Amlodipine Dosing for Adults with Hypertension
Start amlodipine at 5 mg once daily for most adults with hypertension, with a maximum dose of 10 mg once daily. 1
Initial Dosing Strategy
- The standard starting dose is 5 mg once daily for most adults with hypertension 1, 2
- Small, fragile, or elderly patients, or those with hepatic insufficiency should start at 2.5 mg once daily 1
- Amlodipine can be taken at any convenient time of day to improve adherence 2, 3
- Long-acting amlodipine is recommended as the first-line calcium channel blocker for hypertension management 4
Dose Titration Protocol
Wait 7 to 14 days between titration steps under normal circumstances, though more rapid titration is acceptable if clinically warranted with frequent patient assessment. 1
- If blood pressure remains above target (≥130/80 mmHg) after 2-6 weeks at 5 mg, increase to 10 mg once daily 2
- The maximum dose is 10 mg once daily 1, 2
- Confirm inadequate control with home blood pressure monitoring (≥135/85 mmHg) or 24-hour ambulatory monitoring (≥130/80 mmHg) before escalating therapy 2
- Check medication adherence before escalating dose, as non-adherence is a common cause of apparent treatment failure 2
Combination Therapy Considerations
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
- Most adults with hypertension, especially Black adults, will require two or more antihypertensive medications to achieve BP targets <130/80 mmHg 3
- Preferred combinations include amlodipine + ACE inhibitor/ARB, or amlodipine + thiazide-type diuretic 2
- Fixed-dose single-pill combinations are recommended when patients receive combination BP-lowering treatment 2, 3
Monitoring and Follow-up
- Target blood pressure is <130/80 mmHg for most adults with hypertension 2
- Schedule monthly visits until blood pressure target is achieved 4, 2
- Measure blood pressure at trough (just before next dose) to ensure 24-hour control 2
- Replace 30-day with 90-day refills when possible to improve adherence 4, 2
Clinical Evidence Supporting Dosing
Research demonstrates that 5 mg once daily is the most appropriate starting dose, with simple adjustment to 10 mg if necessary 5. A comparative trial showed that S-amlodipine 2.5 mg (equivalent to racemic amlodipine 5 mg) effectively reduced systolic blood pressure by approximately 20 mmHg and diastolic blood pressure by approximately 14 mmHg over 6 weeks 6. Studies indicate no advantage to early dose escalation; dose increases should not be considered until after 6 weeks of treatment at 5 mg once daily 7.