Amlodipine is one of the most commonly prescribed blood pressure reducers in Germany and belongs to the class of calcium channel blockers (type dihydropyridine). It reliably lowers blood pressure, is only taken once a day and has strong evidence for reducing stroke and cardiovascular events.
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This article is for informational purposes only and does not replace medical advice. Amlodipine is a prescription medication. Never change your dose or stop taking the medication without consulting your doctor.
| Property | Details |
|---|---|
| Active substance | Amlodipine (as besylate or mesilate) |
| ATC code | C08CA01 |
| Drug class | Calcium channel blocker (dihydropyridine type) |
| Available forms | Tablets 5 mg, 10 mg (also splittable as 2.5 mg) |
| Half-life | 30–50 hours (very long!) |
| Onset of action | Slow: maximum effect after 6–12 hours |
| Steady state | After 7–10 days of daily intake |
| Bioavailability | 64–80% |
| Protein binding | 97.5% |
| Prescription only | Yes |
| Special feature | Once daily, independent of meals |
Amlodipine blocks L-type calcium channels in the smooth muscle cells of the arterial wall. When calcium cannot flow into the cell, the muscle relaxes — the artery dilates. This reduces peripheral vascular resistance and thereby lowers blood pressure.
| Property | Amlodipine (dihydropyridine) | Verapamil / Diltiazem (non-dihydropyridine) |
|---|---|---|
| Primary site of action | Smooth vascular muscle (arteries) | Heart muscle + conduction system + vessels |
| Heart rate effect | Slight reflex tachycardia possible | Heart rate-lowering (negatively chronotropic) |
| Combination with beta-blocker | Yes — recommended and safe | Verapamil + beta-blocker = contraindicated! |
| Oedema risk | High (dose-dependent) | Lower (diltiazem) / less frequent (verapamil) |
| Use in heart failure | Possible (amlodipine is the only safe CCB in HF) | Contraindicated in systolic HF |
Amlodipine acts exclusively on the arteries, not on the veins, and has little direct effect on the heart muscle. It has the longest half-life of all calcium channel blockers (30–50 hours), which allows once-daily dosing and minimises blood pressure fluctuations. It is also the only calcium channel blocker proven to be safe in heart failure (PRAISE trial).
| Indication | Starting dose | Target dose | Note |
|---|---|---|---|
| High blood pressure | 5 mg once daily | 5–10 mg | Start at 2.5 mg in older patients |
| Chronic stable angina pectoris | 5 mg once daily | 10 mg | Can be combined with a beta-blocker |
| Vasospastic angina (Prinzmetal) | 5 mg once daily | 10 mg | Particularly effective for coronary spasm |
| Combination therapy with ramipril | 5 mg (+ ramipril 5 mg) | 10 mg (+ ramipril 10 mg) | Fixed combinations available (e.g. telmisartan/amlodipine) |
| Patient group | Recommendation |
|---|---|
| Older patients (≥ 70 years) | Start at 2.5 mg — slower metabolism, higher plasma levels |
| Hepatic impairment | Lower dose (2.5–5 mg) — prolonged half-life (up to 60 h) |
| Renal impairment | No dose adjustment required — amlodipine is hepatically metabolised |
| Children (6–17 years) | 2.5–5 mg once daily (hypertension only; off-label under 6 years) |
Amlodipine dilates the arteries and pre-capillary arterioles — but not the veins. This raises the pressure in the capillaries: more blood flows in (through the dilated arteries), but outflow through the unchanged veins stays the same. The result: fluid is pushed from the capillaries into the surrounding tissue. Gravity causes this fluid to accumulate mainly in the ankles and lower legs.
| Dose | Oedema frequency | Comment |
|---|---|---|
| 2.5 mg | approx. 1–3% | Rarely problematic |
| 5 mg | approx. 3–8% | Moderate frequency |
| 10 mg | approx. 10–25% | 1 in 4 to 1 in 10 patients affected! |
Important: the oedema is dose-dependent and typically appears 2–4 weeks after starting treatment or increasing the dose. Women are more frequently affected than men. The oedema resolves completely after stopping the medication.
ACE inhibitors (ramipril, enalapril) and sartans (candesartan, valsartan) additionally dilate the veins and post-capillary venules. This normalises the elevated capillary pressure — oedema recedes or does not develop at all. Studies show: the combination amlodipine + ACE inhibitor/sartan reduces the oedema rate by approximately 50–70% compared to amlodipine alone.
