Amlodipine Dosing for Hypertension and Coronary Artery Disease
For adults with hypertension, the recommended initial dose of amlodipine is 5 mg once daily, with a maximum dose of 10 mg once daily, while patients with coronary artery disease should receive 5-10 mg once daily. 1
Initial Dosing Recommendations
- The usual initial antihypertensive oral dose of amlodipine is 5 mg once daily, with titration to a maximum of 10 mg once daily based on blood pressure response 1
- Small, fragile, or elderly patients, and those with hepatic insufficiency should start at a lower dose of 2.5 mg once daily 1
- For patients with coronary artery disease, the recommended dose range is 5-10 mg once daily, with most patients requiring the 10 mg dose for adequate effect 1
- When adding amlodipine to other antihypertensive therapy, a starting dose of 2.5 mg once daily may be appropriate 1
Titration Schedule
- Wait 7-14 days between dose titration steps to allow for full effect assessment 1
- More rapid titration may be clinically warranted in some cases, provided the patient is assessed frequently 1
- Studies show that blood pressure control with amlodipine is maintained throughout the 24-hour dosing interval due to its long half-life (36-45 hours) 2, 3
- Dose increases should not be considered until after six weeks of treatment at 5 mg once daily, as early dose increases have not shown significant advantages in antihypertensive effect 4
Role in Hypertension Management
- Amlodipine is a dihydropyridine calcium channel blocker that is considered a first-line agent for hypertension management 5
- In patients with stable angina and hypertension, amlodipine can be part of a regimen that includes:
- A β-blocker (particularly in patients with prior MI)
- An ACE inhibitor or ARB (if there is prior MI, LV dysfunction, diabetes, or CKD)
- A thiazide or thiazide-like diuretic 6
- For patients with resistant hypertension, amlodipine is often included as part of a multi-drug regimen 5
Combination Therapy
- If hypertension or angina remains uncontrolled on initial therapy, a long-acting dihydropyridine CCB like amlodipine can be added to a basic regimen of β-blocker, ACE inhibitor, and thiazide diuretic 6
- When used in combination with ACE inhibitors, β-blockers, or thiazide diuretics, amlodipine can produce important additional antihypertensive effects 7
- The combination of a β-blocker and a non-dihydropyridine CCB (diltiazem or verapamil) should be used with caution due to increased risk of bradyarrhythmias and heart failure, but this caution does not apply to dihydropyridines like amlodipine 6
Blood Pressure Targets
- For patients with stable angina, the BP target is <140/90 mmHg 6
- A lower target BP (<130/80 mmHg) may be considered in some individuals with CAD, previous stroke/TIA, or CAD risk equivalents 6
Special Considerations
- Amlodipine has been shown to be effective and well-tolerated in long-term use with no development of tolerance 7
- The most common adverse effect is peripheral edema 2
- Unlike some other calcium channel blockers, amlodipine has minimal effect on myocardial contractility or cardiac conduction 2
- Amlodipine is indicated for use in hypertensive or anginal patients who also have congestive heart failure due to systolic dysfunction (NYHA classes II and III) 2
Monitoring and Follow-up
- Monitor blood pressure response 7-14 days after initiation or dose changes 1
- Assess for common side effects including headache, flushing, dizziness, and peripheral edema 8
- No clinically important drug interactions have been observed with amlodipine 2
- Amlodipine has not shown unfavorable effects on serum glucose or lipid levels 2