Initial: 5mg orally once daily. Titrate over 7–14 days. Maximum: 10mg/day. Elderly or hepatic impairment: Start at 2.5mg/day.
Standard Dose
5–10mg OD
Elderly / Hepatic
2.5mg OD
Max Daily Dose
10mg/day
Angina Pectoris
5–10mg orally once daily. Most patients require 10mg for adequate effect. Use lower doses in patients also receiving other anti-anginals.
Clinical Pearl
Amlodipine has a long half-life (~40hrs). Full antihypertensive effect may not be apparent until 7–14 days after initiation or dose change. Do not titrate too quickly.
Common (>1%)
Peripheral edema~10%
Headache7.3%
Fatigue4.5%
Dizziness3.4%
Flushing2.6%
Nausea2.9%
Uncommon (0.1–1%)
Palpitations<1%
Abdominal pain<1%
Somnolence<1%
Rare (<0.1%)
Gingival hyperplasiaRare
Hepatitis / jaundiceRare
Clinical Pearl
Peripheral edema is dose-dependent and more common at 10mg. Reducing dose or adding an ACE inhibitor/ARB can help mitigate this effect.
Absolute Contraindications
Hypersensitivity
Known allergy to amlodipine or any dihydropyridine calcium channel blocker.
Severe aortic stenosis
Risk of cardiovascular collapse due to afterload reduction in fixed obstruction.
Cardiogenic shock
Vasodilation may worsen hemodynamic instability in cardiogenic shock.
Unstable angina
Except in variant (Prinzmetal’s) angina where it may be indicated.
Use with Caution
Hepatic impairment
Extensively metabolized by the liver. Reduce starting dose to 2.5mg in hepatic dysfunction.
Severe hypotension
Monitor blood pressure closely. Risk of reflex tachycardia at higher doses.
Heart failure (HFrEF)
Use cautiously. Although PRAISE trial showed safety, negative inotropic effects are possible.
Significant Interactions
Simvastatin
Amlodipine increases simvastatin exposure. Limit simvastatin to 20mg/day when co-administered to reduce risk of myopathy/rhabdomyolysis.
Strong CYP3A4 inhibitors increase amlodipine plasma levels. Monitor for hypotension and consider dose reduction.
Severe
Cyclosporine
Amlodipine may increase cyclosporine levels. Monitor trough concentrations and adjust immunosuppressant dose.
Moderate
Beta-blockers (Atenolol, Metoprolol)
Additive bradycardic and hypotensive effects. Monitor heart rate and blood pressure when combining.
Moderate
CYP3A4 Inducers (Rifampicin, Carbamazepine)
May reduce amlodipine efficacy by increasing hepatic metabolism. Monitor blood pressure and consider dose increase.
Minor
Clinical Pearl
Grapefruit juice is a moderate CYP3A4 inhibitor. While the interaction with amlodipine is generally mild, advise patients to avoid excessive consumption.