipine was better tolerated than isosorbide, mainly because of a lower incidence of headache [ ].
Vasodilatory calcium channel blockers have been reported to improve exercise tolerance in some preliminary studies. A multicenter, randomized, placebo-controlled trial was therefore performed in 437 patients with mild to moderate heart failure to assess the effects of amlodipine 10 mg/day in addition to standard therapy [ ]. Over 12 weeks amlodipine did not improve exercise time and did not increase the incidence of adverse events.
Mental stress is a risk factor for cardiovascular disease. In 24 patients with mild to moderate hypertension, amlodipine reduced the blood pressure rise during mental stress compared with placebo, but increased plasma noradrenaline concentrations [ ].
Hypertension leading to cardiac dysfunction is very frequent in patients with the inherited syndrome called Ribbing’s disease, which is characterized by multiple epiphyseal dystrophy. In a randomized, double-blind comparison of amlodipine (10 mg/day) and enalapril (20 mg/day) in 50 patients for 6 months, both drugs significantly reduced blood pressure, but amlodipine increased heart rate and plasma concentrations of noradrenaline and angiotensin II [ ]. These undesired effects make ACE inhibitors a better choice for prevention of cardiac dysfunction.
Drug studies
Placebo-controlled studies
The efficacy and safety of amlodipine have been assessed in a multicenter, double-blind, placebo-controlled trial in 268 children with hypertension aged 6–16 years [ ]. Amlodipine produced significantly greater reductions in systolic blood pressure than placebo. Twelve patients withdrew from the study because of adverse events, six of which were attributed to the study drug: three cases of worsening hypertension, one of facial edema, one of finger edema and rash, and one of ventricular extra beats. The maximal dose, 5 mg/day, was not high, and the target to reduce blood pressure below the 95th centile was reached in 35% of children with systolic hypertension and in 55% of those with diastolic hypertension.
Organs and systems
Nervous system
-
A 35-year-old woman with benign intracranial hypertension and high blood pressure was given amlodipine, with good control of her blood pressure [ ]. However, her headache worsened and she developed papilledema. The CSF pressure was 30 cm. Her symptoms disappeared shortly after amlodipine withdrawal.
Fluid balance
Calcium channel blockers often cause peripheral edema, usually limited to the lower legs; periocular and perioral edema are less common. Occasionally edema can be more severe, and a case of anasarca has been reported in a 77-year-old woman with essential hypertension taking amlodipine 10 mg/day [ ].
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here