Calcium channel blockers (dihydropyridines)
ATC code: C08CA01 (Amlodipine)
Long-acting dihydropyridine L-type calcium channel blocker. Acts mainly on vascular smooth muscle, dilating peripheral arterioles and reducing systemic vascular resistance and afterload. A 30–50 h half-life gives stable 24-hour blood pressure control with once-daily dosing.
First line
Amlodipine is prescribed in stable angina to reduce attack frequency. Suitable for patients with contraindications to beta-blockers or insufficient control on beta-blocker monotherapy. The CAMELOT trial demonstrated reduced cardiovascular events with amlodipine in patients with angiographically confirmed CAD and normal BP.
First line
Amlodipine belongs to one of the five first-line antihypertensive classes per 2024. Start at 5 mg once daily, maximum 10 mg. Particularly favored in elderly patients, isolated systolic hypertension, and Black patients. Frequently used in fixed-dose combinations with ACE inhibitors or ARBs.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Amlodipine is a long-acting dihydropyridine calcium channel blocker. It is prescribed for hypertension and stable angina ( 2023, SEH-LELHA, 2017). In healthy normotensives, amlodipine is used for improving cerebral circulation in older adults and protecting vessels from aging. In people with normal blood pressure, no clinical studies of prophylactic use exist, and a rejuvenating effect has not been demonstrated. The drug causes ankle edema (5-20% of patients, especially women), flushing, headache, and gingival hyperplasia on chronic use. If amlodipine was prescribed to a person with normal blood pressure, consider seeking a second opinion.
40 pairs found. Sorted from critical to minor.
Mechanism
Carbamazepine induces CYP3A4 – the main amlodipine metabolic route. Amlodipine plasma levels fall and the antihypertensive effect weakens.
Symptoms
Blood pressure returns to baseline or higher, headache. In angina, episodes reappear. Symptoms emerge 1–2 weeks after starting carbamazepine.
Management
During carbamazepine therapy, increase amlodipine 1.5- to 2-fold with blood pressure monitoring, or switch to an ACE-I (enalapril) or diuretic (hydrochlorothiazide). Alternative anticonvulsants without induction: levetiracetam, lamotrigine.
Mechanism
Clarithromycin blocks CYP3A4 – the main amlodipine metabolic route. Amlodipine plasma levels rise by 50–60%. Symptomatic hypotension and acute kidney injury have been reported in older patients.
Symptoms
Blood pressure drop: postural dizziness, syncope. Ankle oedema (typical of amlodipine), facial flushing, reflex tachycardia are possible.
Management
During clarithromycin therapy, halve amlodipine and monitor blood pressure. Alternative antibiotics: azithromycin or doxycycline (minimal CYP3A4 effect).
Mechanism
Dronedarone is a strong CYP3A4 inhibitor, the main amlodipine metabolic route. Amlodipine plasma levels may double.
Symptoms
Blood pressure drop: postural dizziness, syncope. Ankle oedema (typical of amlodipine), facial flushing, reflex tachycardia are possible.
Management
Cap amlodipine at 5 mg/day when combined. Alternative calcium channel blocker: diltiazem (with caution combined with an antiarrhythmic), or replace amlodipine with an ACE-I/ARB.
Mechanism
Ketoconazole is a strong CYP3A4 inhibitor – the main amlodipine metabolic route. Amlodipine plasma levels rise 2- to 3-fold; symptomatic hypotension and acute kidney injury risk.
Symptoms
Blood pressure drop: postural dizziness, syncope. Ankle oedema (typical of amlodipine), facial flushing, reflex tachycardia are possible.
Management
Avoid the combination. Alternative antifungals: terbinafine for dermatophytosis or echinocandins for systemic mycoses. If ketoconazole is needed, halve amlodipine.
Mechanism
Rifampicin strongly induces CYP3A4 – the main amlodipine metabolic route. Amlodipine plasma levels fall by 80%; the antihypertensive effect practically disappears.
Symptoms
Blood pressure returns to baseline or higher, headache. In angina, episodes reappear. Symptoms develop 1–2 weeks after starting rifampicin.
Management
During anti-TB therapy, replace amlodipine with an ACE-I (enalapril) or a diuretic (hydrochlorothiazide) – their metabolism is less affected by rifampicin. Induction persists for 2 weeks after rifampicin stops – reintroduce amlodipine gradually.
