Prescribing Guides
Amlodipine Prescribing Guide for Indian Clinical Practice
Amlodipine prescribing reference for Indian clinicians covering calcium channel blocker pharmacology, dosing, ankle oedema management and NEET PG points.
MedNext Editorial Team | 2026-08-01 | 8 min read
Amlodipine Prescribing Guide for Indian Clinical Practice
Amlodipine prescribing reference for Indian clinicians covering calcium channel blocker pharmacology, dosing, ankle oedema management and NEET PG points.
Amlodipine is the most widely prescribed calcium channel blocker in India and a first-line antihypertensive agent. Its long half-life, predictable pharmacokinetics, and safety profile make it suitable across a wide range of patients.
Clinical Pharmacology Overview
Amlodipine is a third-generation dihydropyridine calcium channel blocker that inhibits L-type voltage-gated calcium channels in vascular smooth muscle, causing peripheral arteriolar vasodilation and reduced systemic vascular resistance. It has minimal effect on cardiac conduction (unlike verapamil and diltiazem) and minimal negative inotropy at therapeutic doses.
Pharmacokinetics: Bioavailability is 64-90%. Slowly absorbed, with peak plasma concentration at 6-12 hours. Extensively protein-bound (93-98%). Very long half-life of 30-50 hours, the longest among CCBs, allowing reliable once-daily dosing. Extensively metabolised by CYP3A4 in the liver. Steady state reached in 7-8 days.
Indian Brand Names
- Amlong (Micro Labs)
- Amlokind (Mankind Pharma)
- Amlopress (Cipla)
- Stamlo (Dr. Reddy's)
- Amlodac (Zydus Cadila)
Approved Indications in Indian Clinical Practice
- Hypertension (first-line monotherapy or combination)
- Chronic stable angina
- Vasospastic (Prinzmetal) angina
- Raynaud phenomenon (off-label but commonly used)
Dosing in Adults
Hypertension: Start at 5 mg once daily. Maximum: 10 mg once daily. In the elderly or patients with hepatic impairment, start at 2.5 mg.
Angina: 5-10 mg once daily.
Can be taken at any time of day, with or without food. The long half-life means missed doses have less impact on blood pressure control than with shorter-acting agents.
Important Drug Interactions
- CYP3A4 inhibitors (clarithromycin, itraconazole, grapefruit juice): may increase amlodipine levels
- CYP3A4 inducers (rifampicin, carbamazepine): may reduce amlodipine efficacy
- Simvastatin: amlodipine increases simvastatin levels -- do not exceed simvastatin 20 mg when combined
- Cyclosporine, tacrolimus: amlodipine may increase their levels
- Beta-blockers: safe and effective combination for angina and hypertension
Side Effects and Monitoring
Common: peripheral oedema (ankle swelling -- dose-dependent, up to 10% at 10 mg), flushing, headache, dizziness, palpitations.
The ankle oedema is due to precapillary arteriolar dilation (not fluid retention) and often improves when an ACE inhibitor or ARB is added.
Serious: excessive hypotension (rare at usual doses), gingival hyperplasia (less common than with nifedipine).
Monitoring: blood pressure and heart rate. No routine blood test monitoring needed. Monitor for ankle oedema and adjust strategy (add ACEI/ARB or reduce dose) rather than adding diuretics.
Special Populations
Pregnancy: Category C. Not recommended as first-line in pregnancy (nifedipine or labetalol preferred). However, sometimes used in resistant hypertension in pregnancy under specialist guidance.
Renal impairment: No dose adjustment needed. Amlodipine is not removed by dialysis.
Hepatic impairment: Start at 2.5 mg. Half-life is significantly prolonged in cirrhosis.
Elderly: Well-suited for elderly patients. Start at 2.5 mg. Good compliance with once-daily dosing.
NEET PG High-Yield Points
- Dihydropyridine CCB -- acts on vascular smooth muscle, not cardiac conduction
- Longest half-life among CCBs (30-50 hours) -- once daily, steady state in 7-8 days
- Ankle oedema mechanism: precapillary arteriolar dilation (NOT fluid retention)
- Safe in heart failure (PRAISE trial) -- unlike other dihydropyridines
- Does NOT cause reflex tachycardia (gradual onset)
- Short-acting nifedipine capsules are CONTRAINDICATED in hypertension
- CCB classification: dihydropyridines (vessel-selective) vs non-dihydropyridines (heart-selective: verapamil, diltiazem)
- No negative inotropy at therapeutic doses
- Simvastatin dose cap when combined with amlodipine
Indian Regulatory Status
Amlodipine is a Schedule H drug under the Drugs and Cosmetics Act. It is included in the NLEM and is price-controlled under DPCO. It is one of the most commonly prescribed antihypertensives in India and is available in numerous fixed-dose combinations with ARBs (telmisartan, losartan, olmesartan), beta-blockers (atenolol, metoprolol), and statins (atorvastatin). Generic amlodipine is widely affordable.
Frequently Asked Questions
Why does amlodipine cause ankle swelling?
Amlodipine dilates arterioles more than venules, creating a pressure gradient that pushes fluid into the interstitial space (precapillary vasodilation). This is not fluid retention or heart failure. It is dose-dependent and can be mitigated by combining with an ACE inhibitor or ARB, which dilates the venous side and restores the balance.
Is amlodipine safe in the elderly?
Yes. Amlodipine is well-suited for elderly hypertensive patients because of its long half-life (once daily dosing aids compliance), gradual onset (no reflex tachycardia), and no dose adjustment needed for age. Start at 2.5 mg and titrate.
Can amlodipine be used in heart failure?
Unlike other dihydropyridine CCBs, amlodipine is safe in heart failure (PRAISE trial). However, it does not improve mortality -- it is used as an add-on antihypertensive or antianginal when needed, not as heart failure therapy.
Why is amlodipine preferred over nifedipine?
Amlodipine has a much longer half-life (30-50 hours vs 2-5 hours for nifedipine), allowing once-daily dosing. It has a gradual onset, avoiding the reflex tachycardia seen with short-acting nifedipine. Short-acting nifedipine capsules are now discouraged in hypertension due to adverse cardiovascular outcomes.
Continue reading
Prescribing GuidesMetformin Prescribing Guide for Indian Clinical Practice
Evidence-based metformin prescribing for Indian clinicians covering dosing, brands, interactions, monitoring and NEET PG high-yield points.
Prescribing GuidesCeftriaxone Prescribing Guide for Indian Clinical Practice
Complete ceftriaxone prescribing reference for Indian clinicians covering indications, dosing, reconstitution, drug interactions and NEET PG points.
Prescribing GuidesAmoxicillin Prescribing Guide for Indian Clinical Practice
Comprehensive amoxicillin prescribing reference for Indian doctors covering dosing, brands, resistance patterns and NEET PG high-yield pharmacology.
Continue with Prescribing Guides
Apply what you have read with clinical prescribing MCQs that test real decision-making: drug choice, dose selection, interactions and monitoring.
Try prescribing questionsBrowse all prescribing guides