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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 information only and does not replace medical advice. Amlodipine is a prescription medication. Never change the dose or stop the medication on your own initiative.
| Property | Details |
|---|---|
| Active substance | Amlodipine (as besilate or mesilate) |
| ATC code | C08CA01 |
| Drug class | Calcium channel blocker (dihydropyridine type) |
| Available forms | Tablets 5 mg, 10 mg (also divisible to 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 the 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 widens. This lowers peripheral vascular resistance and thereby blood pressure.
| Property | Amlodipine (dihydropyridine) | Verapamil / diltiazem (non-dihydropyridine) |
|---|---|---|
| Main site of action | Vascular smooth muscle (arteries) | Heart muscle + conduction system + vessels |
| Effect on heart rate | Mild reflex tachycardia possible | Rate-lowering (negatively chronotropic) |
| Combination with beta-blocker | Yes – recommended and safe | Verapamil + beta-blocker = contraindicated! |
| Oedema risk | High (dose-dependent) | Lower (diltiazem) or less common (verapamil) |
| Use in heart failure | Possible (amlodipine is the only safe CCB in heart failure) | Contraindicated in systolic heart failure |
Amlodipine acts exclusively on the arteries, not on the veins, and barely directly on the heart muscle. It has the longest half-life of all calcium channel blockers (30–50 hours), which allows once-daily intake and minimises blood pressure fluctuations. It is also the only calcium channel blocker that has been shown to be safe to use in heart failure (PRAISE trial).
| Indication | Starting dose | Target dose | Note |
|---|---|---|---|
| High blood pressure | 5 mg once daily | 5–10 mg | Start older patients at 2.5 mg |
| 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 combination 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 60h) |
| Renal impairment | No dose adjustment required – amlodipine is metabolised hepatically |
| Children (6–17 years) | 2.5–5 mg once daily (hypertension only, off-label < 6 years) |
Amlodipine widens the arteries and pre-capillary arterioles – but not the veins. This raises the pressure in the capillaries: more blood flows in (through the widened arteries), but the outflow through the unchanged veins stays the same. The result: fluid is pushed out of the capillaries into the surrounding tissue. Because of gravity, this fluid collects mainly in the ankles and lower legs.
| Dose | Frequency of oedema | Comment |
|---|---|---|
| 2.5 mg | approx. 1–3% | Rarely problematic |
| 5 mg | approx. 3–8% | Moderate frequency |
| 10 mg | approx. 10–25% | Affects every 4th to 10th patient! |
Important: the oedema is dose-dependent and typically appears 2–4 weeks after starting therapy or increasing the dose. Women are affected more often than men. The oedema resolves completely after stopping.
ACE inhibitors (ramipril, enalapril) and sartans (candesartan, valsartan) additionally widen the veins and post-capillary venules. This normalises the raised capillary pressure – the oedema recedes or does not appear in the first place. Studies show that the combination amlodipine + ACE inhibitor/sartan reduces the oedema rate by approximately 50–70% compared with amlodipine alone.
If 10 mg causes oedema, reducing to 5 mg can help. Blood pressure is then compensated by adding a second agent (ACE inhibitor, sartan, or diuretic).
Lercanidipine is a more modern calcium channel blocker with a similar effect but markedly less oedema. The lipophilic substance distributes more evenly in the vessel walls and raises capillary pressure less strongly. However, lercanidipine must be taken in the morning on an empty stomach (15 minutes before breakfast).
| Measure | Why it does not work |
|---|---|
| Loop diuretics (furosemide, torasemide) | The oedema arises from a change in capillary pressure, not from fluid retention. Diuretics dehydrate the body without lowering capillary pressure. |
| HCT (hydrochlorothiazide) | Same reason – does not work against capillary oedema. May, however, be useful as a second blood-pressure-lowering agent. |
| Salt reduction alone | May help minimally but does not solve the mechanical problem. |
Like any medication, amlodipine can cause unwanted effects – most of them are dose-dependent and occur mainly at the start of therapy. The most important point first: common side effects such as headaches, flushing, and mild dizziness usually improve on their own after a few weeks, once the body has adjusted to the changed vascular conditions. Stopping on your own is therefore almost never necessary – but a conversation with the doctor is always sensible.
| Side effect | Frequency | Note |
|---|---|---|
| Ankle/leg oedema | Very common (>10%, dose-dependent) | See chapters 4 + 5 |
| Headaches | Common | Mostly 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 therapy, monitor blood pressure |
| Palpitations | Occasional | Reflex tachycardia from the drop in blood pressure |
| Abdominal pain, nausea | Occasional | Rarely therapy-limiting |
| Gum overgrowth (gingival hyperplasia) | Rare | With long-term therapy, good oral hygiene is important! |
| Gynaecomastia (breast growth in men) | Very rare | With long-term therapy, reversible after stopping |
| Liver inflammation / jaundice | Very rare | Check liver values if symptoms occur |
Two rarer long-term effects deserve particular attention: gingival hyperplasia (gum overgrowth) can be well controlled with consistent oral hygiene. Gynaecomastia – breast growth in men – is very rare and resolves completely after stopping. 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 broken down 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 also take statins, antibiotics, or St John's wort. Use the interaction check to review your combination. The table below shows the clinically most important interactions.
| Substance / medication | Interaction | Recommendation |
|---|---|---|
| Simvastatin | Amlodipine raises simvastatin levels by approx. 77% | Limit the simvastatin dose to a maximum of 20 mg! Other statins (atorvastatin, rosuvastatin) are not affected. |
| Grapefruit juice | Inhibits CYP3A4 → raised amlodipine levels | Avoid grapefruit during amlodipine therapy |
| CYP3A4 inhibitors (clarithromycin, ketoconazole, ritonavir) | Raise amlodipine levels | Monitor blood pressure closely, reduce the dose if needed |
| CYP3A4 inducers (rifampicin, St John's wort) | Lower amlodipine levels → loss of effect | Monitor blood pressure, increase the dose if needed |
| 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 the combination |
| Ibuprofen / diclofenac (NSAIDs) | Weaken the blood-pressure-lowering effect | Tolerable short term, avoid long-term use. Prefer paracetamol. |
