Usual Adult Dose for Coronary Artery Disease

Initial dose: 4 mg orally once a day for 2 weeks, then increase to maintenance dose as tolerated.
Maintenance dose: 8 mg orally once a day

Use: Treatment of patients with stable coronary artery disease to reduce the risk of cardiovascular mortality or nonfatal myocardial infarction.

Usual Adult Dose for Hypertension

Initial dose: 4 mg orally once a day
Maintenance dose: 4 to 8 mg orally per day in 1 or 2 divided doses
Maximum dose: 16 mg/day

Comments: In patients treated with a diuretic, consider reducing the diuretic dose prior to starting this drug.

Usual Geriatric Dose for Coronary Artery Disease

Greater than 70 Years:
Initial dose:

• Week 1: 2 mg orally once a day
• Week 2: 4 mg orally once a day, then increase to maintenance dose as tolerated.

Usual Geriatric Dose for Hypertension

Initial dose: 4 mg orally per day in 1 or 2 divided doses

Comments: Experience with doses above 8 mg is limited; administer with careful blood pressure monitoring and dose titration.

Renal Dose Adjustments

Mild to moderate renal dysfunction (CrCl 30 mL/min or greater): Initial dose: 2 mg/day; Maximum dose: 8 mg/day
Severe renal dysfunction (CrCl less than 30 mL/min): Not recommended

Liver Dose Adjustments

Data not available

Precautions

US BOXED WARNING:

• FETAL TOXICITY: If pregnancy is detected, discontinue this drug as soon as possible. Drugs that act directly on the renin angiotensin system (RAS) can cause injury and death to the developing fetus.

Dialysis

This drug is dialyzable; however, no dose adjustment guidelines have been reported.

Other Comments

Monitoring:

• Monitor serum electrolytes and renal function periodically.
• Monitor white blood cell counts periodically in patients with collagen vascular disease or those who are taking a drug known to affect white blood cells or the immune response, particularly when there is impaired renal function.
• Monitor glycemic control closely in diabetic patients treated with oral medication or insulin during the first month of treatment with this drug.

• 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.
• Advise patients to report any signs of infection (e.g., sore throat, fever). If infection is suspected, white blood cell counts should be performed immediately.