Side effects of amlodipine
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Side Effects of Amlodipine
Peripheral Edema and Headache
Amlodipine, a widely used calcium channel blocker, is associated with several side effects, the most notable being peripheral edema and headache. A meta-analysis of randomized, placebo-controlled trials revealed that the incidence of peripheral edema in patients treated with amlodipine was significantly higher compared to those on placebo (16.6% vs. 6.2%). This side effect is dose-dependent, with higher doses (10 mg) resulting in a greater risk of edema compared to lower doses (2.5-5 mg). Interestingly, up to one-third of edema cases might not be directly induced by amlodipine. On the other hand, the incidence of headaches was actually lower in patients treated with amlodipine compared to placebo, particularly at low to medium doses.
Comparison with Other Antihypertensive Agents
When compared to other antihypertensive agents, amlodipine generally has a favorable safety profile. For instance, in studies comparing amlodipine with beta-blockers like atenolol and nadolol, amlodipine was associated with fewer severe side effects. Additionally, in comparisons with other calcium channel blockers such as nifedipine retard, amlodipine had a lower incidence of adverse effects like headache and flushing during the initial treatment period. However, amlodipine was more likely to cause edema compared to verapamil, another calcium channel blocker.
Common Side Effects
The most common side effects of amlodipine include flushing, headache, and dizziness. These side effects are generally mild to moderate in severity and are related to the vasodilatory action of the drug. In pediatric populations, the incidence of amlodipine-related edema is lower compared to adults, but monitoring for edema remains important.
Metabolic and Renal Effects
Amlodipine does not appear to cause adverse changes in serum lipid patterns, cardiac conduction disturbances, or postural hypotension, which are often associated with other cardiovascular agents. It is also not associated with deleterious effects on serum creatinine, urate, and fasting glucose levels, unlike hydrochlorothiazide. In renal transplant recipients, amlodipine has been shown to reduce cyclosporin-induced hyperuricaemia and improve renal function parameters.
Tolerability and Dosage Considerations
Amlodipine is well tolerated by elderly patients and does not require dosage modifications in cases of renal impairment. However, the dosage regimen for patients with hepatic impairment is not yet established. The drug's long half-life and gradual absorption make it effective for once-daily dosing, minimizing the incidence of side effects due to rapid absorption.
Conclusion
Amlodipine is a well-tolerated antihypertensive and antianginal agent with a favorable safety profile. While it is associated with side effects such as peripheral edema and headache, these are generally mild to moderate and dose-dependent. Compared to other antihypertensive agents, amlodipine offers several advantages, including fewer severe side effects and no adverse metabolic effects. However, monitoring for edema, especially in higher doses, remains crucial.
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