Amlodipine, a dihydropyridine calcium channel blocker, is widely prescribed for hypertension due to its vasodilatory effects and minimal influence on heart rate. However, rare cases of bradycardia have been reported, particularly in elderly patients with multiple comorbidities. We describe the case of an 84-year-old male with chronic resistant hypertension and stage III chronic kidney disease who developed asymptomatic junctional bradycardia while on amlodipine 10 mg daily as part of a multidrug antihypertensive regimen. Laboratory workup excluded electrolyte abnormalities, thyroid dysfunction, and myocardial infarction. Amlodipine was discontinued, resulting in resolution of bradycardia 48 hours later. This case highlights the potential for amlodipine to cause clinically significant bradycardia even at therapeutic doses, particularly in elderly patients with polypharmacy and impaired renal function. Early recognition may prevent unnecessary invasive interventions.
References
[1]
Bulsara, K.G. and Cassagnol, M. (2024) Amlodipine. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519508/
[2]
U.S. Food and Drug Administration (2007) Amlodipine Besylate Prescribing Information (Approval Package 019787/S-042). FDA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/019787s042lbl.pdf
[3]
Naranjo, C.A., Busto, U., Sellers, E.M., Sandor, P., Ruiz, I., Roberts, E.A., et al. (1981) A Method for Estimating the Probability of Adverse Drug Reactions. Clinical Pharmacology and Therapeutics, 30, 239-245. https://doi.org/10.1038/clpt.1981.154
[4]
Kusumoto, F.M., Schoenfeld, M.H., Barrett, C., Edgerton, J.R., Ellenbogen, K.A., Gold, M.R., et al. (2019) 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Circulation, 140, e333-e381. https://doi.org/10.1161/cir.0000000000000627
[5]
Ramadan, R. and Quyyumi, A. (2010) A Case of Symptomatic Bradycardia from Amlodipine. Journal of Hospital Medicine, 5.
[6]
Tu, A. and Adjovu, S.K. (2020) Amlodipine Causing Symptomatic Bradycardia in a Healthy 71-Year-Old Male. Case Reports in Internal Medicine, 7, 22-26. https://doi.org/10.5430/crim.v7n1p22
[7]
Algahtani, H.A., Aldarmahi, A.A., Alshehri, S.A., et al. (2014) Amlodipine-Induced Sinus Bradycardia: A Rare Adverse Effect. American Journal of Case Reports, 15, 300-303 https://doi.org/10.12659/AJCR.890144
[8]
Lee, J.H., Kim, J., Park, S., et al. (2015) Amlodipine-Induced Bradycardia with Renal Insufficiency: Case Report and Review of the Literature. Korean Journal of Internal Medicine, 89, 697-700. https://doi.org/10.3904/kjim.2015.89.6.697
[9]
Gouveia, R., Veiga, H., Costa, A.A., Pereira, J. and Lourenço, P. (2022) Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia Syndrome Due to Amlodipine: A Case Report of an Underdiagnosed Medical Condition. Cureus, 14, e21144. https://doi.org/10.7759/cureus.21144