Amlodipine Then Furosemide Prescribing Cascade

amlodipine then furosemide

As a geriatric pharmacist, I can’t tell you the number of times I have seen amlodipine prescribed with the subsequent addition (usually a few weeks later) of furosemide. It is finally nice to have some solid evidence to back up what I have anecdotally seen in practice.

A recent study looked at over 40,000 patients and compared the frequency of diuretic prescriptions in patients who were started on a calcium channel blocker and those who didn’t start a CCB. There was a significant increase in the number of patients who were placed on diuresis following starting a calcium channel blocker.

If you are dispensing or prescribing a diuretic for a patient, please take a look and see if a calcium channel blocker has recently been started. In addition to not only starting this drug, recall that edema is typically a dose-dependent effect. Dose increases of a calcium channel blocker may also be the cause for a diuretic prescription.

It is also important to note that calcium channel blockers cause more fluid redistribution than retention, so using a diuretic in a situation where a patient is not going to be fluid overloaded is not typically appropriate.

Here are more common examples of the prescribing cascade like amlodipine then furosemide that I have seen in clinical practice.


  1. Dede

    As a summary is it proper to say edema caused by a calcium channel blocker cannot be relieved by a loop diuretic

  2. Heidi

    So what’s the answer??

  3. Josie Rodriguez

    This pertains to another side effect that I have been experiencing. I have been having hallucinations since I began taking Amoldipine. I know it’s this med that has been causing me to have this because I did research. I was without the medication for about three weeks and I didn’t hear voices or see people that weren’t there. As soon as I began taking the med again within two days I was again having hallucinations. I told my doctor and my visiting nurses and they told me that as long as I knew I was seeing and hearing this it was fine. But sometimes I get scared cause sometimes the voices become very loud when they sing or the fans motor sounds like a motorcycle as does my oxygen machine. I don’t fit the profile of being mentally disturbed so I know it’s the meds. I take eight other meds and I tested with all of them but I’m still not sure what med it doesn’t agree with. Can you help?


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Written By Eric Christianson

December 9, 2020

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