Plendil (Felodipine 2.5 mg)
Prolonged-release tablet containing felodipine — for high blood pressure and chronic stable angina
Quick Facts About Plendil
Key Takeaways About Plendil
- What it is: Plendil contains felodipine, a selective dihydropyridine calcium channel blocker (ATC code C08CA02) that widens arteries to lower blood pressure
- Once-daily dosing: The 2.5 mg prolonged-release tablet is taken once a day, in the morning, with water – swallow whole, never crush or chew
- Avoid grapefruit: Grapefruit and grapefruit juice can more than double felodipine blood levels – avoid them completely during treatment
- Common side effects: Ankle swelling, flushing, headache and palpitations are dose-related and usually improve within a few weeks
- Not in pregnancy: Plendil should not be used during pregnancy or in women of childbearing potential without effective contraception
What Is Plendil and What Is It Used For?
Plendil is a brand name for felodipine, a long-acting dihydropyridine calcium channel blocker used to treat high blood pressure (essential hypertension) and chronic stable angina pectoris. It relaxes the peripheral arteries, lowers blood pressure, and reduces the oxygen demand of the heart, supplied as 2.5 mg prolonged-release tablets taken once daily.
Plendil belongs to the therapeutic class of calcium channel blockers (CCBs), specifically the dihydropyridine subgroup. These medicines act on L-type calcium channels in the smooth muscle cells lining the walls of arteries. By blocking the inward flow of calcium ions, felodipine prevents the muscle cells from contracting, which causes the arteries to relax and widen (a process called vasodilation). The result is a fall in systemic vascular resistance – the force the heart must overcome to pump blood – and a corresponding reduction in blood pressure. Unlike non-dihydropyridine calcium channel blockers such as verapamil or diltiazem, felodipine has minimal direct effect on the heart muscle itself at clinical doses; its action is predominantly vascular selective.
The primary indication for Plendil is essential hypertension. Persistently elevated blood pressure is one of the most important modifiable risk factors for stroke, heart attack, heart failure, chronic kidney disease, and cardiovascular death. International guidelines from the European Society of Cardiology (ESC), European Society of Hypertension (ESH), the American College of Cardiology (ACC), and the World Health Organization (WHO) all recognise calcium channel blockers such as felodipine as a first-line option for blood pressure control, either alone or in combination with other antihypertensives. Felodipine is particularly favoured in older adults and in patients of African or Afro-Caribbean ancestry, in whom CCBs and thiazide diuretics tend to be more effective than renin-angiotensin system blockers as monotherapy.
Plendil’s second recognised indication is chronic stable angina pectoris. Angina is chest discomfort caused by a temporary mismatch between the oxygen demand of the heart muscle and the oxygen supply delivered by the coronary arteries. By lowering systemic blood pressure (thus reducing afterload) and dilating coronary arteries, felodipine reduces myocardial oxygen demand and improves coronary perfusion. This helps to prevent angina episodes and improves exercise tolerance in patients with stable coronary artery disease.
The prolonged-release (also called extended-release or sustained-release) formulation is central to how Plendil works in practice. Immediate-release felodipine has a short half-life and could cause sharp, short-lived drops in blood pressure with reflex tachycardia. The prolonged-release tablet uses a hydrophilic matrix technology that releases felodipine slowly and steadily over approximately 24 hours. This produces smooth, consistent blood pressure control with a single daily dose, avoids peaks and troughs in drug concentration, and reduces the risk of reflex heart rate increases. For this reason, the tablet must always be swallowed whole: crushing or chewing destroys the controlled-release mechanism and would release the entire dose at once.
Felodipine was first approved in Europe in 1988 and has been included on the World Health Organization (WHO) Model List of Essential Medicines under the broader category of antihypertensive agents. Tens of millions of patients worldwide have been treated with felodipine. Large outcome trials such as HOT (Hypertension Optimal Treatment) and STOP-Hypertension-2 have demonstrated that effective blood pressure lowering with regimens that include felodipine reduces cardiovascular events in high-risk patients.
What Should You Know Before Taking Plendil?
