Klin Farmakol Farm. 2011;25(4):193-198

A side effect of calcium channel blockers - ankle oedema. A case report.

Milan Grundmann, Ivana Kacířová

Ústav klinické farmakologie Ostrava

Lékařská fakulta Ostravské univerzity a Fakultní nemocnice Ostrava

Introduction: Arterial hypertension is present in 60% to 80% of renal transplant recipients. Angiotenzin-converting enzyme inhibitors

(ACEIs) are safe and effective and in combination with calcium channel blockers (CCBs) control arterial pressure more adequately than

either class alone. Ankle oedema is a common adverse event of CCBs and is responsible for treatment discontinuation or limited patient

compliance with antihypertensive treatment and has a deleterious impact on health-related quality of life.

Method: A patient after renal transplantation was treated with cyclosporine A and mycophenolate and a combination of five antihypertensive

drugs including amlodipine. The patient suffered from marked bilateral ankle oedema but his hypertension was well controlled.

The dose of amlodipine was decreased from 10 mg/day to 5 mg/day and later to 2.5 mg/day and the dose of perindopril was increased

from 5 mg/day to 10 mg/day. We followed up the casual blood pressure, ABPM and home blood pressure during one year. The aim was

to eliminate ankle oedema, increase the quality of life and control blood pressure.

Results: Ankle oedema started to diminish after three weeks and disappeared during the treatment with a dose of amlodipine of 2.5 mg/

day and that of perindopril of 10 mg/day. The patient was able to use normal shoes and his mobility and sexual activity were significantly

improved. His blood pressure remained well controlled in all methods of measurement and changes in the doses of both antihypertensive

drugs prevented fluctuation of systolic blood pressure and pulse rate during the day.

Conclusion: The marked ankle oedema due to amlodipine was eliminated by reducing the dose of the calcium channel blocker and

increasing the dose of the ACEI perindopril while maintaining normotension. The fluctuations of systolic blood pressure and pulse rate

were also diminished.

Keywords: renal transplantation, hypertension, calcium channel blockers, oedema, quality of life

Published: December 18, 2011  Show citation