20 to 50     : Dose as in normal renal function
10 to 20     : Dose as in normal renal function. Start with low doses
<10           : Dose as in normal renal function Initial dose 10 mg daily and gradually increase
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Not dialysed. Dose as in GFR <10 mL/min
HD                     :Not dialysed. Dose as in GFR <10 mL/min
HDF/high flux   :Unlikely to be dialysed. Dose as in GFR <10 mL/min
CAV/VVHD      :Unknown dialysability. Dose as in 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 toxicity)
Potassium 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
Hyperkalaemia and other side effects are more common in patients with impaired renal functionRenal 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 failureClose monitoring of renal function during therapy is necessary in those with renal insufficiencyIn mild, moderate and severe renal failure, the AUC is increased by 62, 82 and 179% respectively