If 10 mg is causing oedema, reducing to 5 mg may help. The blood pressure is then compensated by adding a second active substance (ACE inhibitor, sartan, or diuretic).
Lercanidipine is a more modern calcium channel blocker with similar efficacy but significantly less oedema. The lipophilic substance distributes more evenly in the vessel walls and raises capillary pressure less. However, lercanidipine must be taken in the morning on an empty stomach (15 minutes before breakfast).
| Measure | Why it doesn't work |
|---|---|
| Loop diuretics (furosemide, torasemide) | The oedema is caused by a change in capillary pressure, not fluid retention. Diuretics dehydrate the body without lowering capillary pressure. |
| HCT (hydrochlorothiazide) | Same reason — does not work against capillary oedema. May still be useful as a second antihypertensive agent. |
| Salt reduction alone | May help minimally, but does not resolve the mechanical problem. |
Like any medication, amlodipine can cause unwanted effects — most of them are dose-dependent and occur primarily at the start of treatment. The most important point: common side effects such as headaches, flushing, and mild dizziness generally resolve on their own after a few weeks as the body adjusts to the changed vascular conditions. Stopping on your own is therefore almost never necessary — but a conversation with your doctor is always worthwhile.
| Side effect | Frequency | Note |
|---|---|---|
| Ankle/leg oedema | Very common (>10%, dose-dependent) | See chapters 4 + 5 |
| Headaches | Common | Usually at the start; improve after 1–2 weeks |
| Flushing (facial redness, sensation of warmth) | Common | Due to vasodilation; dose-dependent |
| Fatigue, drowsiness | Occasional | Especially in older patients |
| Dizziness | Occasional | Especially at the start of treatment; monitor blood pressure |
| Heart palpitations | Occasional | Reflex tachycardia due to blood pressure lowering |
| Abdominal pain, nausea | Occasional | Rarely treatment-limiting |
| Gum overgrowth (gingival hyperplasia) | Rare | With long-term therapy; good oral hygiene is important! |
| Gynaecomastia (breast enlargement in men) | Very rare | With long-term therapy; reversible after stopping |
| Hepatitis / jaundice | Very rare | Monitor liver values if symptoms appear |
Two rarer long-term effects deserve special attention: gingival hyperplasia (gum overgrowth) can be managed well with thorough oral hygiene. Gynaecomastia — breast enlargement in men — is very rare and resolves completely after stopping the medication. Anyone who notices such changes should document them and raise them at their next doctor's appointment rather than stopping the medication on their own.
Amlodipine is metabolised almost exclusively by the liver enzyme CYP3A4. Anything that inhibits this enzyme raises amlodipine levels — anything that activates it lowers them. This is particularly relevant for patients who are also taking statins, antibiotics, or St John's wort. Use the interaction check to review your combination. The table below shows the most clinically important interactions.
| Substance / medication | Interaction | Recommendation |
|---|---|---|
| Simvastatin | Amlodipine raises simvastatin levels by approx. 77% | Limit simvastatin dose to a maximum of 20 mg! Other statins (atorvastatin, rosuvastatin) are not affected. |
| Grapefruit juice | Inhibits CYP3A4 → elevated amlodipine levels | Avoid grapefruit during amlodipine therapy |
| CYP3A4 inhibitors (clarithromycin, ketoconazole, ritonavir) | Raise amlodipine levels | Monitor blood pressure closely; reduce dose if necessary |
| CYP3A4 inducers (rifampicin, St John's wort) | Lower amlodipine levels → loss of efficacy | Monitor blood pressure; increase dose if necessary |
| Beta-blockers (bisoprolol, metoprolol) | Synergistic blood pressure lowering — recommended combination | Safe! The contraindication applies ONLY to verapamil + beta-blocker, NOT to amlodipine |
| Ciclosporin, tacrolimus | Amlodipine raises their plasma levels | Level monitoring recommended |
| Dantrolene (i.v.) | Risk of fatal cardiac arrhythmias | Avoid combination |
| Ibuprofen / diclofenac (NSAIDs) | Reduce the blood pressure-lowering effect | Acceptable short-term; avoid long-term use. Prefer paracetamol (acetaminophen). |
