Amlodipine dosing time
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Amlodipine Dosing Time and 24-Hour Blood Pressure Control
Amlodipine is a long-acting calcium channel blocker commonly used for hypertension and angina. Its pharmacokinetic profile, with a long half-life and gradual absorption, allows for once-daily dosing that maintains stable blood pressure control over 24 hours 10947.
Morning vs. Evening Dosing of Amlodipine
Several studies have compared the effects of taking amlodipine in the morning versus the evening. A large meta-analysis found that the time of administration did not significantly affect office, daytime, or 24-hour mean blood pressure, nor heart rate. However, evening dosing was associated with a greater reduction in nighttime blood pressure and improved the conversion of non-dipper patients (those whose blood pressure does not drop at night) to dippers, suggesting a potential benefit for patients with non-dipper hypertension . Another randomized controlled trial confirmed that both morning and nighttime dosing of amlodipine provided similar reductions in nighttime systolic blood pressure, restoration of dipping rhythm, and improvement in arterial elasticity in younger adults with non-dipper hypertension .
Once-Daily vs. Divided Dosing
Research comparing once-daily to twice-daily (divided) dosing of amlodipine found no significant differences in 24-hour blood pressure control, trough plasma concentrations, or arterial stiffness. This supports the use of once-daily dosing for most patients, as it simplifies treatment without compromising efficacy 347.
Efficacy Across the 24-Hour Period
Multiple studies have shown that amlodipine, when taken once daily, provides effective blood pressure reduction throughout the entire 24-hour dosing interval, including both daytime and nighttime periods 476. This consistent effect is important for reducing cardiovascular risk, especially in high-risk or non-dipper patients .
Personalized and Low-Dose Approaches
Recent evidence suggests that even very low doses of amlodipine (as little as 1–3 mg) can be effective for blood pressure control in many patients, with fewer side effects. Personalized titration, even at low doses, achieved blood pressure targets in the majority of patients .
Pharmacokinetic Considerations
Amlodipine’s long elimination half-life (40–60 hours) and gradual absorption mean that plasma concentrations remain stable with once-daily dosing, and blood pressure control is maintained with minimal fluctuation between doses 109. This makes the timing of dosing less critical for most patients, though evening dosing may offer additional benefits for those with non-dipper hypertension 21.
Conclusion
Amlodipine is effective for 24-hour blood pressure control with once-daily dosing, regardless of whether it is taken in the morning or evening. Evening dosing may provide extra benefit for patients with non-dipper hypertension by improving nighttime blood pressure reduction. Dividing the daily dose does not offer additional advantages. Personalized, low-dose regimens can be effective and well-tolerated. Overall, the choice of dosing time can be tailored to individual patient needs and preferences, with strong evidence supporting flexibility in administration.
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