Maximum Dose of Amlodipine
The maximum recommended dose of amlodipine for adults with hypertension or coronary artery disease is 10 mg once daily. 1
Standard Adult Dosing
- Start at 5 mg once daily as the usual initial antihypertensive dose 1
- Maximum dose is 10 mg once daily for hypertension, chronic stable angina, vasospastic angina, and coronary artery disease 1
- Small, fragile, or elderly patients, or those with hepatic insufficiency may be started on 2.5 mg once daily 1
Dose Titration Timeline
- Wait 7 to 14 days between titration steps when adjusting dosage according to blood pressure goals 1
- The American College of Cardiology recommends waiting 2-6 weeks before increasing from 5 mg to 10 mg if blood pressure remains ≥130/80 mmHg 2
- Titrate more rapidly if clinically warranted, provided the patient is assessed frequently 1
Pediatric Maximum Dose
- For pediatric patients ages 6-17 years, the effective dose range is 2.5 mg to 5 mg once daily 1
- Doses exceeding 5 mg daily have not been studied in pediatric patients and are not recommended 2, 1
Important Drug Interaction Limitation
- When coadministered with simvastatin or lovastatin, amlodipine doses should not exceed 20 mg daily due to increased statin exposure and myopathy risk 2
- This is a critical safety consideration that supersedes the standard 10 mg maximum in this specific context 2
Special Population Exception (Off-Label)
- For idiopathic pulmonary arterial hypertension in carefully selected vasoreactive patients only (approximately 10% of IPAH patients who demonstrate positive acute vasodilator response during right heart catheterization), doses of 20-30 mg daily may be used 2
- This applies exclusively to this rare, specific indication and should not be extrapolated to hypertension or coronary artery disease 2
Clinical Considerations Before Dose Escalation
- Check medication adherence first before escalating dose, as non-adherence is a common cause of apparent treatment failure 3, 2
- Measure blood pressure at trough (just before next dose) to ensure 24-hour control 3, 2
- Confirm inadequate control with home blood pressure monitoring (≥135/85 mmHg) or 24-hour ambulatory monitoring (≥130/80 mmHg) before escalating therapy 3, 2
- Consider adding a second agent rather than maximizing amlodipine if blood pressure control is inadequate after 4-6 weeks at 5 mg 3
Preferred Combination Strategies
- Preferred combinations include amlodipine + ACE inhibitor/ARB or amlodipine + thiazide-type diuretic 3
- For most adults with hypertension, especially black adults, two or more antihypertensive medications are recommended to achieve a BP target of less than 130/80 mm Hg 3
Common Pitfalls to Avoid
- Do not exceed 10 mg daily for standard hypertension or coronary artery disease indications 1
- Side effects are dose-dependent (peripheral edema, headache, flushing, constipation) and occur in approximately 10-30% of patients at the 10 mg dose 3
- Most patients with coronary artery disease will require 10 mg for adequate effect 1