Amlodipine induced edema legs

Amlodipine causes marked coronary and peripheral arterial vasodilation (which leads to plasma leakage in dependent areas since the veins remain constricted). As happens with other dihydropyridine calcium blockers, this results in a small percentage of patients having a problem with pedal edema 





 The pedal edema is not related to congestive heart failure and 
responds only inconsistently to diuretics, but it is not harmful.

This results in near permanent  collection of fluid  especially  near  the ankle . 

Systemic fluid retention has no major role . However few patients may  show 

an  augmented   RASS  response due to sudden arteriolar dilatation  .  In these

 patients   addition of ACEI or ARB may help relieve  edema legs .The Amlodipine  

induced edema is  dose  and  time dependent .(Cumulative)  . It is mostly benign

 in nature ,  rarely warrants withdrawal of the drug.  The edema can  occasionally

 be generalised   and weight  gain is  possible .

Other factors that increase the chance of edema is age , women  , obesity. They 

have loose  interstitial  tissues.Many especailly women complain tingling feeling

 in the edematous zone.

The calcium blocker induced edema is  an  exclusive feature of dihydrpyridine

 group  .(For some reason  , Verapamil and Diltiazem do not  share  this 

side effect .Are they a balanced Arteriolar and venous dilator  )

Can we use diuretics to treat 

Amlodipine induced edema legs ?

Hydrochorthiazide  is rarely useful as 

the primary problem is not in the renal  retention.

How to  treat Amlodipine induced edema ?

Unfortunately the popular combination with diuretics do not work . Angiotensin  inhibitors which has some veno dilatation is shown to reduce this edema  . 

Olmesartan / Telmisartan combination  is an option ) .It defies logic ,  to  add 

 another anti HT drug for the sole  purpose of reducing  the side effect of the 

initial  anti HT drug . Ideally if  your patient is not tolerating  Amlodipine due

 to edema ,  switch to  an another group of  anti HT drugs.