Amlodipine

Calcium channel blockers (dihydropyridines)

ATC code: C08CA01

Updated 12 Oct 2026 · Methodology

Indications

Coronary artery disease

First line

In stable angina amlodipine reduces attack frequency and nitroglycerin use: in the CAPE trial attacks became less frequent in 70% of patients versus 44% on placebo. 2024 no longer splits antianginal drugs into first and second line: treatment starts with a beta-blocker or a calcium channel blocker according to the patient profile, and the two are combined if the effect is insufficient; / 2023 places both classes side by side. Amlodipine does not abort an attack; a short-acting nitrate is needed for that. In the CAMELOT trial, in patients with confirmed coronary disease and a mean blood pressure of 129/78 mmHg, the rate of cardiovascular events over two years fell from 23.1% to 16.6%, mainly through fewer hospitalisations for angina and revascularisations; an effect on death or myocardial infarction is not proven, so antiplatelets and statins are not stopped. The AEMPS label also lists vasospastic angina, which has its own card. Contraindications: severe hypotension, shock, severe aortic stenosis, haemodynamically unstable heart failure after myocardial infarction; in NYHA class III–IV heart failure pulmonary oedema was more frequent. CYP3A4 inhibitors (clarithromycin, azole antifungals, diltiazem, verapamil) raise amlodipine exposure.

Sources

ICD-10: I25 · ICD-11: BA5Z

Hypertension

First line

Amlodipine is a dihydropyridine calcium channel blocker, a first-line class for hypertension. 2024 names four first-line classes: ACE inhibitors, ARBs, dihydropyridine CCBs and thiazide or thiazide-like diuretics; ESH 2023 adds beta-blockers. For most patients with blood pressure of 140/90 mmHg or higher, these documents and the Spanish SEH-LELHA 2022 guideline advise starting with a single-pill combination: a RAAS blocker plus a dihydropyridine CCB or a diuretic. In patients of African origin, CCBs and thiazides are preferred over RAAS blockers (ESH 2023). In the ALLHAT trial amlodipine matched chlorthalidone and lisinopril on coronary outcomes, but heart failure was more frequent (10.2% vs 7.7%). Dose per the AEMPS label: 5 mg once daily, maximum 10 mg; in children aged 6–17 years 2.5–5 mg. Contraindications: severe hypotension, shock, severe aortic stenosis, haemodynamically unstable heart failure after myocardial infarction. Common adverse reactions: ankle oedema (dose-dependent), flushing, headache, palpitations. CYP3A4 inhibitors (clarithromycin, azole antifungals, diltiazem, verapamil) raise amlodipine exposure; simvastatin should not exceed 20 mg when combined. In pregnancy it is not a first-line drug: labetalol, methyldopa and nifedipine are preferred; 3–7% of the maternal dose passes into breast milk. It is not used for hypertensive emergencies.

Sources

ICD-10: I10 · ICD-11: BA00

Hypertension during breastfeeding

Second line

After delivery amlodipine is compatible with breastfeeding: 3–7% of the maternal dose passes into milk, at most 15% (Naito 2015, the same figures as in section 4.6 of the AEMPS label), no adverse reactions in infants have been described, and e-lactancia rates it as low risk. NG133 recommends enalapril after birth, and nifedipine or amlodipine for women of African or Caribbean family origin; if one drug is not enough, they are combined. The AEMPS label asks to weigh the benefit of breastfeeding against the benefit of treatment for the mother. Amlodipine is a second choice here after enalapril and nifedipine, which have more lactation data.

Sources

ICD-10: I10 · ICD-11: BA00

Raynaud's phenomenon

Second line

Raynaud's phenomenon is attacks of finger blanching and cyanosis triggered by cold or stress. The first step is cold protection and stopping smoking; when attacks are frequent, dihydropyridine calcium channel blockers are the drugs of first choice ( 2023 recommendations for systemic sclerosis, Cochrane review 2017: 38 randomised trials, 982 participants). The review covers the class as a whole: attacks become less frequent, with moderate-quality evidence; most data exist for nifedipine and direct studies of amlodipine are few. The AEMPS label does not include this indication, so use is off-label. The price is the same adverse reactions: ankle oedema, flushing, headache, lower blood pressure.

