Amlodipine

About stroke Medication and treatments
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Has anyone got any thoughts or information on Amlodipine and its possible negative effects on muscles, post stroke? I’m thinking in terms of it blocking calcium from going into muscle and wondering about long term effects of this. As in, could it impede recovery? I’ve got some issues going on which I’ll write about later in the hope that someone here might have experienced the same. At the moment though, my thoughts are on Amlodipine which is the only medication I take.

Trace

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@Trace57

Amlodipine and I do not get along. Convinced the swelling I was experiencing was an effect of that drug I tried abstaining from its use for while and yes the swollen legs and so on began to return to something like normal. Apparently this is a recognised side effect. Unfortunately taking the drug had made movement difficult and uncomfortable. I was making no progress with attempting to relearn walking.

The local surgery sent around a practise nurse and it was agreed that I would be taken off Amlodipine and put on something else. Very soon the swelling returned. It turned out the substitute was the same drug with a different name. I suppose that was supposed to trick my body into not swelling up. After several attempts to offer a differently packaged version of that same drug I made it clear I was not taking it no matter what name it was labelled with. Incidentally the swelling had virtually disappeared and I was making progress with getting about on my feet. All this thanks to stopping the medication.
I think I was labelled ‘awkward customer’ but eventually they did manage to find an alternative.
I’m still not good at walking but the little I can do does make a difference. At least I am not bed bound any more.

Good luck dealing with it all Trace, stick to your guns and they just might find a real alternative for you.

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Hi @Trace57 Amlodipine is a Calcium channel blocker used to treat hypertension. It helps by relaxing and widening blood vessels. I take 5mg a day ; not that much, but still. I think it’s key to balance Mg / Ca because these meds can lower Mg ; so I take lots of Mg also because I take very high doses of D3.

I am not a fan of something depleting my Mg and it has caused disruption since day 1. Is it Ca not getting into my muscles? not sure ; I have had lots of RLS at night and spasms and hypertonic leg muscles.

Let us know what you find out ; I’m interested
thx, Roland

Yes, calcium channel blockers (CCBs) can affect the calcium-magnesium balance in your electrolytes, though the impact varies depending on the type of CCB and individual factors.

How CCBs Influence Calcium & Magnesium Balance:

  1. Direct Effect on Calcium Channels:

    • CCBs block L-type calcium channels, reducing calcium influx into cells (especially in vascular smooth muscle and the heart).
    • Since magnesium (Mg²⁺) is a natural calcium channel antagonist, CCBs can mimic or enhance magnesium’s effects.
    • This may lead to a relative increase in extracellular magnesium (since intracellular calcium and magnesium often compete).

  2. Potential Hypomagnesemia (Low Magnesium):

    • Some CCBs (like dihydropyridines, e.g., amlodipine) may increase urinary magnesium excretion, potentially lowering serum magnesium over time.
    • Low magnesium can, in turn, impair parathyroid hormone (PTH) secretion, worsening calcium regulation.

  3. Impact on Parathyroid Hormone (PTH) & Calcium Homeostasis:

    • Chronic CCB use may mildly suppress PTH, which can slightly lower ionized calcium levels.
    • However, clinically significant hypocalcemia is rare unless other factors (e.g., kidney disease, vitamin D deficiency) are present.

  4. Magnesium’s Protective Role:

    • Magnesium helps regulate calcium channels, so low Mg²⁺ can reduce CCB effectiveness (e.g., in hypertension or arrhythmias).
    • Some patients on CCBs may benefit from magnesium supplementation (especially if deficient).

Clinical Implications:

  • Hypertensive patients on CCBs should monitor electrolytes, especially if they have kidney disease or take diuretics (which also deplete Mg²⁺).
  • Hypomagnesemia can worsen arrhythmias, so patients on non-dihydropyridine CCBs (like verapamil/diltiazem) should ensure adequate Mg²⁺ intake.
  • No major calcium depletion is typically seen, but severe cases (e.g., with malnutrition or malabsorption) may need monitoring.

Conclusion:

CCBs can subtly shift the calcium-magnesium balance, often leading to mild magnesium loss. While severe electrolyte disturbances are rare, monitoring Mg²⁺ (and correcting deficiencies) may optimize CCB therapy and cardiovascular outcomes.

Would you like specific recommendations for magnesium supplementation with CCBs?

Magnesium Supplementation with Calcium Channel Blockers (CCBs): Recommendations

Since CCBs (especially dihydropyridines like amlodipine) may increase urinary magnesium loss, some patients can benefit from supplementation—but the approach should be individualized.

