HTNAdult Initially 20 mg once daily. Titrate as needed up to 40 mg once daily after 2 wk. Childn 6-16 yr weighing ≥35 kg Initially 20 mg once daily. May be increased to max 40 mg/day after 2 wk, if initial response is inadequate, <35 kg Initially 10 mg once daily. May be increased to max 20 mg/day after 2 wk, if initial response is inadequate. Elderly May consider starting at 5-10 mg once daily. Patients w/ renal impairment (CrCl <20 mL/min) Max: 20 mg/day.
Administration
May be taken with or without food.
Contraindications
Hypersensitivity. Concomitant use w/ aliskiren in patients w/ DM or moderate to severe renal impairment (GFR <60 mL/min/1.73 m2).
Special Precautions
Angioedema. May develop severe, chronic diarrhea w/ significant wt loss from mth to yr after treatment initiation. Hyperkalemia may occur; risk factors include renal dysfunction, DM, concomitant use w/ K-sparing diuretics, K supplements &/or K-containing salts. Symptomatic hypotension may occur upon initiation in patients who are salt- or vol-depleted. Renal function deterioration &/or increase in serum creatinine in patients w/ low renal blood flow w/ GFR dependent on efferent arteriolar vasoconstriction by angiotensin II. Aortic/mitral stenosis; ascites; unstented unilateral/bilateral renal artery stenosis & avoid use if unstented bilateral artery stenosis occur. Pregnancy (discontinue immediately) & lactation.
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