Adult Essential HTN Initial & maintenance dose: 150 mg once daily, can be increased to 300 mg or in combination w/ other antihypertensive agents. Renal disease in patients w/ HTN & type 2 DM Initially 150 mg once daily, titrated up to 300 mg once daily. Elderly >75 yr & patients undergoing hemodialysisEssential HTN Consider initial dose of 75 mg.
Hypersensitivity. Not for patients w/ galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Symptomatic hypotension after the 1st dose in patients w/ depleted vol &/or Na. Increased risk of severe hypotension & renal insufficiency in patients w/ bilateral renal artery stenosis of the artery to a single functioning kidney. Renal impairment & kidney transplantation; periodic monitoring of K & creatinine serum levels. Close monitoring of serum K in patients at risk of hyperkalaemia. Patients w/ aortic or mitral stenosis or obstructive hypertrophic cardiomyopathy. Not recommended in patients w/ primary aldosteronism. Excessive BP decrease in patients w/ ischaemic cardiopathy or ischaemic CV disease could result in MI or stroke. Pregnancy (2nd & 3rd trimesters) & lactation.
Increased K level; dizziness, feeling sick/vomiting, fatigue, raised levels of creatine kinase enzyme, orthostatic hypotension, joint or muscle pain, decreased Hb levels.
Increased hypotensive effects w/ other antihypertensive agents; serum K levels w/ K-sparing diuretics, K supplements, salt substitutes containing K. Reversible increase in serum lithium conc & toxicity. Attenuation of antihypertensive effect, increased risk of worsening of renal function & increased serum K w/ NSAIDs.