Usual Adult Dose for Hypertension

Initial dose: 2.5 mg orally once a day for patients not taking a diuretic

Maintenance dose: 2.5 to 20 mg/day in one or two equally divided doses

Comments:

• Adjust dose according to blood pressure response.
• The antihypertensive effect may diminish toward the end of a once daily dosing interval; consider increasing dose or twice daily administration.
• If blood pressure is not controlled with this drug alone, a diuretic may be added.

Use: Treatment of hypertension, to lower blood pressure, alone or in combination with a thiazide diuretic.

Usual Adult Dose for Congestive Heart Failure

Initial dose: 2.5 mg orally twice a day

Maintenance dose: 5 mg orally twice a day

Comments:

• If possible, decrease concomitant diuretic dose to reduce likelihood of hypotension.
• After first initial dose, observe at least two hours and until blood pressure has stabilized at least an additional hour.
• If patient becomes hypotensive on initial dose, reduce to 1.25 mg twice a day.
• After one week on initial dose, increase toward maintenance dose as tolerated; may increase about every 3 weeks.
• Initial hypotension does not preclude subsequent titration with this drug, following effective hypotension management.

Use: Treatment of stable patients who have demonstrated clinical signs of congestive heart failure within the first few days after sustaining acute myocardial infarction.

Usual Adult Dose for Cardiovascular Risk Reduction

Initial dose: 2.5 mg orally once a day for one week; 5 mg orally once a day for next three weeks, then increase as tolerated

Maintenance dose: 10 mg orally once a day

Comments:

• If patient is hypertensive or recently post myocardial infarction, may administer in divided doses.

Use: Reduce the risk of myocardial infarction, stroke, or death from cardiovascular causes in patients 55 years or older at high risk of developing a major cardiovascular event because of a history of coronary artery disease, stroke, peripheral vascular disease, or diabetes that is accompanied by at least one other cardiovascular risk factor (hypertension, elevated total cholesterol levels, low high-density lipoprotein (HDL) levels, cigarette smoking, or documented microalbuminuria); can be used in addition to other needed treatment such as antihypertensive, antiplatelet, or lipid lowering therapy.

Renal Dose Adjustments

CrCl 40 mL/min or less: Reduce usual dose by 25%

CrCl less than 90 mL/min and hypertension: Initial dose: 1.25 mg orally once a day; may titrate up until blood pressure controlled or to maximum dose of 5 mg/day.

CrCl less than 90 mL/min and heart failure: Initial dose: 1.25 mg orally once a day; may increase to 1.25 mg twice daily and to maximum dose of 2.5 mg twice daily.

Renal artery stenosis: Initial dose: 1.25 mg orally once a day

Liver Dose Adjustments

Data not available

Dose Adjustments

Volume depletion (e.g., past and current diuretic use):

• Initial dose: 1.25 mg orally once a day

Precautions

US BOXED WARNING:

• FETAL TOXICITY: When 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.

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:

• Capsules may be opened and sprinkled in 4 ounces of applesauce, apple juice, or water; mixture may be stored 24 hours at room temperature or 48 hours refrigerated.

Monitoring:

• Monitor serum potassium periodically.
• In hypertensive patients with unilateral or bilateral renal artery stenosis, monitor renal function during the first few weeks of therapy.
• Consider monitoring white blood cells in patients with collagen vascular disease, especially if associated with renal impairment.

Frequently asked questions

• Do ACE inhibitors make COVID-19 worse?