From the Guidelines
Norvasc (amlodipine) dosing should be initiated at 2.5-10 mg once daily, with a maximum recommended dose of 10 mg daily, as recommended by the 2018 ACC/AHA guideline 1. The dosing of Norvasc (amlodipine) is crucial for managing hypertension and coronary artery disease.
- The initial dose for adults is typically in the range of 2.5-10 mg once daily.
- For elderly patients or those with hepatic impairment, a lower starting dose of 2.5 mg daily is advised.
- Children aged 6-17 years usually start at 2.5 mg once daily, with a maximum of 5 mg daily.
- The medication should be taken at the same time each day, with or without food.
- Full therapeutic effects may take 1-2 weeks to develop, so patients should continue taking it even if they don't notice immediate benefits.
- Amlodipine works by blocking calcium channels in blood vessel walls, causing them to relax and widen, which reduces blood pressure and improves blood flow.
- Common side effects include peripheral edema (swelling of ankles/feet), headache, and flushing.
- Patients should not abruptly discontinue the medication without consulting their healthcare provider, as this could lead to rebound hypertension. The most recent guideline from 2018 provides the best evidence for the dosing of Norvasc (amlodipine) 1, which should be prioritized over older studies 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
- Dose for special populations:
- Small, fragile, or elderly patients: 2.5 mg once daily
- Patients with hepatic insufficiency: 2.5 mg once daily
- Dose for specific conditions:
- Angina: 5 to 10 mg once daily
- Coronary artery disease: 5 to 10 mg once daily
- Pediatric patients (ages 6 to 17 years): 2.5 mg to 5 mg once daily 2
From the Research
Norvasc Dosing
The recommended dosing for Norvasc (amlodipine) can vary depending on the patient's condition and response to treatment.
- The initial dose is typically 5 mg once daily, with a maximum dose of 10 mg once daily 3, 4, 5.
- In some cases, the dose may be titrated to achieve the target blood pressure, with a median daily dose of 5 mg (range, 1.25-15 mg) 3.
- For patients with mild-to-moderate hypertension, a fixed-dose combination of metoprolol extended release/amlodipine (25 mg/2.5 mg or 50 mg/5 mg) may be used 6.
- For patients with hypertension and comorbidity of arteriosclerosis obliterans, a combination of lisinopril and amlodipine (10 mg/5 mg) may be used, with the option to double the dose of lisinopril if necessary 7.
Factors Affecting Dosing
- Patient age: elderly patients (age > 60 years) may experience a greater reduction in systolic blood pressure with amlodipine 3.
- Baseline plasma renin activity: patients with higher plasma renin activity may respond better to lisinopril 5.
- Severity of hypertension: patients with more severe hypertension may respond better to amlodipine 5.
- Ethnicity: Black patients may not respond as well to lisinopril as Caucasian patients, but may respond similarly to the combination of lisinopril and amlodipine 5.