What is the recommended dosage of Amlodipine (Amlodipine besylate) - Benazepril HCL for treating hypertension?

Amlodipine Besylate-Benazepril HCL Dosage for Hypertension

The recommended dosage of amlodipine besylate-benazepril HCL for hypertension typically starts at 2.5-5 mg/10-20 mg once daily, with titration up to 10 mg/40 mg once daily as needed to achieve blood pressure control.

Initial Dosing

• For most patients:

  • Starting dose: 5 mg amlodipine/10-20 mg benazepril once daily
  • Maximum dose: 10 mg amlodipine/40 mg benazepril once daily 1

• For special populations:

  • Elderly, fragile patients, or those with hepatic insufficiency: 2.5 mg amlodipine/10 mg benazepril once daily 2
  • Patients already on ACE inhibitors or with renal impairment may require lower initial doses

Titration Schedule

• Wait 7-14 days between dose adjustments to assess full effect 2
• Titration can be more rapid if clinically warranted, provided the patient is monitored frequently
• If blood pressure remains uncontrolled after 2-4 weeks:
  1. Increase to 5 mg amlodipine/20 mg benazepril
  2. If needed, further increase to 10 mg amlodipine/40 mg benazepril

Efficacy Evidence

• Combination therapy with amlodipine/benazepril has demonstrated superior efficacy compared to monotherapy with either agent:
  • Mean BP reduction of 17/14 mmHg with combination therapy versus 5/7 mmHg with benazepril alone 3
  • 80% of patients achieved target diastolic BP with combination therapy versus 45% with benazepril monotherapy 3
  • Higher BP control rates at 2,4, and 6 weeks with combination therapy compared to amlodipine monotherapy 4

Clinical Considerations

• Combination therapy is particularly beneficial for patients who do not respond adequately to monotherapy 3
• The incidence of peripheral edema (a common side effect of amlodipine) may be lower with combination therapy than with amlodipine alone 5, 6
• Monitor for potential adverse effects:
  • Hyperkalemia, especially in patients with CKD or those on potassium supplements
  • Acute renal failure in patients with bilateral renal artery stenosis
  • Angioedema (contraindicated if history of ACE inhibitor-induced angioedema)
  • Hypotension, particularly in volume-depleted patients

Special Populations

• Hepatic impairment: Start with lower dose (2.5 mg amlodipine component) 2
• Elderly patients: Start with lower dose (2.5 mg amlodipine component) 2
• Pregnancy: Contraindicated due to risk of fetal injury from ACE inhibitor component 1

Monitoring

• Assess blood pressure response after 1-2 weeks of therapy
• Monitor renal function and electrolytes, particularly in patients with renal impairment
• Evaluate for signs of angioedema, especially during initial therapy

This combination provides complementary mechanisms of action (calcium channel blockade and ACE inhibition) that effectively lower blood pressure while potentially reducing the incidence of side effects associated with higher doses of either agent alone.