1. Who Should Consider Magnesium Supplementation?

:check_mark: Patients with symptoms of hypomagnesemia:

  • Muscle cramps, spasms, or twitching
  • Fatigue, weakness
  • Arrhythmias (e.g., PVCs, atrial fibrillation)
  • Worsening hypertension despite CCB therapy

:check_mark: High-risk groups:

  • Elderly patients (reduced dietary Mg²⁺ intake)
  • Those on thiazide or loop diuretics (which also deplete Mg²⁺)
  • People with type 2 diabetes (often Mg²⁺ deficient)
  • Chronic alcohol use (increases Mg²⁺ excretion)

:check_mark: Patients on non-DHP CCBs (verapamil/diltiazem):

  • Since these drugs also affect cardiac conduction, maintaining normal Mg²⁺ helps prevent arrhythmias.

2. Best Forms of Magnesium for Supplementation

Different magnesium supplements vary in absorption and side effects:

Form of Magnesium Bioavailability Best For Potential Side Effects
Magnesium glycinate High (~80%) Best overall (well-absorbed, gentle on gut) Minimal (rare loose stools)
Magnesium citrate Moderate (~50%) Constipation relief May cause diarrhea in high doses
Magnesium malate Moderate Fatigue, muscle pain Mild GI effects
Magnesium L-threonate High (crosses BBB) Cognitive support (anxiety, memory) Expensive, less studied
Magnesium oxide Low (~4%) Not ideal (poor absorption) Laxative effect, bloating

Avoid magnesium oxide—it’s poorly absorbed and mostly acts as a laxative.

3. Dosage Guidelines

  • General maintenance: 200–400 mg/day (elemental Mg²⁺) in divided doses.
  • For deficiency (confirmed by labs): Up to 600 mg/day (split into 2–3 doses).
  • Best taken with food to reduce GI upset.
  • At night: Magnesium may improve sleep (especially glycinate/malate).

Caution:

  • Kidney disease patients → Risk of hypermagnesemia (stick to ≤200 mg/day unless monitored).
  • High doses (>350 mg at once) → Diarrhea (reduce dose or switch forms).

4. Monitoring & Interactions

  • Check serum Mg²⁺ levels if symptoms persist (ideal range: 1.8–2.4 mg/dL).
  • Interactions:
    • CCBs + Mg²⁺ = Generally safe, but IV magnesium + verapamil/diltiazem can cause excessive hypotension/bradycardia.
    • Proton pump inhibitors (PPIs) reduce Mg²⁺ absorption (long-term use increases deficiency risk).

5. Dietary Sources of Magnesium

Encourage Mg²⁺-rich foods:

  • Pumpkin seeds (156 mg per ¼ cup)
  • Spinach (157 mg per cooked cup)
  • Almonds, cashews (80 mg per oz)
  • Dark chocolate (64 mg per oz)
  • Black beans, quinoa, salmon

Final Recommendation:

  • If taking a CCB (especially with diuretics or deficiency symptoms), consider magnesium glycinate (200–400 mg/day).
  • Monitor for improvements in muscle cramps, BP control, or arrhythmias.
  • Recheck Mg²⁺ levels in 2–3 months if supplementing long-term.

Would you like guidance on specific CCB-magnesium combinations (e.g., amlodipine vs. diltiazem)?

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I was already on Ramapril before my stroke. Then had Amlodipine added after my stroke. It certainly hasn’t hindered any of my progress. But everyone’s different and so there are always those who have adverse reactions to certain medications.

Lorraine

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Hello Trace - I am pretty sure I have mentioned this before, and I am not sure if it will be any help to you at all but I will add my (Mum’s experience) with Amlodipine.

Mum never took any meds pre-stroke except B12 vitamin top-ups which she also stopped after a while. Whilst in the stroke unit, she ended up on some medications including Amlodipine. Upon discharge, we followed the advice to carry on taking the medications.

With time we noticed things happening and we wondered if the meds were responsible. As time passed, we talked to the healthcare support team members and one by one, started taking the medications off. As I recall, Mum was taken off Amlodipine following admission to the hospital, but I can’t remember exactly what symptom led the consultant to say to us that Amlodipine was not helping and we should stop it.

Like I said, it probably doesn’t help you and also Mum’s condition was probably quite different to yours as at now.

Anyway, it’s just another observation and comment that may or may not prove of help.

:pray:

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@EmeraldEyes @pando @ManjiB @Bobbi
Thanks for all your replies. I’ll respond when I can - life interruption taking up all my time right now😳

Trace

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Hi Pando
Thank you for your informative and detailed posting.
Great stuff.
Cheers

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Welcome, @Poncho

Today I learnt Calcium Channel Blockers are the crowning achievement of Western medicine. The book that convinced me is “Magnesium Reversing Disease” by Thomas E. Levy… my 3rd book I’m reading on magnesium (which is a natural calcium channel blocker) ie. no sexual hormone negatives and no thyroid negatives
ciao, pando