Sources

ICD-10: I73.0

Vasospastic (Prinzmetal) angina

First line

Vasospastic (Prinzmetal) angina is one of the three indications for amlodipine in the AEMPS label. Calcium channel blockers are the basis of treatment: they relieve coronary artery spasm, while beta-blockers are avoided in pure vasospasm because they can worsen it ( 2024 chronic coronary syndromes guideline, Japanese JCS 2023 guideline). Data on amlodipine itself are limited: a small randomised trial in 52 patients showed fewer attacks and ischaemic episodes than placebo; most data exist for diltiazem and nifedipine. Amlodipine is therefore a first choice by class with a modest evidence base for the molecule itself. Attacks are relieved with nitroglycerin, and stopping smoking is essential. Contraindications and interactions are the same as in stable angina.

Sources

ICD-10: I20.1 · ICD-11: BA85

Hypertension in pregnancy

Individual decision

Amlodipine is not a drug of choice in pregnancy: ESH 2023 and the 2025 guideline on cardiovascular disease in pregnancy name labetalol, methyldopa and nifedipine. Under the AEMPS label (section 4.6) it is used only when no safer alternative exists and the disease poses a greater risk to mother and fetus than the drug. Data are limited: a 2022 meta-analysis pooled 17 small randomised trials, mostly from China, found no signal of congenital malformations, but the quality of the studies was low. For a woman whose blood pressure is already controlled on amlodipine, switching to another drug is an individual decision made with her doctor; stopping treatment on her own is not an option, since uncontrolled hypertension is more dangerous.

Sources

ICD-10: O13 · ICD-11: JA23

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

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.

Safety

Contraindications

Severe hypotension (systolic BP below 90 mmHg)
Severe aortic stenosis
Cardiogenic shock
Unstable angina (except vasospastic Prinzmetal angina)

Serious adverse effects

Significant hypotension (rare with monotherapy)
Gingival hyperplasia with long-term use (rare)

Common adverse effects

Peripheral edema (up to 10 % at 10 mg dose)
Headache
Flushing
Dizziness, fatigue

Pregnancy: can you take Amlodipine?

AEMPS summary of product characteristics (section 4.6): the safety of amlodipine in human pregnancy has not been established; animal studies showed reproductive toxicity at high doses. Use in pregnancy is recommended only when there is no safer alternative and the disease itself carries a greater risk for mother and fetus.

Breastfeeding: can you take Amlodipine?

Hale L3 · Probably compatible, limited data

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.

RID, infant dose via milk: 4.2%
Maternal half-life: 35.0 h
Maternal peak time: 8 h
Peak milk concentration: 0.01 mg/L
Milk-to-plasma ratio: 0.85

Calculate RID Safe feeding window Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Take once daily at any time, with or without food. The long half-life means a single missed dose does not cause abrupt BP rebound. Full antihypertensive effect develops over 7–14 days.

Monitoring

Check BP 2–4 weeks after starting or changing dose. Watch for ankle edema – the most common side effect, dose-dependent. For significant edema, consider dose reduction or switch to lercanidipine. Combination with ACEi/ARB reduces edema severity.

Drug–nutrient interactions

Grapefruit juice

Grapefruit and its juice can increase amlodipine bioavailability in some people, and blood pressure falls further than expected. The Norvas SmPC does not recommend combining amlodipine with grapefruit or grapefruit juice. Signs of excess are dizziness on standing, headache, flushing and ankle swelling.

Source: AEMPS: Ficha técnica de Norvas 5 mg comprimidos (amlodipino) (2024)

Drug–drug interactions

40 pairs found. Sorted from critical to minor.

MajorCarbamazepineAntiepileptics. Carboxamide derivatives

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.

Sources

Pair details →Carbamazepine →

MajorDronedaroneClass III antiarrhythmic

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.

Sources

Pair details →Dronedarone →

MajorKetoconazoleSystemic antimycotics. Imidazole derivatives

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.

Sources

Pair details →Ketoconazole →

MajorSimvastatinHMG-CoA reductase inhibitors (statins)

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.

Sources

Pair details →Simvastatin →

MajorVerapamilNon-dihydropyridine calcium channel blocker

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.

Sources

Pair details →Verapamil →

ModerateAcetylsalicylic acidAntiplatelet agents (low dose) / NSAIDs (analgesic dose)

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.

Sources

ESH: 2023 ESH Guidelines for the management of arterial hypertension (2023)

Pair details →Acetylsalicylic acid →

ModerateAtorvastatinHMG-CoA reductase inhibitors (statins)

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

Pair details →Atorvastatin →

ModerateBisoprololSelective beta-adrenergic blockers

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

Pair details →Bisoprolol →

ModerateBupropionOther antidepressants (NDRI)

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.

