Adult Initially 10 mg once daily, may be increased to 20 mg once daily. Max dose: 40 mg daily or hydrochlorothiazide may be added if additional BP reduction is required. Mild to moderate renal impairment (CrCl 20-60 mL/min) 20 mg once daily. Moderate hepatic impairment 10 mg once daily. Max dose: 20 mg once daily.
Vol &/or Na depleted patients, other conditions w/ stimulation of the renin-angiotensin-aldosterone system. Increased risk of severe hypotension & renal insufficiency in patients w/ bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney. Hyperkalaemia; close monitoring of serum K in at risk patients is recommended. Patients w/ aortic or mitral valve stenosis, obstructive hypertrophic cardiomyopathy, primary aldosteronism, sprue-like enteropathy, ischaemic heart disease or ischaemic cerebrovascular disease. Concomitant use of ACE-inhibitors, ARBs or aliskiren. Not recommended in combination w/ lithium. Patients w/ rare hereditary problems of galactose intolerance, the Lapp-lactase deficiency or glucose-galactose malabsorption. Minor or moderate influence on the ability to drive & use machines. Not recommended in patients w/ severe renal (CrCl <20 mL/min) & hepatic impairment. Childn & adolescents <18 yr.
Increased BP lowering effect w/ other antihypertensives. Concomitant use w/ ACE inhibitor, ARBs or aliskiren may cause higher frequency of adverse events (eg, hypotension, hyperkalaemia & decreased renal function). Increases in serum K w/ K-sparing diuretics, K supplements, salt substitutes containing K or other drugs that may increase serum K levels (eg, heparin). May decrease GFR & cause acute renal failure w/ NSAIDs. Reduced systemic exposure & peak plasma conc w/ bile acid sequestering agent colesevelam HCl. Reduction in bioavailability w/ antacids (Al Mg hydroxide). Increases serum lithium conc.
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