Amlodipine Dosing and Management

Initial Dosing and Titration

Amlodipine can be administered at any time of day to improve adherence 1
Increase from 5 mg to 10 mg once daily if blood pressure remains ≥130/80 mmHg after 2-6 weeks of treatment 1
Before escalating the dose, confirm inadequate control with home blood pressure monitoring (≥135/85 mmHg) or 24-hour ambulatory monitoring (≥130/80 mmHg) 1
Check medication adherence before dose escalation, as non-adherence is the most common cause of apparent treatment failure 1
Measure blood pressure at trough (just before the next dose) to ensure true 24-hour control 1

Consider adding a second antihypertensive agent rather than maximizing amlodipine to 10 mg if blood pressure control is inadequate after 4-6 weeks at 5 mg 1
Preferred combinations include amlodipine + ACE inhibitor/ARB or amlodipine + thiazide-type diuretic 1
For black adults with hypertension, initial treatment should include a thiazide-type diuretic or calcium channel blocker like amlodipine 1
Fixed-dose single-pill combinations are recommended when using combination therapy 1
Titrate cautiously with increased monitoring for orthostatic hypotension, falls, and syncope in elderly patients 2
No dose adjustment required regardless of severity of renal impairment 1
Amlodipine has minimal renal clearance (7 mL/min/mg) and demonstrates renoprotective effects 1
Long-acting calcium channel blockers like amlodipine are preferred for vasospastic angina 3

Schedule monthly visits until blood pressure target is achieved, then transition to 90-day refills when possible 1
The ALLHAT trial demonstrated that amlodipine was equally effective as chlorthalidone for primary cardiovascular outcomes, though it showed a 38% increase in heart failure compared to diuretic therapy 5
Headache and constipation are non-dose-related side effects (>1% incidence) 4