Amlodipine Dosage and Treatment Protocol for Hypertension and Coronary Artery Disease
The recommended initial dose of amlodipine for hypertension or coronary artery disease is 5 mg once daily, with titration to a maximum of 10 mg once daily if necessary after 7-14 days. 1, 2
Dosing Guidelines
Adult Patients
- Standard initial dose: 5 mg once daily 2
- Maximum dose: 10 mg once daily 2
- Special populations requiring lower initial dose (2.5 mg):
Pediatric Patients
- Ages 6-17 years: 2.5-5 mg once daily 1, 2
- Doses exceeding 5 mg daily have not been studied in pediatric patients 2
Titration Protocol
- Wait 7-14 days between dose adjustments to assess full response 1, 2
- More rapid titration may be appropriate if clinically warranted, with frequent patient assessment 2
- Consider waiting 6 weeks before increasing dose, as some studies show continued blood pressure reduction over this period 3
Specific Indications
Hypertension
- Target BP for most patients: <140/90 mmHg 4, 1
- Consider lower target (<130/80 mmHg) for patients with:
- Coronary artery disease
- Diabetes
- Chronic kidney disease
- CAD risk equivalents 1
Angina
- Chronic stable or vasospastic angina: 5-10 mg once daily 2
- Lower dose (5 mg) suggested for elderly and patients with hepatic insufficiency
- Most patients require 10 mg for adequate effect 2
Coronary Artery Disease
- Recommended dose: 5-10 mg once daily 2
- Most patients in clinical studies required 10 mg 2
- Amlodipine has shown benefits in reducing hospitalization for angina and coronary revascularization procedures 2
Combination Therapy Considerations
Effective Combinations
Cautions with Combination Therapy
- When combining with beta-blockers, monitor for hypotension, particularly in the first 1-2 weeks 1
- Amlodipine is one of the few calcium channel blockers safe to use in heart failure patients 1
Heart Failure Considerations
- Avoid non-dihydropyridine CCBs (verapamil, diltiazem) in heart failure patients due to negative inotropic effects 4, 1
- Amlodipine can be safely used in patients with left ventricular dysfunction 1
- For heart failure patients with hypertension, the primary treatment should include:
- ACE inhibitors or ARBs
- Beta-blockers (carvedilol, metoprolol succinate, bisoprolol, or nebivolol)
- Aldosterone receptor antagonists 4
Monitoring Protocol
- Assess blood pressure response 7-14 days after initiation or dose changes 1
- Monitor for common adverse effects:
- Peripheral edema (most common)
- Headache
- Flushing
- Dizziness 1
- More careful monitoring needed for:
- Elderly patients (higher risk of hypotension)
- Volume-depleted patients (risk of first-dose hypotension)
- Patients with hepatic dysfunction (reduced clearance) 1
Clinical Pearls
- Amlodipine provides effective 24-hour blood pressure control with once-daily dosing 6, 7
- No tolerance develops with long-term use 5
- In angina, amlodipine increases exercise time and decreases attack rate 2
- For patients with both hypertension and angina, amlodipine is particularly valuable as it addresses both conditions 1