Hypertension, as monotherapy or with other antihypertensives. As initial therapy in patients likely to need multiple drugs to achieve blood pressure goals.
Take consistently with regard to meals (absorption reduced by high-fat 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: may be substituted for the titrated components.
Direct renin inhibitor + angiotensin II receptor blocker.
Fetal toxicity may develop; discontinue if pregnancy is detected. Correct hypovolemia before starting, or start under close supervision. CHF. Recent MI. Severe heart failure in patients whose renal function depends on renin-angiotensin-aldosterone system. Moderate renal impairment (CrCl <60mL/min): avoid. Hepatic dysfunction. Renal artery stenosis. History of dialysis. Surgery. Monitor renal function, serum potassium periodically. Neonates. Pregnancy (Cat.D); avoid. Nursing mothers: not recommended.
Concomitant cyclosporine, itraconazole: not recommended. Hyperkalemia with NSAIDs, K+ supplements, K+ sparing diuretics, K+ containing salt supplements. May be antagonized by, and renal toxicity potentiated by NSAIDs (including COX-2 inhibitors): monitor renal function in elderly and/or volume-depleted. May be potentiated by inhibitors of hepatic uptake transporter OATP1B1 (eg, rifampin), or efflux transporter MRP2 (eg, ritonavir).
Fatigue, nasopharyngitis, GI upset; rare: hypotension, angioedema (discontinue if occurs).