Amlodipine Then Furosemide Prescribing Cascade
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.