Amlodipine vs. Hydrochlorothiazide
See how Amlodipine and Hydrochlorothiazide compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Amlodipine is a calcium channel blocker that relaxes blood vessels, while hydrochlorothiazide is a diuretic that helps the body release excess salt and water.
Both are taken once daily by mouth, but amlodipine needs no dose adjustment for kidney function, which matters for people with reduced kidney function.
Doctors often prescribe amlodipine and hydrochlorothiazide together, since pairing a calcium channel blocker with a diuretic can control blood pressure better than either drug alone.
Amlodipine vs. Hydrochlorothiazide Drug Summary
Amlodipine
Amlodipine is a dihydropyridine calcium channel blocker used to treat high blood pressure, chronic stable angina, and coronary artery disease. It works by relaxing blood vessels, which lowers the effort the heart needs to pump blood. It comes as a tablet taken once a day, with the dose increased gradually if needed.
Hydrochlorothiazide
Hydrochlorothiazide is a thiazide diuretic used to treat high blood pressure and fluid retention from conditions like heart failure or cirrhosis. It works by prompting the kidneys to release more sodium and water into the urine, lowering overall fluid volume. It is also taken as a tablet once a day, with the dose adjusted based on response.
Amlodipine vs. Hydrochlorothiazide Side Effects
Amlodipine
Hydrochlorothiazide
Amlodipine vs. Hydrochlorothiazide Dosage
Amlodipine
Hydrochlorothiazide
| STAGE | DOSE | WHEN |
| Starting dose | 2.5 mg once daily | At the start |
| Maximum dose | 10 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg once daily | At the start |
| Maximum dose | 25-100 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Amlodipine
| STAGE | DOSE | WHEN |
| Starting dose | 2.5 mg once daily | At the start |
| Maximum dose | 10 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Hydrochlorothiazide
| STAGE | DOSE | WHEN |
| Starting dose | 25 mg once daily | At the start |
| Maximum dose | 25-100 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Amlodipine vs. Hydrochlorothiazide Indications
Amlodipine
Amlodipine is FDA-approved for high blood pressure, chronic stable angina, vasospastic (Prinzmetal's) angina, and coronary artery disease. It is often used long-term to control blood pressure and reduce angina episodes. It can be prescribed alone or alongside other blood pressure medications.
Hypertension
Chronic stable angina
Vasospastic (Prinzmetal's) angina
Coronary artery disease
Hydrochlorothiazide
Hydrochlorothiazide is FDA-approved for high blood pressure and for fluid retention caused by heart failure, cirrhosis, kidney disease, or steroid or estrogen therapy. It is sometimes used off-label to help prevent calcium-containing kidney stones. Like amlodipine, it can be used alone or combined with other antihypertensives.
Hypertension
Edema from heart failure, cirrhosis, or kidney disease
Edema from corticosteroid or estrogen therapy
Off-label: prevention of calcium kidney stones
Amlodipine vs. Hydrochlorothiazide Pros and Cons
Amlodipine
Amlodipine has a long half-life that keeps blood pressure steady with once-daily dosing, and it does not need dose adjustment for kidney function. It is also approved for angina, so it can cover more than one condition at once. Its main downside is dose-related swelling in the legs and ankles.
Pros
Long half-life provides steady blood pressure control all day
No renal dose adjustment needed, useful for kidney disease patients
Also approved for chronic and vasospastic angina, not just hypertension
Missing an occasional dose has less impact due to slow drug clearance
Cons
Edema (swelling) is the most common side effect, more so in women
Can worsen angina or trigger a heart attack in severe coronary disease
Not a diuretic, so it does not reduce fluid retention from heart failure
Symptomatic low blood pressure can occur, especially with aortic stenosis
Hydrochlorothiazide
Hydrochlorothiazide has decades of real-world use and doubles as a treatment for fluid retention, not just high blood pressure. It is often paired with other diuretics to help balance potassium levels. Its main downsides are electrolyte shifts and a long-term skin cancer risk with cumulative use.
Pros
Also treats fluid retention from heart failure, cirrhosis, or kidney disease
Decades of clinical use, one of the most studied antihypertensives
Often combined with potassium-sparing diuretics to offset potassium loss
Can help prevent calcium kidney stones (off-label use)
Cons
Can cause electrolyte imbalances such as low potassium and sodium
Linked to a higher risk of non-melanoma skin cancer with long-term use
Contraindicated in anuria and in people with sulfonamide allergy
Not approved for angina or coronary artery disease
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