Understanding the Evidence: Can Amlodipine Cause Falls?

October 9, 2025 •

4 min read

According to a study from the ALLHAT trial, older adults starting amlodipine experienced a higher risk of falls within the first year compared to those on certain other antihypertensive medications. This raises important questions for patients: Can amlodipine cause falls?

Quick Summary

Studies suggest amlodipine may increase short-term fall risk, especially in older adults within the first year of treatment, due to its blood pressure-lowering effects. Long-term risk is comparable to other medications, but monitoring for dizziness is essential, and risk can be managed with proper dosage.

Key Points

Short-Term Risk: Studies show amlodipine can increase fall risk in older adults, primarily during the first year of treatment compared to some other antihypertensives.
Orthostatic Hypotension: The increased risk is often linked to orthostatic hypotension—a sudden drop in blood pressure when standing up—which can cause dizziness.
Elderly Sensitivity: Elderly patients are particularly susceptible due to decreased drug clearance, leading to higher concentration levels in the body.
Manageable Risk: The risk can be mitigated by starting with a low dose, slowly rising from a sitting or lying position, and careful monitoring by a healthcare provider.
Long-Term Profile: While a short-term risk exists, long-term studies suggest the cumulative incidence of falls is not significantly different from other common antihypertensive classes.
Polypharmacy Risk: The risk of falls is heightened when amlodipine is taken alongside other medications that can also cause dizziness or hypotension.

Amlodipine and Its Impact on Blood Pressure

Amlodipine is a calcium channel blocker widely prescribed to treat high blood pressure (hypertension) and angina. It works by relaxing and widening the blood vessels, which allows blood to flow more easily and effectively reduces blood pressure. By easing the heart's workload and increasing blood and oxygen supply to the heart, it helps prevent serious cardiovascular events. While highly effective, its mechanism of action is directly related to the potential for certain side effects, including a drop in blood pressure that can contribute to falls.

The Short-Term Link Between Amlodipine and Falls

For many patients, the potential connection between amlodipine and an increased risk of falls is a significant concern. Research, particularly a secondary analysis of the large-scale ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), has provided crucial insights. This analysis revealed that older participants randomized to amlodipine had a higher risk of falls during the first year of treatment compared to those taking chlorthalidone or lisinopril.

While this short-term risk was notable, the same study found no significant differences in the cumulative incidence of falls over the entire trial period of nearly five years. This suggests that the initial adjustment period is a particularly vulnerable time, after which the body may adapt, or other factors normalize the risk.

Why Do Falls Occur on Amlodipine?

The primary mechanism linking amlodipine to an increased risk of falls is related to its blood pressure-lowering effect, which can lead to dizziness, lightheadedness, and fainting. Specifically, a condition known as orthostatic hypotension can occur, where a sudden drop in blood pressure happens when moving from a sitting or lying position to a standing one.

Several factors can exacerbate this effect:

Dosage: Higher doses of amlodipine are more likely to cause significant blood pressure drops and associated side effects.
Age: Older adults have a decreased clearance of amlodipine from their body, leading to higher drug levels and a greater risk of adverse effects like orthostatic hypotension.
Polypharmacy: Taking multiple medications, especially other drugs that also lower blood pressure or cause sedation, can compound the risk.
Combined Medications: The concurrent prescription of amlodipine and diuretics, such as frusemide, has been identified as a prescribing cascade that may further increase fall risk factors.

Managing and Mitigating Fall Risk

While the risk of falls is a valid concern, it is not an insurmountable barrier to using amlodipine effectively. Here are several strategies for managing and minimizing risk:

Start with a Low Dose: Your doctor may start you on the lowest effective dose of amlodipine, especially if you are an older adult, and increase it gradually as needed.
Take It at Night: For some patients, taking amlodipine at bedtime can help reduce the effects of dizziness during the day.
Rise Slowly: Practice moving slowly when transitioning from lying down or sitting to a standing position. This gives your body time to adjust to the blood pressure change.
Stay Hydrated: Dehydration can lower blood pressure and increase the risk of dizziness. Ensure you are drinking enough fluids, but consult your doctor regarding your fluid intake if you are also on diuretics.
Review All Medications: Discuss all of your current medications and supplements with your doctor or pharmacist to identify any that might be increasing your fall risk.
Regular Monitoring: Regularly monitor your blood pressure and report any instances of dizziness or near-fainting to your healthcare provider.
Assess Environmental Hazards: Modify your home environment to remove tripping hazards, improve lighting, and use assistive devices if necessary.

