Lower leg and ankle oedema is a common side effect of amlodipine, nifedipine, and other CCBs, especially in women and where lymph drainage is already reduced.^13,15,17,18

Incidence increases the longer people have been taking a CCB and it can take years before oedema starts to appear. Typically, up to 15% of patients develop ankle oedema but levels can potentially be 80% in people on a long-term high dose.¹⁴

Treatment options include reducing or restoring a lower dose but oedema risk is not necessarily directly proportional to dose; someone on long-term amlodipine 5mg daily may find ankle oedema only appears after increasing the dose to 10mg.

If hypertension control needs to be stepped up, rather than increase the amlodipine dose, an ACE inhibitor (eg ramipril) or an angiotensin II receptor blocker (ARB) (eg valsartan) could be added. Combination therapy can reduce ankle oedema likelihood by 38%.

Another option is to switch to a non-dihydropyridine CCB such as verapamil or a more lipophilic third-generation CCB such as lercanidipine.