What is the recommended dosage and usage of Amlodipine for patients with hypertension or coronary artery disease?

Amlodipine Dosage and Usage for Hypertension and Coronary Artery Disease

For hypertension and coronary artery disease, amlodipine should be initiated at 5 mg once daily for most adults, with titration to 10 mg once daily if necessary after 7-14 days, while elderly, fragile patients, or those with hepatic insufficiency should start at 2.5 mg once daily. 1, 2

Recommended Dosing for Adults

Hypertension

• Initial dose: 5 mg once daily 2
• Maximum dose: 10 mg once daily 2
• Special populations:
  • Elderly, fragile patients, or those with hepatic insufficiency: 2.5 mg once daily 1, 2
  • When adding to other antihypertensive therapy: Consider starting at 2.5 mg once daily 2

Coronary Artery Disease and Angina

• Chronic stable or vasospastic angina: 5-10 mg once daily 2
• Coronary artery disease: 5-10 mg once daily (majority of patients require 10 mg) 2
• Elderly and hepatic insufficiency: Start with lower dose (5 mg) 2

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 and Monitoring

• Wait 7-14 days between titration steps for blood pressure response assessment 1, 2
• More rapid titration may be appropriate if clinically warranted, with frequent patient assessment 2
• Blood pressure response should be monitored 7-14 days after initiation or dose changes 1
• Evidence suggests that blood pressure typically stabilizes after approximately 6 weeks of treatment, so early dose increases may not provide additional benefit 3

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, 5. Studies have demonstrated:

• Significant reductions in both daytime and nighttime blood pressure 5
• Maintenance of normal circadian blood pressure patterns 5
• Return to baseline blood pressure values after discontinuation during washout periods 6

Combination Therapy Considerations

• Amlodipine can be safely combined with beta-blockers for patients with both hypertension and angina 1
• For resistant hypertension (BP ≥140/90 mmHg despite three antihypertensive drugs including a diuretic), consider adding a mineralocorticoid receptor antagonist 7
• Amlodipine can be added to a regimen of beta-blocker, ACE inhibitor, and thiazide diuretic if either angina or hypertension remains uncontrolled 1

Common Adverse Effects

• Peripheral edema
• Headache
• Flushing
• Dizziness 1

Important Monitoring Considerations

• Monitor for signs of hypotension, particularly within the first 1-2 weeks of therapy 1
• Volume-depleted patients are at higher risk for first-dose hypotension 1
• For patients also taking ACE inhibitors, ARBs, or diuretics, monitor serum creatinine/eGFR and potassium levels at least annually 7

Special Populations

• Heart failure patients: Amlodipine is one of the few calcium channel blockers that can be safely used in patients with heart failure and angina 1
• Hepatic dysfunction: Use lower doses and monitor closely due to reduced clearance 1, 2
• Elderly patients: More susceptible to hypotension; start with 2.5 mg once daily 1, 2

Amlodipine's efficacy in hypertension and coronary artery disease has been well-established, with studies showing significant blood pressure reductions maintained throughout a 24-hour period with once-daily dosing 4, 6, 5.