Plendil (Felodipine) vs Other Calcium Channel Blockers: Full Comparison & Alternatives
Calcium Channel Blocker Comparison Tool
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Plendil is a brand name for felodipine, a dihydropyridine calcium channel blocker that relaxes arterial smooth muscle to lower blood pressure. It is prescribed for essential hypertension and sometimes for chronic stable angina. Felodipine’s long half‑life (≈ 12‑15hours) allows once‑daily dosing, which many patients find convenient.
How Felodipine Lowers Blood Pressure
Felodipine blocks L‑type calcium channels in vascular smooth muscle. By preventing calcium influx, the drug reduces peripheral vascular resistance, the main driver of high systolic pressure. This mechanism is shared with other calcium channel blockers (CCBs), but felodipine’s high lipophilicity gives it a steadier plasma concentration, limiting the peaks that cause flushing.
Clinical Efficacy and Safety Profile
Randomised trials involving over 4,000 patients show felodipine reduces systolic pressure by an average of 10‑12mmHg, comparable to other dihydropyridines. Common side‑effects include ankle edema, headache, and mild tachycardia. Rarely, reflex tachycardia can exacerbate angina, prompting clinicians to consider non‑dihydropyridine CCBs or beta‑blockers.
Key Alternatives to Plendil
When deciding whether to start felodipine, doctors weigh its profile against other antihypertensives. Below are the most frequently discussed alternatives.
Amlodipine is a long‑acting dihydropyridine CCB widely used for hypertension and peripheral artery disease. Its half‑life (≈ 30‑50hours) is longer than felodipine, making it attractive for patients with adherence challenges. Nifedipine comes in both immediate‑release and extended‑release (ER) forms. The ER version mimics felodipine’s smooth plasma curve, but the immediate‑release tablet can cause abrupt drops in pressure, so it is rarely a first‑line option. Diltiazem is a non‑dihydropyridine CCB that also slows heart‑rate by acting on the SA and AV nodes. It is preferred when a patient has both hypertension and atrial arrhythmias. Verapamil similarly reduces heart‑rate and myocardial contractility, making it useful in angina and supraventricular tachycardia, but it may worsen heart‑failure in some patients.
Comparison Table
| Drug | Class | Typical Dose (once daily) | Half‑Life | Common Side‑effects | Cost (AU$/month) |
|---|---|---|---|---|---|
| Felodipine (Plendil) | Dihydropyridine CCB | 5‑10mg | 12‑15h | Edema, headache, flushing | ≈30 |
| Amlodipine | Dihydropyridine CCB | 5‑10mg | 30‑50h | Peripheral edema, gum overgrowth | ≈35 |
| Nifedipine ER | Dihydropyridine CCB | 30‑60mg | 9‑12h | Headache, dizziness, reflex tachycardia | ≈28 |
| Diltiazem | Non‑dihydropyridine CCB | 120‑240mg | 3‑5h | Constipation, bradycardia, edema | ≈40 |
| Verapamil | Non‑dihydropyridine CCB | 80‑240mg | 3‑7h | Constipation, bradycardia, heart failure | ≈38 |
When to Choose Felodipine Over the Rest
If a patient needs a once‑daily pill with a predictable plasma curve and is not prone to severe edema, felodipine is a solid pick. It is especially useful in older adults who may metabolise drugs slower; the moderate half‑life avoids accumulation while still covering the 24‑hour period.
However, in patients with chronic peripheral edema or a history of gout, a non‑dihydropyridine like diltiazem may be better because it exerts less venous dilation.
Cost, Availability, and Practical Tips
In Australia, felodipine is listed on the PBS, making it affordable for most retirees. Generic versions cost about the same as brand‑name Plendil, but the latter may be preferred when medication reconciliation is crucial-pharmacies often recognise the brand more readily.
Key practical advice:
- Take the tablet with food to reduce gastric irritation.
- Monitor weight weekly; a gain of >2kg may signal problematic edema.
- Check for interactions with simvastatin or cimetidine, which can raise felodipine levels.
Related Concepts and Next Steps in Your Hypertension Journey
Understanding felodipine fits into a broader knowledge cluster that includes ACE inhibitors (e.g., ramipril), beta‑blockers (e.g., metoprolol), and lifestyle measures (dietary sodium reduction, regular exercise). Readers who want to explore combination therapy should look at recent Australian hypertension guidelines, which recommend pairing a CCB with either an ACE inhibitor or a thiazide‑type diuretic when monotherapy fails.
Future topics to dive into could include:
- Impact of renal function on CCB dosing.
- Managing drug‑induced edema without adding diuretics.
- Pharmacogenomics: how genetics influence response to felodipine.
Frequently Asked Questions
What makes felodipine different from amlodipine?
Felodipine has a shorter half‑life (12‑15h) than amlodipine (30‑50h). This can be an advantage for patients who experience amlodipine‑related gum overgrowth or who need more flexibility when adjusting doses.
Can I take felodipine with a statin?
Yes, but caution is needed with simvastatin or atorvastatin because felodipine can increase their plasma levels, raising the risk of myopathy. Switching to pravastatin or rosuvastatin, which have fewer interactions, is a common solution.
Is felodipine safe during pregnancy?
Pregnancy category C. Animal studies show some risk, and there are limited human data. Most clinicians prefer to switch to methyldopa or labetalol, which have a stronger safety record.
Why do I get ankle swelling with felodipine?
Dihydropyridine CCBs dilate precapillary arterioles but not post‑capillary venules, leading to fluid shifting into the interstitial space. Raising the dose gradually or adding a low‑dose thiazide diuretic often mitigates the swelling.
How quickly does felodipine start lowering blood pressure?
Significant reductions are usually seen within 2‑4weeks of consistent dosing, although the drug begins to act within hours of ingestion.
Can felodipine be combined with ACE inhibitors?
Yes, the combination is common and often more effective than either agent alone because they target different pathways-vascular resistance and renin‑angiotensin‑aldosterone system.
What should I do if I miss a dose?
Take the missed tablet as soon as you remember, unless it’s near the time of the next dose. In that case, skip the missed one and continue with the regular schedule-don’t double‑dose.
Harshitha Uppada
September 27, 2025 AT 15:37plendil sounds like a fancy coffee but it's just another pill.