What is the recommended dose and frequency of Amlodipine (Calcium Channel Blocker)?

From the Guidelines

Amlodipine should be prescribed at an initial dose of 5 mg once daily for adults with hypertension or angina, with the option to increase to a maximum of 10 mg once daily if needed for blood pressure control, as recommended by the most recent guidelines 1. The medication should be taken at the same time each day to maintain consistent blood levels, and it can be taken with or without food.

• Amlodipine works by blocking calcium channels in blood vessel walls, causing them to relax and widen, which reduces blood pressure and improves blood flow to the heart.
• The full effect of amlodipine may take 7-14 days to develop, so patience is needed when starting treatment.
• Common side effects include ankle swelling, headache, and flushing, which often improve with continued use.
• It's essential to take amlodipine regularly even if feeling well, as hypertension is typically asymptomatic but requires ongoing management. According to the study published in Circulation 1, the usual dose of amlodipine is 5 to 10 mg once daily, with a long duration of action, and common side effects include headache and edema.
• For elderly patients or those with hepatic impairment, starting at a lower dose of 2.5 mg daily is recommended.
• The study also notes that amlodipine has coronary dilatory properties that appear to be similar to other calcium channel blockers, and its beneficial effects in unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) are believed to be due to variable combinations of decreased myocardial oxygen demand and improved myocardial flow 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 dose of Amlodipine is:

• Initial dose: 5 mg once daily for adults
• Maximum dose: 10 mg once daily for adults
• Initial dose for small, fragile, or elderly patients, or patients with hepatic insufficiency: 2.5 mg once daily
• Dose for children: 2.5 mg to 5 mg once daily for pediatric patients ages 6 to 17 years The recommended frequency is once daily 2.

From the Research

Amlodipine Dose and Frequency

• The provided studies do not directly mention the dose and frequency of amlodipine 3, 4, 5, 6.
• However, it is mentioned that amlodipine is a dihydropyridine calcium channel blocker that has been widely used for 2 decades and has good efficacy and safety 4.
• Amlodipine should be considered a first-line antihypertensive agent, but the optimal dose and frequency are not specified in the provided studies 4.
• The studies focus on the effects of amlodipine on blood pressure, cardiovascular events, and renal function, but do not provide information on the dose and frequency of administration 3, 5, 6.

Relevant Studies

• A study published in 1998 compared the effects of losartan and amlodipine on proteinuria, renal haemodynamics, and tubular function in hypertensive patients with non-diabetic nephropathy 5.
• A review paper published in 2011 summarized the clinical evidence on the effects of various antihypertensive drugs, including amlodipine, on central aortic pressure and biomarkers of vascular function 6.
• Another study published in 2016 discussed the use of amlodipine as a first-line antihypertensive agent, but did not provide information on the dose and frequency 4.
• A study published in 2020 discussed the management of hypertension using combination therapy, but did not specifically mention the dose and frequency of amlodipine 3.