HTN in adults & in childn & adolescents 6 to <18 yr. Heart failure in adults w/ reduced heart muscle function when ACE inhibitors cannot be used, or in addition to ACE inhibitors when symptoms persist despite treatment & mineralocorticoid receptor antagonists (MRA) cannot be used.
HTN Adult 8 mg once daily, may be increased to 16 mg once daily & further up to 32 mg once daily depending on BP response. Childn & adolescent 6 to <18 yr Initially 4 mg once daily. Weighing <50 kg: Increase dose to max of 8 mg once daily if BP is not adequately controlled. Weighing ≥50 kg: Increase dose to 8 mg once daily & to 16 mg once daily if BP is not adequately controlled. Heart failure Adult Initially 4 mg once daily, may be increased by doubling dose at intervals of at least 2 wk up to 32 mg once daily.
Check kidney function, BP, & electrolytes (eg, K) at regular intervals. Dual blockade of renin-angiotensin-aldosterone system (RAAS) through the combined use of ACE inhibitors, ARBs or aliskiren is not recommended. Do not concomitantly use ACE inhibitors & ARBs in patients w/ diabetic nephropathy. Risk of drop in BP when combined w/ some anaesth. May impair ability to drive or operate machinery. Caution in patients w/ heart, liver or kidney problems, or those on dialysis; w/ recent kidney transplant; who are vomiting, have recently had severe vomiting, or have diarrhoea; w/ Conn's syndrome (primary hyperaldosteronism); w/ low BP; w/ history of stroke; w/ intolerance to lactose or other sugars. Not recommended in early pregnancy & during breast-feeding.
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