Usual Adult Dose for Hypertension

Initial dose: 10 mg orally once a day alone or in combination with a diuretic
Maintenance dose: 20 to 40 mg orally once a day; some patients may have further response at 80 mg once a day

Comments:

• Dosages should be adjusted according to blood pressure response at peak (2 to 6 hours post dose) and trough (about 24 hours after dosing) blood levels.
• Consider dividing the daily dose in patients where the trough response is inadequate.
• Stop the diuretic 2 to 3 days prior to beginning therapy with this drug; it may be resumed at a later time if clinically indicated.
• If stopping the diuretic is not possible, careful medical supervision is recommended for several hours until blood pressure has stabilized.

Uses: For the treatment of hypertension alone or in combination with other medications

Usual Adult Dose for Congestive Heart Failure

Initial dose: 10 mg orally once a day
Target dose range: 20 to 40 mg orally once a day
Maximum dose: 40 mg orally once a day

Comments:

• Patients should be observed under medical supervision for at least 2 hours following the initial dose until blood pressure stabilizes.
• Dosages should be increased over a several week period based on tolerability.
• The presence of hypotension, orthostasis, or azotemia early in dose titration should not preclude further careful dose titration; consider dose reducing concomitant diuretic.

Use: For the management of heart failure as adjunctive therapy when added to conventional therapy including diuretics with or without digitalis

Usual Pediatric Dose for Hypertension

6 to 16 years:
Greater than 50 kg: 5 to 10 mg orally once a day as monotherapy
Less than 50 kg: Appropriate dose not available

Renal Dose Adjustments

Heart Failure:

• Moderate to severe renal dysfunction: Initial dose: 5 mg orally once a day

Liver Dose Adjustments

Data not available

Dose Adjustments

Heart failure patients with vigorous diuresis:

• Initial dose: 5 mg orally once a day

Precautions

US BOXED WARNING: FETAL TOXICITY:

• When pregnancy is detected, this drug should be discontinued as soon as possible.
• Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

Safety and efficacy have not been established in patients younger than 6 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Storage requirements:

• Keep bottle tightly closed to protect from moisture.

Monitoring:
Cardiovascular: Monitor blood pressure for response to therapy periodically.
Hematologic: Periodically monitor white blood cell counts in patients with collagen-vascular disease and/or renal disease.
Renal: Monitor renal function prior to initiating and periodically during therapy.

Patient advice:

• Advise patients to immediately report any signs or symptoms of angioedema (breathing difficulty or swelling of face, eyes, lips, or tongue) and to stop taking this drug until consulting a physician.
• Tell patients to promptly report any sign of infection (e.g., sore throat, fever), which may be a sign of neutropenia.
• Caution patients to consult their physician if excessive perspiration, dehydration, vomiting, or diarrhea occurs as it may lead to excessive blood pressure reduction due to reduced fluid volume.
• Advise patients against using potassium-sparing diuretics, potassium supplements or potassium-containing salt substitutes without consulting their physician.
• Caution heart failure patients against rapid increases in physical activity.
• 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.

Frequently asked questions

• Do ACE inhibitors make COVID-19 worse?