Recommended Initial Dose of Amlodipine
For most adults starting amlodipine for hypertension, the recommended initial dose is 5 mg once daily, with 2.5 mg reserved only for small, fragile, or elderly patients, or those with hepatic insufficiency. 1
Standard Adult Dosing
- The FDA-approved initial dose for adults is 5 mg once daily, which represents the most appropriate starting dose for typical patients 1
- The American College of Cardiology confirms that 5 mg once daily is the standard initial dose for adults 2
- Maximum dose is 10 mg once daily for adults 2, 1
When to Start at 2.5 mg Instead
The lower 2.5 mg starting dose should be used in specific populations 1:
- Small or fragile patients
- Elderly patients
- Patients with hepatic insufficiency
- When adding amlodipine to existing antihypertensive therapy
Pediatric Dosing (Ages 6-17 Years)
- Start at 2.5 mg once daily 2, 1
- Maximum dose is 5 mg once daily 3, 1
- Doses exceeding 5 mg daily are not recommended due to lack of studies in this population 3
- Children under 6 years should not receive amlodipine 3
Dose Titration Strategy
- Wait 7 to 14 days between titration steps under normal circumstances 1
- Research supports waiting at least 6 weeks at 5 mg before increasing to 10 mg, as there is no advantage to early dose escalation 4
- The American Heart Association recommends increasing from 5 mg to 10 mg if blood pressure remains ≥130/80 mmHg after 2-6 weeks 2
- Titrate more rapidly if clinically warranted, provided the patient is assessed frequently 1
Evidence Supporting 5 mg as Initial Dose
Multiple dose-ranging studies confirm the rationale for 5 mg as the standard starting dose:
- A 1988 multicenter trial demonstrated that 2.5 mg is the minimum effective dose, with 5-10 mg producing optimal dose-related blood pressure reductions 5
- A 1989 study showed target blood pressure was reached in 56% of patients with 5 mg and 73% with 10 mg, compared to only 41% with 2.5 mg 6
- The long half-life (30-50 hours) supports true once-daily dosing with sustained 24-hour blood pressure control 7, 3
Common Pitfalls to Avoid
- Do not escalate dose prematurely: Research shows no advantage to increasing the dose before 6 weeks of treatment at 5 mg 4
- Check medication adherence before escalating: Non-adherence is a common cause of apparent treatment failure 2
- Confirm inadequate control with home BP monitoring (≥135/85 mmHg) or 24-hour ambulatory monitoring (≥130/80 mmHg) before escalating 2
- Consider adding a second agent (ACE inhibitor/ARB or thiazide diuretic) rather than maximizing amlodipine if BP control is inadequate after 4-6 weeks at 5 mg 2