Amlodipine

NORVASC

What it isDihydropyridine L-type calcium-channel blocker; arterial vasodilator for hypertension and angina.

Why this oneIts unusually long, smooth action makes it the default dihydropyridine and makes missed doses less consequential.

What limits itAnkle edema is the common trial-ending effect; it reflects precapillary dilation, so diuretics usually do not fix it.

FDA-approved for

FDA dosing	Population	Start	Target	Max
Hypertension	Adult	5 mg QD (2.5 mg QD if small/fragile/elderly or hepatic insufficiency)		10 mg QD
Hypertension	Pediatric 6-17 yr	2.5 mg QD	2.5-5 mg QD	5 mg QD
Chronic stable or vasospastic angina	Adult	5 mg QD	10 mg QD (most patients)	10 mg QD
Coronary artery disease	Adult	5 mg QD	10 mg QD (most patients)	10 mg QD

Titration Wait 7-14 days between titration steps (faster if clinically warranted with frequent assessment).

Renal Undefined

Hepatic Severe hepatic impairment: start 2.5 mg QD and titrate slowly.

Symptomatic hypotension, particularly with severe aortic stenosis
Worsening angina or acute MI after starting or increasing dose, particularly with severe obstructive CAD
Titrate slowly in severe hepatic impairment

Pregnancy Limited post-marketing data insufficient to inform drug-associated risk; poorly controlled hypertension poses maternal and fetal risks.

Lactation Present in human milk (median relative infant dose ~4.2%); no adverse effects observed in breastfed infants.

NO BOXED WARNINGS

Principal riskPeripheral edema

Cost, est. cash$300–$2,500/month

Generic entry2023

Therapeutic safety burden2 / 4

Overdose danger4 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryC

Defining liabilityHypotension and edema therapeutically; overdose can cause prolonged vasodilatory or cardiogenic shock.

CYP3A4 substrate