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 and highest quality study 1.
Key Considerations
- 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 antihypertensive effect typically develops over 1-2 weeks of consistent use.
- Common side effects include peripheral edema (swelling of ankles/feet), headache, flushing, and dizziness, which are often dose-dependent and may diminish over time.
Special Populations
- For elderly patients or those with hepatic impairment, starting at a lower dose of 2.5 mg daily is recommended, as indicated in the study 1.
- Patients should not abruptly discontinue amlodipine without medical supervision, as this could lead to rebound hypertension.
Evidence Summary
The recommended dose and frequency of Amlodipine are based on the study published in the Journal of the American College of Cardiology in 2013 1, which provides the most recent and highest quality evidence for the management of patients with unstable angina/non-ST-elevation myocardial infarction. The study suggests that Amlodipine can be used to control symptoms in patients with hypertension or angina, with a typical dose range of 5-10 mg once daily. Additionally, the study published in Hypertension in 2003 1 provides further guidance on the use of Amlodipine in patients with hypertension, recommending a dose range of 2.5-10 mg once daily.
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 and frequency of Amlodipine are:
- Initial dose: 5 mg once daily for adults
- Maximum dose: 10 mg once daily for adults
- Dose for specific conditions:
- Angina: 5 to 10 mg once daily
- Coronary artery disease: 5 to 10 mg once daily
- Pediatric dose: 2.5 mg to 5 mg once daily for patients ages 6 to 17 years 2
From the Research
Recommended Dose and Frequency of Amlodipine
- The recommended starting dose of Amlodipine is 5 mg once daily, with the option to increase to 10 mg once daily if necessary 3, 4, 5.
- Dose-ranging studies have shown that 5 mg once daily is the most appropriate starting dose, with 10 mg once daily being the maximum recommended dose 3, 5.
- The pharmacokinetics of Amlodipine allow for once-daily dosing, with effective blood levels and good control of blood pressure maintained throughout the dosing interval 3.
- Studies have shown that Amlodipine is well tolerated at all dose levels, with no changes in heart rate, body weight, or electrocardiogram during treatment 4, 5.
Dose Titration
- There is no advantage in an early increase in dosage of Amlodipine in terms of antihypertensive effect, and a dose increase should not be considered until after six weeks of treatment at 5 mg once daily 6.
- A dose-response study found that target blood pressure was reached in 25% of patients with placebo, 41% with 2.5 mg of Amlodipine, 56% with 5 mg of Amlodipine, and 73% with 10 mg of Amlodipine once daily 5.
Combination Therapy
- Amlodipine can be used in combination with other antihypertensive agents, such as angiotensin-converting enzyme inhibitors, beta-blockers, or thiazide diuretics, to produce additional antihypertensive effects 3, 7.
- The addition of Amlodipine to quinapril or losartan monotherapy has been shown to be safe and effective in lowering blood pressure in patients with hypertension and diabetes 7.