What is the recommended initial dose and titration of Amlodipine (calcium channel blocker) for patients with hypertension or angina?

Amlodipine Dosing for Hypertension and Angina

For patients with hypertension, the recommended initial dose of amlodipine is 5 mg once daily, with titration to 10 mg once daily if needed after 6-8 weeks if blood pressure remains uncontrolled. 1

Initial Dosing

Hypertension

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

Angina (Chronic Stable or Vasospastic)

• Initial dose: 5 mg once daily
• Maximum dose: 10 mg once daily
• Most patients with angina require 10 mg for adequate effect 1, 2

Titration Protocol

Hypertension

1. Start with 5 mg once daily (or 2.5 mg in special populations)
2. Wait 6-8 weeks before considering dose increase 3
3. If blood pressure remains above target after 6-8 weeks, increase to 10 mg once daily
4. The FDA label suggests waiting 7-14 days between titration steps, but clinical evidence shows optimal results when waiting 6 weeks 1, 3

Angina

1. Start with 5 mg once daily
2. If symptoms persist after 2 weeks, increase to 10 mg once daily
3. Approximately 83% of angina patients require uptitration to 10 mg daily for symptom control 2

Expected Response

• Amlodipine typically produces approximately 9/5 mmHg reduction in office blood pressure and 5/3 mmHg with ambulatory blood pressure monitoring 4
• Response rates (diastolic BP ≤ 90 mmHg) of approximately 84% can be expected after 6 weeks of treatment 3
• For angina, significant reduction in weekly angina attacks can be expected (from 13.3 to 1.6 attacks per week in clinical studies) 2

Monitoring Recommendations

• Reassess blood pressure after 1-3 months (preferably 1 month) to evaluate the full blood pressure lowering effect 4
• Encourage home blood pressure monitoring twice daily to track effectiveness 4
• Target blood pressure range: 120-129/70-79 mmHg if tolerated 4

Common Pitfalls and Caveats

1. Premature dose escalation: Research shows no advantage to early dose increases; wait at least 6 weeks before increasing the dose from 5 mg to 10 mg 3
2. Inadequate monitoring: The full antihypertensive effect may take several weeks to develop, so avoid premature judgments about efficacy
3. Ankle edema: Monitor for peripheral edema, which occurs in approximately 10% of patients 2
4. Special populations: Remember to start with 2.5 mg in elderly, fragile patients, or those with hepatic insufficiency 1

Amlodipine's long half-life makes it suitable for once-daily dosing with consistent 24-hour blood pressure control 5, 6. When used in combination with other antihypertensive agents (ACE inhibitors, beta-blockers, or thiazide diuretics), amlodipine can produce important additional blood pressure reductions 5.