A 50-year-old male with a medical history significant for newly diagnosed hypertension presents to your clinic complaining of increased swelling of his ankles. He states that he has been very compliant with the “blood pressure pills” that were prescribed by you 6 months ago. If his swelling is a side effect of this medication, what was he most likely prescribed?
1.Linsinopril
2.Propanolol
3.Carvedilol
4.Amlodipine
5.Verapamil
exp:
The patient in this vignette is most likely experiencing peripheral edema caused by dihydropyridine calcium-channal blockers, in this case amlodipine (aka Norvasc).
There are 2 types of calcium channel blockers: dihydropyridine and non-dihydropyridine. The non-dihydropyridine family includes verapamil and diltiazem while the dihydropyridine includes amlodipine, nifedipine, nicardipine, isradipine, felodipine, and nisoldipine. The dihydropyridine CCBs are more selective for vasodilation while the non-dihydropyridine CCBs favor a depressive effect on the heart. Diltiazem has both effects. Other potential side effects of non-DHP CCBs include bradycardia, AV block, flushing, dizziness, and constipation.
Illustration A shows a patient with lower extremity pitting edema, similar to what could be seen with CCB-associated edema.