What is the maximum dose of Amlodipine (Calcium Channel Blocker)?

From the Guidelines

The maximum dose of amlodipine is 10 mg once daily for adults. This recommendation is based on the most recent and highest quality study available, which is the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. According to this guideline, the usual dose range for amlodipine is 2.5-10 mg per day, with a daily frequency of 1.

Key Considerations

• Amlodipine is a calcium channel blocker primarily used to treat hypertension and coronary artery disease.
• It works by relaxing blood vessels, allowing blood to flow more easily and reducing the workload on the heart.
• The medication has a long half-life of 30-50 hours, which allows for once-daily dosing.
• Patients should take amlodipine at the same time each day to maintain consistent blood levels.
• Dose adjustments should be made gradually, typically waiting 7-14 days between increases to allow the full effect to be assessed.
• Common side effects include peripheral edema, headache, and flushing.
• No dosage adjustment is needed for patients with renal impairment, making it a suitable option for those with kidney disease.

Special Populations

• For elderly patients or those with hepatic impairment, starting at a lower dose of 2.5 mg daily is recommended, with the same maximum of 10 mg daily.
• Amlodipine may be used in patients with heart failure with reduced ejection fraction (HFrEF) if required, but with caution 1.
• The use of amlodipine in pediatric patients is supported by guidelines from the American Heart Association and American Thoracic Society, with a maximum adult dose of 10 mg/d orally 1.

Monitoring and Follow-up

• Patients on amlodipine should be monitored for signs of peripheral edema, headache, and flushing.
• Regular blood pressure checks should be performed to assess the effectiveness of the medication.
• Patients should be educated on the importance of taking the medication at the same time each day and reporting any side effects to their healthcare provider.

From the FDA Drug Label

The usual initial antihypertensive oral dose of Amlodipine besylate tablets is 5 mg once daily, and the maximum dose is 10 mg once daily. The recommended dose for chronic stable or vasospastic angina is 5 to 10 mg, with the lower dose suggested in the elderly and in patients with hepatic insufficiency. The recommended dose range for patients with coronary artery disease is 5 to 10 mg once daily.

The maximum dose of Amlodipine is 10 mg once daily 2.

• For adults, the maximum dose is 10 mg once daily.
• For children ages 6 to 17 years, doses in excess of 5 mg daily have not been studied 2.

From the Research

Amlodipine Max Dose

• The maximum dose of amlodipine is not explicitly stated in the provided studies, but the dosages used in the studies are as follows:
  • 5-10 mg once daily 3, 4, 5
  • Side effects such as edema, palpitations, dizziness, and flushing are more common with the higher dose of 10 mg 6

Dosage Adjustment

• Dose-ranging studies have shown that the most appropriate starting dose is 5 mg once daily, with simple adjustment to 10 mg if necessary 3
• Amlodipine can be used in combination with other agents, such as angiotensin converting enzyme inhibitors, beta-blockers, or thiazide diuretics, to produce additional antihypertensive effects 3

Special Considerations

• Amlodipine appears to be particularly indicated in patients concomitantly treated with cyclosporine 4
• Amlodipine is a wise choice for older adults due to its ability to control blood pressure and protect against stroke and myocardial infarction 6