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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes chronic swelling in the ankles while on Amlodipine?

Answered by
Dr.
Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7135 Questions

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Posted on Thu, 25 Aug 2016 in Hypertension and Heart Disease
Question: my feet and ankles are continuing to swell and I have developed a theory about high systolic morning pressures 170 to 189, I am on my feet all day off and on and my systolic is always 150 or less at 8 pm, usually around 140, but at night when sleeping my feet don't move and wham !!!! I intend to follow your suggestion about getting a Doppler ultrasound very soon, I have a meeting with my pcp this afternoon and will discuss your recommendation to drop clonidine gradually and go to methyldopa 250 mg to start and the possibility of 2 at night, I would prefer removing the swelling first if possible. I also need to get off amlodipine which I have only been on with lisinipril only since may 1 2016, I had the swelling long ago but had eliminated it for about 6 months before starting amlodipine and lisinipril, since lisinipril and valsartan should maybe not be taken together what would be a good replacement for lisinipril ??? hope I !m not asking just asking for a miracle but I ntend to resolve this problem one way or the other,,,thanks again for all of your excellent council, XXXXXXX Ward
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Dear XXXXXXX

Welcome back on HCM!

I am glad you find my recommendations helpful!

It is true that amlodipine can contribute in leg swelling, as all calcium channel blockers do.

A Doppler ultrasound of the leg vessels would help examine your veins and exclude possible chronic venous insufficiency as a possible cause of leg swelling.

Another point to consider would be review again your cardiac function by performing a new cardiac ultrasound.

Regarding lisinopril, I would recommend starting a loop diuretic like torasemide.

It is similar to furosemide ( I know about your past problems with furosemide), but it does not have the same adverse effects.


I would also recommend you to follow my advice to start methyldopa, which is a central antihypertensive drug, which can be really helpful to have a better control of your blood pressure.

Hope to have been helpful!

I remain at your disposal for any other questions, whenever you need!

Kind regards,

Dr. Iliri



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 32 minutes later
thanks for that quick response, question...........since I am already on 12.5 mg of hydroclorathazide with the 160 / 12.5 valsartan two times per day would that be to much of a diaretic and if so should the 12.5 in the valsartan be eliminated or if the torasemide is taken then if I continued to take valsartan 160/12.5 and the torasemide what strength torasemide should be started, in the event torasemide cannot be taken with the valsartan 160/12.5 what would you suggest in place of torasemide ???? wow !! what a tongue XXXXXXX thanks XXXXXXX Ward
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again Bobby!

Hydrochlorothyazide is another type of diuretic and it can be taken concomitantly with Torasemide. There is nothing wrong in this combination.

So you can take both Valsartan 160/12.5 and Torasemide.

I would recommend starting with 2.5-5 mg/day initially; increasing to 10 mg/day after 4 weeks.

It will help with the leg swelling too, as it is a diuretic.

Besides, adding Methyldopa to your actual therapy (instead of clonidine) will help you have a better control of your blood pressure through 24 hours.

Hope to have been helpful!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 2 days later
thank u for your response, the reason I am a bit late with this follow up is because late Friday I had an appointment with my primary care physician, we discussed your recommendations and he agreed to take me off both lisinipril and amlodipine, however he did not feel good about putting me on the methyldopa because he had no experience with it, he said it was a much older med, he did not put me on the torasimide but put me on 1 25mg spironolactone per day, he said that a cardiologist that specializes in extreme blood pressures told him it was an awesome treatment for that, he acknowledged that the 25 mg may not be enough.. I am aware of the start low and go slow system u guys operate under and that makes good sense......I have another appointment with him on august 25th, but if my pressures get too high from being off lisinipril and amlodipine after about 10 days I will see him sooner, please give me your thoughts and any other suggestions you may have........as always I am thankful to have u as an advisor.....I!m XXXXXXX Ward
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:
Dear XXXXXXX

I would like to explain you that clonidine and spironolactone are drugs much older than methyldopa.

Besides, methyldopa is still the only drug approved in hypertensive pregnant women. So, it is certainly used in nowadays.

While spironolactone has a really low antihypertensive effect. It will not help in controlling your blood pressure. It is mainly used when combined with hydroclorothyazide and furasemide in order to help increase potassium levels.

So, taking spironolactone will only help increase your potassium levels (especially when considering that you are taking valsartan), but I don't think that it will show any spectacular effect on your blood pressure.

I strongly recommend you to add methyldopa. Although it is not a new drug, it is has shown to be really helpful in some cases of uncontrolled high blood pressure.

From the other hand, spironolactone is a weak diuretic. It can not substitute torasemide, especially for the treatment of your swollen legs.

So, I hope you consider my opinion on these drugs.

I remain at your disposal if you have any other uncertainties whenever you need.

Regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 1 hour later
thank u so much for sharing your wisdom with me, I will get another appointment with my PCP and have him change the present strategy, what strength methyldopa would be a good starter for me knowing my systolic pressures are very high, would you recommend starting with just methyldopa and check the results or would you go with it plus adding torasemide and if so what strength torasemide would you use to start ? also since my systolic pressure is out of sight at night should I use stronger meds at night are as always start low and go slow, I would also appreciate your providing me with a direct contact link with you...............thank you again so much...... XXXXXXX Ward
doctor
Answered by Dr. Ilir Sharka 8 hours later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Dear XXXXXXX

I would recommend starting first Methyldopa and increase gradually the dose up to 1000mg daily (you can take tow tablets in the evening, one at lunch and one in the morning) and then try to add torasemide if your blood pressure is still not under control.

Torasemide can be really helpful for your swollen legs too. You can also take 750mg methyldopa per day and then start torasemide. (1000mg/day is the maximal daily dose for methyldopa).

You should discuss with your doctor on the above issues.

Hope you will find this answer helpful!

Best wishes,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka 8 hours later
thank you for that fine response, I will discuss this with my doctor soon. don!t know if you can give me a direct link to you or not, if you can do t I would be very grateful, thanks, yours in the faith.......... XXXXXXX Ward
doctor
Answered by Dr. Ilir Sharka 33 minutes later
Brief Answer:
My personal link as follows:

Detailed Answer:
Dear XXXXXXX

I am glad to have been helpful to you!

You can ask me directly at any time if you have any other questions on the link below:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765

I would be happy to answer to all your questions!

Wishing all the best,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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