📋 Indications & Clinical Dosage
*Hypertension:*
Adult: Initially 8 mg once daily, increased if necessary up to 32 mg once daily, increased at intervals of 4 weeks; usual dose 8 mg once daily.
Children 6-18 yrs: initially 4 mg once daily (reduced dose in intravascular volume depletion), adjusted according to response, max 8 mg once daily.
*Hypertension with intravascular volume depletion:*
Adult: Initially 4 mg once daily, increased if necessary up to 32 mg daily, increased at intervals of4 weeks; usual dose 8 mg once daily.
*Heart failure with impaired left ventricular systolic function when ACE inhibitors are not tolerated or in conjunction with an ACE inhibitor:*
Adult: Initially 4 mg once daily, increased at intervals of at least 2 weeks to required dose of 32 mg once daily or to max. tolerated dose.
⛔ Contraindications
Severe hepatic impairment, cholestasis.
⚠️ Precautions & Warnings
Correct volume/salt depletion before starting ther-apy, anaesthesia, renal impairment; monitor serum potassium and creatinine, severe renal impairment, haemodialysis; carefully titrate dose and monitor BP thoroughly, renal artery stenosis, aortic or mitral stenosis, kidney transplant, obstructive hypertrophic cardiomyopathy, severe congestive heart failure, mild to moderate hepatic impairment, primary hyperaldosteronism.
🔄 Drug Interactions
K+-sparing diuretics, K+-supplement, lithium.
⚠️ Adverse Reactions / Side Effects
Headache, vertigo. Rare: Arthralgia, back pain, blood disorders, cough, hepatitis, hyponatraemia, myalgia, nausea, pruritus, rash, urticaria
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Contraindicated in pregnancy.
Lactation / Breastfeeding:
Not recommended.
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.