Drug-induced peripheral oedema: A common, overlooked, reversible harm

This is the authors' abstract. We don't add key points for this paper.

Background: Drug-induced peripheral oedema is a common, under-recognised and usually reversible adverse event. Up to 10% of older adults taking amlodipine or nifedipine and up to 5% using gabapentin or pregabalin develop peripheral oedema within a year of starting treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) double the rate of oedema through sodium retention. Because vasodilation-induced oedema does not respond to diuretics, misdiagnosis may lead to prescribing cascades or unnecessary diagnostic investigations for conditions like heart failure. Aim: This Therapeutics Letter aims to guide clinicians in identifying medication-related harms of new or worsening peripheral oedema, differentiating between physiological mechanisms (vasodilation vs. sodium retention) and prioritising deprescribing strategies over active pharmacological management. Recommendations: Clinicians evaluating new-onset peripheral oedema should execute a five-step strategy alongside standard diagnostic protocols: (1) Conduct a careful medication review targeting recent prescription changes and over-the-counter drugs such as NSAIDs. (2) Identify drugs associated with oedema, including dihydropyridine calcium channel blockers, gabapentinoids, psychotropics, NSAIDS and hormonal therapies. (3) If safe to do so, briefly stop, reduce or switch the suspected culprit drug before considering new treatments. (4) Align clinical decisions with patient goals of care to determine whether oedema severity outweighs the therapeutic benefit of the medication. (5) Employ symptom-focussed measures, such as compression stockings and leg elevation, as nonpharmacological adjuncts rather than substitutes for addressing the underlying cause. Conclusion: Medication side effects should be the main consideration in cases of new-onset peripheral oedema, particularly in patients with polypharmacy. Deprescribing or modifying the offending drug is preferable to adding medications or diagnostic interventions.