Amlodipine , the most popular anti hypertensive drug used world wide has an very important action on coronary blood flow.When nifedipine was introduced three decades ago it was known for it’s powerful anti anginal properties. Subsequently amlodipine was introduced with almost similar action. But over the years, amlodipine was projected primarily as anti hypertensive drug and gradually many of the physicians are made to believe it is a drug that should be used only if the blood pressure is high.The fear of reflex tachycardia in few was exaggerated.
In fact a cross section of today’s general physicians were queried about amlodipine and none of them acknowledged using this drug as an anti anginal drug. And few of them went to the extent of withdrawing amlodipine if it was used for the purpose of angina relief !
Why amlodipine’s anti anginal action is in doldrums ?
The single word answer is unfortunate! Marketing bias ,coupled with the fact that mainstream cardiology texts have ignored this aspect.
Final message
Amlodipine , can still be used as a antianginal drug especially in a patient who has angina with associated bradycardia , significant LV dysfunction . Some reserve amlodipine and nifedipine exclusively for vasospastic angina where beta blockers alone are theoretically contraindicated .
Dr.S.Venkatesan MD 
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