From the Guidelines
The patient should not exceed the maximum recommended dose of 10 mg of amlodipine daily and should adhere to the prescribed dosage to avoid potential harmful side effects. The patient's current practice of taking two amlodipine tablets, despite having a normal in-office blood pressure reading, is unsafe and could lead to severe hypotension, reflex tachycardia, and peripheral edema. According to the guideline-driven management of hypertension update in Circulation Research 1, the keys to effective blood pressure control include agreeing on a blood pressure target, using fixed-dose combinations, and substituting long-acting chlorthalidone for hydrochlorothiazide. The use of long-acting amlodipine as a first-line calcium channel blocker is also recommended.
Some key points to consider in the patient's management include:
- Monthly visits until blood pressure target is achieved
- Replacing 30-day prescriptions with 90-day refills, if allowed
- Using telehealth strategies to augment office-based management
- Enhancing connectivity between patient, provider, and electronic health record for better feedback and communication
- Screening for social determinants of health and considering obstacles to care
- Using multidisciplinary team-based care to enhance lifestyle and medication adherence and to solve social issues, as outlined in the study 1.
If the patient's blood pressure remains uncontrolled on the maximum dose of amlodipine, adding a different class of antihypertensive medication would be the appropriate next step, rather than exceeding the maximum recommended dose of amlodipine. The patient should be educated on the importance of adhering to the prescribed medication regimen and scheduling follow-up appointments to discuss blood pressure concerns.
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.
The patient is asking for an increased dose of amlodipine, but the maximum dose is already 10 mg once daily 2. The patient has been educated to take the medication as prescribed, and since the in-office blood pressure is within normal limits, there is no need to increase the dose.
From the Research
Patient's Current Condition
- The patient is being managed for a wound and has a follow-up appointment every Wednesday.
- A doppler test was completed, and the patient reported being told that everything was normal.
- The patient is also being evaluated for a possible umbilical hernia surgery and is awaiting a response from the general surgery department.
Medication Management
- The patient is currently taking two amlodipine medications and is requesting an increased dose.
- The patient was educated that the maximum dose of amlodipine is 10 mg and was advised to take the medication as prescribed 3.
- Studies have shown that amlodipine is effective in controlling blood pressure and has a low risk of adverse effects, even in older adults 4, 5.
Blood Pressure Management
- The patient's blood pressure is currently controlled, and their in-office blood pressure reading is within normal limits.
- Amlodipine has been shown to be effective in reducing blood pressure and improving cardiovascular outcomes 3, 6, 7.
- The patient's current dose of amlodipine is 10 mg, which is the maximum recommended dose, and increasing the dose may not provide additional benefits and may increase the risk of adverse effects 3, 5.
Additional Considerations
- The patient's overall health and medical history should be taken into consideration when managing their blood pressure and medication regimen.
- Regular follow-up appointments and monitoring of the patient's blood pressure and medication adherence can help ensure optimal management of their condition 3, 7.