20 to 50     : Dose as in normal renal function
10 to 20     : Initial dose 2 mg and increase according to response
<10           : Initial dose 2 mg and increase according to response
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Unlikely to be dialysed. Dose as for GFR <10 mL/min
HD                     :Not dialysed. Dose as for GFR <10 mL/min
HDF/high flux   :Not dialysed. Dose as for GFR <10 mL/min
CAV/VVHD      :Unlikely to be dialysed. Dose as for GFR 10 to 20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Anaesthetics: enhanced hypotensive effect Analgesics: antagonism of hypotensive effect and increased risk of renal impairment with NSAIDs; hyperkalaemia with ketorolac and other NSAIDs
Ciclosporin: increased risk of hyperkalaemia and nephrotoxicity
Diuretics: enhanced hypotensive effect; hyperkalaemia with potassium-sparing diuretics
Epoetin: increased risk of hyperkalaemia; antagonism of hypotensive effect
Lithium: reduced excretion, possibility of enhanced lithium toxicityP
otassium salts: increased risk of hyperkalaemia.
Tacrolimus: increased risk of hyperkalaemia and nephrotoxicity
ADMINISTRATION
Reconstition
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Route
Oral
Rate of Administration
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Comments
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OTHER INFORMATION
In patients with mild–moderate renal impairment Cmax and AUC are increased by 50% and 70% respectively. Corresponding changes in patients with severe renal impairment are 50% and 110% respectively
Adverse reactions, especially hyperkalaemia, are more common in patients with renal impairment
Renal failure has been reported in association with angiotensin-II antagonists in patients with renal artery stenosis, post renal transplant, and in those with congestive heart failure
Close monitoring of renal function during therapy is necessary in those with renal insufficiency