How should ankle oedema caused by calcium channel blockers be treated?

Sue Dickinson, Director of Pharmacy, Regional Drug & Therapeutics Centre (Newcastle)Source Regional Drug and Therapeutics CentrePublished

Ankle oedema is a common, often troublesome adverse effect for patients who are receiving calcium channel blocker (CCB) therapy, and may affect compliance. It is usually refractory to diuretic treatment as it is due to changes in capillary pressure leading to leakage into interstitial areas, rather than due to water retention.

Treatment strategies include:

  • Non-pharmacological interventions.
  • Dosage adjustments.
  • Switching to a non-dihydropyridine CCB.
  • Adding an angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB).
  • Adding a nitrate.
  • Discontinuation of CCB.

Of these options, the strongest evidence base is for adding in an ACEI. ARBs may be used in patients in whom ACEIs are not tolerated.

For information regarding the incidence of ankle oedema with CCBs a specific Q&A has been published: ‘What are the reported incidences of ankle oedema with different calcium channel blockers?’

A video by GP Notebook TV discussing this Q&A is also available here.