Beyond Amlodipine-The Case for S-amlodipine as the First Choice Calcium Channel Blocker: An Expert Opinion from India
Jagdish Hiremath1, J C Mohan2, Jabir Abdullakutty3
1Director, Department of Cardiology, Cath Lab, Ruby Hall Clinic, Pune, Maharashtra, India, Corresponding Author.
Insights
S-amlodipine, a single isomer of amlodipine, effectively manages hypertension and reduces side effects like pedal edema. It offers comparable efficacy to amlodipine but with improved tolerability and patient compliance.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Calcium channel blockers (CCBs) are first-line hypertension treatments.
- Amlodipine, a common CCB, causes pedal edema, reducing patient adherence.
- Amlodipine is a racemic mixture; only the S(-) isomer has vasodilating action.
Purpose of the Study:
- To evaluate S-amlodipine's role in managing hypertension and cardiovascular disorders in India.
- To assess S-amlodipine's efficacy and tolerability compared to amlodipine.
Main Methods:
- A panel of nine Indian cardiologists convened to discuss S-amlodipine in clinical practice.
- Review of existing data on S-amlodipine's antihypertensive effects and side effect profile.
Main Results:
- S-amlodipine demonstrates comparable antihypertensive efficacy to amlodipine.
- S-amlodipine significantly reduces pedal edema and gingival hypertrophy, improving patient compliance.
- It offers consistent blood pressure reduction across diverse patient populations.
Conclusions:
- S-amlodipine possesses antihypertensive and antianginal properties with additional pleiotropic effects.
- S-amlodipine 2.5 mg is therapeutically equivalent to amlodipine 5 mg for mild to moderate hypertension, with better tolerability.
Background:
Calcium channel blockers (CCBs) have been recommended as the first-line treatment option for the management of hypertension. Amlodipine has been used to treat hypertension over the past 3 decades. However, the chief limitation of amlodipine is pedal edema; it is associated with poor adherence to therapy. Amlodipine is a racemic mixture of two stereoisomers [R(+), S(-)]. Only the S(-) isomer exerts vasodilating action. The R-amlodipine isomer is considered to cause adverse effects.
Aim:
To understand the place of S-amlodipine and its combinations in the management of hypertension and related cardiovascular (CV) disorders in the real-world setting in India.
Methodology:
A conclave of nine Indian cardiologists was formed to discuss the place of S-amlodipine in the management of hypertension in their clinical practice.
Results:
The antihypertensive efficacy of S-amlodipine is comparable to that of amlodipine. S-amlodipine does not cause pedal edema. In fact, switching patients on amlodipine who develop pedal edema to S-amlodipine is helpful in improving patient compliance. However, it would be prudent to initiate treatment with S-amlodipine itself rather than amlodipine, which causes pedal edema. S-amlodipine does not cause gingival hypertrophy, and this improves patient compliance. S-amlodipine consistently lowers blood pressure (BP) across different patient populations such as young, elderly, and patients with CV risk factors.
Conclusion:
S-amlodipine has antihypertensive, antianginal actions, and pleiotropic effects. S-amlodipine 2.5 mg is found to be equivalent in its efficacy and tolerability when compared to amlodipine 5 mg in the treatment of mild to moderate hypertension.
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