Before starting Plendil, your doctor will assess your medical history for contraindications such as pregnancy, severe heart valve disease, uncontrolled heart failure, recent heart attack, or severe liver disease. Tell your prescriber about every other medicine, supplement, and herbal product you take, and follow dietary advice to avoid grapefruit.
Contraindications
Plendil is contraindicated – meaning it must not be used – in the following situations:
- Hypersensitivity to felodipine, to other dihydropyridines (such as amlodipine, nifedipine, nicardipine, lacidipine), or to any of the excipients in the tablet
- Pregnancy – felodipine has shown reproductive toxicity in animal studies and is not recommended at any stage of pregnancy
- Decompensated (unstable) heart failure – particularly New York Heart Association (NYHA) class III–IV with signs of fluid overload
- Acute myocardial infarction (heart attack) and unstable angina
- Haemodynamically significant left ventricular outflow obstruction, including severe aortic stenosis or obstructive hypertrophic cardiomyopathy, where further peripheral vasodilation can dangerously lower coronary perfusion
- Cardiogenic shock or other states of circulatory collapse
Your doctor will review your past medical history, medication list, and family history before deciding that Plendil is suitable for you. If you have ever had an allergic reaction to any dihydropyridine calcium channel blocker, this must be disclosed, because cross-reactivity within the class is possible. Signs of an allergic reaction include a sudden widespread rash, hives (urticaria), swelling of the face, lips, tongue, or throat (angioedema), wheezing, or difficulty breathing. If any such symptoms occur, stop Plendil and seek urgent medical attention.
Warnings and Precautions
Even when Plendil is not formally contraindicated, certain conditions call for extra caution, dose adjustment, or closer monitoring. Discuss your full history with your doctor if you have:
- Liver (hepatic) impairment: Felodipine is almost entirely metabolised by the liver. Patients with significantly reduced liver function have higher plasma concentrations and should usually start at the lowest dose, such as 2.5 mg once daily, with careful blood-pressure monitoring
- Heart failure: Plendil can be used in some patients with heart failure when the condition is stable, but may worsen symptoms in others. Any new or worsening breathlessness, ankle swelling, or fatigue should be reported promptly
- Aortic stenosis: Non-severe aortic stenosis requires extra caution; severe aortic stenosis is a contraindication (see above)
- Recent cardiovascular events: Patients with a recent heart attack or unstable angina should not start Plendil until their condition has been stabilised for at least one month
- Low blood pressure (hypotension): Plendil adds to the effect of other blood pressure-lowering medicines, alcohol, and volume depletion (e.g. severe vomiting or diarrhoea). Take care when standing up quickly, especially in the first weeks of treatment
- Dental/gum health: Felodipine, like other CCBs, can cause gingival hyperplasia (overgrowth of gum tissue). Good oral hygiene and regular dental check-ups greatly reduce this risk
- Elderly patients: Age-related changes in liver function and increased sensitivity to vasodilation mean older adults are often started at 2.5 mg and up-titrated only if needed
During the first weeks of Plendil therapy you may notice side effects such as flushing, headache, or ankle swelling. These symptoms are pharmacologically expected, are usually dose-related, and generally lessen as your body adjusts. Persistent or troublesome effects should always be reported to your doctor, who may consider dose reduction, combination with another antihypertensive, or a change of medication.
Pregnancy and Breastfeeding
Pregnancy: Plendil should not be used during pregnancy. Reproductive toxicity studies in animals have shown dose-related embryofetal effects, including impaired foetal development and delayed parturition. Human data are limited, and because safer alternatives (such as methyldopa, labetalol, nifedipine, or in some jurisdictions extended-release nifedipine) are established as first-line antihypertensives in pregnancy, felodipine is not considered appropriate for use during pregnancy or labour. Women of childbearing potential should discuss reliable contraception with their prescriber before starting Plendil. If pregnancy occurs during treatment, contact your doctor promptly so that a safer alternative can be arranged.
Breastfeeding: Felodipine is excreted into breast milk in small amounts. The effects on the nursing infant have not been fully established, and manufacturers generally recommend against breastfeeding during treatment with Plendil unless considered essential. Your doctor will help you weigh the benefit of continued treatment against the benefits of breastfeeding and may suggest switching to a compatible alternative.
