Not for initial therapy. Initially 10mg/12.5mg or 20mg/12.5mg. Wait 2–3 weeks before increasing HCTZ dose. Max 80mg/50mg daily. CrCl <30mL/min: not recommended.
ACE inhibitor + diuretic.
History of ACEI-associated or other angioedema. Anuria. Sulfonamide hypersensitivity. Concomitant aliskiren in patients with diabetes.
Fetal toxicity may develop; discontinue if pregnancy is detected. Severe CHF. Ischemic heart disease. Cerebrovascular disease. Arrhythmias. Salt/volume depletion. Postsympathectomy. Renal or hepatic impairment. Dialysis (esp. high-flux membrane). Gout. Asthma. SLE. Acute myopia. Secondary angle-closure glaucoma. Renal or aortic stenosis. Hypertrophic cardiomyopathy. Surgery. Monitor renal function and serum potassium in diabetics, serum electrolytes. Monitor WBCs in renal and collagen vascular disease. Discontinue if angioedema, laryngeal edema, marked elevations of liver enzymes, or jaundice occurs. Black patients may have higher risk of angioedema than non-black patients. Elderly. Neonates. Pregnancy (Cat.D); montor. Nursing mothers: not recommended.
See Contraindications. Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Concomitant aliskiren in renal impairment (CrCl <60mL/min): not recommended. May cause hypotension or increased BUN with diuretics. Antagonized by, and increased risk of renal failure with, NSAIDs including selective COX-2 inhibitors; monitor. May increase lithium levels (not recommended); monitor frequently. Nitritoid reactions with concomitant injectable gold (sodium autothiomalate); rare. Dosage adjustment of antidiabetics (oral agents, insulin) may be required. Impaired absorption with cholestyramine, colestipol resins. May antagonize pressor amines (eg, norepinepherine). Potentiates tubocurarine. Hyperkalemia with K+-sparing diuretics, K+ supplements and K+-containing salt substitutes. Hypokalemia with ACTH, corticosteroids. Orthostatic hypotension may be increased by alcohol, CNS depressants. May interfere with parathyroid tests.
Dizziness, headache, cough, fatigue, orthostatic hypotension, diarrhea, vomiting, dyspepsia, upper respiratory infection, muscle cramps, asthenia, paresthesia, rash, impotence, electrolyte disturbances (hypokalemia, hyperkalemia, hyponatremia), hyperuricemia.