Mechanism
Amlodipine moderately inhibits CYP3A4 – the main simvastatin metabolic route. Simvastatin plasma levels rise by about 77%. Rhabdomyolysis has been reported at simvastatin doses of 40 mg or above.
Symptoms
Pain and weakness in large muscle groups (thighs, shoulders, calves), dark urine, elevated creatine kinase. Severe cases progress to rhabdomyolysis with acute kidney injury. Symptoms appear within 1–4 weeks of co-administration.
Management
Cap simvastatin at 20 mg/day when combined with amlodipine. If targets are missed, switch to pravastatin or rosuvastatin (no CYP3A4 dependence) or replace amlodipine with lisinopril or telmisartan.
Mechanism
Dual calcium channel blockade: amlodipine is a dihydropyridine blocker, verapamil is non-dihydropyridine. Additive hypotension, bradycardia, AV block risk.
Symptoms
Blood pressure drop, dizziness, syncope. Bradycardia, ECG first- to second-degree AV block. Older patients: fall risk.
Management
Avoid the combination. In hypertension, choose one calcium channel blocker (amlodipine or verapamil). For difficult hypertension, ACE-I + amlodipine + diuretic (without verapamil) or ACE-I + verapamil.
Mechanism
At high aspirin doses (above 1 g/day), vasodilator prostaglandins are suppressed, weakening amlodipine's antihypertensive effect. At cardioprotective doses (75–100 mg/day), the effect is minimal.
Symptoms
Gradual blood pressure rise 1–2 weeks after starting the NSAID. In chronic kidney disease: risk of fluid retention and oedema.
Management
Cardioprotective aspirin doses (75–100 mg) are acceptable without adjustment. At anti-inflammatory aspirin doses, monitor blood pressure and increase amlodipine if needed.
Mechanism
Amlodipine weakly inhibits CYP3A4 – a partial atorvastatin metabolic route. Atorvastatin plasma levels rise by about 18%. Clinically significant myopathy is rare.
Symptoms
Usually no additional symptoms. In patients with risk factors (older age, chronic kidney disease, hypothyroidism): muscle pain and weakness are possible.
Management
The combination is acceptable without dose change. Cap atorvastatin at 40 mg/day if needed. Check creatine kinase on muscle symptoms.
Sources
Mechanism
Dihydropyridine calcium channel blocker (amlodipine) + cardioselective beta-blocker (bisoprolol) – additive bradycardia and hypotension. In reduced ejection fraction (below 40%), heart failure decompensation risk.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk. With additional antihypertensives: bradycardia (pulse below 60/min).
Management
The combination is a standard hypertension and angina treatment. In heart failure with reduced ejection fraction, cap amlodipine at 5 mg/day. Check pulse and blood pressure at 1–2 weeks.
Sources
Mechanism
Bupropion blocks CYP2D6. Amlodipine is minorly metabolised via CYP2D6 (main route is CYP3A4). The effect is weak – possible mild amlodipine level rise without clinically significant effect.
Symptoms
Minimal changes. Mild additional hypotension or ankle oedema possible in some patients.
Management
No dose adjustment is usually needed. In older patients and reduced ejection fraction, check blood pressure and pulse 2 weeks after starting bupropion.
Mechanism
Additive hypotension and peripheral oedema. Amlodipine causes ankle oedema; the beta-blocker (carvedilol) may potentiate fluid retention.
Symptoms
Lower-leg and ankle oedema, weight gain. Hypotension and dizziness on standing. Worsening dyspnoea in heart failure patients.
Management
Standard combination in ischaemic heart disease with hypertension. In heart failure with reduced ejection fraction, titrate carefully and monitor weight and dyspnoea. For marked ankle oedema: switch to lercanidipine (less oedema among dihydropyridines).
Sources
Mechanism
Dexamethasone is a weak CYP3A4 inducer. With prolonged therapy, amlodipine plasma levels may modestly fall and the antihypertensive effect weaken.
Symptoms
Gradual blood pressure rise 2–4 weeks after starting the glucocorticoid. In heart failure: oedema, weight gain.
