Maximum Recommended Dose of Amlodipine for Hypertension
The maximum recommended dose of amlodipine for treating hypertension is 10 mg once daily. 1
Dosing Guidelines for Amlodipine
Standard Dosing
- Initial dose: 5 mg once daily 1
- Maximum dose: 10 mg once daily 1
- Special populations requiring lower initial dosing (2.5 mg once daily):
- Elderly patients
- Fragile patients
- Patients with hepatic insufficiency
- When adding amlodipine to other antihypertensive therapy
Dose Titration Protocol
- Wait 7-14 days between dose adjustments 1
- More rapid titration may be considered if clinically warranted, with frequent patient assessment 1
- Dose titration should be based on blood pressure response
Evidence Supporting Maximum Dose
The FDA-approved labeling clearly establishes 10 mg once daily as the maximum dose for hypertension 1. This is consistent with European guidelines that also indicate the maximum dose of amlodipine is 20 mg for pulmonary arterial hypertension (PAH), though this is a different indication 2.
Clinical studies have demonstrated:
- Dose-dependent blood pressure reductions with amlodipine 3, 4
- 5 mg is the appropriate starting dose for most patients 5
- Titration to 10 mg provides additional benefit in patients not adequately controlled on 5 mg 6
Clinical Considerations
Efficacy
- Response rates of approximately 84% have been observed with both 5 mg and 10 mg doses 6
- Blood pressure typically decreases steadily until the end of the sixth week of treatment 6
- No evidence of tolerance development with long-term use 5
Safety Considerations
- Limiting factors for dose increase include:
- Systemic hypotension
- Lower limb peripheral edema 2
- Amlodipine is generally well tolerated at all dose levels 4
- No significant effects on heart rate, electrocardiogram, or body weight at therapeutic doses 3
Administration in Patients with Swallowing Difficulties
- Amlodipine tablets can be crushed if needed 7
- When crushing:
- Crush completely to ensure uniform dosing
- Mix with small amount of soft food or liquid
- Administer immediately after crushing
- Ensure entire mixture is consumed 7
Pitfalls to Avoid
Premature dose escalation: Consider waiting at least 6 weeks before increasing from 5 mg to 10 mg, as blood pressure response may continue to improve during this period 6
Inappropriate dosing in special populations: Start with 2.5 mg in elderly, fragile patients, or those with hepatic insufficiency 1
Exceeding maximum dose: No evidence supports using doses above 10 mg for hypertension, and this could increase risk of adverse effects 1
Inadequate monitoring after dose changes: Close monitoring is essential after dose adjustments to assess both efficacy and potential adverse effects 1