Fertility: Reversible biochemical changes in the head of human sperm (capable of impairing fertilisation) have been reported in vitro with calcium channel blockers. If you are a man undergoing fertility investigations or assisted reproduction, discuss this with your physician.
Do not stop taking Plendil suddenly without medical advice. Although felodipine does not typically cause classic rebound hypertension, abrupt discontinuation in some patients – particularly those with angina or heart failure – may lead to worsening of symptoms and a rapid rise in blood pressure. If treatment needs to be stopped, your doctor will usually taper the dose.
How Does Plendil Interact with Other Drugs?
Felodipine is metabolised by the liver enzyme CYP3A4. Medicines and foods that inhibit or induce this enzyme can dramatically change felodipine blood levels, while other blood-pressure-lowering drugs can intensify its effect. The most clinically important interaction is with grapefruit juice, which must be avoided throughout treatment.
Drug interactions can occur by several mechanisms. Pharmacokinetic interactions alter how the body absorbs, metabolises, or eliminates a drug – in this case usually by affecting CYP3A4 in the liver and intestinal wall. Pharmacodynamic interactions occur when two drugs act on the same physiological pathway, either adding to or opposing each other’s effect. Because felodipine lowers blood pressure and dilates blood vessels, it readily interacts pharmacodynamically with other cardiovascular and vasoactive medications.
Felodipine is extensively metabolised in the liver by the cytochrome P450 enzyme CYP3A4. Drugs or substances that inhibit CYP3A4 slow down the breakdown of felodipine, causing blood levels to rise and increasing the risk of hypotension, flushing, headache, and tachycardia. Conversely, drugs that induce CYP3A4 speed up its breakdown, which may reduce the antihypertensive effect and leave blood pressure poorly controlled. Understanding these interactions is essential for safe prescribing.
The most widely publicised interaction is with grapefruit juice. Grapefruit contains furanocoumarins (notably bergamottin and its derivatives) that irreversibly inhibit intestinal CYP3A4. With felodipine, even a single glass of grapefruit juice can increase peak plasma concentrations by two- to threefold, and the effect can last for up to 72 hours. Seville oranges and pomelos have similar effects. For this reason, patients taking Plendil are routinely advised to avoid grapefruit, grapefruit juice, and grapefruit-containing products throughout treatment.
Major and Clinically Important Interactions
| Drug / Drug Class | Type of Interaction | Clinical Significance | Recommendation |
|---|---|---|---|
| Grapefruit / grapefruit juice | CYP3A4 inhibition (intestinal) | Felodipine levels may rise 2–3×, increasing hypotension, flushing and tachycardia | Avoid completely throughout treatment |
| Strong CYP3A4 inhibitors (itraconazole, ketoconazole, clarithromycin, erythromycin, ritonavir, cobicistat) |
Pharmacokinetic (inhibition) | Substantial rise in felodipine plasma concentration – risk of severe hypotension | Avoid combination; use alternative antihypertensive if possible |
| Strong CYP3A4 inducers (rifampicin, rifabutin, carbamazepine, phenytoin, phenobarbital, St John’s wort) |
Pharmacokinetic (induction) | Felodipine levels fall markedly – loss of blood pressure control | Avoid combination or switch to a non-CYP3A4 antihypertensive |
| Other antihypertensives (ACE inhibitors, ARBs, beta-blockers, diuretics, alpha-blockers) |
Pharmacodynamic (additive) | Enhanced blood pressure lowering – generally therapeutic, but may cause hypotension | Usually intentional in combination therapy; monitor BP closely when starting or changing doses |
| Tacrolimus / ciclosporin | Pharmacokinetic (felodipine inhibits tacrolimus metabolism) | Tacrolimus levels may rise; nephrotoxicity risk | Monitor tacrolimus trough levels and renal function; adjust doses |
| Cimetidine | Mild CYP3A4 inhibition | Modest rise in felodipine levels | Consider famotidine or a PPI as alternative acid-suppressants |
| Simvastatin (high doses) | Shared CYP3A4 metabolism | Limited clinical impact with felodipine, but other CCBs (amlodipine, diltiazem) have stricter caps | Use lowest effective statin dose; review annually |
| Alcohol | Additive vasodilation | May intensify dizziness and low blood pressure | Limit alcohol; avoid binge drinking |
This table is not exhaustive. Many other medicines, supplements, and over-the-counter products can potentially affect felodipine – or be affected by it. Always carry an up-to-date list of everything you take (including vitamins, minerals, and herbal remedies such as St John’s wort) and share it with every doctor, pharmacist, and dentist you see. A brief pharmacy review before starting any new medicine, antibiotic, or supplement can prevent serious interactions.
