HTN Initially 50 mg once daily, may increase to 100 mg daily if BP control is inadequate. Max: 100 mg daily.
Heart failure-post MI Initially 25 mg once daily & titrated in 1 step to the target dose of 50 mg once daily w/in 4 w, taking into account the serum K level. Maintenance: 50 mg once daily. Max: 50 mg daily. Dose adjustment:
Serum K ≥6 mmol/L (or mEq/L) Withhold treatment. May re-start at a dose of 25 mg every other day when K levels have fallen <5 mmol (or mEq/L);
5.5-5.9 mmol/L (or mEq/L) Decrease 50 mg once daily to 25 mg once daily; decrease 25 mg once daily to 25 mg every other day; decrease 25 mg every other day to withhold;
5-5.4 mmol/L (or mEq/L) No dose adjustment;
<5 mmol/L (or mEq/L) Increase 25 mg every other day to 25 mg once daily; increase 25 mg once daily to 50 mg once daily.
NYHA class II (chronic) heart failure Initially 25 mg once daily & titrated to the target dose of 50 mg once daily w/in 4 wktaking into account the serum K level.
Concomitant use w/ mild to moderate CYP3A4 inhibitors (eg, erythromycin, saquinavir, verapamil, & fluconazole) 25 mg once daily.
Moderate renal impairment (CrCl 30-60 mL/min) Initially 25 mg every other day, & dose should be adjusted based on the K level.
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