What is the appropriate dosing for Amlodipine (calcium channel blocker)?

From the Guidelines

Amlodipine should be dosed at 2.5-10 mg once daily, with the usual dose being 5-10 mg daily, as recommended by the most recent guidelines. This dosing is based on the 2018 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. The guideline suggests that amlodipine, a calcium channel blocker, can be used to treat hypertension, with a usual dose range of 2.5-10 mg daily.

Key Considerations

• The dose of amlodipine may need to be adjusted based on the patient's response to the medication and their individual characteristics, such as age and hepatic function.
• Amlodipine should be taken at the same time each day, with or without food, to maintain consistent blood levels and minimize side effects.
• Common side effects of amlodipine include peripheral edema, headache, flushing, and dizziness, which often diminish over time as the body adjusts to the medication.
• Full antihypertensive effects of amlodipine may take 1-2 weeks to develop, and patients should not stop taking the medication suddenly without consulting their healthcare provider.

Comparison with Other Evidence

While the 2013 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction also discusses the use of calcium channel blockers, including amlodipine, the more recent 2018 guideline provides the most up-to-date recommendations for dosing 1. Therefore, the 2018 guideline is prioritized for determining the appropriate dosing for amlodipine.

Clinical Implications

In clinical practice, amlodipine is a commonly used medication for the treatment of hypertension and angina. By following the recommended dosing guidelines, healthcare providers can help ensure that patients receive effective treatment while minimizing the risk of side effects. Regular blood pressure monitoring is essential to assess the effectiveness of the medication and adjust the dose as needed.

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION

2.1 Adults The usual initial antihypertensive oral dose of Amlodipine besylate tablets is 5 mg once daily, and the maximum dose is 10 mg once daily. Small, fragile, or elderly patients, or patients with hepatic insufficiency may be started on 2. 5 mg once daily and this dose may be used when adding Amlodipine besylate tablets to other antihypertensive therapy. Adjust dosage according to blood pressure goals. In general, wait 7 to 14 days between titration steps. Titrate more rapidly, however, if clinically warranted, provided the patient is assessed frequently Angina: The recommended dose for chronic stable or vasospastic angina is 5 to 10 mg, with the lower dose suggested in the elderly and in patients with hepatic insufficiency. Most patients will require 10 mg for adequate effect. Coronary artery disease: The recommended dose range for patients with coronary artery disease is 5 to 10 mg once daily. In clinical studies, the majority of patients required 10 mg [see Clinical Studies (14. 4)] . 2.2 Children The effective antihypertensive oral dose in pediatric patients ages 6 to 17 years is 2.5 mg to 5 mg once daily. Doses in excess of 5 mg daily have not been studied in pediatric patients [see Clinical Pharmacology (12.4), Clinical Studies (14.1)] .

The appropriate dosing for Amlodipine is:

• Initial dose: 5 mg once daily for adults, and 2.5 mg once daily for small, fragile, or elderly patients, or patients with hepatic insufficiency
• Maximum dose: 10 mg once daily for adults
• Dose for specific conditions:
  • Angina: 5 to 10 mg once daily
  • Coronary artery disease: 5 to 10 mg once daily
  • Pediatric patients (ages 6 to 17): 2.5 mg to 5 mg once daily
• Titration: Adjust dosage according to blood pressure goals, waiting 7 to 14 days between titration steps 2

From the Research

Dosing Information for Amlodipine

• The most appropriate starting dose for amlodipine is 5 mg once daily, with simple adjustment to 10 mg if necessary 3.
• The dose can be titrated to achieve the target blood pressure, with a median daily dose of 5 mg (range, 1.25-15 mg) 4.
• Amlodipine can be used once daily in hypertension, with effective blood levels and good control of blood pressure maintained throughout the dosing interval 3, 5.
• The pharmacokinetics of amlodipine, including its high oral bioavailability (60-80%) and long half-life (35-50 h), allow it to sustain its anti-hypertensive effect for more than 24 h following a single dose 5, 6.

Considerations for Specific Patient Populations

• Amlodipine is effective in reducing systolic blood pressure in elderly patients (age > 60 years) and patients with isolated systolic hypertension 4.
• Amlodipine can be used in patients with diabetes or chronic kidney disease without worsening glycemic or kidney function 6.
• Amlodipine is a wise choice for older adults due to its ability to control blood pressure and protect against stroke and myocardial infarction 6.

Comparison with Other Antihypertensive Agents

• Amlodipine has antihypertensive efficacy superior to verapamil and comparable with atenolol, hydrochlorothiazide, captopril, or nitrendipine 3.
• Amlodipine was compared with chlorthalidone and lisinopril in the ALLHAT trial, which found that thiazide-type diuretics are superior in preventing major forms of cardiovascular disease 7.