Usual Adult Dose for Hypertension

Extended Release Capsules:

• Initial dose: 120 to 240 mg orally once a day, increasing the dose as needed
• Maintenance dose: 120 to 540 mg orally once a day
• Maximum dose: 540 mg/day

• Initial dose: 180 to 240 mg orally once a day, increasing the dose as needed
• Maintenance dose: 240 to 360 mg orally once a day
• Maximum dose: 480 mg/day

• Initial dose: 180 to 240 mg orally once a day, increasing the dose as needed
• Maximum dose: 540 mg/day

• Once a day formulations should be taken at the same time of day, either in the morning or evening.
• The manufacturer product information should be consulted for details regarding specific extended release formulation dosing.

Usual Adult Dose for Atrial Fibrillation

Bolus Injection:

• Initial bolus dose: 0.25 mg/kg IV as a bolus administered over 2 minutes. After 15 minutes, a second bolus of 0.35 mg/kg IV (administered over 2 minutes) may be used if necessary.

• The continuous infusion should begin immediately following a bolus injection of 0.25 mg/kg IV OR 0.35 mg/kg IV administered over 2 minutes.
• Initial infusion rate: 10 mg/hr IV
• Maintenance infusion rate: The infusion rate may be increased in 5 mg/hr increments up to 15 mg/hr.
• Maximum duration: 24 hours

• Unless contraindicated, appropriate vagal maneuvers should be attempted before administration of this drug.
• Bolus dosing should be calculated using actual body weight, including those with low body weight.
• Some patients may respond to an initial bolus dose of 0.15 mg/kg, but the duration of action may be shorter.
• Some patients may respond to a continuous infusion initial rate of 5 mg/hr.

• Temporary control of rapid ventricular rate in atrial fibrillation/flutter
• Rapid conversion of paroxysmal supraventricular tachycardias (PSVT) to sinus rhythm, including atrioventricular (AV) nodal reentrant tachycardia and reciprocating tachycardia associated with an extranodal accessory pathway (e.g., Wolff Parkinson White or short PR syndromes)

Usual Adult Dose for Atrial Flutter

Bolus Injection:

• Initial bolus dose: 0.25 mg/kg IV as a bolus administered over 2 minutes. After 15 minutes, a second bolus of 0.35 mg/kg IV (administered over 2 minutes) may be used if necessary.

• The continuous infusion should begin immediately following a bolus injection of 0.25 mg/kg IV OR 0.35 mg/kg IV administered over 2 minutes.
• Initial infusion rate: 10 mg/hr IV
• Maintenance infusion rate: The infusion rate may be increased in 5 mg/hr increments up to 15 mg/hr.
• Maximum duration: 24 hours

• Unless contraindicated, appropriate vagal maneuvers should be attempted before administration of this drug.
• Bolus dosing should be calculated using actual body weight, including those with low body weight.
• Some patients may respond to an initial bolus dose of 0.15 mg/kg, but the duration of action may be shorter.
• Some patients may respond to a continuous infusion initial rate of 5 mg/hr.

• Temporary control of rapid ventricular rate in atrial fibrillation/flutter
• Rapid conversion of paroxysmal supraventricular tachycardias (PSVT) to sinus rhythm, including atrioventricular (AV) nodal reentrant tachycardia and reciprocating tachycardia associated with an extranodal accessory pathway (e.g., Wolff Parkinson White or short PR syndromes)

Usual Adult Dose for Supraventricular Tachycardia

Bolus Injection:

• Initial bolus dose: 0.25 mg/kg IV as a bolus administered over 2 minutes. After 15 minutes, a second bolus of 0.35 mg/kg IV (administered over 2 minutes) may be used if necessary.

• The continuous infusion should begin immediately following a bolus injection of 0.25 mg/kg IV OR 0.35 mg/kg IV administered over 2 minutes.
• Initial infusion rate: 10 mg/hr IV
• Maintenance infusion rate: The infusion rate may be increased in 5 mg/hr increments up to 15 mg/hr.
• Maximum duration: 24 hours

• Unless contraindicated, appropriate vagal maneuvers should be attempted before administration of this drug.
• Bolus dosing should be calculated using actual body weight, including those with low body weight.
• Some patients may respond to an initial bolus dose of 0.15 mg/kg, but the duration of action may be shorter.
• Some patients may respond to a continuous infusion initial rate of 5 mg/hr.

