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We've all seen it in our OPDs: a patient on Amlodipine comes back complaining of swollen feet (pedal edema). It's one of the most common reasons for non-compliance. Here's a quick clinical refresher on why it happens and how to manage it.
The "Why":
Amlodipine causes potent arteriolar dilation but less venular dilation. This imbalance increases capillary hydrostatic pressure, leading to fluid leakage into the interstitium.
What's the Solution? 💡
You have two excellent, evidence-based options:
ADD an ACE Inhibitor or ARB: Co-prescribing a drug like Telmisartan or Ramipril causes venodilation, which balances the hydrostatic pressure and often resolves the edema. This is why Amlodipine+Telmisartan is such a popular combination! 💊
SWITCH to Cilnidipine: Cilnidipine is an L/N-type calcium channel blocker that has a more balanced effect on arterioles and venules. Switching the patient from Amlodipine to Cilnidipine can resolve the edema while maintaining blood pressure control.
🚨 Crucial Safety Check: Before attributing edema solely to Amlodipine, always rule out systemic causes. A quick review for cardiac (CHF), renal, or hepatic dysfunction is mandatory.
What's your preferred strategy in your practice? Adding an ARB/ACEi or switching to Cilnidipine? Share your experience below! 👇
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