Amlodipine leg swelling
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Amlodipine and Leg Swelling: An Overview
Introduction to Amlodipine and Its Uses
Amlodipine is a widely used calcium channel blocker (CCB) prescribed for the treatment of hypertension, angina, and coronary artery disease. It works by inhibiting the influx of calcium ions into vascular smooth muscle and myocardial cells, leading to vasodilation and reduced blood pressure . However, one of the common adverse effects associated with amlodipine is leg swelling or edema.
Mechanism of Amlodipine-Induced Leg Swelling
Amlodipine-induced leg swelling occurs due to its effect on postural skin vasoconstriction. Normally, this autoregulatory mechanism minimizes gravitational increases in capillary pressure and prevents fluid extravasation when standing. Amlodipine blunts this vasoconstriction, leading to increased capillary pressure and fluid leakage into the interstitial space, causing edema .
Comparative Studies on Amlodipine and Other CCBs
Amlodipine vs. Lercanidipine
Several studies have compared the edema-forming potential of amlodipine with other CCBs. For instance, a study involving postmenopausal hypertensive women found that amlodipine caused significantly more leg swelling compared to lercanidipine. The increase in leg volume was notably higher in the amlodipine group (60.4 ± 8.6 ml) compared to the lercanidipine group (5.3 ± 8.1 ml) . Additionally, a higher percentage of patients on amlodipine reported symptoms of leg swelling and heaviness .
Amlodipine vs. (S)-Amlodipine
Another study compared conventional amlodipine with (S)-amlodipine, a stereoisomer of amlodipine. The incidence of leg edema was significantly lower in patients treated with (S)-amlodipine (31.40%) compared to those on conventional amlodipine (46.51%) . This suggests that (S)-amlodipine may be a better-tolerated alternative with similar antihypertensive efficacy.
Amlodipine vs. Mibefradil
In a comparative study, mibefradil, another CCB, was found to cause significantly less leg edema than amlodipine. Only 7% of patients on mibefradil reported leg edema compared to 17% of those on amlodipine . This indicates that mibefradil may be a preferable option for patients who experience significant edema with amlodipine.
Case Reports and Clinical Observations
Clinical case reports have also highlighted the occurrence of leg swelling with amlodipine. For example, a 32-year-old female patient developed significant ankle and leg swelling after being on amlodipine for hypertension. The symptoms improved upon discontinuation of the drug, confirming the adverse reaction . Another case involved a 56-year-old man who developed bilateral leg swelling and Schamberg’s disease while on amlodipine, which improved after stopping the medication .
Conclusion
Amlodipine is an effective antihypertensive agent but is commonly associated with leg swelling due to its impact on postural vasoconstriction. Comparative studies indicate that other CCBs like lercanidipine, (S)-amlodipine, and mibefradil may cause less edema, offering potential alternatives for patients who experience this side effect. Clinicians should be aware of this adverse effect and consider alternative treatments or dose adjustments to manage and mitigate leg swelling in patients on amlodipine.
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