Management
For short dexamethasone courses (up to 7 days), no adjustment. For prolonged systemic therapy, monitor blood pressure every 2 weeks; increase amlodipine if needed.
Mechanism
NSAIDs weaken amlodipine's antihypertensive effect via prostaglandin suppression. Diclofenac additionally raises cardiovascular risk.
Symptoms
Gradual blood pressure rise 1–2 weeks after starting the NSAID. In chronic kidney disease: risk of fluid retention and oedema.
Management
Avoid prolonged diclofenac use. For acute pain: short course (5–7 days) with pantoprazole cover. For chronic analgesia: paracetamol, celecoxib, or topical NSAIDs.
Mechanism
Dual calcium channel blockade: amlodipine (dihydropyridine), diltiazem (non-dihydropyridine). Additive vasodilation, oedema. Sometimes used in refractory hypertension under cardiology supervision.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
Avoid in routine practice. Alternative for refractory hypertension: triple therapy amlodipine + ARB + diuretic. If unavoidable: monitor pulse, blood pressure, ECG.
Mechanism
SGLT2 inhibitors (empagliflozin) cause osmotic diuresis and mild hypovolaemia. Combined with amlodipine: risk of hypotension and acute kidney injury in dehydration.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
Standard combination in type 2 diabetes with hypertension. In hypovolaemia (dehydration, vomiting, diarrhoea), temporarily stop empagliflozin. Check blood pressure and creatinine 2 weeks after start.
Sources
Mechanism
Fluconazole at high doses (200 mg/day or above) blocks CYP3A4 – the main amlodipine metabolic route. Amlodipine plasma levels may rise. The effect is clinically weak in short courses.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
For short fluconazole courses (up to 7 days), no adjustment is usually needed. For prolonged systemic therapy (>14 days), reduce amlodipine by 25% with blood pressure monitoring.
Mechanism
Fluoxetine and its active metabolite norfluoxetine moderately block CYP3A4 – the main amlodipine metabolic route. Amlodipine plasma levels may rise modestly. In older patients: additive hypotension.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
The combination is acceptable in most patients without dose change. In older patients, monitor blood pressure and hypotension symptoms 2 weeks after start.
Mechanism
Additive hypotension (haloperidol blocks α1-adrenoceptors) and sedation. Haloperidol prolongs QT; amlodipine does not contribute to QT.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
Avoid the combination, especially with parenteral haloperidol. Alternative antipsychotics with minimal α1-blockade: olanzapine or aripiprazole.
Mechanism
NSAIDs weaken amlodipine's antihypertensive effect via renal prostaglandin suppression. Additive acute kidney injury risk in dehydration.
Symptoms
Gradual blood pressure rise 1–2 weeks after starting the NSAID. In chronic kidney disease: risk of fluid retention and oedema.
Management
For short ibuprofen courses (5–7 days), monitor blood pressure. For chronic analgesia: switch to paracetamol, celecoxib (with PPI cover), or topical NSAIDs.
Mechanism
Ketorolac suppresses vasodilator prostaglandins, weakening amlodipine's antihypertensive effect. Plus additive nephrotoxicity.
Symptoms
Gradual blood pressure rise 1–2 weeks after starting the NSAID. In chronic kidney disease: risk of fluid retention and oedema.
Management
Ketorolac courses are limited to 5 days. Monitor blood pressure and creatinine in the first days. In chronic kidney disease or reduced ejection fraction, avoid ketorolac; use paracetamol or a short opioid course for analgesia.
Mechanism
Linezolid is a reversible MAO inhibitor. It can potentiate sympathomimetic effects of tyramine-containing foods, but the effect on amlodipine is weak.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
The combination is acceptable for short linezolid courses with blood pressure monitoring. In hypovolaemia or with the first dose: increased orthostatic hypotension risk. The main linezolid combination risk is serotonin syndrome with SSRI/SNRI (see those pairs).
Mechanism
Synergistic blood pressure reduction – a target hypertension combination. Amlodipine dilates peripheral vessels; losartan (ARB) blocks the renin-angiotensin system.
Symptoms
Older patients may have symptomatic and orthostatic hypotension, dizziness on standing. With the first losartan dose: risk of marked blood pressure drop.
Management
Standard hypertension treatment (fixed-dose product available). Take the first losartan dose in the evening, lying down. Check blood pressure and creatinine 1–2 weeks after start.
