felodipine: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
felodipine: clinical details
Prescribing considerations
- Not established for hypertensive emergencies.
- Review hepatic impairment because reduced clearance can increase exposure; use particular caution in severe renal impairment where specified by the product.
- Avoid strong CYP3A4 inhibitors and inducers.
- Maintain good dental hygiene because gingival enlargement is associated particularly with pre-existing gingivitis or periodontitis.
- Check excipients and the individual SmPC where excipient sensitivity is relevant.
Contraindications and cautions
- Hypersensitivity to felodipine or relevant excipients
- Pregnancy
- Acute myocardial infarction
- Unstable angina
- Decompensated heart failure
- Haemodynamically significant cardiac valvular obstruction
- Dynamic cardiac outflow obstruction
Monitoring
- Blood pressure and symptoms of hypotension, particularly after treatment changes or switching prolonged-release preparations
- Peripheral oedema, flushing, headache, palpitations and dizziness
- Gingival condition and oral hygiene
- Liver-related clinical factors that may increase exposure
- Tacrolimus serum concentration if co-administered
Clinical pharmacology
Felodipine is a vascular-selective dihydropyridine calcium antagonist. It reduces systemic vascular resistance with little direct effect on cardiac contractility or atrioventricular conduction, is highly protein bound and is extensively metabolised by hepatic CYP3A4.
Formulation and product differences
- Selected products are prolonged-release tablets and must retain their modified-release properties during administration.
- Prolonged-release products may not be therapeutically identical; check blood pressure after switching.
- Tablet appearance and excipients vary. Selected products contain lactose, while Delofine XL also contains macrogolglycerol hydroxystearate, which may cause gastrointestinal upset.
felodipine preparations and strengths
Modified-release tablet
Route: Oral
Strengths: 2.5 mg, 5 mg, 10 mg
Tablet
Route: Oral
Strengths: 10 mg
felodipine interactions
Check new prescriptions, over-the-counter products and herbal remedies with a pharmacist or prescriber.
Strong CYP3A4 inhibitors, including itraconazole, ketoconazole, erythromycin and ritonavir
Can substantially increase felodipine exposure and adverse effects; strong combinations should be avoided.
Strong CYP3A4 inducers, including carbamazepine, phenytoin, rifampicin, barbiturates and St John’s wort
Can markedly reduce felodipine exposure and effectiveness; strong combinations should be avoided.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.