| ANGIOTENSIN II RECEPTOR BLOCKER (ARB) |
| candesartan cilexetil |
Atacand
(AstraZeneca) |
4mg, 8mg, 16mg, 32mg |
tabs |
≥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.
<18yrs: Not recommended. |
| eprosartan (as mesylate) |
Teveten
(Abbott) |
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
(Bristol-Myers Squibb) |
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 |
Adults: 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: Not recommended |
| 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 alternative
therapy. 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). |
| 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 (besylate)/ telmisartan |
Twynsta
(Boehringer Ingelheim) |
5mg/40mg, 5mg/80mg, 10mg/40mg, 10mg/80mg |
tabs |
Adults: Take once daily. Initial therapy: 40/5mg or
80/5mg; may titrate at 2-week intervals to max
80/10mg. Add-on therapy: may be used if not controlled on monotherapy;
if dose-limiting adverse reactions with amlodipine 10mg, switch to 40/5mg tab.
Replacement therapy: may be substituted for the titrated components. Renal and/or hepatic
impairment: titrate slower. >75yrs, or hepatic impairment: not for initial use
(initially use amlodipine alone, or add amlodipine 2.5mg to telmisartan).
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. |
| ANGIOTENSIN II RECEPTOR BLOCKER + DIURETIC |
| candesartan cilexetil/ hydrochlorothiazide |
Atacand HCT
(AstraZeneca) |
16mg/12.5mg, 32mg/12.5mg |
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
(Abbott) |
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
(Bristol-Myers Squibb) |
150mg/12.5mg, 300mg/12.5mg,
300mg/25mg |
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. |