📋 Indications & Clinical Dosage
*Hypertension:*
Adult: Initially 20-40 mg once daily for at least 4 weeks, increased if necessary up to 80 mg once daily.
*Prevention of cardiovascular events in patients with established atherosclerotic cardiovascular disease, or type 2 diabetes mellitus:*
Adult: 80 mg once daily
Children: Not recommended.
⛔ Contraindications
Cholestasis & biliary obstructive disorders, severe hepatic impairment, refractory hypokalaemia, hypercalcaemia.
⚠️ Precautions & Warnings
Patients who are volume or sodium depleted by diuretic therapy, dietary salt restriction, diarrhoea or vomiting, Impaired hepatic function, bilateral renal artery stenosis or stenosis of the artery to single functioning kidney, mild to moderate renal impairment, severe CHF; primary aldosteronism; aortic or mitral stenosis, obstructive hypertrophic cardiomyopathy, may impair glucose tolerance, he-reditary fructose intolerance, ischaemic cardiopathy or CV disease. Monitor serum K in patients at risk of hyperkalaemia.
🔄 Drug Interactions
Monitor digoxin & lithium levels during concomitant use, other kaliuretic diuretics, laxatives, corticoster-oids, ACTH, amphotericin, carbenoxolone, penicillin-G potassium, salicylic acid & derivatives.
⚠️ Adverse Reactions / Side Effects
Arthralgia, back pain, chest pain, eczema, GI disturbances, influenza-like symptoms, leg cramps, myalgia, pharyngitis, sinusitis, urinary-tract infection, asthenia, syncope, abnormal vision, anxiety, dry mouth, flatulence, sweating, tendinitis-like symptoms, vertigo. Rare: Blood disorders, bradycardia, depression, dyspnea, eosinophilia, increase in uric acid, insomnia, pruritus, rash, tachycardia
🤰 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.