Usual Adult Dose for Hypertension

Initial dose: 40 mg orally once a day

Maintenance dose: 40 to 80 mg orally once a day

Comments: Most of the antihypertensive effect is present within 2 weeks; maximum blood pressure reduction at a given dose is generally observed within 4 weeks of starting that dose.

Usual Adult Dose for Cardiovascular Risk Reduction

80 mg orally once a day

Comments:

• It is unknown whether doses lower than 80 mg are effective in reducing the risk of cardiovascular morbidity and mortality.
• When initiating this drug for cardiovascular risk reduction, monitoring of blood pressure is recommended, and if appropriate, adjustment of other medications that lower blood pressure.

Use: Reduction of risk of myocardial infarction, stroke, or death from cardiovascular causes in patients 55 years or older at high risk of developing major cardiovascular events who are unable to take angiotensin-converting enzyme (ACE) inhibitors. High risk for cardiovascular events can be evidenced by a history of coronary artery disease, peripheral arterial disease, stroke, transient ischemic attack, or high-risk diabetes (insulin-dependent or non-insulin dependent) with evidence of end-organ damage.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

Initiate at low doses and titrate slowly

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.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Hemodialysis: No adjustment recommended
Peritoneal dialysis: Data not available

Other Comments

Monitoring: Monitor serum electrolytes periodically.

Patient advice: 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.