Initial Dosing and Dose Escalation of Amlodipine

Dose Escalation Strategy

• The American Heart Association recommends increasing from 5mg to 10mg only after 2-6 weeks if blood pressure remains above target (≥130/80 mmHg) 1
• Consider adding a second agent rather than increasing amlodipine to 10mg if blood pressure control is inadequate after 4-6 weeks at 5mg 1
• The International Society of Hypertension recommends starting with low-dose combination therapy in many patients rather than monotherapy escalation 2

Monitoring Before Dose Escalation

• Check medication adherence before escalating dose, as non-adherence is a common cause of apparent treatment failure 1
• Confirm inadequate control with home blood pressure monitoring (≥135/85 mmHg) or 24-hour ambulatory monitoring (≥130/80 mmHg) before escalating therapy 1
• Measure blood pressure at trough (just before next dose) to ensure 24-hour control 1

Safety Considerations

• Side effects are dose-dependent, with peripheral edema, headache, flushing, and constipation occurring more commonly at the 10mg dose (approximately 10-30% of patients) 1
• The long half-life of amlodipine (30-50 hours) means steady-state is not achieved for 7-8 days, making premature dose escalation ineffective 3