From the Guidelines
Amlodipine should be dosed once daily due to its long half-life and the benefits of improved medication adherence with once-daily dosing, as supported by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
Key Considerations
- The standard dosing ranges from 2.5 mg to 10 mg once daily, with most patients starting at 5 mg and adjusting based on response.
- Once-daily dosing allows for consistent 24-hour blood pressure control with a single dose, providing stable calcium channel blockade throughout the 24-hour period.
- Medication adherence is greatest with once-daily dosing, with a range of 71% to 94%, and declines as dosing frequency increases, as noted in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1.
Special Situations
- Twice-daily dosing may be considered in specific situations, such as for patients who experience end-of-dose wearing off or have variable blood pressure control throughout the day.
- If a patient experiences side effects like peripheral edema with once-daily dosing, splitting the dose (for example, 5 mg twice daily instead of 10 mg once daily) may sometimes reduce these adverse effects while maintaining efficacy.
Additional Guidance
- The British Hypertension Society guidelines for hypertension management 2004 (BHS-IV) recommend that the drug or formulation used should ideally be effective for 24 hours when taken as a single daily dose, and that an interval of at least four weeks should be allowed to observe the full response 1.
- The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure also provides guidance on antihypertensive drug dosing, including the use of amlodipine once daily 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.
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.
Coronary artery disease: The recommended dose range for patients with coronary artery disease is 5 to 10 mg once daily.
The dosing of Amlodipine is once daily. The recommended dose ranges from 5 mg to 10 mg for adults, depending on the condition being treated.
- Hypertension: 5 mg to 10 mg once daily
- Angina: 5 to 10 mg once daily
- Coronary artery disease: 5 to 10 mg once daily 2
From the Research
Amlodipine Dosing: Once vs Twice Daily
- Amlodipine can be administered once daily due to its slow rate of elimination, with an elimination half-life of 40-60 hours 3.
- The drug has high oral bioavailability, ranging from 60-80%, and accumulates to a steady-state with once-daily administration over a period of 1-1 1/2 weeks 3.
- Fluctuation of plasma drug concentration between doses is relatively small, between 20 and 25%, when once-daily dosing is used 3.
- Amlodipine shows linear dose-related pharmacokinetic characteristics, and at steady-state, there are relatively small fluctuations in plasma concentrations across a dosage interval, making it suitable for administration in a single daily dose 4.
- Clinical trials have demonstrated the effectiveness of amlodipine in lowering blood pressure and relieving symptoms of angina pectoris with once-daily dosing 5, 6.
- Amlodipine is well tolerated and does not appear to cause some of the undesirable effects often associated with other cardiovascular agents, making it a useful alternative for the treatment of essential hypertension and chronic stable angina pectoris 5, 6.
- Large randomised controlled trials have provided strong evidence for the use of amlodipine as a first-line antihypertensive agent, with good efficacy and safety profiles 7.