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Amlodipine

Grade

Systemic Hypertension

Recommendations by ACVIM Stage

We recommend following ACVIM and similar consensus guidelines for identifying, evaluating, and managing systemic hypertension in dogs and cats (Acierno et al., 2018).

Initial Dosing

  • 0.05-0.1 mg/kg, PO, q12-24h

  • Administer directly to the patient or with a small quantity of food. 

Subsequent Dosing

  • After 14 days of treatment, the dose may subsequently be doubled or increased up to 0.5 mg/kg once daily if adequate clinical response has not been achieved (e.g. systolic blood pressure remaining over 150 mmHg or a decrease of less than 15% from the pre-treatment measurement).

Therapeutics

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About Amlodipine

Amlodipine is a dihydropyridine calcium-channel blocker. Calcium-channel blockers (less correctly called ‘calcium-antagonists’) interfere with the inward displacement of calcium ions through the slow channels of active cell membranes. They influence the myocardial cells, the cells within the specialised conducting system of the heart, and the vascular smooth muscle cells. Thus, myocardial contractility may be reduced, the formation and propagation of electrical impulses within the heart may be depressed, and coronary or systemic vascular tone may be diminished.

ACVIM Hypertension Classification 

Blood Pressure by the risk of TOD (Target Organ Damage) (Acierno et al., 2018)


  1. Normotensive: SBP <140 mm Hg  (minimal TOD risk) 

  2. Prehypertensive: SBP 140-159 mm Hg (low TOD risk) 

  3. Hypertensive: SBP 160-179 mm Hg (moderate TOD risk) 

  4. Severely hypertensive: SBP ≥180 mm Hg (high TOD risk)

Choice of Antihypertensive Agents

  • ACEi/ARB: 

  • Adrenergic Blockers

Therapeutic Goals

  • TOD Reduction: Decreasing the likelihood of future TOD (i.e., decreasing SBP by at least 1 SBP substage over 2-3 weeks).

  • Proteinuria Reduction: Decreasing proteinuria preferably to <0.5) (i.e., urinary protein-to-creatinine [UPC] ratio decreased by ≥50%).

Secondary Hypertension 

  • 80% of canine hypertension is secondary; therefore, clinicians should address any underlying or associated condition where the hypertension is secondarily initiated (Acierno et al., 2018).

UK Formulations

  • Amlodipine 1.25 mg chewable tablets are authorised for feline use.

Evidence

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  1. Acierno, M.J., Brown, S., Coleman, A.E., Jepson, R.E., Papich, M., Stepien, R.L., Syme, H.M., 2018. ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. J Vet Intern Med 32, 1803–1822. https://doi.org/10.1111/jvim.15331

  2. Ames, M.K., Adin, D.B., Wood, J., 2023. Beyond Angiotensin-Converting Enzyme Inhibitors: Modulation of the Renin–Angiotensin–Aldosterone System to Delay or Manage Congestive Heart Failure. Veterinary Clinics of North America: Small Animal Practice, Advancements in Companion Animal Cardiology 53, 1353–1366. https://doi.org/10.1016/j.cvsm.2023.05.015

  3. Atkins, C.E., Rausch, W.P., Gardner, S.Y., Defrancesco, T.C., Keene, B.W., Levine, J.F., 2007. The effect of amlodipine and the combination of amlodipine and enalapril on the renin-angiotensin-aldosterone system in the dog. Journal of Veterinary Pharmacology and Therapeutics 30, 394–400. https://doi.org/10.1111/j.1365-2885.2007.00894.x

  4. Becker, M.D., Young, B.C., 2017. Treatment of severe lipophilic intoxications with intravenous lipid emulsion: a case series (2011-2014). Vet Med (Auckl) 8, 77–85. https://doi.org/10.2147/VMRR.S129576

  5. Beresford, A.P., Macrae, P.V., Stopher, D.A., 1988. Metabolism of amlodipine in the rat and the dog: A species difference. Xenobiotica 18, 169–182. https://doi.org/10.3109/00498258809041653

  6. Brown, S.A., Henik, R.A., 1998. Diagnosis and Treatment of Systemic Hypertension. Veterinary Clinics of North America: Small Animal Practice 28, 1481–1494. https://doi.org/10.1016/S0195-5616(98)50133-7

