Amlodipine and Swollen Ankles: What You Can Do About It

June 27, 2025/Andrew Le

If you’re taking amlodipine and notice your feet or ankles puffing up, that’s a side effect can creep in slowly, and it often feels confusing, especially when other parts of your health seem stable.

So why does it happen? 

Amlodipine relaxes your arteries to lower blood pressure, but it doesn’t relax the veins. That mismatch causes pressure to build in tiny blood vessels, which pushes fluid into nearby tissues. Over time, that fluid builds up in your ankles and feet.

🔑 Key Takeaways

➤ Amlodipine can cause ankle swelling because it relaxes arteries but not veins, which leads to fluid leaking into nearby tissues.

➤ This kind of swelling isn’t due to extra fluid in the body, so diuretics usually don’t help much.

➤ The risk of swelling goes up with higher doses and longer use, especially in people taking 10 mg or using the drug for many years.

➤ Older adults, women, people with heart failure, and those who stand a lot or live in hot places are more likely to get this side effect.

➤ Lowering the dose of amlodipine is often the simplest and most effective way to reduce swelling.

➤ Switching to (S)-amlodipine or a different type of calcium channel blocker may reduce the chance of swelling without affecting blood pressure control.

➤ Mild swelling might improve with leg elevation or compression socks, but these don’t work for everyone.

➤ If swelling is severe or painful, or comes with other symptoms like chest pain or trouble breathing, medical help is needed right away.

Why edema occurs

Edema from amlodipine happens because of how it affects the small blood vessels in your body. Amlodipine is a calcium channel blocker, and one of its main jobs is to relax and widen the arteries. This helps lower blood pressure. 

But the problem is it doesn’t relax the veins the same way. According to a study, this imbalance between arteriolar dilation and unchanged venous tone causes an increase in pressure inside the capillaries. That extra pressure pushes fluid out of the blood vessels and into nearby tissues, which leads to swelling, especially in the ankles and feet.

This process doesn’t involve salt or water retention like other types of swelling. In fact, calcium channel blockers are actually natriuretic, meaning they help the body get rid of sodium. That’s why diuretics, which remove fluid by increasing urine output, usually don’t help much in this case. The fluid is not from overload; it’s just in the wrong place.

The Specialist Pharmacy Service also explains that this type of edema is caused by fluid shifting from capillaries to the interstitial space, not because of fluid buildup in the body. Amlodipine blocks the body’s normal response when you stand up, which is to tighten capillaries to counteract gravity. When that response is blocked, fluid leaks out more easily into the lower legs.

Adding more insight, studies found that precapillary dilation without matching venous dilation is the main reason why plasma escapes into the surrounding tissues. This process leads to hydrostatic pressure building up in the capillaries, and that pressure causes fluid to leak. 

Over time, if the fluid escaping exceeds what the lymphatic system can drain, swelling appears.

This side effect is dose-dependent. The higher the dose, the more likely swelling is to occur. For example, only 1.8% of patients on a 2.5 mg dose of amlodipine reported edema, but that number jumped to 10.8% at the 10 mg dose. The longer a person takes amlodipine, the greater the risk. One study found that people on the drug for over five years were 20 times more likely to experience edema compared to newer users.

✂️ In Short

Amlodipine can cause swelling in the feet and ankles because it relaxes arteries but not veins, which raises pressure in tiny blood vessels and pushes fluid into nearby tissues. This swelling happens not from having too much fluid in the body, but because the fluid moves to the wrong place.

Who’s at Risk

Who is more likely to get swelling from amlodipine? Could your age, gender, or health condition raise your risk? Some people are more likely to develop swelling while taking this medicine, especially older adults, women, or those with heart problems.

Others may be at risk just because they stand a lot during the day or live in warm places.

Older Adults

According to the Specialist Pharmacy Service, the risk is notably higher in older adults, women, individuals with heart failure, and those who spend a lot of time standing or are in warmer environments. These risk factors suggest that the body’s ability to regulate fluid distribution may be more vulnerable in these groups, which leads to fluid leaking from capillaries into surrounding tissues. 

So, if you’re in one of these groups, you might need extra monitoring.

Additionally, the COHORT study looked at 828 elderly patients with high blood pressure and found that ankle swelling often developed gradually over time, rather than being a short-term side effect. This delayed onset means it can creep up unnoticed, especially in older people who are already at risk.

Women

Women are at a higher risk of developing peripheral oedema when taking calcium channel blockers like amlodipine. This pattern was also seen in a pharmacovigilance study where subgroup analysis by gender confirmed that females reported more adverse reactions related to amlodipine, including swelling of the ankles. This difference may be linked to variations in vascular response or hormonal influences, although the exact mechanism is not yet understood.

Heart Failure Patients

People with heart failure are more vulnerable to developing peripheral oedema while on amlodipine. Their compromised circulation and fluid balance may make them less able to manage the vasodilatory effects of the medication, which can lead to fluid pooling in the lower limbs.

People Who Spend Long Periods Standing or in Warm Environments

Standing for long periods or being in warm environments are two additional risk factors identified by the same study above. These conditions may reduce venous return and increase capillary pressure, encouraging fluid to leak into surrounding tissues and accumulate around the ankles.

Elderly Patients 

The same pharmacovigilance study confirmed that elderly people and women are among those more prone to adverse effects from amlodipine, including peripheral oedema. Their analysis, which included data from over 500 identified adverse drug reactions, showed that these effects were significantly more frequent in older age groups. The researchers used multiple detection methods and validated the results using multivariable logistic regression, which showed odds ratios greater than 1 with statistically significant values, reinforcing age and sex as reliable predictors of risk.

