ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Pharmacoepidemiology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1598161
This article is part of the Research TopicEmerging Trends in Real-World Pharmacoepidemiology and Drug Safety: 2025View all 5 articles
Amlodipine and Frusemide: Pharmacological Factors Contributing to Increased Fall Risk in Concurrently Treated Patients -A Retrospective Cross-Sectional Study
Provisionally accepted
Aymen Ali Alqurain1*
Murtada Albaharnah2
Samanah Al Zayer3Maha Alanzi4Razan Alblushi4Rawan Aleid4Rand Ashoor5Ali Albahrani4Mustafa Almahdi4Samaher Al-Shaibi6Luma Ameer4
Sherihan Ghosn4Marwa Algoraini4
Nawal Alsubaie7Afnan Alshnbari4
Fadhel Ahmed Alomar8- 1Department of Clinical Practice, Faculty of Pharmacy, Northern Border University, Rahaf, Saudi Arabia
- 2King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Al Khobar, Riyadh, Saudi Arabia
- 3Department of pharmaceutical care Mouwasat Hospital, Qatif, Saudi Arabia
- 4Mohammed Al Mana College for Health Sciences (MACHS), Dammam, Saudi Arabia
- 5Dar Al Uloom University, Riyadh, Saudi Arabia
- 6Johns Hopkins Aramco Healthcare (JHAH), Dhahran, Saudi Arabia
- 7Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
- 8College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Damam, Saudi Arabia
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Background. Calcium channel blockers, such as amlodipine, are commonly prescribed for hypertension but can cause peripheral edema, often requiring adjunctive frusemide.Concerns exist regarding the potential increase in fall risk, particularly in older populations. However, few studies have assessed the prevalence of amlodipine and frusemide combination (AFC) prescriptions and their association with fall risk factors.Objectives. The aims of this study are to determine the prevalence of AFC prescriptions and evaluate their association with fall risk factors in an outpatient cardiology clinic population.Methods. This retrospective, cross-sectional study included patients aged ≥40 years from Al-Qatif Central Hospital's outpatient cardiology clinic, (January 2021 -December 2022) prescribed amlodipine. Fall risk factors were identified from literature. The Charlson Comorbidity Index (CCI) was used to estimate one-year mortality risk. The number of prescribed orthostatic hypotension-inducing drugs (OHDs) and fall-risk increasing drugs (FRIDs) was recorded. Binary logistic regression was performed to determine the association between AFC prescriptions and fall risk factors, adjusting for significant covariates. Results are expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI).Results. Of 3681 patients, 18%. were prescribed AFC. AFC patients were older (70 vs 64 years, P < 0.001), had a higher prevalence of diabetes mellitus (64% vs 44%, P < 0.001), anemia (55% vs 32%, P < 0.001), and osteoporosis (51% vs 28%, P < 0.001), and received more OHDs prescriptions (2.8 vs 1.3, P < 0.001) compared to non-AFC patients. Higher CCI scores (OR = 1.51, 95% CI 1.41 -1.62) and more OHDs prescriptions (OR = 2.5, 95% CI 2.3 -2.7) were significantly associated with AFC prescriptions.AFC prescriptions are prevalent, and patients prescribed AFC have higher prevalence of fall risk factors. Comprehensive patients assessment is essential to minimize fall risk and related complications.
Keywords: Amlodipine, Frusemide, Prescribing cascade, fall risk, orthostatic hypotension
Received: 22 Mar 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Alqurain, Albaharnah, Al Zayer, Alanzi, Alblushi, Aleid, Ashoor, Albahrani, Almahdi, Al-Shaibi, Ameer, Ghosn, Algoraini, Alsubaie, Alshnbari and Alomar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Aymen Ali Alqurain, Department of Clinical Practice, Faculty of Pharmacy, Northern Border University, Rahaf, Saudi Arabia
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