Minor and Theoretical Interactions
Some interactions are of lower clinical importance but may still matter in individual patients:
- NSAIDs (e.g. ibuprofen, naproxen): Regular use can blunt the antihypertensive effect of most blood-pressure-lowering medicines, including felodipine, and may increase the risk of kidney injury in combination therapy
- Oral corticosteroids: Long-term use can raise blood pressure and reduce the effectiveness of Plendil
- Decongestants containing pseudoephedrine or phenylephrine: May transiently raise blood pressure; check with your pharmacist before using cold and flu remedies
- Herbal products such as liquorice, ginseng, or ephedra-containing supplements: Unpredictable effects on blood pressure
Alcohol is itself a vasodilator and can add to the blood-pressure-lowering effect of Plendil, occasionally causing pronounced dizziness, light-headedness on standing, or facial flushing. Moderate consumption (within national low-risk guidelines) is usually tolerated, but avoid binge drinking and heavy use. Chronic heavy alcohol intake raises blood pressure and worsens cardiovascular risk, counteracting the benefits of treatment.
What Is the Correct Dosage of Plendil?
The usual starting dose of Plendil is 5 mg once daily in the morning, but many patients – particularly older adults and those with liver problems – start at the 2.5 mg dose. The dose is adjusted by the prescriber to an effective maintenance dose of 2.5–10 mg once daily. Tablets must be swallowed whole with water.
The correct dose of Plendil depends on the indication (hypertension or angina), the severity of the condition, other medicines taken, age, kidney and liver function, and how the patient responds. Dose adjustments are made gradually, typically after at least two weeks at a given dose, because the full blood-pressure effect of felodipine develops over 2–4 weeks of consistent dosing. Never change the dose yourself; always follow the prescriber’s instructions.
Adults
Hypertension – Adult Dosing
The typical starting dose in adults is 5 mg once daily in the morning. In patients at higher risk of hypotension or side effects – including older adults – treatment may begin at 2.5 mg once daily, which is the strength covered in this article. Depending on response, the dose can be increased to 10 mg once daily. The maintenance dose is usually 5 mg daily; doses above 10 mg rarely add much benefit but do increase side effects. Plendil can be combined with other first-line antihypertensives (such as an ACE inhibitor, angiotensin receptor blocker, thiazide diuretic, or beta-blocker) when a single drug does not achieve target blood pressure.
Chronic Stable Angina – Adult Dosing
For the prevention of angina episodes, the usual starting dose is 5 mg once daily, titrated if necessary to 10 mg once daily. Plendil is often combined with a beta-blocker and/or long-acting nitrate to optimise symptom control and improve exercise tolerance. Patients should continue to carry and use their short-acting nitrate (such as glyceryl trinitrate) for acute angina episodes.
Children and Adolescents
Paediatric Use
The safety and efficacy of Plendil in children and adolescents under 18 years of age have not been established for routine use. Limited data exist from small studies in children with hypertension, but felodipine is not licensed for paediatric use in most jurisdictions. Where treatment of paediatric hypertension is required, specialist paediatric cardiologists or nephrologists will choose from medicines with more robust paediatric data. Plendil should not be given to children unless specifically directed by a specialist.
Elderly Patients
Geriatric Dosage Considerations
Older adults tend to have higher felodipine plasma concentrations for any given dose, reflecting age-related decline in hepatic first-pass metabolism. They are also more sensitive to the blood-pressure-lowering effects and more prone to symptoms such as dizziness, postural hypotension, and falls. The recommended starting dose in elderly patients is 2.5 mg once daily, with gradual upward titration as needed. Regular blood pressure monitoring, including standing blood pressure to detect postural changes, is advised.
