CCB - edema

[Bonny2007]

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swelling of the legs with fluid while on amlodipine, diuretics don't seem to be of any help, reduce partially only.
Any suggestions?

 

[SpirivaSunrise]

swelling of the legs with fluid while on amlodipine, diuretics don't seem to be of any help, reduce partially only.
Any suggestions?

Need a lot more patient info...

Age, sex, height/weight. Inpatient or outpatient? Concomitant disease states? What else are they on? Do they have CHF? Fluid/salt intake? Degree of edema? Or is it strictly CCB edema? What kind of diuretic you using? Does it worsen after they've been standing a while/improve after sleeping?

Switching to Verapamil/Diltiazem may be an option...or going with an ACEI...but we need more info. Diuretic with CCB-edema isn't always the right way to go.

 

[Bonny2007]

Yes, you are right (I knew you would ask for more details), but it's a general question related to amlodipine side-effect. Every now and then I come across a patient on amlodipine with such a swelling. I was wondering if switching within a group would be of any help assuming that other drugs are not to blame for some interaction or the swelling..

 

[SpirivaSunrise]

Yes, you are right (I knew you would ask for more details), but it's a general question related to amlodipine side-effect. Every now and then I come across a patient on amlodipine with such a swelling. I was wondering if switching within a group would be of any help assuming that other drugs are not to blame for some interaction or the swelling..

Ok, gotcha. CCB edema isn't really salt/water related. So diuretics aren't exactly the best option. Switching to a non-DHP CCB (i.e. Verapamil/Diltiazem) can be an option if you want to stick with a CCB. ACEI or an ARB may be another option. All depends on the patient profile though 😉

 

[Bonny2007]

Yes, it depends on a patient. I'll try to "catch" the patient over the next weeks. Verapamil and Diltiazem have a greater effect on the heart, so when BP associated with fast heart rate they may be helpful, ACE are as effective as CCB in reducing BP, and can be a better solution in diabetes.
The issue gets more complicated if amlodipine is used to help prevent angina attacks in patient with asthma.

Please write if you ever came across edema associated with CCB.

 

[Priapism321]

Peripheral edema secondary to the dihydropyridine calcium channel antagonists has everything to do with their mechanism of action. They primarily dilate the arteriolar vasculature with little to no effect on the venous side. If you can imagine, this creates pressure to build up in capillary beds, and the fluid must go somewhere. Diuretics are not effective for this problem. What has been found to be beneficial is the addition of an ACE inhibitor, which also exerts its effects on the venous circulation, allowing the fluid an outlet from the capillaries, so to speak. A patient would of course have to have blood pressure that would tolerate another medication for this to be a viable strategy.

 

[Bonny2007]

Yes, you are absolutely right, CCB prevent calcium from entering cells of the arteriolar vasculature. I'll consider ACE, then. I don't like the idea of taking diuretics (furosemide!) to alleviate the swelling.