Sources
Mechanism
NSAIDs antagonise amlodipine's antihypertensive effect via renal prostaglandin-dependent sodium regulation suppression.
Symptoms
Gradual blood pressure rise 1–2 weeks after starting meloxicam. In chronic kidney disease: fluid retention and oedema risk.
Management
For short meloxicam courses (5–7 days), monitor blood pressure. For chronic analgesia: switch to paracetamol or celecoxib (with PPI cover).
Mechanism
Similar to amlodipine + prednisolone. Methylprednisolone causes sodium retention via mineralocorticoid effect, reducing amlodipine's antihypertensive action.
Symptoms
Gradual blood pressure rise 2–4 weeks after starting the glucocorticoid. In heart failure: oedema, weight gain.
Management
For short methylprednisolone courses, no adjustment. For prolonged systemic therapy, increase amlodipine or add a diuretic (hydrochlorothiazide, indapamide) with blood pressure monitoring every 2 weeks.
Mechanism
Target combination in angina and hypertension. Amlodipine dilates vessels; metoprolol slows heart rate. The drugs compensate each other's reflex effects.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
Standard combination in ischaemic heart disease with hypertension. Check pulse and blood pressure 1–2 weeks after start. In patients with ejection fraction below 40%, watch for heart failure decompensation.
Sources
Mechanism
Additive hypotension and sedation. Morphine reduces sympathetic tone; amlodipine dilates vessels. Older patients: fall risk.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
The combination is acceptable in palliative care and acute coronary syndrome. Titrate morphine from a low dose; monitor pulse, blood pressure, and saturation. Older patients: enhanced fall monitoring.
Mechanism
NSAIDs weaken amlodipine's antihypertensive effect via renal prostaglandin suppression.
Symptoms
Gradual blood pressure rise 1–2 weeks after starting naproxen. In chronic kidney disease: fluid retention and oedema risk.
Management
For short naproxen courses (5–7 days), monitor blood pressure. For chronic analgesia: switch to paracetamol or celecoxib (with PPI cover).
Mechanism
Additive hypotension with sublingual or parenteral nitroglycerin. Both drugs are vasodilators (amlodipine – calcium channel blocker, nitroglycerin – nitrate vasodilator).
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
The combination is acceptable in angina. The patient takes the first nitroglycerin dose sitting or lying down. Older patients: fall risk after nitroglycerin. Advise the patient to consult a clinician with frequent episodes.
Mechanism
Prednisolone causes sodium and water retention via mineralocorticoid effect, antagonising amlodipine's antihypertensive action.
Symptoms
Gradual blood pressure rise 2–4 weeks after starting the glucocorticoid. In heart failure: oedema, weight gain.
Management
For short prednisolone courses, no adjustment. For prolonged systemic therapy, increase amlodipine or add a diuretic (hydrochlorothiazide, indapamide) with blood pressure monitoring.
Mechanism
Additive bradycardia and hypotension. Propranolol is non-selective (blocks β1 and β2); risk is higher than with bisoprolol – bronchospasm possible in asthma.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
The combination is acceptable in ischaemic heart disease. In asthma or COPD, a selective beta-blocker (bisoprolol, metoprolol) is preferable. Check pulse and blood pressure 1–2 weeks after start.
Sources
Mechanism
Additive hypotension. Quetiapine blocks α1-adrenoceptors; amlodipine dilates vessels.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
The combination is acceptable at low quetiapine doses (≤300 mg/day). Check blood pressure 1–2 weeks after start. In older patients, olanzapine or aripiprazole (less α1-blockade) is preferable.
Mechanism
Ritonavir is the most potent CYP3A4 inhibitor available – the main amlodipine metabolic route. Amlodipine plasma levels rise 2- to 3-fold, with hypotension and peripheral oedema.
Symptoms
Lower blood pressure, postural dizziness, marked lower-leg oedema. Older patients: fall risk.
Management
Halve amlodipine when combined (starting 2.5 mg/day) and monitor blood pressure 1–2 weeks after. Alternative antihypertensive on ritonavir: ACE-I or ARB (no CYP3A4 dependence).
