Adult >18 yr HTN 80 or 160 mg once daily, may be increased to 320 mg once daily or diuretic may be added. Heart failure Initially 40 mg bd, up-titrated to 80 & 160 mg bd as tolerated. Max: 320 mg daily in divided doses. Post MI Initially 20 mg bd, up-titrated to max: 160 mg bd as tolerated. May be initiated as early as 12 hr after MI.
Discontinue immediately & not to be re-administered in patients w/ history of or develop angioedema. Risk of hypotension in Na &/or vol-depleted patients. Patients w/ biliary obstructive disorders. Initiation therapy in patients w/ heart failure or post MI. Triple combination w/ ACE inhibitor & β-blocker. Concomitant use w/ renin angiotensin system (RAS) blockers eg, ACE inhibitors or aliskiren. Avoid concomitant use w/ aliskiren in patients w/ severe renal impairment (GFR <30 mL/min). Renal artery stenosis, severe renal impairment (CrCl <10 mL/min). Not to be used in women of childbearing potential. Not to be used during lactation. Childn & adolescents <18 yr.
Increased incidence of hypotension, hyperkalemia & changes in renal function w/ other agents acting on renin-angiotensin-system eg, ACE inhibitors or aliskiren. Increased serum K levels & creatinine w/ K-sparing diuretics, K supplements, K-containing salt substitutes or other drugs increasing K levels (eg, heparin). Attenuated antihypertensive effect w/ NSAIDs including COX-2 inhibitors. Increased systemic exposure w/ uptake transporter (eg, rifampin, ciclosporin) or efflux transporter (eg, ritonavir) inhibitors. Reversible increased in serum lithium conc & toxicity.
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