Sources

FDA: Norvasc (amlodipine) prescribing information (2017)

Pair details →Bupropion →

ModerateCarvedilolAlpha and beta blocker (non-selective β + α1)

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

ESC: ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2021)

Pair details →Carvedilol →

ModerateCiprofloxacinFluoroquinolone antibacterials

Mechanism

Amlodipine is broken down in the liver by the CYP3A4 enzyme. The US Food and Drug Administration () classifies ciprofloxacin as a moderate CYP3A4 inhibitor (FDA table of CYP inhibitors). Moderate and strong inhibitors of this enzyme raise amlodipine blood levels and with them the risk of low blood pressure, more so in older patients (amlodipine SmPC; amlodipine FDA label). The labels give no specific data for this pair.

Symptoms

Dizziness and weakness, especially on standing, from low blood pressure; swelling of the ankles and feet (amlodipine labels). These effects are more marked in older patients (amlodipine SmPC).

Management

During the ciprofloxacin course, watch for signs of low blood pressure and for swelling to decide whether the amlodipine dose needs adjusting (amlodipine label of the US Food and Drug Administration, ). The Spanish amlodipine SmPC also states that moderate CYP3A4 inhibitors may require clinical monitoring and a dose adjustment, especially in older patients (amlodipine SmPC). Raise the amlodipine dose with caution in older patients (amlodipine SmPC).

Sources

Pair details →Ciprofloxacin →

ModerateClarithromycinMacrolide antibiotic

Mechanism

Clarithromycin inhibits CYP3A4, the enzyme that clears amlodipine, so amlodipine blood levels rise and so does the risk of hypotension (amlodipine SmPC). The labels give no exact figure for this pair. The US Food and Drug Administration () expects clarithromycin, as a strong inhibitor of the enzyme, to raise amlodipine levels more than diltiazem, which increases them by 60% (amlodipine FDA label). Clarithromycin levels may also rise (clarithromycin SmPC). The effect is stronger in older patients (amlodipine SmPC).

Symptoms

Blood pressure drop: postural dizziness, syncope. Ankle oedema (typical of amlodipine), facial flushing, reflex tachycardia are possible.

Management

The combination can be used, but with caution because of the risk of hypotension (clarithromycin SmPC). During the clarithromycin course, monitor blood pressure and how the patient feels, and lower the amlodipine dose if needed (amlodipine SmPC). The US Food and Drug Administration () advises using signs of hypotension and swelling to decide whether a dose change is needed (amlodipine FDA label). Watch older patients more closely: the effect is stronger in them (amlodipine SmPC), and most reports of acute kidney injury with clarithromycin and these calcium channel blockers involved patients aged 65 or older (clarithromycin FDA label).

Sources

Pair details →Clarithromycin →

ModerateDexamethasoneGlucocorticoids

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.

Sources

Pair details →Dexamethasone →

ModerateDiclofenacNon-steroidal anti-inflammatory drugs (NSAIDs)

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.

Sources

Pair details →Diclofenac →

ModerateDiltiazemCalcium channel blocker, non-DHP (benzothiazepine derivative)

Mechanism

Diltiazem is a moderate CYP3A4 inhibitor (diltiazem SmPC), and CYP3A4 takes part in amlodipine metabolism. In older patients with hypertension, diltiazem 180 mg a day increased systemic exposure to amlodipine 5 mg by 60% (US Food and Drug Administration () amlodipine label). Both drugs lower blood pressure, and their effects add up when they are taken together.

Symptoms

Lower blood pressure, dizziness on standing, fatigue, leg oedema. Older patients: fall risk.

Management

The combination is acceptable with monitoring. Clinical monitoring and a lower amlodipine dose may be needed, and the effect can be stronger in older patients (amlodipine SmPC). Watch for signs of hypotension and oedema and use them to decide whether the amlodipine dose should change (US Food and Drug Administration () amlodipine label).

Sources

Pair details →Diltiazem →

ModerateEmpagliflozinSodium-glucose co-transporter 2 inhibitors (SGLT2i)

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

ESC: ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2021)

Pair details →Empagliflozin →

ModerateFluconazoleAntifungals, triazole derivatives

Mechanism

Fluconazole is a moderate CYP3A4 inhibitor (fluconazole SmPC), and CYP3A4 takes part in amlodipine metabolism. Amlodipine levels may rise, and with them the risk of hypotension. The effect can be stronger in older patients (both SmPCs). Fluconazole has a long half-life, so its effect on the enzyme lasts 4–5 days after it is stopped (fluconazole SmPC). The documents do not give the size of the rise.

