Formulary
Amlodipine: Uses, Dosing, Side Effects and Indian Brand Names
Amlodipine is a long-acting dihydropyridine calcium channel blocker used as first-line therapy for hypertension and chronic stable angina, with the longest half-life in its class allowing reliable once-daily dosing.
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Amlodipine: Uses, Dosing, Side Effects and Indian Brand Names
Amlodipine is a long-acting dihydropyridine calcium channel blocker used as first-line therapy for hypertension and chronic stable angina, with the longest half-life in its class allowing reliable once-daily dosing.
NEET PG High-Yield: Dihydropyridine vs non-dihydropyridine distinction is heavily tested. Amlodipine = vasodilation, no AV block. Verapamil/diltiazem = cardiac conduction effects. Ankle oedema is the signature side effect. Longest-acting CCB (36-hour half-life). ASCOT-BPLA is a commonly cited trial.
Clinical overview
Amlodipine is a third-generation dihydropyridine calcium channel blocker and one of the most widely prescribed antihypertensives in India. Its exceptionally long half-life of approximately 36 hours allows reliable once-daily dosing, which improves patient compliance -- a critical factor in a country where hypertension treatment adherence remains below 30% in rural populations. Amlodipine lowers blood pressure by reducing systemic vascular resistance through arteriolar vasodilation, with negligible effect on venous capacitance vessels. Unlike non-dihydropyridines such as verapamil and diltiazem, amlodipine does not depress the sinoatrial or atrioventricular nodes, making it safe in combination with beta-blockers without compounding bradycardia risk. The ASCOT-BPLA trial demonstrated superiority of amlodipine-based regimens over atenolol-based regimens in reducing cardiovascular events, consolidating its place as a first-line agent. In Indian practice, amlodipine is available across all tiers of the healthcare system, from tertiary hospitals to Jan Aushadhi centres, at highly affordable prices. It is metabolically neutral, does not worsen glycaemic control, and requires no dose adjustment in renal impairment, making it suitable for the large diabetic hypertensive population in India. Fixed-dose combinations with ARBs and thiazides are extremely popular in Indian prescribing.
Pharmacological class
Amlodipine belongs to the Calcium Channel Blockers (Dihydropyridine) class. Blocks L-type voltage-gated calcium channels in vascular smooth muscle, reducing peripheral vascular resistance. Has minimal effect on cardiac conduction, unlike verapamil and diltiazem. The dihydropyridine structure confers vascular selectivity, producing vasodilation without significant negative inotropy or chronotropy at therapeutic doses.
Indian brand names and formulations
Available as: Amlong (Micro Labs), Amlodac (Zydus), Stamlo (Dr. Reddy's), Amlopress (Cipla).
Tablets: 2.5 mg, 5 mg, 10 mg. Also available in fixed-dose combinations with atenolol, telmisartan, olmesartan, losartan, and hydrochlorothiazide.
Regulatory status
Amlodipine is classified under Schedule H in India under the Drugs and Cosmetics Act, 1940. Prescription-only. Available widely at Jan Aushadhi centres at subsidised rates.
Indications
- Hypertension (first-line, JNC 8 and Indian Hypertension Guidelines)
- Chronic stable angina
- Vasospastic (Prinzmetal) angina
- Raynaud phenomenon (off-label)
Dosing
Adults: 5 mg once daily, may increase to 10 mg. Elderly or hepatic impairment: start at 2.5 mg. No dose adjustment needed in renal impairment. Steady state reached in 7-8 days due to long half-life.
Contraindications
- Severe aortic stenosis
- Cardiogenic shock
- Unstable angina (not recommended as monotherapy)
- Hypersensitivity to dihydropyridines
Adverse effects
- Peripheral oedema (dose-dependent, most common reason for discontinuation, occurs in up to 10% at 10 mg dose)
- Headache and flushing
- Dizziness
- Gingival hyperplasia (less common than with nifedipine)
- Fatigue and somnolence
Drug interactions
- Simvastatin: limit simvastatin to 20 mg daily when co-prescribed (increased myopathy risk via CYP3A4 competition)
- CYP3A4 inhibitors (ketoconazole, erythromycin, diltiazem): may increase amlodipine levels
- Cyclosporine: amlodipine may increase cyclosporine levels; monitor trough levels
Pregnancy and lactation
Category C. Not recommended in pregnancy. Labetalol or nifedipine (short-acting for acute, extended-release for chronic) are preferred for hypertension in pregnancy per Indian guidelines.
Exam-style clinical scenario
A 55-year-old man with hypertension and chronic stable angina. Which single antihypertensive also addresses his angina? Amlodipine -- it reduces both BP (through vasodilation) and myocardial oxygen demand (through afterload reduction), making it ideal for this dual indication.
Cost in India
Rs 15-50 for a strip of 10 tablets (5 mg). Available at subsidised rates through Jan Aushadhi at approximately Rs 1 per tablet.
Clinical governance
Author: MedNext Editorial Team. Clinical reviewer: Awaiting clinical review. Jurisdiction: India (Drugs and Cosmetics Act, 1940). Sources: CIMS India, Indian Pharmacopoeia. Publication state: Awaiting clinical review. Correction: Report errors at support@mednext.academy.
Frequently Asked Questions
Is amlodipine safe in diabetic patients?
Yes. Amlodipine is metabolically neutral and does not worsen glucose control. It is a preferred antihypertensive in diabetic patients when an ACE inhibitor or ARB alone is insufficient.
Why does amlodipine cause ankle swelling?
It preferentially dilates pre-capillary arterioles without matching venodilation, increasing capillary hydrostatic pressure. This drives fluid into the interstitium. The effect is dose-dependent and reversible on discontinuation. Adding an ACE inhibitor or ARB can reduce the oedema by causing venodilation.
What is the NEET PG significance of amlodipine?
Key exam points: longest half-life CCB (36h), dihydropyridine (no cardiac conduction effects), peripheral oedema as dose-limiting side effect, safe in renal impairment, and the simvastatin dose cap interaction.
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