Amlodipine Dosage for Adults with Hypertension
The recommended initial dose of amlodipine for adults with hypertension is 5 mg once daily, with a maximum dose of 10 mg once daily. 1
Initial Dosing
- Standard starting dose: 5 mg once daily for most adults 1
- Lower starting dose: 2.5 mg once daily for:
- Elderly patients
- Fragile patients
- Patients with hepatic insufficiency
- When adding amlodipine to other antihypertensive therapy 1
Dose Titration
- Wait 7-14 days between titration steps 1
- More rapid titration may be appropriate if clinically warranted, provided the patient is assessed frequently 1
- If blood pressure control is not achieved with 5 mg daily after 6 weeks, consider increasing to 10 mg daily 2
Special Populations
- Black adults: Amlodipine is a preferred first-line agent (along with thiazide diuretics) for black adults with hypertension without heart failure or chronic kidney disease 3
- Elderly patients: Start with 2.5 mg once daily and titrate cautiously 1
- Hepatic insufficiency: Start with 2.5 mg once daily 1
Efficacy
- Amlodipine provides smooth 24-hour blood pressure control with once-daily dosing 4
- Systolic blood pressure typically decreases by a mean of 17.5 mm Hg from baseline 5
- The effect on systolic blood pressure is greater in elderly patients (≥60 years) and patients with isolated systolic hypertension 5
- No tolerance develops with long-term use 4
Combination Therapy
- Amlodipine is effective as monotherapy but can also produce additional antihypertensive effects when combined with:
- ACE inhibitors
- Beta-blockers
- Thiazide diuretics 6
- For stage 2 hypertension, combination therapy that includes amlodipine as the calcium channel blocker is recommended 3
Monitoring
- Assess blood pressure response at trough effect (24 hours after dosing) 4
- Monitor for common side effects:
- Peripheral edema (more common in women)
- Headache
- Flushing 3
- Avoid use in patients with heart failure with reduced ejection fraction (HFrEF) 3
Clinical Pearls
- Amlodipine is specifically recommended as the first-line calcium channel blocker for hypertension management 3
- The full antihypertensive effect may take up to 6 weeks to develop, so avoid premature dose increases 2
- Amlodipine does not cause orthostatic hypotension, making it safer for elderly patients 4
- Unlike some other calcium channel blockers, amlodipine can be administered once daily, which may improve adherence 6
Remember that blood pressure control is the ultimate goal, and dose adjustments should be made based on individual response. If blood pressure remains uncontrolled despite maximum amlodipine dose, adding a second agent from a different class is recommended rather than exceeding the maximum dose.