What is the recommended dose of amlodipine (calcium channel blocker) for treating hypertension?

From the Guidelines

The recommended dose of amlodipine for hypertension is 2.5-10 mg once daily, with a usual starting dose of 5 mg once daily. This dosage is based on the most recent and highest quality study available, which suggests that amlodipine is effective in reducing blood pressure and improving outcomes in patients with hypertension 1.

Key Considerations

• The dose of amlodipine can be increased to a maximum of 10 mg once daily if blood pressure control is inadequate after 1-2 weeks.
• For elderly patients or those with hepatic impairment, starting at a lower dose of 2.5 mg daily is advised.
• Amlodipine is a long-acting calcium channel blocker that works by relaxing blood vessels, making it easier for the heart to pump blood and reducing blood pressure.
• 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.
• Patients may experience side effects such as peripheral edema (swelling of ankles/feet), headache, flushing, or dizziness, particularly when starting therapy.

Monitoring and Adjustments

• Full antihypertensive effects typically develop over 1-2 weeks of consistent use.
• Blood pressure should be monitored regularly while adjusting the dose, and patients should not stop taking amlodipine suddenly without medical advice as this could cause a rebound increase in blood pressure.
• The ALLHAT study, which compared the effects of chlorthalidone, amlodipine, lisinopril, and doxazosin in patients with hypertension, found that amlodipine was effective in reducing blood pressure and improving outcomes 1.

Additional Information

• The study also found that amlodipine was well-tolerated, with a low incidence of side effects.
• The dose of amlodipine used in the study was 2.5-10 mg once daily, with a mean dose of 6.8 mg once daily.
• The study suggests that amlodipine is a suitable option for patients with hypertension, particularly those who are at high risk for cardiovascular events.

From the FDA Drug Label

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.

The dose of amlodipine for hypertension is:

• Initial dose: 5 mg once daily
• Maximum dose: 10 mg once daily
• Alternative initial dose: 2.5 mg once daily for small, fragile, or elderly patients, or patients with hepatic insufficiency 2

From the Research

Dose of Amlodipine for Hypertension

• The recommended starting dose of amlodipine for hypertension is 5 mg once daily, with simple adjustment to 10 mg if necessary 3.
• Dose-ranging studies have shown that amlodipine can be used once daily in hypertension, with effective blood levels and good control of blood pressure maintained throughout the dosing interval 3.
• A study found that 5 mg amlodipine and 10 mg lisinopril monotherapy achieved the target blood pressure in 71% and 72% patients respectively 4.
• The combination of 2.5 mg amlodipine with 5 mg lisinopril produced a much more significant lowering of blood pressure in a higher percentage of patients than that with an individual low dose 4.
• A double-blind, placebo-controlled parallel group study found that amlodipine produced a significant reduction in blood pressure compared with placebo, with a mean difference between baseline and 8 weeks of 16/12 mm Hg supine, 14/4 mm Hg standing 5.
• The dose range of amlodipine in this study was 2.5-10 mg daily, titrated at 2 weekly intervals for a total treatment period of 8 weeks 5.
• A study found that the combination of lisinopril and amlodipine is optimal and universal for effective treatment of patients with hypertension in combination with arteriosclerosis obliterans, with a fixed dose of 10 mg lisinopril and 5 mg amlodipine 6.
• If the target blood pressure was not achieved, the dose of lisinopril was doubled without changing the dose of amlodipine 6.
• A double-blind, randomized crossover study found that the combination of amlodipine and lisinopril had a marked additional effect on blood pressure compared with either given as a monotherapy, with a significant additional blood pressure-lowering effect at trough and peak 7.