What is the recommended initial dose of amlodipine for hypertension management?

Initial Dosing of Amlodipine for Hypertension Management

The recommended initial dose of amlodipine for hypertension management is 5 mg once daily for most adults. 1

Standard Dosing Protocol

• The FDA-approved initial dose for amlodipine in hypertension treatment is 5 mg once daily 1
• Maximum dose for hypertension is 10 mg once daily 1
• Lower starting doses (2.5 mg) should be considered for:
  • Elderly patients
  • Fragile patients
  • Patients with hepatic insufficiency
  • When adding amlodipine to other antihypertensive therapy 1

Dose Titration Considerations

• Allow 7-14 days between dose titration steps to assess full effect 1
• Faster titration may be appropriate if clinically warranted, but requires more frequent patient assessment 1
• Studies show that blood pressure reduction with amlodipine occurs gradually, with maximum effect typically seen after 6 weeks of treatment 2
• There is no advantage to early dose increases - a study showed equal response rates (84%) between patients maintained on 5 mg and those with early titration to 10 mg 2

Population-Specific Considerations

Black Patients

• Calcium channel blockers like amlodipine are particularly effective first-line agents in Black patients 3
• For Black patients with hypertension but without heart failure or chronic kidney disease, initial treatment should include either a thiazide-type diuretic or a calcium channel blocker like amlodipine 3
• Amlodipine has been shown to be as effective as chlorthalidone (a thiazide diuretic) in reducing BP, cardiovascular disease, and stroke events in Black patients 3

Special Situations

• In patients receiving bevacizumab who develop hypertension (BP ≥150/95 mmHg), amlodipine 5 mg daily is the recommended initial antihypertensive treatment 3
• For pediatric patients (ages 6-17 years), the effective antihypertensive dose range is 2.5 mg to 5 mg once daily 1

Efficacy and Duration of Action

• Amlodipine provides effective 24-hour blood pressure control with once-daily dosing due to its long plasma half-life 4
• Studies show significant reductions in both daytime and nighttime blood pressure with once-daily dosing 4
• Amlodipine has superior nighttime blood pressure control compared to some other calcium channel blockers with shorter half-lives 5

Common Pitfalls to Avoid

• Avoid starting at 10 mg in most patients, as this may increase the risk of side effects without providing significant additional benefit initially
• Don't increase the dose too quickly - allow sufficient time (at least 6 weeks) to assess the full effect of the 5 mg dose before considering titration 2
• Remember that amlodipine has a long half-life, so full therapeutic effect may not be seen for several weeks
• Monitor for peripheral edema, which is a dose-dependent side effect and may limit dose increases

By starting with 5 mg once daily for most patients and allowing adequate time to assess response before considering dose increases, you can optimize the balance between efficacy and tolerability in hypertension management.