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

Most common
Edema (up to 10.8%)
Palpitations (up to 4.5%)
Dizziness (up to 3.4%)
Flushing (up to 2.6%)

Hydrochlorothiazide

Most common
Weakness (not specified)
Hypotension (not specified)
Hypokalemia (not specified)
Hyperglycemia (not specified)

Amlodipine vs. Hydrochlorothiazide Dosage

Amlodipine

Dosage
Dosage Table
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

Dosage
Dosage Table
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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