💡 Did You Know?

One randomized controlled trial found that peripheral oedema was less frequent in patients who took (S)-amlodipine compared to the regular racemic form. In their study of 172 patients, 31.4% in the (S)-amlodipine group developed new leg oedema versus 46.5% in the conventional amlodipine group. The absolute risk reduction was 15.1%, and the number needed to treat (NNT) to prevent one case of oedema was 7. 

This means certain types or formulations of amlodipine may reduce the risk, but it does not eliminate it, especially in vulnerable populations.

How to Reduce Swelling

There are several ways to reduce this kind of swelling, from adjusting your medicine to trying simple at-home tips.

Let’s look at some options that can help you feel more comfortable

Lower the Amlodipine Dose

One of the most effective ways to reduce swelling is to lower the dose of amlodipine. 

According to a study, using only half the maximum recommended dose of amlodipine significantly lowers the chance of ankle edema. This side effect, which happens in up to 15% of patients on full-dose dihydropyridines, becomes much less frequent when the dose is reduced. This approach works because the severity of edema increases with higher doses, though not always in a strictly dose-proportional way.

Switch to (S)-Amlodipine

One clinical trial found that using (S)-amlodipine instead of regular racemic amlodipine cut the risk of edema significantly. In their study of 146 patients, the incidence of new swelling was 31.4% with (S)-amlodipine and 46.5% with racemic amlodipine. This represents a 15.1% absolute risk reduction and a 32.47% relative risk reduction, with a number needed to treat (NNT) of just 7 to prevent one case of edema. 

Importantly, both groups had nearly identical blood pressure control, proving that switching to (S)-amlodipine doesn’t compromise effectiveness.

Try a Different Calcium Channel Blocker (CCB)

You might also switch to another type of calcium channel blocker. According to a COHORT study, third-generation dihydropyridines like lercanidipine and lacidipine are less likely to cause edema than amlodipine. They are more lipophilic and stay in tissues longer, which may help reduce the swelling effect. Switching to lercanidipine or lacidipine is a good alternative when edema is a problem.

Alternatively, moving from dihydropyridines like amlodipine to non-dihydropyridine agents like verapamil or diltiazem can help. According to a study, diltiazem is linked to a lower rate of ankle swelling compared to other CCBs. These medications affect blood vessels differently, which might explain their better tolerability in terms of edema.

Consider Using Nitrates

Nitrates can be another option. Their venodilating action might counteract the capillary pressure changes caused by CCBs. One study suggests that adding a nitrate can help, but practical issues like tolerance development and the need for stop-start dosing limit their regular use.

Use Non-Drug Approaches (for Mild Swelling)

What if the swelling is mild and not too uncomfortable? 

In that case, you can try simple non-drug strategies. The NHS SPS recommends elevating your legs while lying down or wearing compression stockings. But there isn’t strong evidence showing these methods work well. They might help in some cases, but shouldn’t be the only strategy if the swelling is bothersome.

Discontinue Amlodipine

If all else fails and the swelling doesn’t go away, stopping amlodipine may be necessary. This is often the last resort when other options don’t work or when the edema becomes too severe to tolerate.

⚠️ Important Considerations

There are times when monitoring isn’t enough and you need emergency help. If the swelling is painful, warm, or comes on quickly, it could signal a blood clot or another serious issue. If you also feel chest pain, have a racing heartbeat, or struggle to breathe, you must get medical care immediately. This isn’t something to wait on.

Final Words

One of the most effective steps is lowering the dose, which can greatly reduce the risk. Some people may benefit from switching to (S)-amlodipine or a different calcium channel blocker that’s less likely to cause fluid buildup. 

Still not working? Talk to your doctor about stopping amlodipine entirely.

FAQs on Swelling as Amlodipine Side Effects 

Is ankle swelling from amlodipine dangerous?

It’s usually not dangerous, but it can be uncomfortable. Always let your doctor know if you notice swelling.

Can other problems cause swollen ankles too?

Yes. Heart, liver, or kidney issues can also cause swelling. That’s why it’s important to see your doctor.

What are other common side effects of amlodipine?

You might feel dizzy, tired, or get a headache. Most side effects are mild but still tell your doctor.

Sources

  • Khadka, S., Joshi, R., Sthapit, S., & others. (2018). Amlodipine-induced pedal edema and its relation to other variables in patients at a tertiary level hospital of Kathmandu, Nepal. Journal of Pharmacy Technology, 35(2). https://doi.org/10.1177/8755122518809005
  • Di, X., Jiang, J., Zhong, Q., Zhou, X., Zhou, L., Zheng, J., & Liu, B. (2025). Adverse events associated with amlodipine: A pharmacovigilance study using the FDA adverse event reporting system. Frontiers in Cardiovascular Medicine, 12. https://doi.org/10.3389/fcvm.2025.1504671
  • Skovbjerg, B. K., Helgestad, O. K., Oxlund, C. S., Christensen, B., & Henriksen, J. N. (2023). Management of amlodipine-induced ankle oedema [Article in Danish]. Ugeskrift for Laeger, 185(16), V07220460.
  • Retrieved from https://pubmed.ncbi.nlm.nih.gov/37114573/
  • Galappatthy, P., Waniganayake, Y. C., Sabeer, M. I. M., Wijethunga, T. J., Galappatthy, G. K. S., & Ekanayaka, R. A. I. (2016). Leg edema with (S)-amlodipine vs conventional amlodipine given in triple therapy for hypertension: A randomized double blind controlled clinical trial. BMC Cardiovascular Disorders, 16, Article 168. https://doi.org/10.1186/s12872-016-0347-4
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