Symptoms

Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.

Management

The combination is acceptable with monitoring. While both drugs are taken, check frequently for amlodipine adverse effects (fluconazole SmPC). Watch for signs of hypotension and leg oedema and use them to decide whether the amlodipine dose should be lowered (amlodipine labels). Monitor older patients with particular care (amlodipine SmPC). The effect of fluconazole on the enzyme lasts 4–5 days after the last dose, so continue monitoring during those days (fluconazole SmPC).

Sources

Pair details →Fluconazole →

ModerateFluoxetineSelective serotonin reuptake inhibitors

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.

Sources

Pair details →Fluoxetine →

ModerateHaloperidolFirst-generation antipsychotics. Butyrophenone derivatives

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.

Sources

FDA: Haloperidol tablet (Ajanta Pharma USA Inc.) – Prescribing Information (2020)

Pair details →Haloperidol →

ModerateIbuprofenNon-steroidal anti-inflammatory drugs (NSAIDs)

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.

Sources

ESH: 2023 ESH Guidelines for the management of arterial hypertension (2023)

Pair details →Ibuprofen →

ModerateKetorolacNon-steroidal anti-inflammatory drugs (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.

Sources

FDA: Ketorolac tromethamine tablet (Amerisyn LLC) – Prescribing Information (2013)

Pair details →Ketorolac →

ModerateLinezolidOxazolidinone antibiotic

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).

Sources

FDA: Zyvox (linezolid) prescribing information (2018)

Pair details →Linezolid →

ModerateLosartanAngiotensin II receptor blockers (sartans)

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

Pair details →Losartan →

ModerateMeloxicamNSAID, COX-2 preferential, oxicam derivative

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).

Sources

FDA: Meloxicam tablet (Terrain Pharmaceuticals, Inc.) – Prescribing Information (2012)

Pair details →Meloxicam →

ModerateMethylprednisoloneSystemic glucocorticoid

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.

Sources

FDA: Norvasc (amlodipine) prescribing information (2017)

Pair details →Methylprednisolone →

ModerateMetoprololSelective β1-adrenoceptor blockers

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

Pair details →Metoprolol →

ModerateMorphineNatural opium alkaloids

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.

Sources

FDA: Verapamil hydrochloride tablet (Zydus Lifesciences Limited) – Prescribing Information (2017)

Pair details →Morphine →

ModerateNaproxenNSAID, propionic acid derivative

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).

Sources

FDA: Naproxen tablet (Glenmark Pharmaceuticals Inc., USA) – Prescribing Information (2016)

Pair details →Naproxen →

ModerateNitroglycerinOrganic nitrate

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.

Sources

FDA: Verapamil hydrochloride tablet (Zydus Lifesciences Limited) – Prescribing Information (2017)

Pair details →Nitroglycerin →

ModeratePrednisoloneGlucocorticoids

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.

Sources

FDA: Prednisolone prescribing information (2016)

Pair details →Prednisolone →

ModeratePropranololNon-selective beta blocker

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

Pair details →Propranolol →

ModerateQuetiapineAtypical antipsychotics

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.

Sources

FDA: Seroquel (quetiapine) prescribing information (2017)

Pair details →Quetiapine →

ModerateRifampicinAntituberculous antibiotic

Mechanism

Rifampicin is a strong inducer of CYP3A4 and other drug-metabolising enzymes (rifampicin SmPC). CYP3A4 takes part in amlodipine metabolism, so amlodipine levels may fall and its blood pressure effect may weaken (both SmPCs). The documents do not give the size of the fall for amlodipine. For other calcium channel blockers it has been measured: rifampicin reduced exposure to nifedipine by 64% and to verapamil by 93% (rifampicin SmPC).

Symptoms

Blood pressure returns to previous values or rises higher, and headache may appear. In angina, attacks may become more frequent.

