Amlodipine

Calcium channel blockers, dihydropyridines

ATC code: C08CA01 (Amlodipine)

Mechanism of action

Blocks L-type calcium channels in vascular smooth muscle, reducing calcium influx, relaxing arterial walls, and lowering total peripheral vascular resistance. Minimal effect on the myocardium. Long half-life of 30–50 hours provides stable 24-hour blood pressure control.

Indications

Coronary artery disease

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.

Hypertension

First line

Amlodipine belongs to one of the five first-line antihypertensive classes per ESC/ESH 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.

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.

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

PregnancyFDA C

FDA category C. Limited safety data in pregnancy. When antihypertensive therapy is needed during pregnancy, methyldopa, labetalol, or nifedipine are preferred.

Breastfeeding

Excreted in breast milk. Limited data on infant effects. Decision on breastfeeding is individualized.