Amlodipine vs. Other Antihypertensives: A Comparison

For many patients, the decision to use amlodipine involves weighing its effectiveness against potential side effects like fall risk. It is useful to compare its risk profile with other common antihypertensives.


Feature	Amlodipine (Calcium Channel Blocker)	Lisinopril (ACE Inhibitor)	Chlorthalidone (Diuretic)	Atenolol (Beta Blocker)
Mechanism	Relaxes blood vessels, reduces blood pressure.	Blocks enzyme that produces a vasoconstrictor, relaxes blood vessels.	Promotes urination, reduces fluid volume, lowers blood pressure.	Blocks adrenaline effects, slows heart rate, lowers blood pressure.
Primary Fall Risk	Increased risk of falls, especially in the first year, potentially from orthostatic hypotension.	May cause a drop in blood pressure, especially with dehydration.	Can cause dehydration and electrolyte imbalance, increasing risk.	Can cause hypotension and dizziness, but risk may vary.
Long-Term Risk (per ALLHAT)	No significant difference observed over the full trial period compared to alternatives.	Long-term risk of falls not significantly higher than chlorthalidone.	Low overall long-term risk of falls.	Not associated with increased fall risk in the ALLHAT analysis.
Initial Management	Start with low dose, especially in older adults; monitor closely.	Careful dosing, monitor kidney function and electrolytes.	Monitor electrolytes and hydration status.	Individualized care; can affect heart rate.

Conclusion

Yes, amlodipine can increase the risk of falls, particularly during the initial phase of treatment and especially in older adults. The primary cause is the medication's effect on blood pressure, which can lead to orthostatic hypotension. However, this risk is often manageable through careful dosage, patient education, and proactive monitoring by healthcare professionals. The long-term benefits of effective blood pressure control generally outweigh the initial risks for many patients. It is crucial for patients and healthcare providers to work together to create a personalized treatment plan that minimizes the risk of falls while effectively managing hypertension. Regular communication with your doctor about any symptoms like dizziness or lightheadedness is the most effective way to ensure treatment is both safe and successful. Further details regarding the short-term fall risk can be reviewed in the Hypertension journal article from 2019 reporting on the ALLHAT trial.

Frequently Asked Questions

No, amlodipine does not definitely cause falls, but studies show it can increase the risk, particularly in older adults during the first year of treatment. The risk is often associated with the medication's effect on blood pressure.

Orthostatic hypotension is a sudden drop in blood pressure when you stand up. Amlodipine, as a blood pressure-lowering medication, can contribute to this effect, leading to dizziness or lightheadedness that may result in a fall.

Older adults are at a higher risk because their bodies clear amlodipine more slowly, which can lead to higher concentrations of the drug. Additionally, those taking multiple medications (polypharmacy) that affect blood pressure or cause sedation are also at increased risk.

If you feel dizzy, lie down immediately to avoid fainting. Afterward, sit for a few minutes before standing up slowly. Report persistent dizziness or lightheadedness to your doctor, who may adjust your dosage or change your medication.

Yes, for some patients, taking amlodipine in the evening can help mitigate the effects of dizziness during the day by having the medication's peak effect occur while they are less active. Consult your doctor to see if this is an appropriate strategy for you.

Many blood pressure medications can potentially increase the risk of falls due to their hypotensive effects, but the degree of risk varies by drug class and individual. Studies like ALLHAT have shown differences in short-term fall risk between different antihypertensives, such as amlodipine, lisinopril, and chlorthalidone.

No, you should never stop taking amlodipine without consulting your healthcare provider. The long-term benefits of controlling high blood pressure are significant. Your doctor can help you manage and minimize the fall risk through dosage adjustments or other strategies.