Calcium channel blockers · Cardiovascular
Amlodipine
Norvasc®(brand names vary by market)
The slow, smooth dihydropyridine: once daily, forgiving, everywhere.
Mechanism
Dihydropyridine L-type calcium channel blocker, vascular-selective: arteriolar vasodilation with minimal direct cardiac effect.
Indications
- Hypertension
- Chronic stable angina
Formulations
Tablet
Dosing concepts
Onset
Very long half-life means slow onset and offset. A missed dose barely shows, and full effect takes weeks.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- ~60-65%
- Half-life
- 30-50 h
- Elimination
- hepatic
Adverse effects
- Ankle edemacommonPrecapillary dilation; diuretics do not fix it, dose reduction or an ACE inhibitor/ARB partner helps.
- Flushing, headachecommon
- Reflex tachycardia (mild)common
- Gingival hyperplasiacommonUnder-recognized; ask about gums.
Contraindications & precautions
Contraindications
- Severe hypotension
- Cardiogenic shock
Precautions
- Severe aortic stenosis
- Hepatic impairment (slower clearance)
Interactions
Monitoring
Blood pressure
Effectiveness
Ankle swelling
The dose-limiting nuisance effect
Counselling points
- Ankle swelling is common and not fluid overload; tell us rather than starting anything for it.
- Effect builds over one to two weeks.
Clinical pearls
- Edema is dose-dependent and mechanical: pairing with a RAAS blocker (postcapillary dilation) reduces it more than any diuretic.
References & review
- Amlodipine product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-15 · jurisdiction: global · drug information changes; verify against current references before practice use.