Management

The combination is acceptable with blood pressure control. While rifampicin is taken and after it is stopped, measure blood pressure and consider adjusting the amlodipine dose (amlodipine labels). Doses of drugs affected by rifampicin may need adjustment both when it is started and when it is stopped (rifampicin SmPC). Nifedipine, nimodipine, nisoldipine and nitrendipine are contraindicated with rifampicin, so they cannot replace amlodipine (rifampicin SmPC). Rifampicin also reduces exposure to the active metabolite of enalapril, so if a patient is switched to it, the dose is set by clinical response (rifampicin SmPC).

Sources

Pair details →Rifampicin →

ModerateRitonavirHIV protease inhibitor / pharmacokinetic booster

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).

Sources

Pair details →Ritonavir →

ModerateSildenafilPhosphodiesterase type 5 inhibitors (PDE5)

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.

Sources

Pair details →Sildenafil →

ModerateTacrolimusCalcineurin inhibitor (immunosuppressant)

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).

Sources

Pair details →Tacrolimus →

MinorApixabanDirect oral anticoagulants (factor Xa inhibitors)

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.

Sources

FDA: Eliquis (apixaban) prescribing information (2021)

Pair details →Apixaban →

MinorBudesonideInhaled corticosteroids (ICS)

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.

Sources

FDA: Pulmicort (budesonide) prescribing information (2010)

Pair details →Budesonide →

MinorCalcium carbonateMineral supplements. Calcium

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.

Sources

ESH: 2023 ESH Guidelines for the management of arterial hypertension (2023)

Pair details →Calcium carbonate →

MinorEnalaprilAngiotensin-converting enzyme inhibitors (ACEi)

