From the Guidelines
Amlodipine is typically prescribed at an initial dose of 5 mg once daily, which can be adjusted based on patient response up to a maximum of 10 mg daily, as recommended by the most recent guidelines 1. For elderly patients or those with hepatic impairment, starting at a lower dose of 2.5 mg daily is recommended. Amlodipine is a calcium channel blocker used to treat high blood pressure and certain types of chest pain (angina). It works by relaxing blood vessels, allowing blood to flow more easily and reducing the workload on the heart. The medication should be taken at the same time each day, with or without food, and patients should continue taking it even if they feel well. Blood pressure improvements typically begin within 1-2 weeks, but full effects may take 3-4 weeks to develop. Common side effects include swelling in the ankles or feet, headache, flushing, and dizziness. Patients should not stop taking amlodipine suddenly without consulting their healthcare provider, as this could lead to worsening of their condition. In certain cases, such as patients receiving bevacizumab, amlodipine can be initiated at a dose of 5 mg daily to manage hypertension 1. It is essential to monitor blood pressure regularly and adjust the dose as needed to achieve optimal blood pressure control. The choice of amlodipine and its dosing should be individualized based on patient characteristics, such as age, renal function, and concomitant medications. Overall, amlodipine is a well-tolerated and effective medication for the treatment of hypertension and angina, and its use should be guided by the most recent clinical guidelines and patient-specific factors.
From the FDA Drug Label
2 DOSAGE & ADMINISTRATION
2.1 Adults The usual initial antihypertensive oral dose of Amlodipine besylate tablets is 5 mg once daily, and the maximum dose is 10 mg once daily. Small, fragile, or elderly patients, or patients with hepatic insufficiency may be started on 2. 5 mg once daily and this dose may be used when adding Amlodipine besylate tablets to other antihypertensive therapy. Angina: The recommended dose for chronic stable or vasospastic angina is 5 to 10 mg, with the lower dose suggested in the elderly and in patients with hepatic insufficiency. Most patients will require 10 mg for adequate effect. Coronary artery disease: The recommended dose range for patients with coronary artery disease is 5 to 10 mg once daily. In clinical studies, the majority of patients required 10 mg [see Clinical Studies (14. 4)] . 2.2 Children The effective antihypertensive oral dose in pediatric patients ages 6 to 17 years is 2.5 mg to 5 mg once daily. Doses in excess of 5 mg daily have not been studied in pediatric patients [see Clinical Pharmacology (12.4), Clinical Studies (14.1)] .
The recommended dose of Amlodipine is:
- Initial dose: 5 mg once daily for adults
- Maximum dose: 10 mg once daily for adults
- Alternative initial dose: 2.5 mg once daily for small, fragile, or elderly patients, or patients with hepatic insufficiency
- Pediatric dose: 2.5 mg to 5 mg once daily for patients ages 6 to 17 years 2
From the Research
Amlodipine Dosage
- The most appropriate starting dose of amlodipine is 5 mg once daily, with simple adjustment to 10 mg if necessary 3.
- Amlodipine has a long half-life (35-50 h) and duration of action, which allows it to sustain its anti-hypertensive effect for more than 24 h following a single dose 4.
- Side effects of amlodipine, such as edema, palpitations, dizziness, and flushing, are more common with the higher dose of 10 mg 4.
Efficacy of Amlodipine
- Amlodipine has proven to reduce blood pressure variability and successfully lower blood pressure 4.
- It is effective in controlling blood pressure in patients with a systolic/diastolic blood pressure of 130/80 mm Hg or higher, diabetes, or chronic kidney disease without worsening glycemic or kidney function 4.
- Amlodipine is a wise choice for older adults due to its ability to control blood pressure and protect against stroke and myocardial infarction 4.
Comparison with Other Agents
- Amlodipine has antihypertensive efficacy superior to verapamil and comparable with atenolol, hydrochlorothiazide, captopril, or nitrendipine 3.
- When used in combination with angiotensin converting enzyme inhibitors, beta-blockers, or thiazide diuretics, amlodipine can produce important additional antihypertensive effects 3.
- Amlodipine and nifedipine-GITS were efficacious in reducing 24-hour blood pressure, but amlodipine became more efficacious than nifedipine-GITS when a dose of medication was missed 5.