Can a patient's dose of Norvasc (amlodipine) be increased from 5mg to 10mg?

Can Amlodipine Be Increased from 5 mg to 10 mg?

Yes, you can increase amlodipine from 5 mg to 10 mg once daily, as the FDA-approved maximum dose is 10 mg daily for hypertension. 1

Dosing Guidelines and Titration

• The FDA label specifies that the usual initial antihypertensive dose is 5 mg once daily, with a maximum dose of 10 mg once daily 1
• Wait 7 to 14 days between titration steps under normal circumstances, though more rapid titration is acceptable if clinically warranted with frequent patient assessment 1
• Clinical trials demonstrate that dose increases from 5 mg to 10 mg provide additional blood pressure reduction, with the 10 mg dose producing an average reduction of approximately 12/6 mmHg in standing position 1

Evidence Supporting Dose Escalation

• Studies show that the blood pressure reduction is dose-related within the recommended dosing range (2.5-10 mg), with 10 mg providing superior efficacy compared to 5 mg 1
• In exercise-induced angina trials, the 10 mg dose produced significantly greater increases in exercise time (63 seconds) compared to the 5 mg dose (38 seconds) 1
• Research indicates that waiting a full 6 weeks at 5 mg before considering dose escalation may be appropriate, as blood pressure continues to decrease steadily through week 6 of treatment 2

Important Considerations Before Dose Increase

• Verify medication adherence first - amlodipine's long half-life (35-50 hours) provides continuous protection even with occasional missed doses, but chronic non-adherence will prevent adequate blood pressure control 3
• Assess current blood pressure control - if the patient is close to target (<140/90 mmHg for most patients), adding a second agent from a different class may be more effective than increasing amlodipine 4
• Monitor for peripheral edema, which is the most common adverse effect and occurs more frequently at the 10 mg dose 5, 3

Alternative Strategy: Adding a Second Agent

• If blood pressure remains significantly elevated on amlodipine 5 mg, consider adding an ACE inhibitor or ARB rather than increasing to 10 mg, as combination therapy provides complementary mechanisms of action and may be more effective 4
• The combination of amlodipine with an ACE inhibitor/ARB is particularly beneficial for patients with chronic kidney disease, heart failure, or coronary artery disease 4
• Adding a thiazide-like diuretic is another effective option, especially for volume-dependent hypertension, elderly patients, or Black patients 4

Monitoring After Dose Adjustment

• Reassess blood pressure within 2-4 weeks after increasing to 10 mg 4
• Target blood pressure should be <140/90 mmHg for most patients 4
• Watch for dose-dependent side effects including peripheral edema, palpitations, dizziness, and flushing 3