Amlodipine Dosage Adjustment for Persistent Hypertension
For a patient currently on amlodipine 5 mg daily with persistent hypertension, the dose should be increased to 10 mg daily. 1
Dosage Recommendations
The FDA-approved dosing guidelines for amlodipine clearly state:
- Initial dose for hypertension is 5 mg once daily
- Maximum dose is 10 mg once daily
- Titration should typically occur after 7-14 days between steps 1
When a patient remains hypertensive on 5 mg daily, the next appropriate step is to increase to the maximum recommended dose of 10 mg daily. This is supported by clinical evidence showing that increasing from 5 mg to 10 mg provides significant additional blood pressure reduction.
Evidence Supporting Dose Increase
A Phase III double-blind controlled study in patients with essential hypertension who had insufficient response to amlodipine 5 mg demonstrated:
- Patients who increased to 10 mg had significantly greater reductions in systolic blood pressure (-13.7 mmHg vs -7.0 mmHg) compared to those who remained on 5 mg 2
- Diastolic blood pressure reductions were also significantly greater with 10 mg (-6.8 mmHg vs -2.7 mmHg) 2
- The responder rate was significantly higher in the 10 mg group (44.0% vs 28.5%) 2
Timing of Dose Adjustment
While older research suggested waiting 6 weeks before increasing the dose 3, more recent FDA guidelines recommend:
- Evaluating response after 7-14 days
- Titrating more rapidly if clinically warranted, provided the patient is assessed frequently 1
Special Considerations
- For elderly, fragile patients, or those with hepatic insufficiency, a lower starting dose of 2.5 mg is recommended, but your patient is already tolerating 5 mg 1
- Monitor for potential side effects with dose increase, particularly peripheral edema, which occurred in about 4% of patients on 10 mg in clinical trials 2
Additional Management Strategies
If blood pressure remains uncontrolled after increasing to amlodipine 10 mg:
Consider adding a second agent from a different class according to the European Society of Cardiology recommendations:
- RAS blocker (ACE inhibitor or ARB)
- Thiazide/thiazide-like diuretic 4
If needed, advance to a three-drug combination:
- RAS blocker + calcium channel blocker + thiazide diuretic 4
For resistant hypertension, consider adding spironolactone as a fourth agent 4
Monitoring After Dose Adjustment
- Reassess blood pressure in 2-4 weeks after dose increase
- Target blood pressure should be <130/80 mmHg for most patients 4
- For patients 65-79 years, target 130-139/80 mmHg
- For patients ≥80 years, target 140-150/<80 mmHg 4
Conclusion
The evidence clearly supports increasing amlodipine from 5 mg to 10 mg daily for patients with persistent hypertension on the lower dose, with monitoring for response and side effects after the adjustment.