Mechanism
Additive hypotension via different mechanisms – calcium channel blockade (amlodipine) + PDE5 blockade (sildenafil). Clinically significant in patients with prior hypotension.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
The combination is acceptable in stable hypertension. Take the first sildenafil dose lying down; do not exceed 25–50 mg. Warn the patient about orthostatic hypotension.
Mechanism
Tacrolimus and amlodipine are both CYP3A4 substrates competing for the enzyme. Tacrolimus plasma levels may rise.
Symptoms
Acute nephrotoxicity: rising creatinine and falling glomerular filtration rate. Tremor, headache, hypertension, hyperglycaemia, hyperkalaemia. In transplant patients: accelerated graft decline.
Management
The combination is acceptable in post-transplant patients with hypertension. Check tacrolimus trough (C0) 1 week after starting or changing amlodipine. Alternative: an ARB or α-blocker (no CYP3A4 dependence).
Mechanism
No clinically significant direct interaction. Amlodipine has minimal effect on CYP3A4 and P-glycoprotein — the main routes of apixaban clearance.
Symptoms
The combination usually causes no specific symptoms. Each drug's individual side effects remain.
Management
No dose adjustment needed. In atrial fibrillation with hypertension, the combination is standard.
Mechanism
No clinically significant direct interaction. With long-term oral budesonide, mild additive sodium retention may slightly reduce amlodipine's antihypertensive effect. Inhaled budesonide does not clinically affect BP.
Symptoms
The combination usually causes no specific symptoms. Each drug's individual side effects remain.
Management
For short systemic budesonide courses, no adjustment needed. For long-term therapy, check BP monthly. If BP rises, increase amlodipine or add a diuretic.
Mechanism
No clinically significant direct interaction. Oral calcium does not affect amlodipine: vascular smooth muscle calcium channel blockade is intracellular and is not overcome by exogenous calcium.
Symptoms
The combination usually causes no specific symptoms. Each drug's individual side effects remain.
Management
No dose adjustment needed. In patients with hypertension and osteoporosis, the combination is standard.
Mechanism
No clinically significant direct interaction. Ciprofloxacin weakly inhibits CYP3A4, which partly metabolises amlodipine. Amlodipine levels may rise slightly.
Symptoms
The combination usually causes no specific symptoms. Each drug's individual side effects remain.
Management
For short ciprofloxacin courses (5–7 days), no adjustment needed. In older patients, watch for leg oedema and dizziness in the first week.
Mechanism
Target combination in hypertension: synergistic BP lowering via different mechanisms (calcium channel blockade plus RAAS suppression). Amlodipine partly offsets peripheral oedema via arteriolar vasodilation; enalapril balances it through venular action.
Symptoms
Possible mild leg oedema (mainly from amlodipine) and a rare dry cough (from enalapril). On starting in older patients: dizziness.
Management
Standard fixed combination in hypertension. Start with minimal doses (5 mg + 5 mg) with up-titration every 2–4 weeks. Check creatinine and potassium 1–2 weeks after enalapril start, then every 6 months.
Sources
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FDA category C. Limited safety data in pregnancy. When antihypertensive therapy is needed during pregnancy, methyldopa, labetalol, or nifedipine are preferred.
Compatible with caution. Hale L3. RID 4.2%, long T½ 35 h – accumulates. Alternative – nifedipine SR (shorter T½). If well controlled on amlodipine – continue, monitor infant.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Amlodipine is evaluated for the following indications with varying evidence strength: Hypertension (evidence tier A), Coronary artery disease (evidence tier A), Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Amlodipine (≥ 1 in 100): Peripheral edema (up to 10 % at 10 mg dose), Headache, Flushing, Dizziness, fatigue. See the Safety section for uncommon and serious reactions.
FDA category C. FDA category C. Limited safety data in pregnancy. When antihypertensive therapy is needed during pregnancy, methyldopa, labetalol, or nifedipine are preferred.
Compatible with caution. Hale L3. RID 4.2%, long T½ 35 h – accumulates. Alternative – nifedipine SR (shorter T½). If well controlled on amlodipine – continue, monitor infant.
Amlodipine is contraindicated in: Severe hypotension (systolic BP below 90 mmHg); Severe aortic stenosis; Cardiogenic shock; Unstable angina (except vasospastic Prinzmetal angina). Full list in the Safety section.