Hepatic Impairment
Because felodipine is extensively metabolised in the liver, patients with significant liver dysfunction have markedly higher plasma concentrations. A starting dose of 2.5 mg once daily is recommended, with careful monitoring. Severe hepatic impairment generally calls for an alternative agent.
Renal Impairment
Felodipine’s pharmacokinetics are not significantly altered by kidney disease, because the drug is cleared almost entirely by hepatic metabolism. No routine dose adjustment is required for reduced kidney function. However, blood pressure should be monitored carefully because patients with chronic kidney disease often require tighter blood pressure control and may be more sensitive to vasodilators.
Missed Dose
If you forget a dose of Plendil, take it as soon as you remember on the same day. However, if you only remember close to the time of your next scheduled dose (or if a day has passed), skip the missed dose entirely and continue with your regular once-daily schedule the next morning. Never take two tablets on the same day to make up for a missed dose – the doubled dose could lower your blood pressure too far and cause dizziness, fainting, or falls.
If you frequently forget your tablets, consider strategies such as taking the dose with another morning routine (for example, after brushing your teeth or with breakfast), using a weekly pill organiser, setting a daily alarm, or using a reminder app. Consistency is important because blood pressure is only well-controlled when drug levels are maintained day after day.
Overdose
Excessive doses of felodipine can cause severe peripheral vasodilation with pronounced hypotension and, occasionally, bradycardia (slow heart rate). Symptoms may include dizziness, fainting, nausea, vomiting, sweating, weakness, confusion, and chest pain. If you or someone else has taken more Plendil than prescribed, contact the nearest emergency department or poison control centre immediately. Take the medication packaging with you. Treatment is supportive and may include intravenous fluids, atropine, vasopressors, intravenous calcium, and – in severe cases – high-dose insulin euglycaemia therapy in an intensive care setting.
| Patient Group | Starting Dose | Maintenance / Maximum | Key Considerations |
|---|---|---|---|
| Adults (hypertension) | 5 mg once daily (2.5 mg if sensitive) | 5 mg daily; max 10 mg once daily | Titrate after 2–4 weeks; combine with other agents if needed |
| Adults (stable angina) | 5 mg once daily | 5–10 mg once daily | Often combined with beta-blocker and/or nitrate |
| Elderly (≥65 years) | 2.5 mg once daily | Titrate cautiously; many stable on 2.5–5 mg | Higher plasma levels; monitor postural BP; fall risk |
| Hepatic impairment | 2.5 mg once daily | Cautious titration; avoid in severe impairment | Reduced first-pass metabolism → higher exposure |
| Renal impairment | 5 mg once daily (2.5 mg in frail patients) | Up to 10 mg daily | No specific adjustment; check BP carefully |
| Children (<18 years) | Not established | Not routinely used | Only under paediatric specialist supervision |
The 2.5 mg prolonged-release tablet discussed in this article is therefore especially relevant as a starting dose in older adults, in patients with hepatic impairment, as a cautious starting dose in otherwise sensitive patients, or as part of fine-tuned combination therapy where a lower felodipine component is desired.
What Are the Side Effects of Plendil?
Like all medicines, Plendil can cause side effects, although not everyone experiences them. The most common effects – ankle swelling, flushing, headache, and palpitations – reflect how felodipine dilates blood vessels and are usually dose-dependent and mild. Severe reactions are rare. Seek urgent medical care for signs of allergy or severe dizziness and fainting.
Side effects with Plendil are described by frequency according to the European Medicines Agency (EMA) convention: very common (affecting more than 1 in 10 people), common (1 in 10 to 1 in 100), uncommon (1 in 100 to 1 in 1,000), rare (1 in 1,000 to 1 in 10,000), and very rare (fewer than 1 in 10,000). Most felodipine side effects are mild, transient, and directly related to the mechanism of action – peripheral vasodilation. They are often worst in the first 1–2 weeks of treatment and after dose increases, then diminish as the body adapts.
Distinguishing between expected pharmacological side effects and potentially serious adverse reactions is important. Mild ankle swelling or a flushed feeling for 30–60 minutes after a dose does not usually require treatment to be stopped. In contrast, sudden severe dizziness with fainting, chest pain, irregular heartbeats, widespread rash, swelling of the face or tongue, or difficulty breathing may indicate a serious event and require urgent assessment.
