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Felodipine belongs to the dihydropyridine class of calcium channel blockers and is approved by the United States Food and Drug Administration (FDA) for the management and treatment of essential hypertension. Felodipine is also recognized for its ability to reduce blood pressure levels, thereby diminishing the risk of cardiovascular morbidity and mortality. A key advantage of felodipine's antihypertensive effect is its notable impact on decreasing the incidence of strokes. For individuals with mild-to-moderate hypertension, felodipine extended-release monotherapy demonstrates comparable efficacy to cardioselective beta blockers, thiazide diuretics, angiotensin-converting enzyme inhibitors, and other calcium channel antagonists. This activity outlines felodipine's indications, mechanism of action, adverse event profile, and contraindications crucial for interprofessional healthcare team members treating patients with essential hypertension. Objectives: Identify FDA-approved indications for felodipine, focusing on its role in the management and treatment of essential hypertension. Differentiate felodipine's mechanisms of action from other antihypertensive agents, recognizing its place within the dihydropyridine class of calcium channel blockers. Assess and monitor patients receiving felodipine, evaluating their response, adherence, and potential adverse events, and adjusting treatment plans as necessary. Collaborate with interprofessional team members to ensure comprehensive patient care and optimal treatment outcomes, considering patient health, lifestyle, and potential interactions with other medications. Access free multiple choice questions on this topic.

A mild-to-moderate overdose of felodipine can result in hypotension secondary to peripheral vasodilation and reflex tachycardia. However, a severe overdose of felodipine can cause life-threatening profound hypotension and bradycardia. Case fatality due to profound, refractory circulatory collapse overdose has been reported in the literature.[31] The risk of overdose increases in elderly individuals, patients with liver impairment, and concomitant administration of felodipine with beta blockers. Overdose symptoms can include lightheadedness, syncope, altered mental status, and shock secondary to profound hypotension. The insulin release from the pancreas depends on calcium influx through the L-type channels. Felodipine blocks these calcium channels and results in hyperglycemia because of decreased insulin release.[32] The first step in managing Felodipine overdose is maintaining a patent airway. Patients who have consumed an excess of felodipine ER tablets but have not yet developed any symptoms should be started on gastrointestinal decontamination with whole bowel irrigation if they present within 6 to 8 hours of drug ingestion. Patients with hypotension should undergo resuscitation with IV fluids. However, caution is necessary for individuals with congestive heart failure and pulmonary edema. Vasopressor therapy with dopamine or norepinephrine is an as-needed option for hypotension. IV calcium gluconate or calcium chloride (given via central line) are also options in treating Felodipine overdose. In patients with severe overdose, atropine should be administered IV for bradycardia. The vital signs, serum electrolytes, especially potassium, blood glucose, urine output, and ECG, should be monitored regularly. Hyperinsulinemia-euglycemia therapy is also an established treatment for CCB overdose.[33] This therapy helps mobilize glucose from the peripheral tissue to serve as an alternative energy source for the myocardium.[34]

Felodipine ER, with daily administration, is a convenient-to-use antihypertensive medication. Healthcare personnel should be aware of the indications and adverse effects of felodipine. Clinicians need to obtain an appropriate medication history to look for drug interactions since CYP3A4 metabolizes felodipine. The healthcare personnel, including pharmacists, should educate the patients regarding medication adherence and regular blood pressure monitoring. If patients develop symptomatic hypotension, discontinue the medicine immediately and transfer to the emergency department. Prescribers (MDs, DOs, NPs, PAs) should accurately determine the initial and maintenance dose of felodipine. The pharmacist should verify that all dosing suits the clinical scenario and report any discrepancies. The pharmacy should also perform medication reconciliation since, as discussed, felodipine can have significant drug-drug interactions. Nurses will be in charge of administration for inpatients, monitoring the patient on subsequent outpatient visits, monitoring for adverse reactions, medication compliance, and therapy effectiveness, and reporting any negative findings to the healthcare team. The outcomes of a cohort study demonstrated the significance of the pharmacist/physician team approach, which incorporated CCBs (such as felodipine) and various antihypertensive agents. This approach proved more effective than standard care in patients with treatment-resistant hypertension.[35] Felodipine therapy requires an interprofessional team approach, including clinicians, specialists, specialty-trained nurses, and pharmacists, all collaborating to achieve optimal patient results.