Hypertension Treatments: Angiotensin II Receptor Blockers

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HYPERTENSION TREATMENTS: ARBs
Generic Brand Strength Form Usual Dose
ANGIOTENSIN II RECEPTOR BLOCKER (ARB)
azilsartan medoxomil Edarbi 40mg, 80mg tabs ≥18yrs: Monotherapy, not volume-depleted: 80mg once daily. Volume-depleted (eg, concomitant high-dose diuretics): initially 40mg once daily.
<18yrs: Not established.
candesartan cilexetil Atacand 4mg, 8mg, 16mg, 32mg scored tabs ≥18yrs: Monotherapy and not volume-depleted: initially 16mg once daily; usual range: 8−32mg once daily or in 2 divided doses. Salt/volume depleted or moderate hepatic impairment: consider lower initial dose. May add diuretic if needed.
<1yr or CrCl<30mL/min: Not recommended. Give once daily or in 2 divided doses. 1−<6yrs (may give oral susp if unable to swallow tabs): initially 0.2mg/kg/day; usual range: 0.05−0.4mg/kg/day. 6−<17yrs (<50kg): initially 4−8mg/day; usual range: 2−16mg/day; (>50kg): initially 8−16mg/day; usual range: 4−32mg/day. Salt/volume depletion: consider lower initial dose.
eprosartan mesylate Teveten 400mg, 600mg tabs Adults: Monotherapy: not volume depleted: initially 600mg once daily. Usual range: 400−800mg/day given as a single dose or in two divided doses.
Children: Not established.
irbesartan Avapro 75mg, 150mg, 300mg tabs ≥16yrs: 150mg once daily; may increase to 300mg once daily. Or, may add a low dose of diuretic. Salt/volume depletion: initially 75mg once daily.
Children: Not recommended.
losartan potassium Cozaar 25mg, 50mg, 100mg tabs Adults: Hypovolemia or hepatic insufficiency: initially 25mg once daily. Hypertension (HTN): initially 50mg once daily; range 25−100mg/day; max 100mg/day in 1 or 2 divided doses. HTN with LVH: initially 50mg once daily; then add HCTZ 12.5mg/day and/or increase losartan to 100mg/day, then may increase HCTZ to 25mg/day.
<6yrs or CrCl<30mL/min: Not recommended.
≥6yrs:
initially 0.7mg/kg (max 50mg) once daily; usual max 1.4mg/kg (100mg) once daily.
olmesartan medoxomil Benicar 5mg, 20mg, 40mg tabs ≥16yrs: Monotherapy, not volume-depleted: initially 20mg once daily; may increase to max 40mg once daily after 2wks. Volume depleted (eg, concomitant diuretic): consider lower initial dose.
<1yr: Do not give.
<6yrs: Not recommended. 6−16yrs: (20kg to <35kg):
initially 10mg once daily; may increase to max 20mg once daily after 2wks; (≥35kg): initially 20mg once daily; may increase to max 40mg once daily after 2wks. Tabs may be prepared as an oral suspension if unable to swallow: see full labeling.
telmisartan Micardis 20mg, 40mg, 80mg tabs Adults: Not volume-depleted: initially 40mg once daily; usual range 20−80mg/day. Salt/volume depleted: monitor closely or consider reduced dose. May add diuretic if insufficient response at 80mg/day.
Children: Not recommended.
valsartan Diovan 40mg+, 80mg, 160mg, 320mg tabs Adults: Monotherapy and not volume-depleted: initially 80mg or 160mg once daily; max 320mg once daily. Or, add a diuretic (more effective than increasing dose above 80mg).
<6yrs or CrCl<30mL/min: Not recommended.
6−16yrs:
Initially 1.3mg/kg once daily (up to 40mg total); max 2.7mg/kg (up to 160mg) once daily. If unable to swallow tabs, or calculated dose (mg/kg) does not correspond to available tab strengths, use suspension.
ARB + CALCIUM CHANNEL BLOCKER (DIHYDROPYRIDINE) + THIAZIDE DIURETIC
olmesartan/
amlodipine/
HCTZ
Tribenzor 20mg/
 
5mg/
  
12.5mg,
40mg/
 
5mg/
  
12.5mg,
40mg/
 
5mg/
  
25mg,
40mg/
 
10mg/
  
12.5mg,
40mg/
 
10mg/
  
25mg
tabs Adults: One tab daily. Titrate at 2‑week intervals; max one 40/10/25mg tab daily. Replacement therapy: may be substituted for individually titrated components. Add‑on/switch therapy: may be used to provide additional BP lowering for patients not adequately controlled on max tolerated, labeled or usual doses of any two antihypertensive classes: ARBs, CCBs, and diuretics. ≥75yrs or severe hepatic impairment: start amlodipine 2.5mg.
Children: Not established.
 
Generic Brand Strength Form Usual Dose
ARB + THIAZIDE DIURETIC
azilsartan medoxomil/
chlortha-
lidone
Edarby-
clor
40mg/
 
12.5mg, 40mg/
 
25mg
tabs ≥18yrs: Initially 40/12.5mg once daily. May increase to 40/25mg after 2−4wks as needed. Max: 40/25mg. Patients titrated to the individual components: may give corresponding dose of Edarbyclor. See full labeling.
<18yrs: Not established.
candesartan cilexetil/
HCTZ
Atacand HCT 16mg/
 
12.5mg, 32mg/
 
12.5mg, 32mg/
 
25mg
scored tabs Adults: Not for initial therapy. May be substituted for titrated components. BP not controlled on HCTZ 25mg once daily, or controlled but serum potassium decreased: one 16/12.5 tab once daily. BP not controlled on candesartan 32mg per day: initially one 32/12.5 tab once daily; may increase to 32/25 once daily. Moderate-to-severe hepatic impairment or CrCl≤30mL/min: not recommended.
Children: Not established.
eprosartan mesylate/
HCTZ
Teveten HCT 600mg/
 
