HTN. Reduce risk of stroke in patients w/ HTN & left ventricular hypertrophy (LVH). Diabetic nephropathy w/ elevated serum creatinine & proteinuria in patient w/ type 2 diabetes & history of HTN.
HTN Initial & maintenance dose: 50 mg once daily, may be increased to 100 mg once daily. Intravascular vol-depletion eg, patient treated w/ high-dose diuretics Initially 25 mg once daily. HTN w/ LVH Initially 50 mg once daily w/ low-dose hydrochlorothiazide, may be increased to 100 mg once daily based on BP response. Renal protection in type 2 diabetic patient w/ proteinuria & HTN Initially 50 mg once daily, may be increased to 100 mg once daily.
Hypersensitivity. Intravascular vol-depletion (eg, those treated w/ high-dose diuretics), symptomatic hypotension; electrolyte imbalance; bilateral renal artery stenosis or artery stenosis to solitary kidney. Black patients. Hepatic impairment. Not to be used during pregnancy. Lactation. Not recommended in ped patients w/ GFR <30 mL/min/1.73 m2, hepatic impairment or neonates.
Reduced levels of active metabolite by rifampin & fluconazole. Increased serum K w/ K-sparing diuretics (eg, spironolactone, triamterene, amiloride), K supplements, K-containing salt substitutes or other drugs increasing serum K (eg, trimethoprim-containing products). Reduced lithium excretion. Attenuated antihypertensive effect w/ NSAIDs including selective COX-2 inhibitors. Not to be co-administered w/ aliskiren. Reduced therapeutic effect w/ grapefruit juice.
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