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 patients with hypertension or coronary artery disease, amlodipine should be initiated at 5 mg once daily, with titration to a maximum of 10 mg once daily if necessary for blood pressure control or angina relief. 1, 2

Initial Dosing Recommendations

Hypertension

• Standard initial dose: 5 mg once daily 1
• Maximum dose: 10 mg once daily 1
• Special populations requiring lower initial dose (2.5 mg):
  • Elderly patients
  • Fragile patients
  • Patients with hepatic insufficiency
  • When adding to other antihypertensive therapy 2, 1

Coronary Artery Disease/Angina

• Initial dose: 5 mg once daily 1
• Effective dose range: 5-10 mg once daily 1
• Most patients require: 10 mg for adequate effect 1
• For stable or vasospastic angina, lower doses (5 mg) are suggested for elderly and those with hepatic insufficiency 1

Pediatric Patients (ages 6-17)

• Effective dose range: 2.5-5 mg once daily 2, 1
• Doses exceeding 5 mg daily have not been adequately studied in pediatric patients 1

Titration and Monitoring

• Titration interval: Wait 7-14 days between dose adjustments to assess response 2, 1
• Monitoring: Blood pressure should be checked 7-14 days after initiation or dose changes 2
• Early dose increases (before 6 weeks) do not provide significant advantages in blood pressure control 3
• Blood pressure typically stabilizes after approximately 6 weeks of treatment 3

Role in Treatment Algorithms

For Hypertension

• Amlodipine is recommended as a first-line treatment for hypertension in most patients 2
• For patients with blood pressure between 140/90 mmHg and 159/99 mmHg, may begin with a single drug like amlodipine 4
• For patients with blood pressure ≥160/100 mmHg, initial treatment with two antihypertensive medications is recommended 4

For Coronary Artery Disease

• Beta-blockers are preferred first-line for angina 2
• Amlodipine should be considered:
  • When beta-blockers cannot be tolerated 2
  • As an add-on therapy when angina persists despite beta-blocker treatment 2

Combination Therapy Considerations

• Amlodipine can be safely combined with beta-blockers, unlike non-dihydropyridine calcium channel blockers 2
• For resistant hypertension (BP ≥140/90 mmHg despite three medications including a diuretic), consider adding a mineralocorticoid receptor antagonist 4
• Amlodipine is one of the few calcium channel blockers that can be safely used in patients with heart failure 2

Common Adverse Effects

• Peripheral edema (most common)
• Headache
• Flushing
• Dizziness 2

Special Considerations

• 24-hour blood pressure control has been demonstrated with once-daily dosing 5, 6
• Amlodipine effectively reduces both daytime and nighttime blood pressure without altering normal circadian patterns 6
• Unlike some calcium channel blockers, amlodipine can be safely used in patients with left ventricular dysfunction 2

Cautions

• Volume-depleted patients are at higher risk for first-dose hypotension 2
• Patients with hepatic dysfunction require careful consideration due to reduced clearance 2
• Close monitoring is essential during initial administration and titration period, particularly within the first 1-2 weeks of combination therapy 2