What is the maximum dose of amlodipine (calcium channel blocker)?

From the Guidelines

The maximum recommended dose of amlodipine is 10 mg once daily for adults, as stated in the most recent guidelines 1. For elderly patients or those with hepatic impairment, starting with a lower dose of 2.5 mg daily is recommended, with careful titration up to a maximum of 10 mg if needed. In children 6-17 years old, the maximum dose is typically 5 mg daily, according to the pediatric guidelines 1. Amlodipine is a calcium channel blocker that works by relaxing blood vessels, making it easier for the heart to pump blood. The medication reaches peak plasma concentrations in 6-12 hours, with a long half-life of 30-50 hours, allowing for once-daily dosing. Some key points to consider when prescribing amlodipine include:

• Starting with a lower dose and titrating up to the maximum dose as needed
• Avoiding use in patients with heart failure with reduced ejection fraction (HFrEF) unless required
• Monitoring for dose-related pedal edema, which is more common in women than men
• Avoiding abrupt discontinuation and tapering the dose gradually when stopping treatment
• Being aware of potential drug interactions, such as those with beta blockers and CYP3A4 substrates. It's also important to note that amlodipine is associated with common side effects at higher doses, including peripheral edema, headache, and flushing, as mentioned in the guidelines 1. If side effects become problematic, dose reduction rather than discontinuation is often preferable. Overall, the use of amlodipine should be guided by the most recent clinical guidelines and tailored to the individual patient's needs and medical history.

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.

The maximum dose of amlodipine is 10 mg once daily 2.

• The dose may be lower for certain patient populations, such as small, fragile, or elderly patients, or patients with hepatic insufficiency.
• The maximum dose for adults is 10 mg once daily.
• For children ages 6 to 17 years, doses in excess of 5 mg daily have not been studied.

From the Research

Maximum Dose of Amlodipine

• The maximum dose of amlodipine is not explicitly stated in the provided studies, but the dosages used in the studies are as follows:
  • 5 mg once daily as the starting dose, with possible adjustment to 10 mg once daily if necessary 3, 4, 5
  • 10 mg once daily as the maximum dose used in the studies 3, 4, 5
• It is worth noting that the studies suggest that amlodipine is effective and well-tolerated at doses of 5-10 mg once daily, with no mention of higher doses being necessary or recommended 3, 4, 5
• A more recent study suggests that S-amlodipine, a stereoisomer of amlodipine, may be effective at a lower dose of 2.5 mg once daily, which is equivalent in efficacy and tolerability to amlodipine 5 mg once daily 6

Dosage Adjustment

• The studies suggest that the dose of amlodipine can be adjusted based on the patient's response to treatment, with possible increases from 5 mg to 10 mg once daily if necessary 3, 4, 5
• The dosage adjustment should be done under the guidance of a healthcare professional, taking into account the patient's individual needs and response to treatment

Safety and Tolerability

• The studies suggest that amlodipine is generally well-tolerated, with most adverse events being mild or moderate 3, 4, 5
• However, higher doses of amlodipine (10 mg once daily) may be associated with more frequent side effects, such as edema, palpitations, dizziness, and flushing 7