Angiotensin II Receptor Blocker (ARB) for Hypertension
| ANGIOTENSIN II RECEPTOR BLOCKER (ARB) FOR HYPERTENSION | ||||
|---|---|---|---|---|
| Generic & Class | Brand & Company | Strength | Formulations | Usual Dose |
| ANGIOTENSIN II RECEPTOR BLOCKER (ARB) | ||||
| azilsartan medoxomil | Edarbi
(Takeda) |
40mg, 80mg | tabs | ≥18yrs: Monotherapy, not volume-depleted: 80mg once daily.
Volume-depleted (eg, concomitant high-dose diuretics): initially 40mg once daily.
<18yrs: Not recommended. |
| candesartan cilexetil | Atacand
(AstraZeneca) |
4mg, 8mg, 16mg, 32mg | scored tabs | Adults: Individualize. ≥18yrs: Monotherapy and not volume-depleted: initially 16mg
once daily; usual range: 8–32mg per day once daily or in 2 divided doses.
Salt/volume depleted or moderate hepatic impairment: consider lower initial dose. May add
diuretic if needed.
Children: <1yr or CrCl<30mL/min: not recommended. Give once daily or in 2 divided doses. 1–<6yrs (may give oral susp if unable to swallow tabs): initially 0.2mg/kg/day; usual range: 0.05–0.4mg/kg/day. 6–<17yrs (<50kg): initially 4–8mg/day; usual range: 2–16mg/day; (>50kg): initially 8–16mg/day; usual range: 4–32mg/day. Salt/volume depletion: consider lower initial dose. |
| eprosartan (as mesylate) |
Teveten
(AbbVie) |
400mg, 600mg | tabs | Adults: Monotherapy: not volume depleted: initially 600mg once
daily. Usual range: 400–800mg/day given as a single dose or in two divided doses.
Children: Not recommended |
| irbesartan | Avapro
(Sanofi Aventis) |
75mg, 150mg, 300mg | tabs | ≥16yrs: 150mg once daily; may increase to 300mg once daily.
Or, may add a low dose of diuretic. Salt/volume depletion: initially 75mg once daily.
Children: Not recommended. |
| losartan potassium | Cozaar
(Merck) |
25mg, 50mg, 100mg | tabs | Adults: Hypovolemia or hepatic insufficiency: initially 25mg once
daily. Hypertension (HTN): initially 50mg once daily; range 25–100mg/day; max
100mg/day in 1 or 2 divided doses. HTN with LVH: initially 50mg once daily; then add
hydrochlorothiazide (HCTZ) 12.5mg/day and/or increase losartan to 100mg/day, then may
increase HCTZ to 25mg/day.
Children: <6 years or CrCl<30mL/min: not recommended. ≥6 years: initially 0.7mg/kg (max 50mg) once daily; usual max 1.4mg/kg (100mg) once daily. |
| olmesartan medoxomil | Benicar
(Daiichi Sankyo) |
5mg, 20mg, 40mg | tabs | ≥16yrs: Monotherapy, not volume-depleted: initially 20mg
once daily; may increase to max 40mg once daily after 2 weeks. Volume depleted (eg,
concomitant diuretic): consider lower initial dose.
Children: <1yr: Do not give. <6yrs: not recommended. 6–16yrs: (20kg to <35kg): initially 10mg once daily; may increase to max 20mg once daily after 2 weeks; (≥35kg): initially 20mg once daily; may increase to max 40mg once daily after 2 weeks. Tablets may be prepared as an oral suspension if unable to swallow: see literature. |
| telmisartan | Micardis
(Boehringer Ingelheim) |
20mg, 40mg, 80mg | tabs | Adults: Not volume-depleted: initially 40mg once daily; usual
range 20–80mg/day. Salt/volume depleted: monitor closely or consider reduced dose.
May add diuretic if insufficient response at 80mg/day.
Children: Not recommended |
| valsartan | Diovan
(Novartis) |
40mg+, 80mg, 160mg, 320mg | tabs | Adults: Monotherapy and not volume-depleted: initially 80mg or
160mg once daily; max 320mg once daily. Or, add a diuretic (more effective than increasing
dose above 80mg).