The EMA Summary of Product Characteristics (SmPC) for felodipine lists the following side effects, adapted here into the iMedic frequency grid:
Very Common Side Effects
May affect more than 1 in 10 people
- Ankle swelling (peripheral oedema) – dose-dependent
Common Side Effects
May affect up to 1 in 10 people
- Headache, particularly at the start of treatment
- Flushing of the face
- Palpitations (awareness of the heart beating)
- Dizziness and light-headedness
- Fatigue
Uncommon Side Effects
May affect up to 1 in 100 people
- Nausea, abdominal pain
- Tachycardia (fast heart rate)
- Hypotension (low blood pressure)
- Skin rash or itching
- Paraesthesia (tingling sensations)
Rare Side Effects
May affect up to 1 in 1,000 people
- Gingival hyperplasia (gum overgrowth) – risk reduced by good oral hygiene
- Urticaria (hives), angio-oedema
- Photosensitivity reactions
- Impotence / sexual dysfunction
- Syncope (fainting)
- Elevated liver enzymes
- Worsening of angina (paradoxical ischaemia, very rare)
- Leukocytoclastic vasculitis
The signature side effect of dihydropyridine calcium channel blockers is ankle swelling. It results from preferential dilation of the small arterioles feeding the capillary bed, which increases capillary hydrostatic pressure and drives fluid into the interstitial tissues. It is not caused by fluid retention in the traditional sense, so diuretics are usually not very effective against it. The swelling is typically worse at the end of the day and better after lying down overnight. If it becomes significant, your doctor may lower the dose, add an ACE inhibitor or angiotensin receptor blocker (which can partially offset the oedema), or switch to a different class of antihypertensive.
Gingival hyperplasia is a class effect of calcium channel blockers, with felodipine being less commonly implicated than nifedipine but still a recognised cause. Risk factors include existing gum disease and poor plaque control. Brushing twice daily, regular flossing, and routine dental check-ups substantially reduce the risk. If gum overgrowth develops, it is often reversible when the medicine is stopped under medical supervision.
Signs of a serious allergic reaction – sudden swelling of the face, lips, tongue, or throat, difficulty breathing or swallowing, widespread hives, or a severe skin rash with blistering or peeling. Also seek urgent care for: severe chest pain or worsening chest pain that could indicate heart attack or unstable angina; fainting or near-fainting; persistent rapid or irregular heartbeats; yellowing of the skin or eyes (possible liver injury); or severe dizziness preventing you from standing safely. Stop Plendil and call your local emergency number or go to the nearest emergency department.
You are encouraged to report any suspected side effects to your healthcare provider or to your national pharmacovigilance authority (for example, the MHRA Yellow Card scheme in the UK, the FDA MedWatch programme in the USA, the EMA reporting system in the EU). Reporting helps regulators and researchers identify previously unknown adverse reactions and continually improve medicine safety for all patients.
How Should You Store Plendil?
Store Plendil at room temperature below 30°C (86°F) in its original packaging to protect the tablets from light and moisture. Keep it out of reach and sight of children. Do not use Plendil after the expiry date printed on the carton, and return any unused tablets to your pharmacy for safe disposal.
Correct storage preserves the strength, stability, and safety of medicines. Plendil prolonged-release tablets should be stored in a cool, dry place at a temperature not exceeding 30°C (86°F), with the actual maximum storage temperature printed on the outer carton (often 25°C or 30°C depending on the manufacturer). Avoid exposure to excessive heat, direct sunlight, or humidity – bathrooms and kitchens close to stoves or sinks are generally unsuitable. A bedside drawer, cupboard, or dedicated medicine box is usually a better choice.
Keep Plendil in the original blister pack or bottle until you are ready to take each dose. The original packaging is designed to shield the tablets from light and moisture, both of which can degrade pharmaceutical ingredients over time. If you need to carry only a few days’ worth when travelling, use a clean pill organiser and keep it away from car dashboards and other places prone to temperature swings. For long travel, check the medicine’s storage requirements and consider a small insulated bag in very hot climates.
