HTN. Reduce risk of CV morbidity & mortality in hypertensive patients w/ left ventricular hypertrophy. Renal protection in type 2 diabetic patients w/ proteinuria.
HTN Usual starting & maintenance dose: 50 mg once daily. May be increased to 100 mg once daily. Patients w/ intravascular vol-depletion Initially 25 mg once daily. Reduction of risk of CV morbidity & mortality in hypertensive patients w/ left ventricular hypertrophy Initially 50 mg once daily. Add low dose hydrochlorothiazide &/or increase dose to 100 mg once daily based on BP response. Renal protection in type 2 diabetic patients w/ proteinuria Initially 50 mg once daily, may be increased to 100 mg once daily based on BP response.
Discontinue if oligohydramnios is observed; angioedema including swelling of larynx & glottis causing airway obstruction &/or swelling of face, lips, pharynx &/or tongue occurs. Fetal toxicity. Symptomatic hypotension may occur in patients who are intravascularly vol-depleted. Electrolyte imbalances in patients w/ renal impairment w/ or w/o diabetes. Black patients. Correct hypotension prior to therapy. Monitor renal function & serum K. Not recommended in concomitant use of K-supplement or K-sparing diuretics. History of hepatic impairment. Renal (serum creatinine >3-4 mg/dL) impairment. Perform serial ultrasound exam to assess intra-amniotic environment. 2nd & 3rd trimesters of pregnancy. Lactation. Neonates w/ history of in utero exposure.
Reduced levels of active metabolite w/ rifampin & fluconazole. Increased serum K w/ K-sparing diuretics (eg, spironolactone, triamterene, amiloride), K supplements or salt substitutes containing K or other drugs increasing serum K eg, trimethoprim-containing products. Reduced lithium excretion. Attenuated antihypertensive effects of ARBs or ACE inhibitors w/ NSAIDs including COX-2 inhibitors. Co-administration w/ aliskiren. Reduced therapeutic effect w/ grapefruit juice.
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