20 to 50     : Dose as in normal renal function
10 to 20     : Dose as in normal renal function
<10           : Initial dose 500 mcg once daily, and increase according to response
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                : Unknown dialysability. Dose as in GFR <10 mL/min
HD                     : Dialysed. Dose as in GFR <10 mL/min
HDF/high flux   : 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 function Close monitoring of renal function required during therapy in patients with renal insufficiency Renal failure has been reported in association with ACE inhibitors in patients with renal artery stenosis, post renal transplant, and those with congestive heart failure High incidence of anaphylactoid reactions has been reported in patients dialysed with high-flux polyacrylonitrile membranes and treated concomitantly with an ACE inhibitor – this combination should therefore be avoided Normal doses can be used in CKD 5 .