Can amlodipine 5 mg be prescribed three times weekly instead of daily for hypertension management?

Amlodipine Must Be Prescribed Daily, Not Three Times Weekly

Amlodipine should be prescribed as a once-daily medication at doses of 5-10 mg, not three times weekly, as this dosing frequency is not supported by any clinical guidelines and would result in inadequate blood pressure control. 1, 2

Why Daily Dosing Is Required

Pharmacokinetic Rationale

• Amlodipine has a long elimination half-life of 35-50 hours, which allows for once-daily dosing but requires daily administration to maintain steady-state plasma concentrations 3, 4
• Steady-state blood levels are achieved only after 7-10 days of continuous daily dosing 4
• Plasma drug concentration fluctuation between doses is only 20-25% with once-daily dosing, ensuring consistent 24-hour blood pressure control 4

Evidence Against Intermittent Dosing

• Even when patients miss doses for 3 consecutive days after achieving steady state, blood pressure begins to rise, though the effect is delayed due to the drug's long half-life 5
• Discontinuation of daily amlodipine results in a gradual return of blood pressure to baseline over 7-10 days 4
• Three-times-weekly dosing would never allow the drug to reach therapeutic steady-state concentrations, rendering it ineffective for blood pressure control 4

Correct Dosing Algorithm

Initial Prescription

• Start with amlodipine 5 mg once daily, taken at the same time each day 2, 3
• The medication can be taken at any time of day that is most convenient for the patient to establish a habitual pattern and improve adherence 1

Dose Adjustment Timeline

• Assess blood pressure response after 2-4 weeks of treatment 3, 6
• If blood pressure remains above target (≥130/80 mmHg), increase to 10 mg once daily 7
• Maximum dose is 10 mg once daily for adults 2, 7

When Single-Agent Therapy Is Insufficient

• If blood pressure is not controlled after 4-6 weeks at amlodipine 5 mg, add a second agent (ACE inhibitor, ARB, or thiazide diuretic) rather than simply increasing the amlodipine dose 7
• Combination therapy with a RAS blocker (ACE inhibitor or ARB) plus amlodipine is a preferred first-line strategy for most patients with confirmed hypertension 1
• Fixed-dose single-pill combinations are recommended to improve adherence 1

Critical Pitfalls to Avoid

The Adherence Misconception

• Do not prescribe three-times-weekly dosing thinking it will improve adherence—this approach will simply result in treatment failure 1, 2
• If adherence is a concern, address it through once-daily dosing at a convenient time, use of fixed-dose combinations, 90-day refills, and patient education 1, 7
• Once-daily dosing has been proven to maximize adherence compared to multiple-times-daily regimens 1

Pharmacologic Reality

• Amlodipine requires continuous daily dosing to maintain the plasma concentrations necessary for 24-hour blood pressure control 6, 4
• The drug's 24-hour efficacy depends on achieving and maintaining steady-state levels, which is impossible with intermittent weekly dosing 3, 4

Guideline-Concordant Practice

• All major hypertension guidelines (ESC 2024, ACC/AHA 2017) specify daily dosing for calcium channel blockers including amlodipine 1, 2
• No clinical trial or guideline supports intermittent weekly dosing of amlodipine 1, 2