Get off amlodipine
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Discontinuing Amlodipine: Insights and Considerations
Introduction to Amlodipine Discontinuation
Amlodipine, a long-acting dihydropyridine calcium antagonist, is commonly prescribed for hypertension and chronic stable angina. Understanding the implications of discontinuing amlodipine is crucial for both patients and healthcare providers to ensure safe and effective management of cardiovascular conditions.
Lack of Withdrawal Phenomenon
One of the significant concerns with discontinuing cardiovascular medications is the potential for withdrawal effects. However, studies have shown that amlodipine does not exhibit a "withdrawal phenomenon" upon abrupt discontinuation. In a double-blind study involving patients with chronic stable angina, no significant problems were noted when amlodipine was abruptly stopped, unlike the issues observed with abrupt cessation of beta-blockers. This suggests that patients can discontinue amlodipine without experiencing severe rebound effects.
Gradual Return to Baseline Blood Pressure
Amlodipine has a long elimination half-life, which contributes to its prolonged antihypertensive effect even after discontinuation. Research indicates that blood pressure gradually returns to baseline over 7-10 days after stopping amlodipine, with no evidence of a rebound effect. This gradual return helps mitigate the risks associated with sudden changes in blood pressure.
Adverse Drug Reactions Leading to Discontinuation
Adverse drug reactions (ADRs) are a common reason for discontinuing amlodipine. A study using primary care prescribing databases found that a significant proportion of patients discontinued amlodipine due to ADRs, with 98% of patients in one subset stopping the medication because of adverse events. Common ADRs include peripheral edema, dizziness, and fatigue, which can impact patient adherence and necessitate discontinuation.
Specific Adverse Effects and Case Reports
Certain adverse effects, although rare, can be severe and lead to discontinuation. For instance, there have been reports of amlodipine-induced parkinsonism and anasarca edema, both of which resolved upon discontinuation of the drug . These cases highlight the importance of monitoring for unusual side effects and considering discontinuation if severe reactions occur.
Impact on Clopidogrel Efficacy
Amlodipine can interact with other medications, such as clopidogrel, used in patients with coronary artery disease. Studies have shown that amlodipine can reduce the bioactivation of clopidogrel, leading to increased platelet reactivity. Discontinuing amlodipine in such patients can improve clopidogrel responsiveness, which is crucial for preventing thrombotic events.
Conclusion
Discontinuing amlodipine is generally safe and does not lead to a withdrawal phenomenon or significant rebound hypertension. However, adverse drug reactions are a common reason for discontinuation, and healthcare providers should monitor patients for these effects. In cases of severe ADRs or drug interactions, discontinuation may be necessary to ensure patient safety and treatment efficacy. Understanding these factors can help manage the discontinuation process effectively and maintain optimal cardiovascular health.
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