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Amlodipine-Induced Bilateral Upper Extremity Edema

Paediatric Registrar, Department of Paediatrics, Starship Children's Hospital, Auckland, New Zealand

William Wong, FRACP

Paediatric Nephrologist, Department of Nephrology, Starship Children's Hospital

Reprints: Dr. Ganeshalingham, Department of Paediatrics, Starship Children's Hospital, Private Bag 92029, Auckland, New Zealand, fax 64-9-3074913, AnushaG{at}adhb.govt.nz

OBJECTIVE: To report a case of bilateral upper extremity edema associated with amlodipine use in a child.

CASE SUMMARY: A previously well and normotensive 6-year-old girl presented with a generalized vasculitis of unknown origin and severe hypertension. Large vessels predominantly affecting the neck, chest, and abdomen were found to be involved, resulting in abnormal arterial circulation and significant blood pressure differences between the upper and lower extremities. Multiple antihypertensive agents were initially required to control blood pressure. She was stabilized and discharged on amlodipine 10 mg each evening, atenolol 50 mg/day, and warfarin. Three days later she was noted to have facial and bilateral upper extremity pitting edema. Laboratory and radiologic assessments for possible etiologies were negative. Discontinuation of amlodipine resulted in resolution of edema.

DISCUSSION: As of June 2007, there had been no cases of bilateral upper extremity edema associated with amlodipine use reported in the English literature. Adverse effects of amlodipine, a widely used antihypertensive, have been well reported. These include flushing, headache, and peripheral edema. Lower limb edema is the most common, while periocular and perioral edema have occurred less frequently. Anasarca edema has been described only once in the English literature. According to the Naranjo probability scale, amlodipine was a probable cause of bilateral upper extremity edema in this child.

CONCLUSIONS: Bilateral upper extremity edema has been associated with amlodipine use in a child with an abnormal arterial circulation. The edema resolved upon discontinuation of the drug.

Key Words: amlodipine, edema, pediatrics

Published Online, July 31, 2007. www.theannals.com, DOI 10.1345/aph.1K235