Usual Adult Dose for Hypertension

Oral:

• Initial dose: 0.1 mg orally 2 times a day (morning and bedtime)
• Titration: Increments of 0.1 mg orally per day may be made at weekly intervals to desired response
• Maintenance dose: 0.2 to 0.6 mg orally per day in divided doses
• Maximum dose: 2.4 mg orally per day in divided doses

Comments:

• Taking the larger portion of the oral daily dose at bedtime may minimize transient adjustment effects of dry mouth and drowsiness

Transdermal patches:

• Initial dose: 0.1 mg/24 hr patch applied every 7 days
• Maintenance dose: If, after 1 to 2 weeks the desired reduction in blood pressure is not achieved, increase the dosage by adding another 0.1 mg/24 hr patch or changing to a larger system
• Maximum dose: Doses above two 0.3 mg/24 hr patches applied every 7 days is usually not associated with additional efficacy

Comments:

• The transdermal patch should be applied to a hairless area of intact skin on the upper outer arm or chest.
• Each new patch should be applied on a different skin site from the previous location.
• If the patch loosens during 7-day wearing, the adhesive cover should be applied directly over the system to ensure good adhesion.
• There have been rare reports of the need for patch changes prior to 7 days to maintain blood pressure control.
• When substituting patches for the oral formulation or for other antihypertensive drugs, physicians should be aware that the antihypertensive effect of the patches may not commence until 2 to 3 days after initial application; therefore, gradual reduction of prior drug dosage is advised. Some or all previous antihypertensive treatment may have to be continued, particularly in patients with more severe forms of hypertension.

Use: For hypertension, alone or in combination with other antihypertensive agents

Usual Adult Dose for Pain

Epidural infusion:

• Initial dose: 30 mcg/hr as a continuous infusion
• Titration: May be titrated up or down depending on pain relief and occurrence of adverse events

Maximum dose 40 mcg/hr as a continuous infusion

Use: For the treatment of severe pain (in combination with opiates) in cancer patients that is not adequately relieved by opioid analgesics alone. The epidural formulation is more likely to be effective in patients with neuropathic pain than somatic or visceral pain.

Usual Pediatric Dose for Attention Deficit Disorder

Extended release:
6 years and older:

• Initial dose: 0.1 mg orally at bedtime
• Titration: Increase in 0.1 mg/day increments every 7 days until desired response; doses should be administered twice daily (either split equally or with the higher split dosage given at bedtime)
• Maximum dose: 0.4 mg/day in 2 divided doses

Comments:

• May be taken with or without food.
• If a dose is missed, that dose should be skipped and take the next dose as scheduled.
• Tablets should be swallowed whole, and not crushed, chewed, or broken to avoid increasing the rate of drug release.
• When discontinuing therapy, taper daily dose by no more than 0.1 mg every 3 to 7 days.

Use: For the treatment of attention deficit hyperactivity disorder (ADHD) as monotherapy or as adjunctive therapy to stimulant medications.

Renal Dose Adjustments

Patients with renal impairment may benefit from a lower initial dose.

Liver Dose Adjustments

Data not available

Dose Adjustments

Elderly patients may benefit from a lower initial dose.

Precautions

US BOXED WARNINGS:

• The 500 mcg/mL strength product should be diluted prior to use in an appropriate solution.
• The epidural formulation is not recommended for obstetrical, postpartum, or perioperative pain management. The risk of hemodynamic instability, especially hypotension and bradycardia, from this form of administration may be unacceptable in these patients; however, in the rare obstetrical, postpartum or perioperative patient, potential benefits may outweigh the possible risks.

• Immediate-release tablets/epidural infusion: This drug is not recommended for use in children.
• Kapvay [R] extended release tablets: Safety and efficacy have not been established in patients younger than 6 years

Consult WARNINGS section for additional precautions.

Dialysis

No adjustment recommended.

Other Comments

Administration advice:

• This drug can be taken with or without food.
• The extended release tablets should be swallowed whole and not crushed, chewed, or broken because this will increase the rate of drug release.
• Taking the larger portion of the oral daily dose at bedtime may minimize dry mouth and drowsiness and also minimize the risk of morning-associated cardiovascular events (i.e., stroke, transient ischemic attacks, myocardial infarction, sudden cardiac death).
• The patch formulation should be applied every 7 days to a hairless area of intact skin on the upper outer arm or chest. Each new application should be on a different skin site from the previous location. If the system loosens during 7-day wearing, the adhesive overlay should be applied directly over the system to ensure good adhesion.

Storage requirements:
The manufacturer product information should be consulted.

Reconstitution/preparation techniques:
The manufacturer product information should be consulted.

IV compatibility:
The manufacturer product information should be consulted.

General:

• This drug may be added to other antihypertensive regimens where blood pressure control has not been adequately achieved.
• Concomitant therapy with a thiazide diuretic may minimize associated fluid retention, particularly during therapy initiation.
• Slow IV administration may help minimize the initial pressor phase of 5 to 10 mmHg (lasting approximately 5 minutes) which can occur after IV injection.