Starting Dose of Amlodipine for Adults with Hypertension
The standard starting dose of amlodipine for adults with hypertension is 5 mg once daily, with dose adjustments made after 7-14 days if blood pressure targets are not achieved. 1
Standard Adult Dosing
- Initial dose: 5 mg once daily is the FDA-approved starting dose for most adults with hypertension 1
- Maximum dose: 10 mg once daily 1
- Titration schedule: Wait 7-14 days between dose adjustments, though more rapid titration is acceptable if clinically warranted with frequent patient assessment 1
Special Populations Requiring Lower Starting Doses
Start with 2.5 mg once daily in the following patient groups 1:
- Small or fragile patients
- Elderly patients
- Patients with hepatic insufficiency
- When adding amlodipine to existing antihypertensive therapy 1
Evidence Supporting the 5 mg Starting Dose
The 5 mg starting dose is well-supported by dose-ranging studies:
- Dose-response trials demonstrated that 5 mg once daily is the most appropriate starting dose, with simple adjustment to 10 mg if necessary 2
- In a large multicenter trial of 205 patients, 56% reached target blood pressure with 5 mg once daily, and 73% with 10 mg once daily 3
- Studies show no advantage to early dose escalation—response rates at 6 weeks were identical (84%) whether patients remained on 5 mg or were increased to 10 mg after 2 weeks 4
Practical Dosing Considerations
- Amlodipine provides smooth 24-hour blood pressure control with once-daily dosing due to its long half-life 2, 5
- Can be administered at any convenient time of day to improve adherence 6
- No tolerance develops with long-term use 2, 7
- Mean blood pressure reductions of approximately 23/13 mmHg can be expected with therapeutic doses 7
Common Pitfalls to Avoid
- Do not increase the dose before 6 weeks of treatment unless clinically urgent—early dose escalation provides no additional benefit 4
- Remember that most adults with hypertension, especially Black adults, will require two or more antihypertensive medications to achieve BP targets <130/80 mmHg 8, 6
- In Black adults without heart failure or CKD, amlodipine (as a calcium channel blocker) is recommended as first-line therapy along with thiazide-type diuretics 8