  7. Caro-Vadillo, A., Daza-González, M.A., Gonzalez-Alonso-Alegre, E., Rodríguez, A., Gómez-García, J., 2018. Effect of a combination of telmisartan and amlodipine in hypertensive dogs. Veterinary Record Case Reports 6, e000471. https://doi.org/10.1136/vetreccr-2017-000471

  8. Choi, H.-I., Kim, J., Shin, I.-S., Kim, H.-J., 2022. Comparative Efficacy of Antihypertensive Drugs in Dogs: A Systematic Review. Topics in Companion Animal Medicine 50, 100674. https://doi.org/10.1016/j.tcam.2022.100674

  9. Creevy, K.E., Scuderi, M.A., Ellis, A.E., 2013. Generalised peripheral oedema associated with amlodipine therapy in two dogs. Journal of Small Animal Practice 54, 601–604. https://doi.org/10.1111/jsap.12104

  10. DeFrancesco, T.C., 2013. Management of Cardiac Emergencies in Small Animals. Veterinary Clinics of North America: Small Animal Practice, Emergency Medicine 43, 817–842. https://doi.org/10.1016/j.cvsm.2013.03.012

  11. Geigy, C.A., Schweighauser, A., Doherr, M., Francey, T., 2011. Occurrence of systemic hypertension in dogs with acute kidney injury and treatment with amlodipine besylate. Journal of Small Animal Practice 52, 340–346. https://doi.org/10.1111/j.1748-5827.2011.01067.x

  12. Hayes, C.L., 2018. An Update on Calcium Channel Blocker Toxicity in Dogs and Cats. Veterinary Clinics of North America: Small Animal Practice, Common Toxicologic Issues in Small Animals: An Update 48, 943–957. https://doi.org/10.1016/j.cvsm.2018.06.002

  13. Hayes, C.L., Knight, M., 2012. Calcium Channel Blocker Toxicity in Dogs and Cats. Veterinary Clinics of North America: Small Animal Practice, Common Toxicologic Issues in Small Animals 42, 263–277. https://doi.org/10.1016/j.cvsm.2011.12.006

  14. Jugdutt, B.I., Menon, V., Kumar, D., Idikio, H., 2002. Vascular remodeling during healing after myocardial infarction in the dog model: Effects of reperfusion, amlodipine and enalapril. Journal of the American College of Cardiology 39, 1538–1545. https://doi.org/10.1016/S0735-1097(02)01805-3

  15. Kano, S., Ichihara, K., Komatsu, K., Satoh, K., 2011. Comparative Effects of Azelnidipine and Amlodipine on Myocardial Function and Mortality After Ischemia/Reperfusion in Dogs. Journal of Pharmacological Sciences 116, 181–187. https://doi.org/10.1254/jphs.10260FP

  16. Keene, B.W., Atkins, C.E., Bonagura, J.D., Fox, P.R., Häggström, J., Fuentes, V.L., Oyama, M.A., Rush, J.E., Stepien, R., Uechi, M., 2019. ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. J Vet Intern Med 33, 1127–1140. https://doi.org/10.1111/jvim.15488

  17. Kellihan, H.B., Stepien, R.L., 2010. Pulmonary Hypertension in Dogs: Diagnosis and Therapy. Veterinary Clinics of North America: Small Animal Practice, Topics in Cardiology 40, 623–641. https://doi.org/10.1016/j.cvsm.2010.03.011

  18. Stopher, D.A., Beresford, A.P., Macrae, P.V., Humphrey, M.J., 1988. The metabolism and pharmacokinetics of amlodipine in humans and animals. J Cardiovasc Pharmacol 12 Suppl 7, S55-59. https://doi.org/10.1097/00005344-198812007-00012

  19. Thomason, J. d., Fallaw, T. l., Carmichael, K. p., Radlinsky, M. a., Calvert, C. a., 2009. Gingival Hyperplasia Associated with the Administration of Amlodipine to Dogs with Degenerative Valvular Disease (2004–2008). Journal of Veterinary Internal Medicine 23, 39–42. https://doi.org/10.1111/j.1939-1676.2008.0212.x

Monograph Details

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