When to increase the dose of amlodipine and what is the maximum recommended dose?

When to Increase Amlodipine Dose and Maximum Dosage

The maximum dose of amlodipine is 10 mg daily for adults, and dose increases should be considered after 7-14 days if blood pressure remains uncontrolled, with careful monitoring for adverse effects. 1

Initial Dosing and Titration Schedule

Adults

• Starting dose: 5 mg once daily
• Alternative starting dose: 2.5 mg once daily for:
  • Elderly patients
  • Fragile patients
  • Patients with hepatic insufficiency
  • When adding to other antihypertensive therapy 1

Children (6-17 years)

• Starting dose: 2.5 mg once daily
• Maximum dose: 5 mg once daily 1, 2

When to Increase the Dose

Standard Titration Timeline

• Wait 7-14 days between titration steps to assess response 1
• More rapid titration may be appropriate if clinically warranted and the patient is monitored frequently 1

Evidence-Based Approach to Dose Increases

• Blood pressure typically decreases steadily over the first 6 weeks of treatment 3
• Consider dose increase from 5 mg to 10 mg if:
  • Diastolic blood pressure remains >90 mmHg after 6 weeks of treatment 3
  • Target blood pressure is not achieved after initial treatment period

Monitoring for Dose Adjustment

• Home blood pressure monitoring twice daily is recommended to assess effectiveness 2
• Complete reassessment after 3-4 months of therapy 4

Maximum Dosage

Adults

• Maximum dose: 10 mg once daily 1
• Higher doses have not shown additional benefit and may increase side effects

Children

• Maximum dose: 5 mg once daily
• Doses exceeding 5 mg have not been studied in pediatric patients 1

Efficacy and Response Rates

• At 5 mg daily: approximately 56% of patients reach target blood pressure 5
• At 10 mg daily: approximately 73% of patients reach target blood pressure 5
• Mean reductions of 23/13 mmHg in supine position and 24/12 mmHg standing have been observed 24 hours after dosing 2, 6

Common Pitfalls in Amlodipine Dosing

1. Premature dose escalation:

   • Early dose increases (before 6 weeks) do not provide additional antihypertensive benefit 3
   • Allow sufficient time (6 weeks) at 5 mg before considering dose increase

2. Failure to recognize adverse effects:

   • Monitor for peripheral edema, the most common side effect 7
   • Dose-dependent side effects may necessitate return to lower dosage

3. Inadequate monitoring:

   • Ensure consistent timing of administration for accurate assessment
   • Evaluate 24-hour blood pressure control, not just office readings 6

4. Special populations considerations:

   • Start with 2.5 mg in elderly, fragile patients, or those with hepatic insufficiency 1
   • Children should not exceed 5 mg daily 1

Amlodipine's long half-life (36-45 hours) allows for once-daily dosing with effective 24-hour blood pressure control 7, 2. When titrating the dose, remember that steady state is reached within 1-1.5 weeks of daily administration 2.