What does NICE guidance define as calcium-channel blocker intolerance in

NICE definition: NICE NG136 does not provide a formal diagnostic definition, severity threshold, or required duration for calcium-channel blocker (CCB) intolerance in primary care. NICE NG136

Instead, it uses a pragmatic clinical concept: a CCB is “not tolerated,” with oedema explicitly given as an example. NICE NG136

Therefore, document the suspected adverse effect, its temporal association with the CCB, its impact on the person, and whether it resolves or improves after dose reduction or withdrawal; this is a clinical prescribing assessment rather than a separate NICE-defined oedema criterion. NICE NG136

Peripheral oedema is a recognised CCB adverse effect, including with dihydropyridine CCBs such as lercanidipine. SmPC Lercanidipine

What to prescribe next: If the person is at the step-1 point where a CCB would otherwise be used—typically age 55 years or over without type 2 diabetes, or Black African/African–Caribbean family origin without type 2 diabetes—then documented CCB intolerance should lead to a switch to a thiazide-like diuretic. NICE NG136

NICE prefers a thiazide-like diuretic such as indapamide over conventional thiazides such as bendroflumethiazide or hydrochlorothiazide when starting or changing diuretic treatment for hypertension. NICE NG136

If blood pressure is uncontrolled in someone already taking a CCB at step 1, this is not automatically a reason to replace the CCB with a diuretic: first address adherence and optimise the tolerated dose, then add an ACE inhibitor, an ARB, or a thiazide-like diuretic according to the step-2 pathway. NICE NG136

However, if the CCB adverse effect is clinically unacceptable and the CCB is stopped because it is not tolerated, the practical replacement is the step-1 alternative, a thiazide-like diuretic. NICE NG136

For a person taking an ACE inhibitor or ARB at step 1 whose BP remains uncontrolled, NICE permits either a CCB or a thiazide-like diuretic as the additional step-2 agent, so a prior documented CCB intolerance supports choosing the thiazide-like option. NICE NG136