Efficacy of Amlodipine in Pediatric Bone Marrow Transplant Patients

Abstract

The calcium antagonist amlodipine may have the potential for expanded use in children owing to its physiochemistry and pharmacokinetic profile that facilitates once-daily dosing in a liquid formulation. Its safety and efficacy have not been previously evaluated in children. A retrospective analysis of 15 pediatric bone marrow transplant patients who had amlodipine incorporated into their antihypertensive drug regimen reveals significantly lower blood pressure as compared with baseline therapy (123.5+/-2.1 mmHg and 117.2+/-2.2 mmHg, systolic blood pressure before and during amlodipine, P<0.05; 81.5+/-1.8 mmHg and 75.5+/-2.6 mmHg, diastolic blood pressure before and during amlodipine, P<0.05). Amlodipine provided improved blood pressure control in this cohort and may provide a valuable pharmacologic alternative for treatment of pediatric hypertension.

Antihypertensive efficacy of amlodipine in children with chronic kidney diseases

“…11,19 The side effects noted in our paediatric patients given amlodipine are similar to those reported in adults and children treated with amlodipine or other dihydropyridines. [1][2][3][4]18,[20][21][22][23] These vasodilators lead in 10 to 20% of patients to one or more of the following: headache, dizziness or lightheadedness, flushing, and peripheral oedema. The peripheral oedema is related to redistribution of fluid from the vascular space into the interstitium, possibly induced by vasodilatation which allows more of the arterial pressure to be transmitted to the capillary circulation.…”

“…[1][2][3][4]16,17 Paediatric use of amlodipine has previously been reported, 12,18,[20][21][22][23] but previous reports have been limited by small patient numbers 12,[20][21][22][23] and rather heterogenous patient populations, that included both in-and outpatients 18,20 or both renal and non renal hypertension. 12,18,20,21 In conclusion the results of the present experience in paediatric outpatients with chronic kidney diseases support the view that amlodipine is an effective and rather well tolerated antihypertensive drug when given once a day in a dosage of 7 to 10 mg/m 2 body surface area and suggest that it has obvious advantages over other dihydropyridines. 26 …”

Efficacy and safety of prolonged amlodipine treatment in hypertensive children

“…Since most of the children in this report have secondary forms of hypertension, it is likely that they will require treatment with amlodipine or other antihypertensive medications for the rest of their lives. Although limited by the lack of active, prospective surveillance for adverse effects such as that seen in industrysponsored trials, the data in this study do add further information with respect to tolerability of amlodipine treatment to that previously reported in the literature [3,4,5,6,7,8,9,10] and suggest that this medication is generally well tolerated by hypertensive children.…”

“…Subjects in this report received amlodipine on average for nearly 2 years, and most for at least 1 year, far longer than in any of the published reports of pediatric amlodipine use to date [3,4,5,6,7,8,9,10]. Amlodipine produced a significant reduction in blood pressure within about 6 weeks after the start of treatment that was sustained for the duration of therapy.…”

“…Given that many hypertensive children have chronic renal disease or other underlying identifiable causes of hypertension, long-term, if not indefinite, antihypertensive therapy will be needed in many such children. Unfortunately, however, the duration of amlodipine treatment in published pediatric series to date has been quite short, usually 6-16 weeks [3,4,5,6,7,8,9,10]. We therefore assessed the long-term efficacy and tolerability of amlodipine use in hypertensive children by studying patients who had received amlodipine treatment for 6 months or longer.…”