What are the recommended doses of amlodipine (calcium channel blocker) for adults with hypertension and coronary artery disease?

Amlodipine Dosing for Hypertension and Coronary Artery Disease

For adults with hypertension or coronary artery disease, start amlodipine at 5 mg once daily and increase to a maximum of 10 mg once daily if blood pressure remains above target after 2-6 weeks. 1, 2

Standard Adult Dosing Algorithm

Initial Dose

• Start with 5 mg once daily for most adults with hypertension or coronary artery disease 2
• Use 2.5 mg once daily for small, fragile, elderly patients, or those with hepatic insufficiency 2
• Administer at any convenient time of day to improve adherence 1

Dose Escalation Strategy

• Wait 2-6 weeks before increasing from 5 mg to 10 mg if blood pressure remains ≥130/80 mmHg 1
• The FDA label suggests waiting 7-14 days between titration steps, but more rapid titration is acceptable if clinically warranted with frequent patient assessment 2
• Maximum dose is 10 mg once daily for standard hypertension and coronary artery disease 1, 2
• Confirm inadequate control with home blood pressure monitoring (≥135/85 mmHg) or 24-hour ambulatory monitoring (≥130/80 mmHg) before escalating 1

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 1. Research demonstrates no advantage to early dose escalation, as both 5 mg and titrated 10 mg groups achieved identical 84% response rates by 6 weeks 3. Preferred combinations include amlodipine plus ACE inhibitor/ARB or amlodipine plus thiazide-type diuretic 1.

Specific Indications and Dosing

Hypertension

• Initial: 5 mg once daily 2
• Maximum: 10 mg once daily 2
• Target blood pressure: <130/80 mmHg for most adults 1

Chronic Stable or Vasospastic Angina

• Recommended dose range: 5-10 mg once daily 2
• Use lower dose (5 mg) in elderly and patients with hepatic insufficiency 2
• Most patients require 10 mg for adequate effect 2

Coronary Artery Disease

• Recommended dose range: 5-10 mg once daily 2
• Majority of patients in clinical studies required 10 mg 2

Pediatric Dosing (Ages 6-17 Years)

• Initial: 2.5 mg once daily 2
• Maximum: 5 mg once daily 2
• Doses exceeding 5 mg daily have not been studied in pediatric patients and are not recommended 4, 2

Special Population: Pulmonary Arterial Hypertension (Off-Label)

This is a highly specialized use that differs dramatically from standard hypertension dosing. For idiopathic pulmonary arterial hypertension in carefully selected vasoreactive patients only, doses of 20-30 mg daily may be used 5, 4. This applies exclusively to the approximately 10% of IPAH patients who demonstrate positive acute vasodilator response during right heart catheterization 5. Do not use these high doses empirically—inappropriate use can increase morbidity and may be fatal 5.

Critical Pitfalls to Avoid

Before Escalating Dose

• Check medication adherence first—non-adherence is a common cause of apparent treatment failure 1
• Measure blood pressure at trough (just before next dose) to ensure 24-hour control 1
• Confirm elevated readings with home or ambulatory monitoring 1

Drug Interaction

• When coadministered with simvastatin or lovastatin, amlodipine doses should not exceed 20 mg daily due to increased statin exposure and myopathy risk 4

Common Side Effects

• Peripheral edema, headache, flushing, and constipation are expected 1
• Ankle edema can be treated with diuretics 5

Monitoring Schedule

• Monthly visits until blood pressure target is achieved 1
• Replace 30-day with 90-day refills when blood pressure is controlled 1
• Consider telehealth strategies to augment office-based management 1