Amlodipine Dosage for Hypertension and Angina
The typical dosage of amlodipine for hypertension is 5 mg once daily initially, with titration up to 10 mg once daily if needed, while for angina the recommended dose is 5-10 mg once daily. 1
Dosing for Hypertension
Adult Patients
- Initial dose: 5 mg once daily
- Maximum dose: 10 mg once daily
- Special populations requiring lower initial dose (2.5 mg):
Pediatric Patients (6-17 years)
- Recommended dose: 2.5-5 mg once daily 1
- Doses exceeding 5 mg daily have not been studied in pediatric patients
Dosing for Angina
Chronic Stable or Vasospastic Angina
- Initial dose: 5 mg once daily
- Typical effective dose: Most patients require 10 mg for adequate effect 1
- Lower dose (5 mg) recommended for elderly patients and those with hepatic insufficiency
Coronary Artery Disease
- Recommended dose range: 5-10 mg once daily
- Typical effective dose: Majority of patients require 10 mg 1
Efficacy Evidence
Hypertension
- Amlodipine produces statistically significant reductions in blood pressure at 24 hours post-dose
- Average reductions of approximately 12/6 mmHg in standing position and 13/7 mmHg in supine position 1
- Blood pressure effect is maintained throughout the 24-hour dosing interval 2
- In the ALLHAT study, amlodipine was dosed at 2.5 mg initially, then titrated to 5 mg and 10 mg as needed 3
Angina
- In chronic stable angina, amlodipine 10 mg increases exercise time by 12.8% (63 seconds) compared to baseline 1
- Amlodipine 5 mg increases exercise time by 7.9% (38 seconds) 1
- In vasospastic angina, amlodipine decreases attacks by approximately 4/week compared to placebo 2, 1
- Amlodipine 10 mg reduces hospitalizations for angina by 42% compared to placebo 2
Monitoring and Titration
- Wait 7-14 days between titration steps to assess blood pressure response 1
- More rapid titration may be appropriate if clinically warranted, with frequent patient assessment
- Monitor for common side effects: peripheral edema, headache, flushing, and dizziness 2
Important Clinical Considerations
- Unlike non-dihydropyridine CCBs, amlodipine can be safely used in patients with left ventricular dysfunction 2
- Amlodipine can be safely added to standard therapy in patients with heart failure and uncontrolled angina or hypertension 3
- When combining with beta-blockers for angina management, amlodipine is generally safe and effective 2
Special Populations
- S-Amlodipine 2.5 mg has been shown to be equivalent in efficacy to racemic amlodipine 5 mg, which may be an option for patients experiencing side effects 4
- Once-daily dosing of amlodipine provides comparable antihypertensive efficacy to beta-blockers like atenolol 5
Remember that the gradual absorption of amlodipine after oral administration produces a gradual vasodilation, which reduces the incidence of side effects such as reflex tachycardia and headache that can be troublesome with other calcium antagonists 6.