Withdrawal symptoms from amlodipine

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Withdrawal Symptoms from Amlodipine: A Comprehensive Review

Introduction to Amlodipine Withdrawal

Amlodipine, a long-acting dihydropyridine calcium channel blocker, is commonly prescribed for conditions such as hypertension and chronic stable angina. Understanding the potential withdrawal symptoms associated with amlodipine is crucial for both patients and healthcare providers to ensure safe discontinuation of the medication.

Lack of Withdrawal Phenomenon

Clinical Studies on Amlodipine Withdrawal

Several studies have investigated the potential withdrawal effects of amlodipine. A notable study involving 226 patients with chronic stable angina pectoris demonstrated that abrupt discontinuation of amlodipine did not result in significant withdrawal symptoms. The study included an 8-week single-blind treatment phase followed by a 4-week double-blind withdrawal phase. The results indicated no significant problems associated with the abrupt cessation of amlodipine, contrasting with the withdrawal issues often seen with beta-blockers .

Randomized Placebo-Controlled Withdrawal Studies

Further supporting these findings, a randomized placebo-controlled study assessed the antianginal and antiischemic efficacy, safety, and potential for withdrawal effects of amlodipine. In this study, 172 patients who responded to amlodipine treatment were either continued on the drug or switched to a placebo for 4 weeks. The group that continued on amlodipine showed minimal changes in exercise capacity and angina onset time, while the placebo group experienced a decline in these parameters. This suggests that amlodipine does not cause significant withdrawal symptoms upon discontinuation 23.

Side Effects and Tolerability

Comparison with Other Calcium Channel Blockers

Amlodipine's side effect profile is generally favorable compared to other calcium channel blockers. In a multicenter crossover study, amlodipine was associated with fewer adverse effects such as headache and flushing compared to nifedipine retard. This lower incidence of side effects resulted in fewer withdrawals during the initiation of therapy .

Meta-Analysis of Amlodipine Tolerability

A comprehensive meta-analysis involving 12,831 patients further confirmed the tolerability of amlodipine. Only 15% of patients reported adverse effects, and a mere 3% discontinued the drug due to intolerance. Common side effects included peripheral edema, headache, and flushing, which are typical of dihydropyridines and related to arteriolar vasodilation. Importantly, the incidence of adverse effects was not influenced by the dosage or disease status, highlighting amlodipine's consistent safety profile .

Conclusion

The available research indicates that amlodipine does not cause significant withdrawal symptoms upon abrupt discontinuation. This is a notable advantage over other cardiovascular medications such as beta-blockers, which are known for their withdrawal phenomena. Amlodipine's favorable side effect profile and high tolerability make it a reliable option for long-term management of hypertension and chronic stable angina.

Sources and full results

Most relevant research papers on this topic

A double-blind evaluation of amlodipine in patients with chronic, stable angina: sustained efficacy and lack of "withdrawal phenomenon" upon abrupt discontinuation.

Amlodipine is an effective and well-tolerated treatment for chronic, stable angina pectoris, with no evidence of tolerance and no significant withdrawal problems.

RCT

1994·

7citations

·Jawahar L. Mehta et al.

Randomized Placebo-Controlled Withdrawal Study of Amlodipine in Agina Pectoris.

Amlodipine include headache, dizziness, and rash, but these side effects are more common in patients with a history of heart attack or stroke.

RCT

1995·

3citations

·J. Gorwit et al.

RANDOMIZED PLACEBO‐CONTROLLED WITHDRAWAL STUDY OF AMLODIPINE IN ANGINA PECTORIS

Amlodipine effectively improves exercise capacity and reduces angina onset in patients with stable angina pectoris, with no significant withdrawal effects observed.

RCT

1995·

2citations

·J. Gorwit et al.

Early side-effects of antihypertensive therapy: comparison of amlodipine and nifedipine retard.

Amlodipine has a lower incidence and reduced severity of vasodilatory side-effects during the first 14 days of treatment for mild hypertension compared to nifedipine retard, leading to fewer withdrawals during initiation of therapy.

RCT

1993·

21citations

·Bremner Ad et al.

Tolerability of Amlodipine

Amlodipine is a well-tolerated drug for treating hypertension and ischemic heart disease, with a 15% incidence of adverse effects and a significantly lower occurrence compared to alternative calcium antagonists, -blockers, or ACE inhibitors.

Meta-Analysis

1997·

6citations

·G. Perna et al.

Clinical safety and efficacy of once-a-day amlodipine for chronic stable angina pectoris.

Once-a-day amlodipine is a safe and effective treatment for chronic stable angina pectoris, reducing angina episodes and improving exercise tolerance and ST-segment depression.

RCT

1988·

23citations

·Stephen P. Glasser et al.

Amlodipine gynaecomastia.

Amlodipine may cause gynecomastia in males, but symptoms resolve within 3 weeks of drug withdrawal.

Case Report

2001·

7citations

·P. Cornes et al.

A randomised, double-blind trial comparing mibefradil and amlodipine: two long-acting calcium antagonists with similar efficacy but different tolerability profiles

Mibefradil and amlodipine effectively reduce blood pressure in patients with mild-to-moderate essential hypertension, with both compounds showing similar tolerability profiles.

RCT

1997·

25citations

·R. Viskoper et al.

Double-blind comparison of amlodipine and hydrochlorothiazide in patients with mild to moderate hypertension.

Amlodipine is more effective than hydrochlorothiazide for achieving blood pressure control in mild to moderate hypertension, with no significant changes in pulse rate or electrocardiogram.

RCT

1994·

27citations

·James F. Burris et al.

Amlodipine decreases fibrosis and cardiac hypertrophy in spontaneously hypertensive rats: persistent effects after withdrawal.

Chronic amlodipine treatment reduces left ventricular hypertrophy and fibrosis in spontaneously hypertensive rats, with the latter effect persisting after drug withdrawal.

Non-RCTAnimal Study

2004·

37citations

·M. Sevilla et al.

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