S-amlodipine--the 2007 clinical review

Area of Science:

• Pharmacology
• Cardiovascular Medicine

Background:

• Amlodipine is a widely used calcium channel blocker for hypertension and angina.
• The S-enantiomer of amlodipine is the primary vaso-active component.
• Racemic amlodipine contains both S- and R-enantiomers.

Purpose of the Study:

• To review the efficacy and tolerability of S-amlodipine compared to racemic amlodipine.
• To evaluate S-amlodipine in specific patient populations, including the elderly and those with isolated systolic hypertension.
• To assess the anti-anginal efficacy of S-amlodipine.

Main Methods:

• Review of published data from randomized controlled trials and postmarketing surveillance studies.
• Analysis of data from nearly 5000 patients, including 4089 in postmarketing surveillance.
• Subgroup analyses and evaluation of fixed-dose combinations.

Main Results:

• S-amlodipine demonstrated equivalent antihypertensive efficacy to racemic amlodipine at half the dose.
• Incidence of peripheral edema was negligible with S-amlodipine compared to racemic amlodipine.
• Patients switched from racemic amlodipine to S-amlodipine experienced resolution of edema while maintaining blood pressure control.
• S-amlodipine proved effective and safe in elderly patients and those with isolated systolic hypertension.
• Anti-anginal efficacy was confirmed in normotensive patients.
• Fixed-dose combinations showed good tolerability and efficacy.

Conclusions:

• S-amlodipine offers a favorable tolerability profile, particularly regarding peripheral edema.
• It is an effective antihypertensive and anti-anginal agent.
• S-amlodipine is a valuable treatment option, alone or in combination therapy, for hypertension and angina.