12.5mg, 600mg/
 
25mg
tabs ≥18yrs: Not for initial therapy. May be substituted for titrated components. One 600mg/12.5mg tab once daily; after 2−3wks may increase to one 600mg/25mg tab once daily. May add eprosartan 300mg once daily in the PM if additional BP control is needed at trough. Moderate-to-severe renal impairment: max 600mg daily.
<18yrs: Not established.
irbesartan/
HCTZ
Avalide 150mg/
 
12.5mg, 300mg/
 
12.5mg
tabs Adults: Take once daily. Not controlled on monotherapy: initially 150/12.5mg, titrate to 300/12.5mg then 300/25mg if needed. Replacement therapy: may be substituted for titrated components. Initial therapy: start at 150/12.5mg for 1−2wks, then titrate as needed up to max 300mg/25mg. Maximum effects within 2−4wks after dose change. CrCl≤30mL/min: not recommended.
Children: Not recommended.
losartan potassium/
HCTZ
Hyzaar 50mg/
 
12.5mg, 100mg/
 
12.5mg, 100mg/
 
25mg
tabs ≥18yrs: One 50/12.5mg tab once daily; may increase after about 3wks (2−4wks for severe HTN) to two 50/12.5mg tabs once daily or one 100/25mg tab once daily. Titrate components: see literature. HTN with LVH: switch from losartan monotherapy (see full labeling). Severe renal impairment (CrCl<30mL/min): not recommended.
<18yrs: Not established.
olmesartan medoxomil/
HCTZ
Benicar HCT 20mg/
 
12.5mg, 40mg/
 
12.5mg, 40mg/
 
25mg
tabs ≥18yrs: Not for initial therapy. May be substituted for titrated components. Individualize. BP not controlled on olmesartan or HCTZ alone: one tab once daily; may titrate at 2−4‑week intervals; usual max 40mg/25mg once daily. Severe renal impairment (CrCl≤30mL/min): not recommended. Volume depleted: reduce dose.
<18yrs: Not established.
telmisartan/
HCTZ
Micardis HCT 40mg/
 
12.5mg, 80mg/
 
12.5mg, 80mg/
 
25mg
tabs Adults: Not for initial therapy. May be substituted for titrated components. BP not controlled on telmisartan 80mg/day: one 80mg/12.5mg tab once daily; may titrate to 160mg/25mg. BP not controlled on HCTZ 25mg/day: one 80mg/12.5mg tab or 80mg/25mg tab once daily; may titrate to 160mg/25mg if BP uncontrolled after 2−4wks. BP controlled on HCTZ 25mg/day but hypokalemic: One 80mg/12.5mg tab once daily. CrCl≤30mL/min: not recommended. Hepatic insufficiency or biliary obstruction: initially one 40mg/12.5mg tab once daily; monitor closely. Severe hepatic impairment: not recommended.
Children: Not established.
valsartan/
HCTZ
Diovan HCT 80mg/
 
12.5mg, 160mg/
 
12.5mg, 160mg/
 
25mg, 320mg/
 
12.5mg, 320mg/
 
25mg
tabs Adults: Take once daily. Add‑on or initial therapy and not volume-depleted: Initially 160mg/12.5mg; may increase after 1−2wks up to max 320mg/25mg. Replacement therapy: may be substituted for the titrated components. Maximum effects within 2−4wks after dose change. CrCl≤30mL/min: not recommended.
Children: Not recommended.
CALCIUM CHANNEL BLOCKER (DIHYDROPYRIDINE) + ARB
amlodipine besylate/
olmesartan medoxomil
Azor 5mg/
 
20mg, 5mg/
 
40mg, 10mg/
 
20mg, 10mg/
 
40mg
tabs Adults: Take once daily. Initial therapy: initially 5/20mg; may increase after 1−2wks up to max 10mg/40mg; ≥75yrs old or hepatic impairment: not recommended. Replacement therapy: may be substituted for titrated components. Add‑on therapy: may be used if not controlled on monotherapy. Individualize; titrate at 2‑week intervals up to max 10/40mg once daily, usually by increasing dose of one or both components if BP not controlled on prior therapy.
Children: Not established.
amlodipine besylate/
telmisartan
Twynsta 5mg/
 
40mg, 5mg/
 
80mg, 10mg/
 
40mg, 10mg/
 
80mg
tabs Adults: Take once daily. Initial therapy: 5/40mg or 5/80mg; may titrate at 2‑week intervals to max 10/80mg. Add‑on therapy: may be used if not controlled on monotherapy; if dose-limiting adverse reactions with amlodipine 10mg, switch to 5/40mg tab. Replacement therapy: may be substituted for the titrated components. Renal and/or hepatic impairment: titrate slower. ≥75yrs, or hepatic impairment: not for initial use (initially use amlodipine alone, or add amlodipine 2.5mg to telmisartan).
Children: Not established.
amlodipine besylate/
valsartan
Exforge 5mg/
 
160mg, 5mg/
 
320mg, 10mg/
 
160mg, 10mg/
 
320mg
tabs Adults: Take once daily. Initial therapy and not volume depleted: Initially 5/160mg; may increase after 1−2wks up to max 10/320mg. Add‑on therapy: may be used if not controlled on monotherapy; if inadequate response after 3−4wks, may titrate up to max 10/320mg. Replacement therapy: may be substituted for the titrated components. Maximum effects within 2wks after dose change. Elderly, hepatic impairment: initial therapy not recommended.
Children: Not established.
NOTES

Key: + = scored tabs.

(Rev. 10/2015)

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