Usual Adult Dose for Hypertension

Initial dose: 10 mg orally once a day
Dose titration: If desired response is not achieved after 1 to 2 weeks, dose may be doubled.
Maximum dose: 40 mg per day

Comments:

• Doses greater than 20 mg once a day did not result in significant additional antihypertensive effects; however, the 40 mg dose has been studied and was well tolerated.

Renal Dose Adjustments

Mild to moderate renal impairment: No adjustment recommended
Severe renal impairment: Initial dose: 5 mg orally once a day; may increase in 5 mg increments every 2 weeks as needed to a maximum dose of 20 mg orally once a day.

Liver Dose Adjustments

No adjustment recommended.

Dose Adjustments

Bronchospastic disease:

• Use not recommended
• However, if use is necessary, use the lowest possible dose and ensure a bronchodilator is available.
• For doses over 10 mg, consider dividing dosage to avoid higher peak blood levels associated with once a day dosing.

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Hemodialysis:

• Initial dose: 5 mg orally once a day
• If response not achieved, increase dose in 5 mg increments every 2 weeks.
• Maximum dose: 20 mg/day

Other Comments

Administration advice:

• If a dose is missed, take it as soon as remembered; if it is close to the next dose, skip the missed dose; do not double the dose.

• If discontinuation is necessary, gradually taper over 2 weeks, monitor for the signs and symptoms of heart failure and limit exercise.
• Monitor patients taking concurrent ophthalmic beta-blocker solutions for additive effects (e.g., bradycardia, reduced intraocular pressure, and hypotension).
• Inform physicians, ophthalmologists, and dentists when using this drug, especially if surgery is planned.
• This drug interferes with allergic reaction modulation and may increase the risk of anaphylactic reactions; additionally, patients may be refractory to epinephrine in treatment for anaphylactic reactions.

• Heart rate and blood pressure
• Signs and symptoms of heart failure (e.g., shortness of breath, edema, and weight gain), especially in at risk patients
• Signs and symptoms of angina in patients with coronary heart disease, especially during withdrawal

• Warn patients to avoid interruptions or abrupt discontinuation of this drug.
• Instruct patients to notify their healthcare provider upon signs and symptoms of angina, bradycardia, hypotension, or heart failure (e.g., shortness of breath, edema, and weight gain).
• Avoid driving or operating machinery until the full effects are known.
• Advise patient to speak to healthcare provider if pregnant, intend to become pregnant, or are breastfeeding.
• Patients with diabetes should be informed that this drug may mask hypoglycemic reactions.