Amlodipine Dosing Recommendations

Standard Adult Dosing for Hypertension

For adults with hypertension, start amlodipine at 5 mg once daily, with a maximum dose of 10 mg once daily. 1

Small, fragile, or elderly patients, and those with hepatic insufficiency should start at 2.5 mg once daily 1
The 2.5 mg starting dose is also appropriate when adding amlodipine to existing antihypertensive therapy 1
Wait 7 to 14 days between dose titration steps under normal circumstances 1
More rapid titration is acceptable if clinically warranted, provided frequent patient assessment occurs 1

For chronic stable angina, vasospastic angina, or coronary artery disease, the recommended dose range is 5 to 10 mg once daily 1

Most patients require 10 mg daily for adequate effect in coronary artery disease 1
Use the lower 5 mg dose in elderly patients and those with hepatic insufficiency 1

The effective antihypertensive dose in children ages 6 to 17 years is 2.5 mg to 5 mg once daily 2, 1

The maximum pediatric dose is 5 mg daily 2, 1
Doses exceeding 5 mg daily have not been studied in pediatric patients 1
Amlodipine can be compounded into stable extemporaneous suspensions for children 2

Amlodipine produces dose-related blood pressure reductions, with 2.5 mg being the minimum effective dose 3

After 4 weeks of treatment, medium-dose (2.5-5.0 mg) and high-dose (5.0-10.0 mg) groups showed significant blood pressure reductions compared to placebo 3
After 8 weeks, all dose groups demonstrated significant blood pressure reductions except standing pressures in the low-dose group 3
Do not increase the dose before 6 weeks of treatment at 5 mg once daily, as there is no advantage to early dose escalation 4

In elderly patients, initiate amlodipine at 2.5 mg once daily and titrate cautiously 2, 1

Monitor for orthostatic hypotension, falls, and syncope, which are increased risks in this population 2
The most potent blood pressure reduction occurs in the first 3 months, then decreases 2
Blood pressure targets should be individualized, generally aiming for <140/90 mmHg in frail elderly patients 5
Recheck blood pressure within 2-3 weeks after starting amlodipine in elderly patients 6

Patients with hepatic insufficiency should start at 2.5 mg once daily due to decreased hepatic clearance and increased drug concentration 2, 1

Amlodipine is lipophilic with decreased hepatic and overall clearance in liver disease 2
Titrate cautiously in this population 2

When adding amlodipine to other antihypertensives, start at 2.5 mg once daily 1

The combination of amlodipine with an ACE inhibitor or ARB provides complementary mechanisms and superior blood pressure control compared to either agent alone 7
Amlodipine combined with ACE inhibitors may reduce the incidence of peripheral edema (7.1% vs 30.6% with amlodipine alone) 8
For uncontrolled hypertension on dual therapy, add a thiazide diuretic as the third agent to achieve guideline-recommended triple therapy 7

Assess blood pressure response after 4 weeks of treatment, allowing adequate time for full therapeutic effect 2

In elderly patients, recheck within 2-3 weeks initially 6
Target blood pressure is <140/90 mmHg for most patients, or <130/80 mmHg for higher-risk individuals 7
Monitor for dose-limiting side effects including peripheral edema, headache, and dizziness 3

Do not use immediate-release nifedipine capsules, which should no longer be prescribed 2

Avoid combining amlodipine with non-dihydropyridine calcium channel blockers (diltiazem, verapamil) due to redundant mechanisms 7
Do not increase doses before allowing adequate time (6 weeks) for full therapeutic response 4
Monitor carefully for orthostatic hypotension in elderly patients by checking both sitting and standing blood pressures 6