Always keep Plendil and every other medicine out of the reach and sight of children. Cardiovascular medicines – calcium channel blockers in particular – can cause severe hypotension and bradycardia if accidentally ingested by children, and are a well-documented cause of paediatric poisoning. Use child-resistant closures and store medicines in a high, locked cupboard where possible. If accidental ingestion is suspected, contact poison control or the emergency services immediately.
Do not use Plendil after the expiry date printed on the packaging. The expiry date refers to the last day of the stated month (for example, “EXP 03/2027” means the tablets should not be used after 31 March 2027). Expired tablets may have reduced potency, which can translate into poor blood pressure control. Check the expiry date each time you start a new pack.
Never pour Plendil down the sink, flush it down the toilet, or throw it in the household rubbish. Incorrect disposal contributes to pharmaceutical contamination of water supplies and can expose children, pets, and wildlife to harm. Most pharmacies operate medicines take-back schemes and will safely destroy unused or expired tablets free of charge. Remove personal information from the label before returning the pack.
What Does Plendil Contain?
Each Plendil prolonged-release tablet contains 2.5 mg of the active substance felodipine together with pharmaceutical excipients that form the slow-release matrix and the tablet coating. If you have known allergies or intolerances, check the specific excipient list in the patient information leaflet.
The active ingredient in each tablet is felodipine 2.5 mg. Felodipine is a 4-phenyl-dihydropyridine derivative with the chemical name ethyl methyl (±)-4-(2,3-dichlorophenyl)-1,4-dihydro-2,6-dimethyl-3,5-pyridinedicarboxylate. It is a yellow crystalline powder, practically insoluble in water but freely soluble in organic solvents such as ethanol and methylene chloride. The molecule is highly lipophilic, which contributes to its tight binding with vascular smooth muscle calcium channels and its long duration of action when formulated as a prolonged-release product.
In addition to the active ingredient, Plendil tablets contain inactive ingredients (excipients) whose job is to create the controlled-release matrix, maintain tablet stability, mask taste, and produce a uniform, identifiable tablet. Exact excipients vary between manufacturers and markets, but a typical Plendil 2.5 mg prolonged-release tablet contains substances such as:
- Matrix formers: hypromellose (hydroxypropyl methylcellulose) of various viscosity grades, which creates a gel layer that slows felodipine release over 24 hours
- Fillers: microcrystalline cellulose, lactose monohydrate, or anhydrous lactose
- Disintegrants and flow aids: colloidal anhydrous silica, sodium stearyl fumarate or magnesium stearate
- Coating agents: hypromellose, macrogol (polyethylene glycol), titanium dioxide (E171), iron oxide pigments (E172) for colour-coding the strength, and talc
Patients with lactose intolerance should note that some formulations of Plendil contain lactose monohydrate and may not be suitable for people with rare hereditary conditions such as galactose intolerance, total lactase deficiency, or glucose-galactose malabsorption. Check the specific excipient list in the patient leaflet, and if in doubt ask your pharmacist whether a lactose-free felodipine alternative is available.
The colour-coded film coating helps patients distinguish between the 2.5 mg, 5 mg, and 10 mg strengths. It also protects felodipine from light, reduces any bitterness, makes the tablet easier to swallow, and allows manufacturers to mark the tablet with identification characters. Importantly, the coating does not significantly affect absorption of the drug – the prolonged-release behaviour comes from the matrix within the tablet core. For this reason, the tablet must never be crushed, chewed, or divided: doing so would destroy the controlled-release architecture and deliver a potentially dangerous dose all at once.
Plendil is the originator brand of felodipine, developed by Astra (now AstraZeneca). After expiry of patent protection, numerous generic versions of felodipine prolonged-release tablets became available internationally under names such as Felodur, Felotens, Hydac, Munobal, Prevex, Renedil, Splendil, Vascalpha, and many other trade names. Generic felodipine tablets are bioequivalent to the originator and subject to the same regulatory quality standards.
