What is the recommended use and dosage of Amlip (Amlodipine) for treating high blood pressure and coronary artery disease?

Amlodipine (Amlip) Use in Hypertension and Coronary Artery Disease

Amlodipine is recommended at an initial dose of 5 mg once daily for hypertension and coronary artery disease, with a maximum dose of 10 mg once daily, producing significant blood pressure reductions averaging 12-13/6-7 mmHg. 1

Dosage Recommendations

• Initial dosing:

  • Standard initial dose: 5 mg once daily 1
  • For elderly, fragile patients or those with hepatic insufficiency: 2.5 mg once daily 1
  • Maximum dose: 10 mg once daily 1

• Titration schedule:

  • Wait 7-14 days between dose adjustments 1
  • More rapid titration may be appropriate if clinically warranted with frequent patient assessment 1

Indications

Hypertension

• Effective as monotherapy or in combination with other antihypertensives 1
• Produces statistically significant reductions in both systolic and diastolic blood pressure 1
• Once-daily administration maintains 24-hour blood pressure control with little difference between peak and trough effect 1, 2

Coronary Artery Disease

• Recommended dose: 5-10 mg once daily 1
• Most patients require 10 mg for adequate effect 1
• Effective for:
  • Chronic stable angina (5-10 mg daily) 1
  • Vasospastic angina (5-10 mg daily) 1
  • Documented coronary artery disease (5-10 mg daily) 1

Efficacy

• In hypertension: Reduces standing blood pressure by approximately 12/6 mmHg and supine blood pressure by 13/7 mmHg 1
• In angina: Increases exercise time by 12.8% with 10 mg dose and 7.9% with 5 mg dose 1
• In coronary artery disease: Reduces hospitalization for angina by 42% and coronary revascularization by 27% compared to placebo 1
• Maintains efficacy without development of tolerance for up to 1 year 1, 3

Combination Therapy

• When blood pressure control is inadequate with amlodipine alone, combination therapy should be considered 4:

  • Preferred combinations include:
    • Amlodipine + ACE inhibitor (e.g., enalapril) 5
    • Amlodipine + ARB 6
    • Amlodipine + thiazide diuretic 6

• For patients with heart failure and hypertension:

  • ACE inhibitors or ARBs should be first-line agents 4
  • Beta-blockers (carvedilol, metoprolol succinate, bisoprolol, or nebivolol) should be included 4
  • Amlodipine (dihydropyridine CCB) can be safely added if needed for additional BP control 4, 6

Blood Pressure Targets

• General target: <140/90 mmHg 4, 6
• Consider lower target (<130/80 mmHg) in selected high-risk patients with coronary artery disease 6
• In heart failure patients, SBP should be lowered to 110-130 mmHg range 4
• In elderly patients, monitor for orthostatic changes and avoid diastolic BP <65 mmHg 4

Special Considerations

Safety in Heart Failure

• Unlike non-dihydropyridine CCBs (verapamil, diltiazem), amlodipine is safe to use in patients with heart failure with reduced ejection fraction 4, 6
• The PRAISE trial demonstrated safety of amlodipine in patients with severe systolic heart failure 4

Side Effects and Management

• Most common side effect: peripheral edema (dose-related, more common in women) 6
• When peripheral edema occurs, consider:
  • Reducing dose
  • Switching to another dihydropyridine CCB
  • Combining with an ACE inhibitor or ARB (which may reduce incidence of edema) 5

Contraindications and Cautions

• Avoid in severe aortic stenosis
• Use lower initial doses (2.5 mg) in elderly, fragile patients, or those with hepatic insufficiency 1
• No significant drug interactions with beta-blockers, making it suitable for combination therapy 7

Monitoring

• Check blood pressure within 2-4 weeks after starting medication or changing dose 6
• Monitor for peripheral edema, especially at higher doses 6
• No routine laboratory monitoring required specifically for amlodipine

Amlodipine offers effective 24-hour blood pressure control with once-daily dosing and has proven benefits in reducing cardiovascular events in patients with coronary artery disease, making it an excellent choice for treating hypertension in these patients.