What is the maximum recommended dose for amlodipine (calcium channel blocker)?

Maximum Dose for Amlodipine

The maximum recommended dose for amlodipine in adults is 10 mg once daily. 1

Dosing Guidelines

Adult Dosing

• Initial dose: 5 mg once daily
• Maximum dose: 10 mg once daily
• Special populations:
  • Elderly, fragile patients, or those with hepatic insufficiency: Start with 2.5 mg once daily 1
  • Titration: Wait 7-14 days between dose increases 1

Pediatric Dosing

• Children 6-17 years:
  • Initial dose: 2.5 mg once daily
  • Maximum dose: 5 mg once daily 1
  • Note: Doses exceeding 5 mg daily have not been adequately studied in pediatric patients 2

Clinical Applications

Hypertension Management

• Most patients achieve adequate blood pressure control with 5-10 mg daily
• Response rates of approximately 84% have been observed with both 5 mg and 10 mg dosing 3
• Dose titration should not be considered until after six weeks of treatment at 5 mg once daily 3

Other Indications

• Angina: 5-10 mg once daily (most patients require 10 mg for adequate effect) 1
• Coronary artery disease: 5-10 mg once daily (majority of patients require 10 mg) 1

Pharmacological Considerations

Duration of Action

• Amlodipine has a long plasma half-life, allowing for once-daily dosing with 24-hour blood pressure control 4
• Studies have shown effective 24-hour duration of action with significant reductions in both daytime and nighttime blood pressure 4

Pharmacokinetics

• Plasma concentration increases proportionally with dose:
  • 2.5 mg: ~2.5 ng/ml
  • 5 mg: ~4.9 ng/ml
  • 10 mg: ~10.5 ng/ml 5

Common Side Effects and Monitoring

Side Effects

• Peripheral edema (more common at 10 mg dose)
• Flushing
• Headache
• Mild leg cramps and constipation 6

Important Precautions

• Avoid concurrent use with diltiazem due to increased risk of additive hypotension, bradycardia, and conduction disturbances 7
• If combination therapy is needed, consider medications from different classes rather than multiple calcium channel blockers 7

Clinical Pearls

• Postural hypotension and reflex tachycardia are typically absent with amlodipine 6
• Amlodipine can be compounded into stable extemporaneous suspensions when needed 2
• When converting from nifedipine extended-release to amlodipine, a dose of 5 or 10 mg once daily is typically appropriate, though titration may be required 8

Remember that exceeding the maximum recommended dose of 10 mg daily does not provide additional benefit but may increase the risk of adverse effects, particularly peripheral edema.