Frequently Asked Questions About Plendil
Plendil (felodipine) is a prescription medicine used for two main indications: essential hypertension (high blood pressure) and chronic stable angina pectoris. It belongs to the dihydropyridine class of calcium channel blockers (ATC code C08CA02) and works by widening the peripheral arteries, which lowers the pressure against which the heart has to pump and reduces the oxygen demand of the heart muscle. Your doctor will decide whether Plendil is suitable for you based on your cardiovascular risk profile and any other conditions you have.
Take one Plendil tablet once a day, ideally at the same time every morning. Swallow the tablet whole with a glass of water, on an empty stomach or with a light meal. Never crush, chew, or divide the tablet – the prolonged-release matrix must stay intact to deliver felodipine smoothly over 24 hours. Avoid taking Plendil with a high-fat meal, and in particular avoid grapefruit or grapefruit juice. If you miss a dose, take it the same day if you remember, otherwise skip it and resume your normal schedule the next day.
Grapefruit, grapefruit juice, Seville oranges, and pomelos all contain furanocoumarins that irreversibly block CYP3A4, the liver and intestinal enzyme that metabolises felodipine. With Plendil, even a single glass of grapefruit juice can double or triple blood levels of the drug, and the effect can last for several days because the enzyme must be regenerated. The increased exposure heightens the risk of hypotension, flushing, headache, rapid heart rate, and dizziness. The safest approach is to avoid grapefruit and grapefruit-containing products entirely throughout treatment.
The most common side effects of Plendil (felodipine) are ankle swelling (peripheral oedema), facial flushing, headache, palpitations, and dizziness. These are pharmacologically expected consequences of vasodilation, are dose-related, and often improve within the first few weeks of treatment. Gum overgrowth (gingival hyperplasia) is a rarer, class-related effect that is minimised by good oral hygiene. Serious reactions – such as allergic swelling, severe low blood pressure, or liver enzyme elevations – are uncommon. Contact your doctor promptly if any side effect is severe or persistent.
Plendil is not recommended during pregnancy. Animal studies have shown reproductive toxicity, and there are safer, better-studied alternatives for treating high blood pressure in pregnancy (such as methyldopa, labetalol, or extended-release nifedipine). Felodipine also passes into breast milk in small amounts, and effects on a nursing infant have not been fully characterised; breastfeeding while taking Plendil is generally not advised. If you are pregnant, planning a pregnancy, or breastfeeding, discuss treatment options with your doctor so that a suitable alternative can be arranged.
Plendil starts to lower blood pressure within a few hours of the first dose, but the full antihypertensive effect of regular daily treatment typically develops over 2 to 4 weeks. For this reason, doctors usually wait at least 2–4 weeks before adjusting the dose. Keep taking Plendil as prescribed even if you feel well – hypertension and stable angina often cause few symptoms, but treatment prevents long-term damage to the heart, brain, kidneys, and arteries. Home blood pressure monitoring can help track your progress.
Yes, Plendil is widely used in elderly patients with hypertension or chronic stable angina, and calcium channel blockers are often preferred as first-line therapy in older adults. However, elderly patients tend to have higher felodipine blood levels for any given dose and are more prone to dizziness and postural low blood pressure. For this reason, treatment in older adults is typically started at 2.5 mg once daily and titrated cautiously under medical supervision, with attention to standing blood pressure and fall risk. Regular review by the prescribing doctor is important.
References and Sources
This article is based on internationally recognised medical and pharmaceutical guidelines, the European Summary of Product Characteristics for felodipine, peer-reviewed clinical literature, and authoritative drug compendia. All content has been reviewed by qualified healthcare professionals and follows evidence-based principles.
- European Medicines Agency (EMA). Summary of Product Characteristics (SmPC): Felodipine prolonged-release tablets. EMA, 2024. Available at: www.ema.europa.eu
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About the Medical Editorial Team
This article has been written and reviewed by iMedic’s Medical Editorial Team, consisting of licensed physicians and specialists in clinical pharmacology and cardiovascular medicine with expertise in hypertension management, drug safety, pharmacovigilance, and evidence-based medicine.
iMedic Medical Editorial Team – specialists in clinical pharmacology and cardiovascular medicine. All content is researched and written using peer-reviewed sources, international pharmaceutical guidelines (EMA, FDA, WHO), and professional society recommendations (ESC, ESH, ACC, AHA).
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