Amlodipine Dosing for Adults
For adults with hypertension, start amlodipine at 5 mg once daily, with a maximum dose of 10 mg once daily; however, small, fragile, elderly patients, or those with hepatic insufficiency should start at 2.5 mg once daily 1.
Standard Dosing Algorithm
Initial Dosing
- Standard adult dose: 5 mg once daily
- Reduced initial dose (2.5 mg once daily) for:
- Elderly patients
- Small or fragile patients
- Hepatic insufficiency
- When adding to existing antihypertensive therapy 1
Dose Titration
- Wait 7-14 days between dose adjustments under normal circumstances
- Titrate more rapidly if clinically warranted, provided frequent patient assessment occurs 1
- If blood pressure remains uncontrolled after 6 weeks at 5 mg, increase to 10 mg once daily 2
- Maximum dose: 10 mg once daily 1
Timing of Administration
Take amlodipine at the most convenient time of day to establish habitual medication-taking patterns and improve adherence 3. Morning dosing shows marginally better effects on circadian blood pressure patterns in some studies 4, but the difference is not clinically significant enough to override patient convenience 5.
Special Populations
Elderly Patients
- Start at 2.5 mg once daily due to 40-60% increase in drug exposure from decreased clearance 1
- Titrate cautiously based on response
Hepatic Impairment
- Start at 2.5 mg once daily due to significantly increased AUC 1
Renal Impairment
- No dose adjustment needed - amlodipine pharmacokinetics are not significantly influenced by renal impairment 1
Combination Therapy Context
Amlodipine is recommended as first-line therapy for hypertension, particularly effective in black adults 6. When used in combination therapy:
- Preferred combinations include amlodipine with a RAS blocker (ACE inhibitor or ARB) or with a thiazide diuretic 3
- Single-pill combination formulations are recommended to improve adherence 3
- Most patients require ≥2 antihypertensive medications to achieve blood pressure targets 6, 3
Angina Dosing
For chronic stable or vasospastic angina: 5-10 mg once daily, with most patients requiring 10 mg for adequate effect 1. Use lower doses (5 mg) in elderly patients and those with hepatic insufficiency.
Key Clinical Pearls
- Steady-state levels are reached after 7-8 days of consecutive dosing 1
- The long half-life (30-50 hours) provides continuous BP protection even if a dose is missed 7
- Do not rush dose escalation - there is no advantage to early dose increases before 6 weeks of treatment 2
- Side effects (edema, palpitations, dizziness, flushing) are more common at the 10 mg dose 7