What is the dosing for Amlodipine (Norvasc)?

From the Guidelines

Norvasc (amlodipine) should be initiated at a dose of 5 mg once daily for adults with hypertension or coronary artery disease, with a maximum dose of 10 mg daily, as recommended by the most recent guidelines 1. The dosing of Norvasc can be adjusted based on the patient's response to the medication, with a recommended interval of 7-14 days between dose adjustments to properly assess the full effect of each dose.

• The medication can be taken with or without food, and it's best taken at the same time each day to maintain consistent blood levels.
• For elderly patients or those with hepatic impairment, starting at 2.5 mg daily is recommended.
• Common side effects of Norvasc include peripheral edema (swelling in ankles/feet), headache, and flushing.
• Patients should not stop taking Norvasc suddenly without consulting their healthcare provider, as this could cause a rebound increase in blood pressure.
• If a dose is missed, it should be taken as soon as remembered unless it's almost time for the next dose. The American College of Cardiology Foundation/American Heart Association guidelines suggest that calcium channel blockers, such as amlodipine, can be used for symptom control in patients with unstable angina/non-ST-elevation myocardial infarction, but the evidence for a benefit is predominantly limited to symptom control 1. In pediatric patients, the initial dose of amlodipine is recommended to be 2.5 mg daily, with a maximum dose of 5 mg daily, as stated in the expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents 1.

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION

2.1 Adults The usual initial antihypertensive oral dose of Amlodipine besylate tablets is 5 mg once daily, and the maximum dose is 10 mg once daily. Small, fragile, or elderly patients, or patients with hepatic insufficiency may be started on 2. 5 mg once daily and this dose may be used when adding Amlodipine besylate tablets to other antihypertensive therapy. Adjust dosage according to blood pressure goals. In general, wait 7 to 14 days between titration steps. Titrate more rapidly, however, if clinically warranted, provided the patient is assessed frequently Angina: The recommended dose for chronic stable or vasospastic angina is 5 to 10 mg, with the lower dose suggested in the elderly and in patients with hepatic insufficiency. Most patients will require 10 mg for adequate effect. Coronary artery disease: The recommended dose range for patients with coronary artery disease is 5 to 10 mg once daily. In clinical studies, the majority of patients required 10 mg [see Clinical Studies (14. 4)] . 2.2 Children The effective antihypertensive oral dose in pediatric patients ages 6 to 17 years is 2.5 mg to 5 mg once daily. Doses in excess of 5 mg daily have not been studied in pediatric patients [see Clinical Pharmacology (12.4), Clinical Studies (14.1)] .

The recommended dosing for Norvasc (Amlodipine) is:

• Initial dose: 5 mg once daily for adults
• Maximum dose: 10 mg once daily for adults
• Special populations:
  • Small, fragile, or elderly patients: 2.5 mg once daily
  • Patients with hepatic insufficiency: 2.5 mg once daily
• Titration: Adjust dosage according to blood pressure goals, waiting 7 to 14 days between titration steps 2

From the Research

Norvasc Dosing

• Norvasc, also known as amlodipine, is a calcium channel blocker (CCB) used to treat hypertension and coronary artery disease 3, 4.
• The American Heart Association recommends a blood pressure goal of <140/90 mm Hg for most adults with hypertension, but <130/80 mm Hg for patients with diabetes mellitus, chronic kidney disease, or known coronary artery disease 3.
• For primary CAD prevention, any effective antihypertensive drug or combination is indicated, but preference is given to ACE inhibitors, ARBs, CCBs, and thiazide diuretics 3.
• In patients with established CAD, beta-blockers and ACE inhibitors (or ARBs) are the basis of treatment, and a dihydropyridine CCB (such as amlodipine) can be added if further blood pressure lowering is needed 3, 4.
• The 2015 guidelines recommend a blood pressure target of <140/90 mm Hg in patients aged ≤80 years and a systolic blood pressure <150 mm Hg in patients aged ≥80 years 4.
• Intensive blood pressure control to ≤135 mm Hg and possibly to ≤130 mm Hg is associated with a modest reduction in stroke and heart failure, but at the expense of hypotension 5.
• Combining beta-blockers and ACE inhibitors, such as bisoprolol and perindopril, into a single pill provides effective blood pressure lowering and improved cardiovascular outcomes 6.