Amlodipine Dosing Parameters

Standard Dosing for Hypertension

The usual initial dose of amlodipine for hypertension is 5 mg once daily, with a maximum dose of 10 mg once daily. 1

For most adults with hypertension, start with 5 mg once daily and titrate to 10 mg once daily if needed to achieve blood pressure control 1
Wait 7 to 14 days between titration steps under normal circumstances, though more rapid titration is acceptable if clinically warranted with frequent patient assessment 1
The long half-life of 35-50 hours allows sustained antihypertensive effect for more than 24 hours following a single dose, providing continuous protection even if a dose is missed 2

Small, fragile, or elderly patients should be started on 2.5 mg once daily. 1

Elderly patients have decreased clearance of amlodipine with a resulting increase in AUC of approximately 40-60%, necessitating a lower initial dose 1
Start at 2.5 mg once daily in patients ≥65 years, particularly those who are frail or have multiple comorbidities 1
Amlodipine is particularly effective in elderly patients with isolated systolic hypertension, showing greater SBP reduction in this population 3
The drug is well-tolerated in older adults and provides protection against stroke and myocardial infarction 2

Patients with hepatic insufficiency should be started on 2.5 mg once daily. 1

Dose titration should be cautious in this population due to altered drug metabolism 1
The lower starting dose accounts for potentially decreased hepatic clearance 1

No dose adjustment is required for patients with renal dysfunction. 4

Amlodipine has low renal clearance (7 mL/min/mg), making it safe in renal impairment 2
Studies in hypertensive patients with renal dysfunction showed effective blood pressure reduction at 2.5-5.0 mg/day without aggravation of renal function 4
Serum concentrations showed no tendency for drug accumulation in patients with renal impairment 4
Blood urea nitrogen and creatinine levels should be monitored, though significant worsening is uncommon 4

The effective antihypertensive dose in pediatric patients ages 6-17 years is 2.5 mg to 5 mg once daily. 1

Doses exceeding 5 mg daily have not been studied in pediatric patients 1
Effect on blood pressure in patients less than 6 years of age is not known 1

When adding amlodipine to other antihypertensive therapy, start with 2.5 mg once daily. 1

Amlodipine produces important additional antihypertensive effects when combined with ACE inhibitors, beta-blockers, or thiazide diuretics 5
The combination of amlodipine with ACE inhibitors or ARBs provides complementary mechanisms and superior blood pressure control 6
For patients on dual therapy with inadequate control, adding amlodipine as a third agent follows guideline-recommended triple therapy algorithms 6

Adjust dosage according to blood pressure goals, with reassessment within 2-4 weeks after dose changes. 1, 6

Target blood pressure should be <140/90 mmHg minimum, ideally <130/80 mmHg for higher-risk patients 6
In elderly patients, monitor for orthostatic hypotension by checking blood pressure in both sitting and standing positions 7
Achieve target blood pressure within 3 months of initiating or modifying therapy 6

Side effects include edema, palpitations, dizziness, and flushing, which are more common with the 10 mg dose. 2

Peripheral edema is the most common side effect and may be attenuated by adding an ACE inhibitor or ARB 6
Most adverse effects are mild and related to vasodilation 2

No tolerance develops with long-term use of amlodipine in hypertension 5
Amlodipine successfully reduces blood pressure variability, providing more consistent control 2
The drug is cost-effective and predicted to be cost-saving compared with usual care 2
Amlodipine controls blood pressure in patients with diabetes or chronic kidney disease without worsening glycemic or kidney function 2