Indication:

Hypertension, IHD, Heart failure

Pharmacology:

Dosage (breakdown or, not) :

Adult:

Oral Adult Hypertension 4-8 mg PO qDay or divided q12hr Maximum: 16 mg/day PO divided q12hr Stable Coronary Artery Disease (CAD) 4 mg PO qDay for 2 weeks, THEN increase as tolerated to 8 mg/day PO divided q12hr Reduce risk of cardiovascular mortality or MI in patients with stable CAD Heart Failure 2 mg PO qDay initially to maximum 8-16 mg PO qDay Elderly: Initially, 2 mg once daily. Dose may be increased to max 8 mg

Child: 

Renal impairment: CrCl (ml/min) Dosage Recommendation <15 2 mg on dialysis days. 15-30 2 mg on alternate days. 30-60 2 mg

Administration

Should be taken on an empty stomach. Take before meals.

 Interaction:

May enhance hypotensive effect w/ diuretics. Additive hyperkalaemic effect w/ K supplements, K-sparing diuretics, and other drugs (e.g. ciclosporin, heparin, indometacin). May increase serum levels and toxicity of lithium. Antihypertensive effect may be reduced by aspirin or other NSAIDs. Coadministration w/ NSAIDs may also increase the risk of renal impairment. Increased risk of hypoglycaemia w/ antidiabetic agents. Rarely, nitritoid reactions occur w/ concomitant use of gold (sodium aurothiomalate). Potentially Fatal: Increased risk of hypotension, hyperkalaemia and changes in renal function (including acute renal failure) w/ aliskiren in patients w/ diabetes or renal impairment.

Contraindication:

History of angioedema related to previous ACE inhibitor treatment. Pregnancy (2nd/3rd trimesters).

Side Effect

>10% Headache (23%),Cough (12%) 1-10% Dizziness (8%),Back pain (6%),Lower extremity pain (5%),Abnormal ECG (2%),Palpitation (1%),Depression (2%),Somnolence (1%),Menstrual disorder (1%),Edema (4%),ALT increased (2%),Sexual dysfunction (male 1%),Sleep disorder (3%),Chest pain (2%),Nausea/vomiting (2%),Flatulence (1%),Rash (2%),Hyperkalemia (1%),Tinnitus (2%) Frequency Not Defined Intestinal angioedema,Liver failure (rare),Leukopenia,Pruritus,Stroke,Syncope,Urinary retention,Vertigo,Amnesia Angioedema, More frequent in black patients (0.1%), Angioedema of lips, More frequent in black patients (0.1%), Angioedema of throat, More frequent in black patients (0.1%) Potentially Fatal: Anaphylactoid reactions, angioedema.

Precaution:

History of airway surgery. Withdraw if there is significant increase in LFTs. Risk factors for hyperkalaemia; monitor potassium closely. Patients dependent on renin-angiotensin-aldosterone system; consider withdrawal in patients with progressive deterioration in renal function. Collagen vascular disease. Hypovolaemia; monitor BP with the 1st dose. Unilateral renal artery stenosis and pre-existing renal insufficiency; valvular aortic stenosis. Before, during, or immediately after anaesthesia. May impair ability to drive or operate machinery. Lactation. Lactation: not known if distributed into breast milk; use caution