What is the recommended dose of Amlodipine (calcium channel blocker) for adults with hypertension (high blood pressure) and coronary artery disease?

Recommended Dosing of Amlodipine for Adults with Hypertension and Coronary Artery Disease

For adults with hypertension and coronary artery disease, the recommended dose of amlodipine is 5 to 10 mg once daily, with most patients requiring 10 mg for adequate effect. 1

Initial Dosing

• The usual initial antihypertensive dose of amlodipine is 5 mg once daily 1
• For elderly, fragile patients, or those with hepatic insufficiency, starting with 2.5 mg once daily is recommended 1
• Amlodipine can be administered at the most convenient time of day for the patient to improve adherence 2
• Long-acting amlodipine is recommended as the first-line calcium channel blocker for hypertension management 2

Dose Titration

• Wait 7 to 14 days between titration steps to assess response 1
• Titration can be accelerated if clinically warranted, provided the patient is monitored frequently 1
• Some evidence suggests waiting 6 weeks before increasing the dose, as there is no advantage to early dose increases 3
• The maximum recommended dose is 10 mg once daily 1

Efficacy and Pharmacokinetics

• Amlodipine has high oral bioavailability (60-80%) and reaches steady state with once-daily administration over 1-1.5 weeks 4
• The elimination half-life is 40-60 hours, allowing for effective 24-hour blood pressure control with once-daily dosing 4
• Fluctuation of plasma drug concentration between doses is only 20-25% with once-daily dosing 4
• Amlodipine produces gradual blood pressure reduction without reflex tachycardia 4

Special Considerations for Coronary Artery Disease

• For patients with coronary artery disease, the recommended dose range is 5 to 10 mg once daily 1
• Clinical studies have shown that the majority of patients with coronary artery disease require 10 mg for optimal effect 1
• Amlodipine is effective for both hypertension and angina pectoris with once-daily dosing 4

Combination Therapy

• Amlodipine can be used in combination with angiotensin-converting enzyme inhibitors, beta-blockers, or thiazide diuretics for additional antihypertensive effects 5
• For most adults with hypertension, especially black adults, two or more antihypertensive medications are recommended to achieve a BP target of less than 130/80 mm Hg 2
• In black adults with hypertension but without heart failure or chronic kidney disease, initial antihypertensive treatment should include a thiazide-type diuretic or calcium channel blocker like amlodipine 2
• Fixed-dose single-pill combinations are recommended when patients receive combination BP-lowering treatment 2

Safety and Tolerability

• Amlodipine is generally well-tolerated with long-term use 5
• Common side effects include peripheral edema, headache, flushing, and constipation 2
• No tolerance appears with long-term use of amlodipine in hypertension 5
• Discontinuation results in a slow return of blood pressure to baseline over 7-10 days, with no evidence of a 'rebound' effect 4

Monitoring and Follow-up

• Monthly visits until blood pressure target is achieved 2
• Replace 30-day with 90-day refills when possible 2
• Consider telehealth strategies to augment office-based management 2

Remember that amlodipine is a cornerstone therapy for hypertension management, particularly in patients with coronary artery disease, and proper dosing is essential for achieving optimal outcomes in terms of morbidity, mortality, and quality of life.