Amlodipine Dosing for Adults with Hypertension
The correct dosification of amlodipine for adults with hypertension is an initial dose of 5 mg once daily, with titration to a maximum of 10 mg once daily if needed for blood pressure control. 1
Initial Dosing
- Standard initial dose: 5 mg once daily
- Lower initial dose (2.5 mg once daily) recommended for:
- Elderly patients
- Fragile patients
- Patients with hepatic insufficiency
- When adding amlodipine to other antihypertensive therapy 1
Dose Titration
- Wait 7-14 days between dose adjustments to assess full response
- Faster titration may be appropriate if clinically warranted with frequent patient assessment 1
- Maximum dose: 10 mg once daily 1
- Full antihypertensive effect may take up to 6 weeks to develop 2
Pharmacokinetic Considerations
- Long elimination half-life (40-60 hours) allows for once-daily dosing 3
- Steady-state plasma levels are achieved after 1-1.5 weeks of daily administration 3
- Peak plasma concentration occurs 6-8 hours after dosing 3
- Minimal fluctuation (20-25%) in plasma concentration between doses with once-daily administration 3
Efficacy
- Provides smooth 24-hour blood pressure control 2, 4
- Typically decreases systolic blood pressure by a mean of 17.5 mm Hg from baseline 2
- Effect on systolic blood pressure is greater in elderly patients and those with isolated systolic hypertension 2
- No development of tolerance with long-term use 5, 4
Special Populations
- Black adults: Amlodipine is a preferred first-line agent (without heart failure or chronic kidney disease) 2
- Elderly: Start with 2.5 mg once daily 1
- Hepatic insufficiency: Start with 2.5 mg once daily 1
Combination Therapy
- For stage 2 hypertension, combination therapy including amlodipine is recommended 2
- Effective when combined with ACE inhibitors, beta-blockers, or thiazide diuretics 2, 5
- If blood pressure remains uncontrolled at maximum amlodipine dose, adding a second agent from a different class is recommended rather than exceeding the maximum dose 2
Monitoring
- Assess blood pressure response at trough effect (24 hours after dosing) 2
- Monitor for common side effects:
- Peripheral edema
- Headache
- Flushing 2
- Avoid use in patients with heart failure with reduced ejection fraction (HFrEF) 2
Amlodipine's long half-life and gradual onset of action provide consistent blood pressure control throughout the 24-hour dosing interval, making it an effective once-daily antihypertensive medication with minimal fluctuations in effect.