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Amlodipine: uses, dosage and side effects

Amlodipine is a calcium channel blocker. It is prescription-only in Ireland and is used to lower high blood pressure and to prevent the chest pain of angina. This page explains what it is used for, how it is taken, its side effects and how an existing prescription is renewed. It is information, not a recommendation to take any medicine, and it does not replace your own doctor's assessment.

What amlodipine is used for

Amlodipine is used to treat high blood pressure and to prevent angina, the chest pain that comes from reduced blood flow to the heart muscle. It is a calcium channel blocker of the dihydropyridine type: it relaxes the muscle in the walls of the arteries, so the vessels widen, the pressure inside them falls and the heart has less resistance to pump against. High blood pressure usually causes no symptoms at all, which is why treatment is judged on readings rather than on how you feel. The point of taking amlodipine every day for years is the reduction of long-term risk of stroke, heart attack, kidney damage and heart failure. It is not a medicine to take when you notice a headache and skip when you do not, and it is not a treatment for an episode of chest pain that is happening now: chest pain at rest, or pain that spreads to the jaw or arm with sweating or breathlessness, needs an emergency service on 112 or 999.

Side effects of amlodipine

The most characteristic side effect is swelling of the ankles and lower legs, which happens because the small vessels dilate, and it is the reason people most often ask to change medicine. Others reported commonly are headache, flushing, dizziness, palpitations, tiredness, nausea and abdominal pain. Dizziness is most likely in the first days and after a dose increase, particularly when standing up quickly. Some effects should prompt medical contact rather than waiting for the next review: fainting, a very fast or irregular heartbeat, chest pain that is new or worse, swelling of the gums, jaundice, or a severe rash. Swelling that is one-sided, painful and warm is a different problem from the symmetrical ankle swelling of amlodipine and needs assessment. If ankle swelling bothers you, tell your doctor rather than stopping the tablets: there are alternatives, and stopping a blood pressure medicine on your own leaves the underlying risk untreated.

Dosage and how to take amlodipine

Amlodipine is taken by mouth once a day, at any time of day but ideally the same time each day, with or without food, and the prescriber sets the strength and any change to it. Treatment normally starts at a low dose and is increased only if blood pressure readings justify it, which is why a follow-up reading is part of the treatment rather than an optional extra. The full effect on blood pressure builds over days to weeks, so do not judge it on a single reading the day after starting. If you miss a dose, take it when you remember unless the next one is nearly due, and do not take two together. Do not stop the medicine because your readings have become normal: normal readings are the medicine working. If you want to come off it, that is a conversation with your doctor, who can plan a change and check what happens afterwards. Keep taking it during minor illness unless a doctor tells you otherwise.

Is amlodipine available without a prescription in Ireland?

No. Amlodipine is a prescription-only medicine in Ireland and no pharmacy can supply it without a valid prescription. That is not a formality: the dose depends on your blood pressure readings, your kidney function and the other medicines you take, and treating high blood pressure without measuring it is guesswork. If you think your blood pressure is high, a pharmacy or your GP practice can measure it. Amlodipine is not a controlled drug, so it is not among the substances excluded from cross-border prescriptions under Article 11(6) of Directive 2011/24/EU. A prescription issued by a prescriber elsewhere in the EU or EEA can be presented in an Irish pharmacy, and the Pharmaceutical Society of Ireland has published guidance for pharmacists on dispensing such prescriptions. The pharmacist still applies professional judgement and may decline where anything is unclear, so the document must carry the fields set out in the Annex to Implementing Directive 2012/52/EU and name the active substance.

Renewing an existing amlodipine prescription

If a doctor has already assessed you, started you on amlodipine and your treatment needs to be continued, you can request a repeat prescription through our medical questionnaire. A doctor reviews what you write and, where continuation is appropriate, issues a cross-border prescription as a PDF document by e-mail; you bring it and photo identification to any pharmacy. There is no PIN code, and there is no video consultation, no telephone appointment and no live chat, because the assessment is asynchronous. Documents are issued by lek. Damian Wojno, a doctor registered in Poland, PWZ no. 3211301. Blood pressure treatment needs monitoring, so have recent readings to hand when you fill in the questionnaire and keep up the reviews with your GP: a renewal service is not a substitute for those checks. This route is for continuing established treatment, not for starting blood pressure medicine for the first time. The fee of 19,90 € covers the medical consultation, not the issuing of a document. If the doctor declines on medical grounds, the fee is returned. If you do not send documentation the doctor asks for, the consultation counts as carried out and the fee is not refunded.

Cost and reimbursement in Ireland

What amlodipine costs at the counter depends on the strength, the pack size, the manufacturer and the pharmacy, and it is set by the pharmacy rather than by us. Generic amlodipine has been available for many years and is among the less expensive cardiovascular medicines. We do not sell medicines and we do not quote prices for them; the pharmacist will tell you the cost before dispensing. On the state side, the HSE runs the medical card scheme and the Drugs Payment Scheme, which caps what a household pays for approved prescribed medicines in a calendar month. Because blood pressure treatment is usually taken for years, it is worth asking the pharmacy how your prescriptions sit within those schemes. How a prescription written by a prescriber in another EU country is handled under them is decided by the HSE and applied at the counter. Our charge is the consultation fee described above and is separate.