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

Pair details →Enalapril →

Label mentions43 mentions

Verbatim lines from the interaction sections, in the language of the label

From this drug’s label

MajorCiclosporin
«Ciclosporina: No se han realizado estudios de interacciones medicamentosas con ciclosporina y amlodipino en voluntarios sanos ni en otras poblaciones, salvo en pacientes sometidos a un trasplante…»
AEMPS, section 4.5 · Open on CIMA
MajorSimvastatin
«7.2. Impact of Amlodipine on Other Drugs: Simvastatin Co-administration of simvastatin with amlodipine increases the systemic exposure of simvastatin. Limit the dose of simvastatin in patients on…»
FDA, section 7 · Open on DailyMed
Moderateantifúngicos azólicosclass named in the label
«Inhibidores del CYP3A4: El uso concomitante de amlodipino con inhibidores fuertes o moderados del citocromo CYP3A4 (inhibidores de la proteasa, antifúngicos azólicos, macrólidos como la eritromicina…»
AEMPS, section 4.5 · Open on CIMA
ModerateClarithromycin
«Inhibidores del CYP3A4: El uso concomitante de amlodipino con inhibidores fuertes o moderados del citocromo CYP3A4 (inhibidores de la proteasa, antifúngicos azólicos, macrólidos como la eritromicina…»
AEMPS, section 4.5 · Open on CIMA
ModerateCYP3A4 inducersclass named in the label
«7.1. Impact of Other Drugs on Amlodipine: CYP3A Inducers No information is available on the quantitative effects of CYP3A inducers on amlodipine. Blood pressure should be closely monitored when…»
FDA, section 7 · Open on DailyMed
ModerateCYP3A4 inhibitorsclass named in the label
«7.1. Impact of Other Drugs on Amlodipine: CYP3A Inhibitors Co-administration with CYP3A inhibitors (moderate and strong) results in increased systemic exposure to amlodipine and may require dose…»
FDA, section 7 · Open on DailyMed
ModerateDiltiazem
«Inhibidores del CYP3A4: El uso concomitante de amlodipino con inhibidores fuertes o moderados del citocromo CYP3A4 (inhibidores de la proteasa, antifúngicos azólicos, macrólidos como la eritromicina…»
AEMPS, section 4.5 · Open on CIMA
ModerateErythromycin
«Inhibidores del CYP3A4: El uso concomitante de amlodipino con inhibidores fuertes o moderados del citocromo CYP3A4 (inhibidores de la proteasa, antifúngicos azólicos, macrólidos como la eritromicina…»
AEMPS, section 4.5 · Open on CIMA
Moderateimmunosuppressantsclass named in the label
«7.2. Impact of Amlodipine on Other Drugs: Immunosuppressants Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. Frequent monitoring of trough blood…»
FDA, section 7 · Open on DailyMed
Moderateinductores del CYP3A4class named in the label
«Inductores del CYP3A4: Tras la administración concomitante de inductores conocidos del CYP3A4, la concentración plasmática de amlodipino puede variar. Por lo tanto, se debe vigilar la presión…»
AEMPS, section 4.5 · Open on CIMA
Moderateinhibidores del CYP3A4class named in the label
«Inhibidores del CYP3A4: El uso concomitante de amlodipino con inhibidores fuertes o moderados del citocromo CYP3A4 (inhibidores de la proteasa, antifúngicos azólicos, macrólidos como la eritromicina…»
AEMPS, section 4.5 · Open on CIMA
Moderatemacrólidosclass named in the label
«Inhibidores del CYP3A4: El uso concomitante de amlodipino con inhibidores fuertes o moderados del citocromo CYP3A4 (inhibidores de la proteasa, antifúngicos azólicos, macrólidos como la eritromicina…»
AEMPS, section 4.5 · Open on CIMA
ModerateRifampicin
«Inductores del CYP3A4: Tras la administración concomitante de inductores conocidos del CYP3A4, la concentración plasmática de amlodipino puede variar. Por lo tanto, se debe vigilar la presión…»
AEMPS, section 4.5 · Open on CIMA
ModerateSildenafil
«7.1. Impact of Other Drugs on Amlodipine: Sildenafil Monitor for hypotension when sildenafil is co-administered with amlodipine [ see Clinical Pharmacology (12.2) ].»
FDA, section 7 · Open on DailyMed
ModerateTacrolimus
«Tacrolimus: Existe el riesgo de que las concentraciones sanguíneas de tacrolimus aumenten cuando se administra conjuntamente con amlodipino, si bien el mecanismo farmacocinético de dicha interacción…»
AEMPS, section 4.5 · Open on CIMA
ModerateTacrolimus
«7.2. Impact of Amlodipine on Other Drugs: Immunosuppressants Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. Frequent monitoring of trough blood…»
FDA, section 7 · Open on DailyMed
ModerateVerapamil
«Inhibidores del CYP3A4: El uso concomitante de amlodipino con inhibidores fuertes o moderados del citocromo CYP3A4 (inhibidores de la proteasa, antifúngicos azólicos, macrólidos como la eritromicina…»
AEMPS, section 4.5 · Open on CIMA
MinorAtorvastatin
«En estudios clínicos de interacción, amlodipino no afectó la farmacocinética de atorvastatina, digoxina o warfarina.»
AEMPS, section 4.5 · Open on CIMA
Digoxin
«En estudios clínicos de interacción, amlodipino no afectó la farmacocinética de atorvastatina, digoxina o warfarina.»
AEMPS, section 4.5 · Open on CIMA
Everolimus
«Los inhibidores de mTOR como, por ejemplo, sirolimus, temsirolimus y everolimus son sustratos del CYP3A. El amlodipino es un inhibidor débil del CYP3A. Con el uso concomitante de inhibidores de mTOR…»
AEMPS, section 4.5 · Open on CIMA
Simvastatin
«Simvastatina: La administración conjunta de dosis múltiples de 10 mg de amlodipino con 80 mg de simvastatina dio lugar a un aumento de un 77% en la exposición a simvastatina comparado con…»
AEMPS, section 4.5 · Open on CIMA
Sirolimus
«Los inhibidores de mTOR como, por ejemplo, sirolimus, temsirolimus y everolimus son sustratos del CYP3A. El amlodipino es un inhibidor débil del CYP3A. Con el uso concomitante de inhibidores de mTOR…»
AEMPS, section 4.5 · Open on CIMA

