Initiating Dose of Amlodipine for Adults with Hypertension
The usual initial antihypertensive oral dose of amlodipine for adults with hypertension is 5 mg once daily. 1
Dosing Guidelines
- The FDA-approved initial dose for adults with hypertension is 5 mg once daily, with a maximum dose of 10 mg once daily 1
- For small, fragile, or elderly patients, or patients with hepatic insufficiency, a lower starting dose of 2.5 mg once daily is recommended 1
- Amlodipine has a long half-life (35-50 hours) and duration of action, allowing for sustained antihypertensive effect for more than 24 hours following a single dose 2
Dose Titration
- After initiating therapy, wait 7 to 14 days between titration steps to assess response 1
- More rapid titration may be appropriate if clinically warranted, provided the patient is assessed frequently 1
- Studies show that blood pressure typically decreases steadily until the end of the sixth week of treatment, suggesting that dose increases should not be considered until after six weeks of treatment at 5 mg once daily 3
Special Populations
- In patients receiving bevacizumab who develop hypertension, amlodipine 5 mg daily is the recommended initial dose for antihypertensive-naive patients 4
- For elderly patients, a starting dose of 2.5 mg is recommended due to potential for increased sensitivity to the drug's effects 1
- Patients with hepatic insufficiency should also start at 2.5 mg once daily due to decreased clearance of the medication 1
Efficacy
- In clinical trials, amlodipine monotherapy has been shown to decrease systolic blood pressure by a mean of 17.5 mmHg from baseline 5
- The antihypertensive effect is greater in elderly patients (age ≥60 years) and patients with isolated systolic hypertension 5
- Target blood pressure is reached in approximately 56% of patients with 5 mg of amlodipine and 73% with 10 mg of amlodipine once daily 6
Practical Considerations
- Amlodipine is considered a long-acting calcium channel blocker and is recommended as a first-line agent for hypertension management 4
- The long half-life provides continuous protection even when a dose has been missed, which is beneficial for patients with occasional non-compliance 2
- Common side effects include edema, palpitations, dizziness, and flushing, which are more common with the higher dose of 10 mg 2
Clinical Pearls
- When adding amlodipine to other antihypertensive therapy, consider starting with 2.5 mg once daily 1
- Amlodipine can be used effectively in patients with diabetes or chronic kidney disease without worsening glycemic control or kidney function 2
- For patients with resistant hypertension, amlodipine is often included as part of a multi-drug regimen 4