Children: <6yrs or CrCl<30mL/min: not recommended. 6–16yrs: Initially 1.3mg/kg once daily (up to 40mg total); max 2.7mg/kg (up to 160mg) once daily. If unable to swallow tabs, or calculated dose (mg/kg) does not correspond to available tablet strengths, use suspension (see literature for susp preparation). |
| ANGIOTENSIN II RECEPTOR BLOCKER + CALCIUM CHANNEL BLOCKER + DIURETIC | ||||
| olmesartan/ amlodipine/ hydrochlorothiazide |
Tribenzor
(Daiichi Sankyo) |
20mg/5mg/12.5mg,
40mg/5mg/12.5mg, 40mg/5mg/25mg, 40mg/10mg/12.5mg, 40mg/10mg/25mg |
tabs | Adults: One tablet daily. Titrate at 2-week intervals; max one
40/10/25mg tablet daily. Replacement therapy: may be substituted for individually titrated
components. Add-on/switch therapy: may be used to provide additional BP lowering for
patients not adequately controlled on max tolerated, labeled or usual doses of any two
antihypertensive classes: ARBs, CCBs, and diuretics.
Children: Not recommended. |
| ANGIOTENSIN II RECEPTOR BLOCKER + DIURETIC | ||||
| azilsartan medoxomil/ chlorthalidone |
Edarbyclor
(Takeda) |
40mg/12.5mg, 40mg/25mg | tabs | ≥18yrs: Initially 40/12.5mg once daily. May increase to 40/25mg after 2–4
weeks as needed. Max: 40/25mg. Patients titrated to the individual components: may give corresponding dose of
Edarbyclor. See literature.
<18yrs: Not recommended. |
| candesartan cilexetil/ hydrochlorothiazide |
Atacand HCT
(AstraZeneca) |
16mg/12.5mg, 32mg/12.5mg, 32mg/25mg | scored tabs | Adults: Not for initial therapy. May be substituted for titrated
components. BP not controlled on HCTZ 25mg once daily, or controlled but serum potassium
decreased: one Atacand HCT 16–12.5 tab once daily. BP not controlled on candesartan
32mg per day: initially one Atacand HCT 32–12.5 tab once daily; may increase to
32–25 once daily. CrCl≤30mL/min: not recommended.
Children: Not recommended. |
| eprosartan (as mesylate)/ hydrochlorothiazide |
Teveten HCT
(AbbVie) |
600mg/12.5mg, 600mg/25mg | tabs | Adults: Not for initial therapy. May be substituted for titrated
components. One Teveten HCT 600mg/12.5mg tab once daily; after 2–3 weeks may increase
to one Teveten HCT 600mg/25mg tab once daily. May add eprosartan 300mg once daily in the PM
if additional BP control is needed at trough.
Children: Not recommended. |
| irbesartan/ hydrochlorothiazide |
Avalide
(Sanofi Aventis) |
150mg/12.5mg, 300mg/12.5mg | tabs | Adults: Take once daily. Not controlled on monotherapy: initially
150/12.5mg, titrate to 300/12.5mg then 300/25mg if needed. Replacement therapy: may be
substituted for titrated components. Initial therapy: start at 150/12.5mg for 1–2
weeks, then titrate as needed up to max 300mg/25mg. Maximum effects within 2–4 weeks
after dose change. CrCl≤30mL/min: not recommended.
Children: Not recommended. |
| losartan potassium/ hydrochlorothiazide |
Hyzaar
(Merck) |
50mg/12.5mg, 100mg/12.5mg, 100mg/25mg | tabs | ≥18yrs: One 50–12.5mg tab once daily; may increase after
about 3 weeks (2–4 weeks for severe HTN) to two 50–12.5mg tabs once daily or one
100–25mg tab once daily. Titrate components: see literature. HTN with LVH: switch from
losartan monotherapy (see literature). Severe renal impairment (CrCl<30mL/min): not
recommended.
<18yrs: Not recommended. |
| olmesartan medoxomil/ hydrochlorothiazide |
Benicar HCT
(Daiichi Sankyo) |
20mg/12.5mg, 40mg/12.5mg, 40mg/25mg | tabs | ≥18yrs: Not for initial therapy. May be substituted for
titrated components. Individualize. BP not controlled on olmesartan or HCTZ alone: one tab
once daily; may titrate at 2–4 week intervals; usual max 40mg/25mg once daily. Severe
renal impairment (CrCl≤30mL/min): not recommended. Volume depleted: reduce dose.
