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Are any calcium channel blockers better than others, within the drug class, for exhibiting the least risk of ankle oedema?

TRIP Answers, 2012

Are any calcium channel blockers better than others, within the drug class, for exhibiting the least risk of ankle oedema?
Are any calcium channel blockers better than others, within the drug class, for exhibiting the least risk of ankle oedema?
The UK Medicines information service answered a query on  the reported incidences of ankle oedema with different calcium channel blockers in May 2011.
"CCBs are generally classified into dihydropyridines (DHP) and non-dihydropyridines based on their chemical structure.
Whilst ankle oedema appears to be a class effect in all CCBs, there does appear to be differences in the incidence of ankle oedema between the different classes, with oedema appearing to be more likely with the dihydropyridine agents.
The incidence of ankle oedema has been reported as ranging from 1-15% in patients treated with DHP agents.
Within the DHP group, it is thought that those which are more “membranophilic” (such as lercanidipine and lacidipine), may be associated with lower incidence of ankle oedema.
Verapamil increases plasma volume whilst also reducing vasoconstriction in the lower extremities, similarly to amlodipine and nifedipine.
Some post-marketing surveillance data has reported a reduced incidence of ankle oedema in patients treated with diltiazem compared to other CCB agents.
Ankle oedema also appears to be dose related, and its incidence may exceed 80% in patients taking long term high doses of DHP agents.
Whilst the longer-acting CCBs generally appear to have fewer adverse effects associated with them (such as flushing, headache, and palpitations), this is not thought to be the case when considering ankle oedema.