HTN 80 or 160 mg once daily. May be increased to 320 mg daily or a diuretic may be added. Heart failure Initially 40 mg bid. May be increased to 80 & 160 mg bid. Max: 320 mg daily in divided doses. Post MI Start therapy as early as 12 hr post MI. Initially 20 mg bid, titrated to 40, 80 & 160 mg bid. Recommended to achieve 80 mg bid dose level 2 wk after initiation, & 160 mg bid (target max dose) by 3 mth.
Increased incidence of hypotension, hyperkalemia & changes in renal function w/ agents blocking the RAS eg, ACE inhibitors or aliskiren. Concomitant use of K supplements, K-sparing diuretics (eg, spironolactone, triamterene, amiloride), K-containing salt substitutes or other drugs that may alter K levels (eg, heparin). Attenuation of antihypertensive effect may occur w/ NSAIDs including selective COX-2 inhibitors. Increase serum conc & toxicity of lithium. Increased systemic exposure w/ inhibitors of hepatic uptake transporter OATP1B1 (eg, rifampin, ciclosporin) & efflux transporter MRP2 (eg, ritonavir).
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