by Anna the Apostle
Some antihypertensives can have the effect of malleolar edema because they reduce pressure values but increase the intercapillary pressure and the leakage of fluids from the capillary bed. A phenomenon amplified by the heat
I am a 67 year old man and, suffering from hypertension, my doctor (now deceased) had prescribed me a permanent therapy: nebivolol, ramipril, 100 mg acetylsalicylic acid, 5 mg amlodipine, distributed throughout the day. I now have constant swelling in my ankles that extends to my toes. They tell me the cause due to amlodipine: what can I do? What other medicine could I replace this medicine with?
Answer by Anna Apostolo, assistant contact person for the Heart Failure Operational Unit, Clinical and Rehabilitative Cardiology, Monzino IRCCS Cardiology Center in Milan (VAI AL FORUM)
Amlodipine is a drug that belongs to the class of calcium channel blockers. These drugs work by interfering with the movement of calcium ions into cells by relaxing vascular smooth muscle. The effect is that of dilatation of the coronary arteries and peripheral vessels, reducing the pressure values but increasing the intercapillary pressure and the leakage of fluids from the capillary bed: this is why malleolar oedemas appear.
This phenomenon is amplified in the summer months where there is greater vasodilation due to the high temperatures.
The dose-dependent effect, so to reduce or eliminate this problem, it is sometimes sufficient to halve the dose of amlodipine, possibly associating a small dose of diuretic to the ramipril you are taking.
I don’t know if you have recently carried out blood chemistry tests which should in any case be checked, to exclude other pathologies as the cause of the edema you are complaining about; I would suggest monitoring, in addition to routine blood tests (including renal function and plasma electrolytes), the examination of the dosage of thyroid function (TSH reflex) and BNP (type B natriuretic peptide).
However, I advise you to rely on a doctor who can replace your previous personal doctor.
August 20, 2023 (change August 20, 2023 | 08:06)
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