Amlodipine Starting Dose for Adults with Hypertension
The standard starting dose of amlodipine for adults with hypertension is 5 mg once daily, with a maximum dose of 10 mg once daily. 1
Standard Dosing Algorithm
For most adults with hypertension, initiate amlodipine at 5 mg once daily. 2, 1 This is the FDA-approved initial dose and represents the most appropriate starting point for the majority of patients. 2
Exceptions 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 existing antihypertensive therapy 1
Dose Titration Strategy
Wait 7 to 14 days between titration steps under normal circumstances. 1 However, the FDA label permits more rapid titration if clinically warranted, provided the patient is assessed frequently. 1
The American Heart Association recommends increasing from 5 mg to 10 mg once daily if blood pressure remains above target (≥130/80 mmHg) after 2-6 weeks of treatment at the initial dose. 2
Important Caveat on Dose Escalation:
Consider adding a second agent rather than maximizing amlodipine to 10 mg if blood pressure control is inadequate after 4-6 weeks at 5 mg. 2 Research supports that there is no advantage to early dose escalation, as blood pressure decreases steadily over the first 6 weeks at 5 mg daily. 3
Practical Administration
- Amlodipine can be administered at any convenient time of day to improve adherence 2, 4
- The long half-life (40-60 hours) provides effective 24-hour blood pressure control with once-daily dosing 5
- Onset of effect is gradual over 4-8 hours, avoiding reflex tachycardia 5
Combination Therapy Considerations
Most adults with hypertension, especially Black adults, will require two or more antihypertensive medications to achieve BP targets <130/80 mmHg. 4 Preferred combinations include:
For Black adults without heart failure or chronic kidney disease, amlodipine is recommended as first-line therapy along with thiazide-type diuretics. 4
Common Pitfalls to Avoid
Check medication adherence before escalating the dose, as non-adherence is a common cause of apparent treatment failure. 2 Measure blood pressure at trough (just before the next dose) to ensure 24-hour control. 2
Confirm inadequate control with home blood pressure monitoring (≥135/85 mmHg) or 24-hour ambulatory monitoring (≥130/80 mmHg) before escalating therapy. 2