Usual Adult Dose for Hypertension

Slow release (old formulation):

• Initial dose: 20 mg orally once a day
• Maintenance dose: 10 to 60 mg orally once a day
• Maximum dose: 60 mg/day

Controlled release (new formulation):

• Initial dose: 17 mg orally once a day
• Maintenance dose: 8.5 to 34 mg orally once a day
• Maximum dose: 34 mg/day

Comment: This drug has been used with diuretics, ACE inhibitors, and beta blockers.

Use: Alone or in combination with other antihypertensive agents for the treatment of hypertension

Usual Geriatric Dose for Hypertension

Slow release (old formulation):

• Initial dose: 10 mg orally once a day
• Maintenance dose: 10 to 60 mg orally once a day
• Maximum dose: 60 mg/day

Controlled release (new formulation):

• Initial dose: 8.5 mg orally once a day
• Maintenance dose: 8.5 to 34 mg orally once a day
• Maximum dose: 34 mg/day

Comments:

• Dosing should be performed with caution.
• This drug has been used with diuretics, ACE inhibitors, and beta blockers.
• Blood pressure should be closely monitored during dose adjustments.

Use: Alone or in combination with other antihypertensive agents for the treatment of hypertension

Renal Dose Adjustments

Mild to moderate renal dysfunction: No adjustment recommended.
Severe renal dysfunction: Data not available

Liver Dose Adjustments

Patients with liver dysfunction:
Slow release (old formulation):

• Initial dose: 10 mg orally once a day
• Maintenance dose: 10 to 60 mg orally once a day
• Maximum dose: 60 mg/day

Controlled release (new formulation):

• Initial dose: 8.5 mg orally once a day
• Maintenance dose: 8.5 to 34 mg orally once a day
• Maximum dose: 34 mg/day

Comments:

• This drug has been used with diuretics, ACE inhibitors, and beta blockers.
• Blood pressure should be closely monitored during dose adjustments.

Use: Alone or in combination with other antihypertensive agents for the treatment of hypertension

Severe liver dysfunction: Use with caution.
Patients with cirrhosis: Lower initial and maintenance doses should be used.

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:

• Patients should swallow the tablets whole once a day; crushing, dividing, or biting the tablets should be avoided.
• This drug should be taken 1 hour before or 2 hours after a meal.
• Grapefruit products should be avoided before and after dosing.

Storage requirements:

• Protect from light and moisture.

General:

• Slow release (old formulation) blood pressure response increases over the 10 to 60 mg daily dose range but, adverse event rates also increase.
• Controlled release (new formulation) blood pressure response increases over the 8.5 to 34 mg daily dose range, but adverse event rates also increase.

Monitoring:

• Cardiovascular: Blood pressure, heart rate, and signs/symptoms of angina, especially during initiation and titration

Patient advice:

• Patients should be told to swallow the tablets whole; chewing, crushing, or splitting tablets should be avoided.
• Patients should be instructed to take this drug 1 hour before or 2 hours after food. Grapefruit juice should be avoided during treatment.
• Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.