Dosage and Administration
Administration
Administer orally.
Dosage
Individualize according to requirements and response. Use lowest dosage necessary to produce desired clinical effect.
If added to potent hypotensive agent regimen, initially reduce hypotensive dosage to avoid the possibility of severe hypotension.
Pediatric Patients
Usual Dosage
Oral
Infants <6 months of age: Up to 3 mg/kg daily, in 2 divided doses; up to 37.5 mg daily.
Infants 6 months to 2 years of age: Usually, 1–2 mg/kg daily, in a single or 2 divided doses, up to 37.5 mg daily.
Children 2–12 years of age: 1–2 mg/kg daily, in a single or 2 divided doses, up to 100 mg daily.
Hypertension
Oral
Initially, 1 mg/kg once daily. Increase dosage as necessary up to a maximum of 3 mg/kg (up to 50 mg) once daily.
Adults
Hypertension
BP Monitoring and Treatment Goals
Carefully monitor BP during initial titration or subsequent upward adjustment in dosage.
Avoid large or abrupt reductions in BP.
Adjust dosage at approximately monthly intervals (more aggressively in high-risk patients [stage 2 hypertension, comorbid conditions]) if BP control is inadequate at a given dosage; it may take months to control hypertension adequately while avoiding adverse effects of therapy.
SBP is the principal clinical end point, especially in middle-aged and geriatric patients. Once the goal SBP is attained, the goal DBP usually is achieved.
The goal is to achieve and maintain a lifelong SBP <140 mm Hg and a DBP <90 mm Hg if tolerated.
The goal in hypertensive patients with diabetes mellitus or renal impairment is to achieve and maintain a SBP <130 mm Hg and a DBP <80 mm Hg.
Monotherapy
Oral
Initially, 12.5–25 mg daily.
Gradually increase until the desired therapeutic response is achieved or adverse effects become intolerable, up to 50 mg daily.
If adequate response is not achieved at maximum dosage, add or substitute another hypotensive agent.
Maintenance
Usually, 12.5–50 mg once daily.
Combination Therapy
Oral
Initially, administer each drug separately to adjust dosage.
May use fixed combination if optimum maintenance dosage corresponds to drug ratio in combination preparation.
Administer each drug separately whenever dosage adjustment is necessary.
Alternatively, may initially use certain (low-dose hydrochlorothiazide/other antihypertensive) fixed combinations for potentiation of antihypertensive effect and minimization of potential dose-related adverse effects of each drug.
Edema
Oral
Usually, 25–100 mg daily in 1–3 divided doses.
Many patients also may respond to intermittent therapy (e.g., alternate days, 3–5 days weekly); decreased risk of excessive diuretic response and resulting electrolyte imbalance.
Prescribing Limits
Pediatric Patients
Usual Dosage
Oral
Infants <2 years of age: Maximum 37.5 mg daily.
Children 2–12 years of age: Maximum 100 daily.
Hypertension
Oral
Maximum 3 mg/kg (up to 50 mg) once daily.
Adults
Hypertension
Oral
Maximum before switching/adding alternative drug is 50 mg daily.
Higher dosages had been used in the past (up to 200 mg daily) but no longer are recommended because of the risk of adverse effects (e.g., markedly decreased serum potassium). Instead, switch to or add alternative drug.
Special Populations
Dosage in Hepatic Impairment
No specific dosage recommendations for hepatic impairment; caution because of risk of precipitating hepatic coma.
Dosage in Renal Impairment
No specific dosage recommendations for renal impairment; caution because of risk of precipitating azotemia.
Geriatric Patients
Initiate therapy at the lowest dosage (12.5 mg daily); may adjust dosage in increments of 12.5 mg if needed.
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