Usual Adult Dose for Hypertension

Initial dose: 5 mg orally once a day
Dose adjustment: Titrate dose at 2-week intervals up to 40 mg once a day as needed.
Maximum dose: 40 mg per day

Comments:

• Titrating doses more frequently than every 2 weeks is unlikely to be beneficial.
• The dose should be individualized to patient requirements.

Renal Dose Adjustments

CrCl less than 30 mL/min:

• Initial dose: 2.5 mg orally once a day; titrate slowly as needed.

Liver Dose Adjustments

Moderate impairment:

• Initial dose: 2.5 mg orally once a day; titrate slowly as needed.

• Not recommended.

Dose Adjustments

Cessation of therapy:

• Abrupt discontinuation should be avoided; taper therapy over approximately 1 to 2 weeks.
• If withdrawal symptoms occur, therapy may be temporarily reinstituted.

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:

• Take orally once a day at the same time each day with or without food.
• If a dose is missed, take it as soon as remembered; but if it is close to the next dose, skip the missed dose; do not double the dose.

• Transient worsening of heart failure, hypotension, and bradycardia may occur during titration; consider discontinuation for heart failure worsening that persists.
• If discontinuation is necessary, gradually taper over 1 to 2 weeks, monitor for the signs and symptoms of heart failure, and limit exercise.
• 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
• Angina in patients with coronary artery disease, especially during withdrawal

• Warn patients to avoid interruptions or abrupt discontinuation of this drug.
• Instruct the patient to notify his or her 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.