Can You Increase Norvasc (Amlodipine)?
Yes, you can increase amlodipine from 5 mg to 10 mg once daily if blood pressure remains uncontrolled, but adding a second antihypertensive agent from a different class (ACE inhibitor, ARB, or thiazide diuretic) is generally more effective than dose escalation alone for achieving blood pressure control. 1
Current Dose Assessment
- Amlodipine is typically started at 5 mg once daily, with adjustment to 10 mg if necessary 2, 3
- The magnitude of blood pressure reduction with amlodipine correlates with pretreatment elevation—patients with moderate hypertension (diastolic 105-114 mmHg) experience approximately 50% greater response than those with mild hypertension (diastolic 90-104 mmHg) 4
- Dose-ranging studies demonstrate that 10 mg amlodipine once daily achieves target blood pressure in 73% of patients versus 56% with 5 mg 3
Preferred Strategy: Add Rather Than Increase
The guideline-recommended approach prioritizes adding a complementary agent over simple dose escalation: 1
First-Line Add-On Options
- Add an ACE inhibitor or ARB to amlodipine for complementary mechanisms of action, particularly beneficial for patients with chronic kidney disease, heart failure, or coronary artery disease 1
- Add a thiazide-like diuretic (chlorthalidone 12.5-25 mg or hydrochlorothiazide 25 mg daily) as an effective combination, especially for volume-dependent hypertension, elderly patients, or Black patients 1
Race-Specific Considerations
- For Black patients, the combination of amlodipine plus a thiazide diuretic may be more effective than amlodipine plus an ACE inhibitor/ARB 1
- For non-Black patients, either combination (amlodipine + ACE inhibitor/ARB or amlodipine + thiazide) is appropriate as initial dual therapy 1
When Dose Escalation Alone Is Reasonable
Increasing amlodipine to 10 mg is appropriate if: 3
- The patient is currently on 5 mg and has not yet tried 10 mg
- You prefer to optimize monotherapy before adding a second agent
- The blood pressure elevation is modest (systolic <160 mmHg)
- There are concerns about polypharmacy or medication adherence
Monitoring After Adjustment
- Reassess blood pressure within 2-4 weeks after any dose adjustment 1
- Target blood pressure should be <140/90 mmHg for most patients, ideally <130/80 mmHg for higher-risk patients 1
- Monitor for peripheral edema, which is more common with amlodipine and may be attenuated by adding an ACE inhibitor or ARB 1
- Steady-state plasma levels of amlodipine are reached after 7-8 days of consecutive daily dosing 4
If Blood Pressure Remains Uncontrolled
After optimizing to amlodipine 10 mg plus a second agent at maximum dose, add a third agent from the remaining class (ACE inhibitor/ARB or thiazide diuretic) to achieve guideline-recommended triple therapy 1
Critical Pitfalls to Avoid
- Do not combine ACE inhibitors with ARBs—this increases risk of adverse effects (hyperkalemia, acute kidney injury) without additional benefit 1
- Do not add a third drug class before maximizing doses of the current regimen—this violates guideline-recommended stepwise approaches and may expose patients to unnecessary polypharmacy 1
- Do not assume treatment failure without first confirming medication adherence—non-adherence is the most common cause of apparent treatment resistance 5
Special Population Considerations
- Elderly patients and those with hepatic insufficiency have decreased clearance of amlodipine with a 40-60% increase in drug exposure, so a lower initial dose may be required, but standard titration to 10 mg is still appropriate if tolerated 4
- Patients with renal impairment can receive usual doses as amlodipine pharmacokinetics are not significantly influenced by renal function 4