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A: Ankle oedema is a common and often troublesome adverse effect of calcium-channel blocker (CCB) treatment that can affect adherence. Because CCB-associated ankle oedema is caused by changes in capillary pressure leading to leakage into interstitial areas, rather than due to water retention, it is usually refractory to diuretic treatment.1 Treatment strategies include:
- Non-pharmacological methods — elevation of legs when in a prone position, or the use of graduated compression stockings, may be an option for some patients with mild oedema; however, there is little evidence to suggest these methods are effective
- Dose adjustments — reducing the dosage of a CCB may reduce the severity of ankle oedema
- Switching CCB — switching from a dihydropyridine CCB to a nondihydropyridine CCB (or vice versa) may reduce ankle oedema, although current evidence on the success rates of this strategy is conflicting
- Diuretics — unlike for other types of oedema, loop and thiazide diuretics appear to have little effect on CCB induced oedema
- Angiotensin-converting enzyme inhibitors (ACEI) — adding an ACEI to treatment with a CCB has been shown to reduce the incidence of ankle oedema in several studies; the mechanism for this is unknown
- Angiotensin-II receptor blockers (ARBs) — like ACEIs, ARBs can reduce CCB-induced ankle oedema, but the mechanism is unknown
- Nitrates — Nitrates may offer some benefit for treating CCB-induced ankle oedema, but the need for a nitrate-free period poses practical challenges
- Discontinuation — a CCB may need to be stopped if the management strategies outlined above fail
This FAQ is taken from a “Medicines Q&A” produced by UK Medicines Information. The full document, including references, is available from www.nelm.nhs.uk (prepared 20 June 2011)