Interactions and alcohol

Tell the prescriber about everything you take. Amlodipine can raise the level of simvastatin in the blood, so a doctor prescribing both will usually limit the statin dose or choose a different statin. Other medicines that lower blood pressure, including some prescribed for the prostate, add to the effect and can cause dizziness on standing. Medicines that inhibit the liver enzyme CYP3A4, such as certain antifungals, some antibiotics and some HIV medicines, can increase amlodipine levels, while others such as rifampicin and St John's wort can reduce them. Grapefruit juice is best avoided with this class. Alcohol lowers blood pressure further in the short term and can make dizziness and flushing worse, and regular heavy drinking raises blood pressure over time, so it works against the treatment in both directions. Anti-inflammatory painkillers taken regularly can also blunt the effect of blood pressure medicines, which is worth mentioning at review.

Who should not take amlodipine

Amlodipine is not suitable for anyone who has had an allergic reaction to it or to another dihydropyridine calcium channel blocker, for anyone with severely low blood pressure or in cardiogenic shock, for people with severe narrowing of the aortic valve, and after a recent heart attack while the situation is still unstable. Unstable angina is another situation where it is not appropriate. Care is needed with liver problems, where the dose is usually lower and increased slowly, and in older adults, in whom dizziness on standing is more likely. Heart failure is a situation where the choice of calcium channel blocker matters and belongs to the treating doctor. This is not a complete list. The contraindications and warnings for your particular product are set out in its leaflet and in the summary of product characteristics published by the HPRA, and only a doctor who knows your history can apply them to you.

Generic and brand names

Amlodipine is the international non-proprietary name of the active substance and is dispensed in Ireland mostly as generic amlodipine carrying the manufacturer's name; the original brand name is Istin. It also appears inside fixed-dose combination products together with another blood pressure medicine or a statin, which are convenient but are a different prescription with a different strength on the box. If you take a combination product, know both substances in it, because otherwise it is easy to end up taking the same medicine twice under two names. At the counter, check the active substance and the strength rather than the brand, since the supplier can change between prescriptions. A cross-border prescription names the active substance rather than a brand, which is what allows a pharmacist in another country to dispense the equivalent product authorised there.

Amlodipine in pregnancy and breastfeeding

Amlodipine is not the usual first choice in pregnancy, and a woman who becomes pregnant or is planning to should speak to her doctor about her blood pressure treatment rather than deciding alone, because some blood pressure medicines are specifically avoided in pregnancy and others are preferred. Do not simply stop treatment: untreated high blood pressure in pregnancy carries its own serious risks for mother and baby. Small amounts pass into breast milk, and whether treatment continues while breastfeeding is a decision for the doctor or maternity service looking after you, taking the alternatives into account. Because this needs individual assessment and usually shared care with a maternity team, our questionnaire is not the right route for it. Contact your GP or maternity service, and seek urgent advice for headache with visual disturbance, upper abdominal pain or sudden swelling in pregnancy.

Where to find the patient information leaflet

Every medicine authorised in Ireland has a patient information leaflet, and the leaflet inside your own pack is the version that applies to you. The Health Products Regulatory Authority (HPRA) keeps a public database of medicines authorised here, where you can look up the leaflet and the summary of product characteristics for the exact strength and manufacturer you have been given. For centrally authorised medicines the European Medicines Agency publishes the same documents. Read the leaflet before the first dose and again if the pack you collect looks different from the last one, because generic versions can differ in their inactive ingredients even when the active substance and the strength are identical. If anything in the leaflet does not match what you were told, ask your pharmacist before taking the medicine. A leaflet is written for the whole patient population, so it lists effects that are uncommon; it is not a prediction of what will happen to you.

Is amlodipine prescription-only in Ireland?

Yes. No pharmacy in Ireland can supply amlodipine without a valid prescription, because the dose depends on your blood pressure readings, your kidney function and your other medicines. It is not a controlled drug, so it is not excluded from cross-border prescriptions under Article 11(6) of Directive 2011/24/EU.

How long does amlodipine take to work?

The full effect on blood pressure builds over days to weeks, so it should not be judged on a single reading the day after starting. Your prescriber will normally arrange a follow-up reading before deciding whether the dose is right.

What are the common side effects of amlodipine?

Swelling of the ankles is the most characteristic, along with headache, flushing, dizziness, palpitations and tiredness. Tell your doctor if ankle swelling bothers you rather than stopping the tablets, because alternatives exist and untreated blood pressure keeps the underlying risk in place.

Can I drink alcohol while taking amlodipine?

Alcohol lowers blood pressure further in the short term and can worsen dizziness and flushing, while regular heavy drinking raises blood pressure over time. Both work against the treatment, so keep intake modest and be honest about it with your doctor.

How do I get a repeat prescription for amlodipine?

If a doctor has already started you on it, fill in our medical questionnaire with recent blood pressure readings to hand. A doctor reviews it and, where continuation is appropriate, issues a cross-border prescription as a PDF by e-mail. Keep up your GP reviews as well; a renewal is not a substitute for monitoring.