📋 Indications & Clinical Dosage
*Hypertension:*
ORAL: Adult: Initially 5 mg once daily, lower initial doses may be required when used in addition to diuretic or in renal impairment; maintenance 20 mg once daily; max. 40 mg per day
Children 2-12 yrs & body-weight >20 kg: initially 100 mcg/kg once daily, monitor blood pressure carefully for 1-2 hr, increased as necessary up to max 1 mg/kg daily in 1-2 divided doses; 12-18 yr: initially 2.5 mg once daily, monitor blood pressure carefully for 1-2 hr, usual maintenance dose 10-20 mg daily in 1-2 divided doses, max 40 mg daily in 1-2 divided doses if body-weight over 50 kg.
BY IV INJ: Adult: 2.5-5 mg/day then increase as required, usual therapeutic dose for hypertension is 10-40 mg/day in 1-2 divided doses.
*Congestive Heart failure:*
Adult: Initially 2.5 mg once daily, increased if tolerated to 10-20 mg twice daily, dose to be increased gradually over 2-4 weeks.
*Prevention of symptomatic heart failure in patients with asymptomatic left ventricular dysfunction:*
Adult: Initially 2.5 mg once daily, increased if tolerated to 10-20 mg twice daily, dose to be increased gradually over 2-4 weeks.
💊 Mode of Administration
Give direct IVP over at least 5 min or dilute up to 50 ml and infuse.
⛔ Contraindications
Aortic stenosis, outflow obstruction.
⚠️ Precautions & Warnings
: Haemodialysis (avoid in patients dialysed with high-flux membranes), renal impairment, renovascular hypertension, severe congestive heart failure; monitor renal function before and during therapy, anaesthesia, desensitization, apheresis; withdraw ACE inhibitor before procedure.
🔄 Drug Interactions
K+ supplement, K+ -sparing diuretics, NSAIDs, antidiabetic agents, lithium, neuroleptics, narcotic drugs, antihypertensives, antacids, sympathomimetics, cyclosporin, immunosuppressants, cytostatic agents, corticosteroids, procainamide, allopurinol, alcohol.
⚠️ Adverse Reactions / Side Effects
Asthenia, blurred vision, depression, dyspnoea, alopecia, anorexia, arrhythmias, confusion, drowsiness, dry mouth, flushing, hyponatraemia, ileus, impotence, insomnia, muscle cramps, nervousness, palpitation, peptic ulcer, sweating, tinnitus, vertigo. Rare: Abnormal dreams, allergic alveolitis, exfoliative dermatitis, glossitis, gynaecomastia, pemphigus, pulmonary infiltrates, Raynauds syndrome, Stevens-
Johnson syndrome, stomatitis, toxic epidermal necrolysis
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Contraindicated in pregnancy.
Lactation / Breastfeeding:
Caution advised
🧪 Compatibility & Storage Stability
Compatibility: Stable in NS, D5W, DSNS.
Stability & Storage: IV solution is stable for 24 hours at room tempera-ture in D5W or NS.
📚 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.