Usual Adult Dose for Hypertension

Initial dose: 16 mg orally once a day
Maintenance dose: 8 to 32 mg/day orally in 1 to 2 divided doses
Maximum dose: 32 mg/day

Comments:

• Consider administration of a lower initial dose in volume depleted patients.
• Most of the antihypertensive effect is present within 2 weeks; maximum blood pressure reduction at a given dose is generally observed within 4 to 6 weeks of starting that dose.

Usual Adult Dose for Congestive Heart Failure

Initial dose: 4 mg orally once a day; double dose every 2 weeks, as tolerated, to target dose of 32 mg orally once a day

Use: Treatment of New York Heart Association (NYHA) class II through IV heart failure

Usual Pediatric Dose for Hypertension

1 TO LESS THAN 6 YEARS:
Initial dose: 0.2 mg/kg/day orally in 1 to 2 divided doses
Maintenance dose: 0.05 to 0.4 mg/kg/day orally in 1 to 2 divided doses

6 TO LESS THAN 17 YEARS:
Less than 50 kg:

• Initial dose: 4 to 8 mg/day orally in 1 to 2 divided doses
• Maintenance dose: 2 to 16 mg/day orally in 1 to 2 divided doses

• Initial dose: 8 to 16 mg/day orally in 1 to 2 divided doses
• Maintenance dose: 4 to 32 mg/day orally in 1 to 2 divided doses

• For patients with possible intravascular volume depletion (e.g., patients treated with diuretics, especially those with renal impairment), initiate this drug under close supervision and consider administration of a lower dose.
• Antihypertensive effect is present within 2 weeks; maximum blood pressure reduction at a given dose is generally observed within 4 weeks of starting that dose.
• For children unable to swallow tablets, an extemporaneous suspension may be used instead.

Renal Dose Adjustments

Adult: No adjustment recommended

Pediatric:

• GFR 30 mL/min/1.73 m2 or greater: Data not available
• GFR less than 30 mL/min/1.73 m2: Not recommended

Liver Dose Adjustments

Adult:

• Mild liver dysfunction (Child-Pugh A): No adjustment recommended
• Moderate liver dysfunction (Child-Pugh B): Initial dose: 8 mg orally once a day
• Severe liver dysfunction (Child-Pugh C): Data not available

Precautions

US BOXED WARNING:

• FETAL TOXICITY: If pregnancy is detected, discontinue this drug as soon as possible. Drugs that act directly on the renin angiotensin system (RAS) can cause injury and death to the developing fetus.

Dialysis

Data not available

Other Comments

Storage requirements:

• Extemporaneous suspension: Store at room temperature (30C or 86F); use within 30 days after first opening.

• Extemporaneous suspension: The manufacturer product information should be consulted.

• Monitor renal function and serum potassium periodically.

• Females of childbearing age should be informed of the consequences of exposure to this drug during pregnancy; ask these patients to report pregnancies as soon as possible.