Felodipine is a long-acting dihydropyridine calcium channel blocker (CCB) primarily used in the management of hypertension and angina pectoris. Like other dihydropyridines, it selectively inhibits L-type calcium channels in vascular smooth muscle, leading to vasodilation, reduced systemic vascular resistance, and a consequent lowering of blood pressure. Its relative vascular selectivity means it has less direct effect on myocardial contractility or conduction compared to non-dihydropyridine CCBs (e.g., verapamil, diltiazem), making it suitable for use in patients with comorbid conduction disorders or heart failure with preserved ejection fraction where blood pressure control is a priority.
Felodipine is formulated as an extended-release tablet to provide consistent 24-hour blood pressure control with once-daily dosing. Peak plasma concentrations occur within 3–5 hours, and its half-life of 11–16 hours supports sustained action. Bioavailability is subject to significant first-pass metabolism in the liver via CYP3A4, meaning drug interactions with inhibitors/inducers of this pathway can be clinically important. Food can influence absorption, and it is generally recommended to take felodipine consistently with respect to meals to maintain stable plasma concentrations.
Clinical outcome data confirm felodipine’s role in reducing cardiovascular events when used as part of antihypertensive therapy. It has proven efficacy across age groups, particularly in older patients and those with isolated systolic hypertension, a common phenotype in the elderly. Its tolerability is generally favourable, though dose-dependent ankle oedema is a notable adverse effect. In European and international guidelines, felodipine and other dihydropyridine CCBs are considered first-line options alongside ACE inhibitors/ARBs, thiazide-like diuretics, and beta-blockers, depending on comorbidities and patient profile.
Beyond hypertension, felodipine is indicated for stable angina and sometimes used off-label in conditions requiring vasodilation, though it is not generally used in arrhythmia control. Its affordability and once-daily dosing support long-term adherence in chronic therapy.
Felodipine is primarily indicated for:
Titration should be cautious, with dose adjustments every 2 weeks. Consistent administration with or without food, but avoid grapefruit juice. Lifestyle changes (dietary salt reduction, physical activity, smoking cessation, and weight control) are important adjuncts.
Most adverse effects are dose-related and improve with lowering the dose or switching to an alternative CCB. Peripheral oedema is not related to salt/fluid retention but due to precapillary arteriolar dilation; adding an ACE inhibitor/ARB may reduce this oedema.
Patients should be monitored for blood pressure response, ankle oedema, and symptoms of hypotension. Caution with elderly patients due to fall risk from vasodilation-related dizziness.
Felodipine is extensively metabolised by CYP3A4; drug interactions are clinically significant:
Patients should avoid grapefruit juice and disclose all medications and supplements to their healthcare provider to reduce interaction risk.
Missed dose: Take as soon as remembered unless nearly time for next dose. Do not double up.
Accidental double dose: May cause flushing, headache, or hypotension. Sit or lie down if dizzy; seek medical advice if severe.
Large overdose: Can cause profound hypotension, reflex tachycardia, or shock. Emergency care required. Management includes IV fluids, vasopressors, calcium gluconate, and monitoring of cardiac rhythm. Activated charcoal may be useful if ingestion is recent.
Children ingesting adult doses require urgent hospital assessment.
Do not use expired medication. Always check the blister/bottle label to confirm the strength before taking.
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