• Temporary control of rapid ventricular rate in atrial fibrillation/flutter
• Rapid conversion of paroxysmal supraventricular tachycardias (PSVT) to sinus rhythm, including atrioventricular (AV) nodal reentrant tachycardia and reciprocating tachycardia associated with an extranodal accessory pathway (e.g., Wolff Parkinson White or short PR syndromes)

Usual Adult Dose for Angina Pectoris Prophylaxis

Extended Release Capsules:

• Initial dose: 120 to 180 mg orally once a day, increasing the dose every 7 to 14 days as needed
• Maximum dose: 540 mg/day

• Initial dose: 120 to 180 mg orally once a day, increasing the dose every 7 to 14 days as needed
• Maximum dose: 480 mg/day

• Initial dose: 180 mg orally once a day, increasing the dose every 7 to 14 days as needed
• Maximum dose: 360 mg/day

• Initial dose: 30 mg orally 4 times a day (before meals and bedtime), increasing gradually every 1 to 2 days until the optimal response is attained
• Maintenance dose: 180 to 360 mg orally per day in divided doses (3 to 4 times a day)

• Extended release tablet formulation doses of greater than 360 mg did not appear to confer additional benefit.
• The manufacturer product information should be consulted for details regarding specific extended release formulation dosing.

• Treatment of chronic stable angina
• Improvement in exercise tolerance in patients with chronic stable angina
• Management of exertional angina pectoris due to atherosclerotic coronary artery disease
• Management of chronic stable angina and angina due to coronary artery spasm

Usual Adult Dose for Congestive Heart Failure

Extended Release Capsules:

• Initial dose: 120 to 180 mg orally once a day, increasing the dose every 7 to 14 days as needed
• Maximum dose: 540 mg/day

• Initial dose: 120 to 180 mg orally once a day, increasing the dose every 7 to 14 days as needed
• Maximum dose: 480 mg/day

• Initial dose: 180 mg orally once a day, increasing the dose every 7 to 14 days as needed
• Maximum dose: 360 mg/day

• Initial dose: 30 mg orally 4 times a day (before meals and bedtime), increasing gradually every 1 to 2 days until the optimal response is attained
• Maintenance dose: 180 to 360 mg orally per day in divided doses (3 to 4 times a day)

• Extended release tablet formulation doses of greater than 360 mg did not appear to confer additional benefit.
• The manufacturer product information should be consulted for details regarding specific extended release formulation dosing.

• Treatment of chronic stable angina
• Improvement in exercise tolerance in patients with chronic stable angina
• Management of exertional angina pectoris due to atherosclerotic coronary artery disease
• Management of chronic stable angina and angina due to coronary artery spasm

Renal Dose Adjustments

Use with caution.

Liver Dose Adjustments

Use with caution.

Extended Release/LA tablets:

• Mild to moderate liver dysfunction: No adjustment recommended
• Severe liver dysfunction: Data not available

Dose Adjustments

The nearest equivalent total daily dosage should be used when switching between different formulations of this drug. Titration to lower/higher doses may be necessary and should be initiated as clinically indicated.

Elderly patients should start on the low end of the dosing range, taking into consideration decreased renal, hepatic, or cardiac function and of concomitant disease or other drug therapies.

Skin eruptions progressing to erythema multiforme/exfoliative dermatitis: Discontinue treatment (Immediate release tablets)

Precautions

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

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Oral, extended-release capsules may be taken by opening and sprinkling the contents of the capsule into a spoonful of applesauce, followed by a glass of cool water. The dose should be used immediately, and the contents should not be subdivided.
• Swallow whole, without crushing or chewing.

• The manufacturer product information should be consulted.

• The manufacturer product information should be consulted.

• The manufacturer product information should be consulted.

• Dosing should be patient-specific.
• Limitations of use: This drug should not be used in patients with atrial fibrillations/flutter associated with an extranodal accessory pathway (e.g., Wolff-Parkinson-White or short PR syndromes).
• The IV formulation should be used with caution in hemodynamically compromised patients or in those taking drugs that decrease peripheral resistance, myocardial filling/contractility, and/or electrical impulse propagation in the myocardium.

• Cardiovascular: Heart rate and cardiac conduction, especially at the beginning of treatment in elderly patients or those with renal or hepatic impairment; continuous ECGs and frequent blood pressure measurements in patients receiving the IV formulation, especially with continuous infusion
• Hepatic: Periodic liver function tests
• Metabolic: Blood glucose in patients with latent/manifest diabetes mellitus
• Renal: Periodic renal function tests

• Warn patients to avoid abrupt discontinuation of this drug.
• Patients should be told to avoid consuming alcohol while taking this drug.
• Instruct patients to immediately report any signs/symptoms of Stevens-Johnson syndrome, toxic epidermal necrolysis, hematological disease, depression, or hypersensitivity reactions.
• Patients should be advised to report all concurrent prescription and nonprescription medications or herbal products they are taking.
• Inform patients that this drug may cause dizziness, drowsiness, or malaise, and they should avoid driving or operating machinery until the full effects of the drug are known.
• Patients should be advised to speak to a healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.