What is the maximum recommended dose of S-amlodipine (amlodipine) for treating hypertension?

Maximum Dose of S-Amlodipine for Hypertension

The maximum recommended dose of amlodipine for treating hypertension in adults is 10 mg once daily. 1

Standard Adult Dosing

• The FDA-approved maximum dose is 10 mg once daily for hypertension, angina, and coronary artery disease. 1
• The usual starting dose is 5 mg once daily, with titration to 10 mg if blood pressure targets are not achieved 1
• Small, fragile, or elderly patients should start at 2.5 mg once daily due to increased sensitivity 1
• Patients with hepatic insufficiency should also begin at 2.5 mg once daily 1

Dosing Algorithm

Initial dose selection: 1

• Standard adults: 5 mg once daily
• Elderly, frail, or hepatic impairment: 2.5 mg once daily
• Adding to existing antihypertensive therapy: 2.5 mg once daily

Titration schedule: 1

• Wait 7-14 days between dose adjustments under normal circumstances
• More rapid titration is acceptable if clinically warranted with frequent patient assessment
• Maximum dose: 10 mg once daily

Pediatric Dosing Limits

• Children aged 6-17 years: maximum dose is 5 mg once daily 2, 1
• Doses exceeding 5 mg daily have not been studied in pediatric patients and are not recommended 2, 1
• Children under 6 years should not receive amlodipine 2

Special Clinical Context: Pulmonary Hypertension

• For idiopathic pulmonary arterial hypertension (IPAH) in carefully selected vasoreactive patients, doses up to 20 mg daily may be used, though this is off-label 3, 2
• This higher dosing (up to 20 mg) is reserved exclusively for IPAH patients who demonstrate positive acute vasodilator response during right heart catheterization 3, 2
• The European Society of Cardiology notes that only a small subset of IPAH patients meet criteria for this approach 3

Important caveat: This 20 mg dosing for pulmonary hypertension is NOT applicable to standard hypertension management and should not be confused with the 10 mg maximum for essential hypertension 3, 1

Drug Interaction Consideration

• When coadministered with simvastatin or lovastatin, amlodipine doses should not exceed 20 mg daily due to increased statin exposure and myopathy risk 2
• This represents a safety ceiling rather than a therapeutic recommendation for hypertension

Pharmacokinetic Rationale

• Amlodipine's long half-life (30-50 hours) supports true once-daily dosing with sustained 24-hour blood pressure control 2, 4
• This extended half-life means steady-state is achieved slowly, justifying the 7-14 day wait between dose adjustments 1