Amlodipine GDMT Dosing Recommendations
For adults with hypertension, start amlodipine at 5 mg once daily, with the option to reduce to 2.5 mg once daily in small, fragile, elderly patients, or those with hepatic insufficiency. 1
Standard Adult Dosing
- Initial dose: 5 mg once daily for most adults with hypertension 1
- Maximum dose: 10 mg once daily 1
- The dose range of 2.5-10 mg once daily is recommended by the American College of Cardiology 2
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
- Research suggests that dose increases should not be considered until after 6 weeks of treatment at 5 mg once daily, as there is no advantage to early dose escalation 3
- Blood pressure decreases steadily until the end of the sixth week of treatment 3
Special Populations Requiring Lower Starting Doses
Start at 2.5 mg once daily in the following groups 1:
- Small or fragile patients
- Elderly patients
- Patients with hepatic insufficiency
- When adding amlodipine to other antihypertensive therapy
Pediatric Dosing (Ages 6-17 Years)
- Starting dose: 2.5 mg once daily 4, 1
- Maximum dose: 5 mg once daily 4, 1
- Doses exceeding 5 mg daily have not been studied in pediatric patients 1
- Higher weight-based doses are required for younger patients compared to adolescents 5
Specific Indications
For chronic stable or vasospastic angina:
- Recommended dose range: 5-10 mg once daily 1
- Use lower doses (5 mg) in elderly patients and those with hepatic insufficiency 1
- Most patients require 10 mg for adequate effect 1
For coronary artery disease:
- Recommended dose range: 5-10 mg once daily 1
- The majority of patients required 10 mg in clinical studies 1
Administration and Monitoring
- Amlodipine can be administered at the most convenient time of day to improve adherence 4
- The long half-life (30-50 hours) supports true once-daily dosing with 24-hour blood pressure control 2, 6
- Monthly visits until blood pressure target is achieved 4
- Replace 30-day with 90-day refills when blood pressure is controlled 4
Common Pitfalls to Avoid
- Do not titrate too early: Waiting at least 6 weeks at 5 mg before increasing to 10 mg allows full assessment of response 3
- Do not start at 10 mg: The FDA label and guidelines consistently recommend 5 mg as the appropriate starting dose for most adults 1
- Do not forget dose reduction in special populations: Elderly, fragile, or hepatically impaired patients should start at 2.5 mg to minimize side effects 1
Expected Side Effects
Common adverse effects include peripheral edema, headache, flushing, and constipation 4, 2