From other drugs’ labels

MajorSimvastatin
«Amlodipino: Los pacientes en tratamiento con amlodipino, tratados concomitantemente con simvastatina, tienen un riesgo mayor de miopatía. En un estudio farmacocinético, la administración concomitante…»
AEMPS, section 4.5 · Open on CIMA
MajorSimvastatin
«Drug Interactions that Increase the Risk of Myopathy and Rhabdomyolysis with Simvastatin: Intervention: For patients taking verapamil, diltiazem, or dronedarone, do not exceed simvastatin 10 mg…»
FDA, section 7 · Open on DailyMed
ModerateBisoprolol
«Combinaciones a usar con precaución: Antagonistas del calcio del tipo dihidropiridina como nifedipino, felodipino y amlodipino: El uso concomitante en pacientes con insuficiencia cardiaca pueda…»
AEMPS, section 4.5 · Open on CIMA
ModerateClarithromycin
«Bloqueantesde canales de calcio: Se recomienda precaución con respecto a la administración concomitante de claritromicina y bloqueantess de los canales de calcio metabolizados por CYP3A4 (p. ej…»
AEMPS, section 4.5 · Open on CIMA
ModerateCobicistat
«Established and Other Potentially Significant Interactions: Calcium Channel Blockers: e.g., amlodipine diltiazem felodipine nifedipine verapamil ↑ calcium channel blockers Clinical monitoring is…»
FDA, section 7 · Open on DailyMed
ModerateDarunavir
«BLOQUEANTES DE LOS CANALES DE CALCIO: Amlodipino Diltiazem Felodipino Nicardipino Nifedipino Verapamilo»
AEMPS, section 4.5 · Open on CIMA
ModerateDarunavir
«Established and Other Potentially Significant Drug Interactions: Calcium Channel Blockers : amlodipine, diltiazem, felodipine, nicardipine, nifedipine, verapamil  calcium channel blockers Clinical…»
FDA, section 7 · Open on DailyMed
ModerateFluconazole
«Antagonistas de los canales de calcio: El isoenzima CYP3A4 está implicado en el metabolismo de algunos antagonistas de los canales de calcio (nifedipino, isradipino, amlodipino, verapamilo y…»
AEMPS, section 4.5 · Open on CIMA
MinorAtorvastatin
«Interacciones farmacológicas: Amlodipino 10 mg, dosis única»
AEMPS, section 4.5 · Open on CIMA
MinorSildenafil
«diuréticos, beta bloqueantes, inhibidores de la ECA, antagonistas de la angiotensina II, fármacos antihipertensivos (vasodilatadores y de acción central), bloqueantes de las neuronas adrenérgicas…»
AEMPS, section 4.5 · Open on CIMA
Clarithromycin
«DRUG INTERACTIONS: Amlodipine Diltiazem Amlodipine, Diltiazem: [See Warnings and Precautions (5.4) ]»
FDA, section 7 · Open on DailyMed
Dofetilide
«Drug-Drug Interactions: Cimetidine: (see WARNINGS, CONTRAINDICATIONS ) Concomitant use of cimetidine is contraindicated. Cimetidine at 400 mg BID (the usual prescription dose) co-administered with…»
FDA, section 7 · Open on DailyMed
Itraconazole
«Antivirales para uso sistémico: Bosentán, Diltiazem, Guanafacina, Otras Dihidropiridinas (p. ej., amlodipino, isradipino, nefidipino, nimodipino), Verapamilo»
AEMPS, section 4.5 · Open on CIMA
Nebivolol
«Asociaciones que es preciso valorar : Antagonistas del calcio de tipo dihidropiridina (amlodipino, felodipino, lacidipino, nifedipino, nicardipino, nimodipino, nitrendipino): su uso concomitante…»
AEMPS, section 4.5 · Open on CIMA
Rifampicin
«amlodipino.»
AEMPS, section 4.5 · Open on CIMA
Sildenafil
«Amlodipine: When sildenafil tablets 100 mg were co-administered with amlodipine (5 mg or 10 mg) to hypertensive patients, the mean additional reduction on supine blood pressure was 8 mmHg systolic…»
FDA, section 7 · Open on DailyMed
Tadalafil
«Potential for Pharmacodynamic Interactions with Tadalafil Tablets: Antihypertensives — PDE5 inhibitors, including tadalafil are mild systemic vasodilators. Clinical pharmacology studies were…»
FDA, section 7 · Open on DailyMed
Valsartan
«En estudios de interacción farmacológica con valsartán, no se han hallado interacciones clínicamente significativas entre valsartán y cualquiera de las siguientes sustancias : cimetidina, warfarina…»
AEMPS, section 4.5 · Open on CIMA

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Frequently asked

What is Amlodipine used for?

Amlodipine is evaluated for the following indications with varying evidence strength: Hypertension (evidence tier A), Coronary artery disease (evidence tier A), Vasospastic (Prinzmetal) angina (evidence tier B). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Amlodipine?

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.

Is Amlodipine safe during pregnancy?

Is Amlodipine compatible with breastfeeding?

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.

Who should not take Amlodipine?

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.

Official sources

Direct links to regulator labels. Open in a new tab.

AEMPS / CIMA
FDA / DailyMedLabel dated 07/17/2026
GRLSLabel dated 03/30/2026

Other drugs in this group

Diltiazem, Lercanidipine, Manidipine, Nifedipine, Verapamil