<18yrs: not recommended. |
| telmisartan/ hydrochlorothiazide |
Micardis HCT
(Boehringer Ingelheim) |
40mg/12.5mg, 80mg/12.5mg, 80mg/25mg | tabs | Adults: Not for initial therapy. May be substituted for titrated
components. BP not controlled on telmisartan 80mg/day: one Micardis HCT 80mg/12.5mg tab once
daily; may titrate to 160mg/25mg. BP not controlled on HCTZ 25mg/day: one Micardis HCT
80mg/12.5mg tab or 80mg/25mg tab once daily; may titrate to 160mg/25mg if BP uncontrolled
after 2–4 weeks. BP controlled on HCTZ 25mg/day but hypokalemic: One Micardis HCT
80mg/12.5mg tab once daily. CrCl≤30mL/min: not recommended. Hepatic insufficiency or
biliary obstruction: initially one Micardis HCT 40mg/12.5mg tab once daily; monitor closely.
Severe hepatic impairment: not recommended.
Children: Not recommended. |
| valsartan/ hydrochlorothiazide |
Diovan HCT
(Novartis) |
80mg/12.5mg, 160mg/12.5mg, 160mg/25mg, 320mg/12.5mg, 320mg/25mg | tabs | Adults: Take once daily. Add-on or initial therapy and not
volume-depleted: Initially 160mg/12.5mg; may increase after 1–2 weeks up to max
320mg/25mg. Replacement therapy: may be substituted for the titrated components. Maximum
effects within 2–4 weeks after dose change. CrCl≤30mL/min: not recommended.
Children: Not recommended. |
| CALCIUM CHANNEL BLOCKER + ANGIOTENSIN II RECEPTOR BLOCKER | ||||
| amlodipine (as besylate)/ olmesartan medoxomil |
Azor
(Daiichi Sankyo) |
5mg/20mg, 5mg/40mg, 10mg/20mg, 10mg/40mg | tabs | Adults: Take once daily. Initial therapy: initially 5/20mg; may
increase after 1–2 weeks up to max 10mg/40mg; ≥75yrs old or hepatic impairment: not
recommended. Replacement therapy: may be substituted for titrated components. Add-on
therapy: may be used if not controlled on monotherapy. Individualize; titrate at 2-week
intervals up to max 10/40mg once daily, usually by increasing dose of one or both components
if BP not controlled on prior therapy. Maximum effects within 2 weeks after dose change.
Children: Not recommended. |
| amlodipine (as besylate)/ telmisartan |
Twynsta
(Boehringer Ingelheim) |
5mg/40mg, 5mg/80mg, 10mg/40mg, 10mg/80mg | tabs | Adults: Take once daily. Initial therapy: Children: Not recommended. |
| amlodipine (as besylate)/ valsartan |
Exforge
(Novartis) |
5mg/160mg, 5mg/320mg, 10mg/160mg, 10mg/320mg | tabs | Adults: Take once daily. Initial therapy and not volume depleted:
Initially 5/160mg; may increase after 1–2 weeks up to max 10/320mg. Add-on therapy:
may be used if not controlled on monotherapy; if inadequate response after 3–4 weeks,
may titrate up to max 10/320mg. Replacement therapy: may be substituted for the titrated
components. Maximum effects within 2 weeks after dose change.
Children: Not recommended. |
| DIRECT RENIN INHIBITOR + ANGIOTENSIN II RECEPTOR BLOCKER | ||||
| aliskiren/valsartan | Valturna
(Novartis) |
150mg/160mg, 300mg/320mg | tabs | Adults: Take consistently with regard to meals. 1 tablet once
daily. Add-on or initial therapy and not volume-depleted: initially 150/160mg; may increase
after 2–4 weeks to max 300/320mg. Replacement therapy: substitute for the titrated
components.
Children: Not recommended. |
| NOTES | ||||
|
+ = scored tablets (Rev. 4/2013) |
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