Amlodipine GDMT Dosing
For adults with hypertension or coronary artery disease, start amlodipine at 5 mg once daily, with the option to start at 2.5 mg once daily in small, fragile, or elderly patients, or those with hepatic insufficiency. 1
Standard Adult Dosing
- Initial dose: 5 mg once daily for most adults with hypertension 1, 2
- Maximum dose: 10 mg once daily 1
- The majority of patients with coronary artery disease require 10 mg for adequate effect 1
- For chronic stable or vasospastic angina, the recommended dose range is 5-10 mg once daily 1
Dose Titration Strategy
- Wait 7 to 14 days between titration steps under normal circumstances 1
- Titrate more rapidly if clinically warranted, provided the patient is assessed frequently 1
- Do not increase the dose before 6 weeks of treatment at 5 mg once daily, as there is no advantage to early dose escalation in terms of antihypertensive effect 3
- Adjust dosage according to blood pressure goals 1
Special Populations Requiring Lower Starting Dose (2.5 mg once daily)
- Small or fragile patients 1
- Elderly patients 1
- Patients with hepatic insufficiency 1
- When adding amlodipine to other antihypertensive therapy 1
Pediatric Dosing (Ages 6-17 Years)
- Starting dose: 2.5 mg once daily 4
- Maximum dose: 5 mg once daily 4, 1
- Doses exceeding 5 mg daily have not been studied in pediatric patients 1
Administration Considerations
- Amlodipine can be administered at the most convenient time of day to improve adherence 4
- Once-daily dosing is supported by amlodipine's long half-life of 40-60 hours, providing consistent 24-hour blood pressure control 5, 2
- Long-acting amlodipine is recommended as the first-line calcium channel blocker for hypertension management 4, 5
Combination Therapy Context
- 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 4
- In Black adults with hypertension but without heart failure or chronic kidney disease, initial treatment should include a thiazide-type diuretic or calcium channel blocker like amlodipine 4
- Fixed-dose single-pill combinations are recommended when patients receive combination BP-lowering treatment 4
Common Pitfalls to Avoid
- Do not titrate too early: Increasing the dose before 6 weeks provides no additional benefit, as blood pressure decreases steadily until the sixth week of treatment 3
- Do not exceed maximum doses: 10 mg daily in adults and 5 mg daily in pediatric patients 1
- Monitor for peripheral edema, headache, flushing, and constipation, which are common side effects 4