Hypertension Treatments: ACE Inhibitors

HYPERTENSION TREATMENTS: ACE INHIBITORS
Generic Brand Strength Form Usual Dose
ACE INHIBITORS
benazepril HCl Lotensin 5mg, 10mg, 20mg, 40mg tabs Adults: If not on diuretic: initially 10mg daily. Usual maintenance: 20−40mg daily in 1 or 2 divided doses; usual max 80mg/day. If on diuretic: discontinue diuretic, if possible, 2−3 days before starting; resume diuretic if pressure not controlled with benazepril alone. If diuretic cannot be discontinued: initially 5mg daily. CrCl <30mL/min/1.73m²: initially 5mg daily; max 40mg/day.
Children: <6yrs or CrCl <30mL/min/1.73m²: not recommended. ≥6yrs: Initially 0.2mg/kg daily; usual max 0.6mg/kg/day (or 40mg/day).
captopril Capoten 12.5mg, 25mg, 50mg, 100mg scored tabs Adults: Take 1hr before meals. Initially 25mg 2−3 times daily. After 1−2wks may increase to 50mg 2−3 times daily. If control unsatisfactory, see literature. Titrate to usual dose after several days. Monitor closely for 1st 2wks and if dose increased; max 450mg/day. Renal impairment: See literature.
Children: See literature.
enalapril maleate Epaned 150mg/
 
150mL
pwd for oral soln Adults: If on diuretics, CrCl <30mL/min, or on dialysis (give on dialysis days): initially 2.5mg daily; max 40mg. Others: initially 5mg daily; may titrate up to max 40mg daily in 1−2 divided doses. Vasotec: if on diuretics, suspend diuretic for 2−3 days before initiation if possible. Monitor closely for 1st 2wks.
Children: Neonates or CrCl <30mL/min: not recommended. ≥1mo: Initially 0.08mg/kg (up to 5mg) once daily; max 0.58mg/kg (or 40mg) daily. Suspension form may be prepared if unable to swallow tabs: see literature.
Vasotec 2.5mg, 5mg, 10mg, 20mg scored tabs
fosinopril sodium 10mg+, 20mg, 40mg tabs Adults: Initially 10mg once daily. Usual maintenance: 20−40mg daily in 1−2 divided doses; max 80mg/day. If on diuretic: suspend diuretic for 2−3 days before starting if possible; resume diuretic if pressure not controlled with fosinopril alone. If diuretic cannot be discontinued: give 10mg and monitor carefully.
Children: <6yrs (≤50kg): not recommended. ≥6yrs (>50kg): 5−10mg once daily.
lisinopril Prinivil 5mg, 10mg, 20mg scored tabs Adults: Initially and if not on diuretics: 10mg once daily. Usual range: 20−40mg once daily. If on diuretic: suspend diuretic for 2−3 days before starting; resume diuretic if BP not controlled by lisinopril alone. If diuretic cannot be discontinued: initially 5mg daily (supervise 1st dose). CrCl 10−30mL/min: initially 5mg daily; CrCl <10mL/min: initially 2.5mg daily; max 40mg daily.
Children: <6yrs or CrCl <30mL/min/1.73m²: not established. ≥6yrs: initially 0.07mg/kg (max 5mg) once daily; usual max 0.61mg/kg (40mg) once daily.
Zestril 2.5mg, 5mg+, 10mg, 20mg, 30mg, 40mg tabs Adults: Initially and if not on diuretics: 10mg once daily. Usual range: 20−40mg once daily. Doses up to 80mg have been used. If BP not controlled by lisinopril alone, may add low-dose diuretic. After adding diuretic, may need to reduce lisinopril dose. If on diuretics: initially 5mg daily. CrCl 10−30mL/min: initially 5mg daily; CrCl<10mL/min or hemodialysis: initially 2.5mg daily; max 40mg daily.
Children: <6yrs or CrCl <30mL/min/1.73m²: not established. ≥6yrs: initially 0.07mg/kg (max 5mg) once daily; usual max 0.61mg/kg (40mg) once daily.
moexipril HCl Univasc 7.5mg, 15mg scored tabs Adults: Take 1hr before meals. Initially and if not on diuretics: 7.5mg once daily; usual range 7.5−30mg/day in 1−2 divided doses. If on diuretic: suspend diuretic for 2−3 days before starting therapy; resume diuretic if BP not controlled by moexipril alone. If diuretic cannot be discontinued: initially 3.75mg once daily. CrCl <40mL/min/1.73m²: initially 3.75mg once daily; max 15mg/day.
Children: Not established.
perindopril erbumine Aceon 2mg, 4mg, 8mg scored tabs Adults: If not on diuretic: initially 4mg once daily. Titrate; max 16mg/day. Usual maintenance 4−8mg daily in 1−2 divided doses. If on diuretic: consider reducing diuretic dose prior to starting therapy. Renal impairment: CrCl <30mL/min: not recommended; CrCl >30mL/min: initially 2mg/day: max 8mg/day.
Children: Not recommended.
quinapril HCl Accupril 5mg+, 10mg, 20mg, 40mg tabs Adults: Monotherapy: initially 10−20mg once daily. Usual maintenance: 20−80mg daily in 1−2 divided doses. Elderly: initially 10mg once daily. Patients on diuretic: suspend diuretic for 2−3 days before starting; resume diuretic if BP not controlled by quinapril alone. If diuretic cannot be discontinued, or if CrCl 30−60mL/min: initially 5mg daily. CrCl 10−30mL/min: initially 2.5mg daily.
Children: Not established.
ramipril Altace 1.25mg, 2.5mg, 5mg, 10mg gel caps Adults: Initially 2.5mg once daily. Maintenance: 2.5−20mg daily in 1−2 divided doses. May add a diuretic if BP is not controlled. CrCl <40mL/min: 1.25mg once daily; max 5mg/day.
Children: Not established.
trandolapril Mavik 1mg+, 2mg, 4mg tabs Adults: If not on diuretic: initially 1mg once daily in non-black patients; 2mg in black patients. If on diuretic: suspend diuretic for 2−3 days before starting therapy; resume diuretic if BP not controlled with trandolapril alone. If diuretic cannot be discontinued (supervise closely until stabilized), or in renal impairment (CrCl<30mL/min) or hepatic cirrhosis: initially 0.5mg once daily. For all: adjust at 1‑week intervals; usual range 2−4mg once daily; usual max 8mg/day; may give in 2 divided doses.
Children: Not established.
 
Generic Brand Strength Form Usual Dose
ACE INHIBITOR + DIURETIC
benazepril HCl/
hydrochloro-
thiazide
Lotensin HCT 5mg/
 
6.25mg, 10mg/
 
12.5mg, 20mg/
 
12.5mg, 20mg/25mg
scored tabs Adults: Switching from benazepril monotherapy: initially 10/12.5mg once daily. Or, titrate individual components.
Children: Not established.
captopril/
hydrochloro-
thiazide
Capozide 25mg/15mg, 25mg/25mg, 50mg/15mg, 50mg/25mg scored tabs Adults: Take 1hr before meals. As initial therapy: one 25/15 tab daily; adjust at 6‑week intervals. Previously titrated: use same doses as individual components. Usual max 150mg/day captopril and 50mg/day HTCZ.
Children: See literature.
enalapril maleate/
hydrochloro-
thiazide
Vaseretic 10mg/25mg tabs Adults: Switching from monotherapy with either component: start 10/25 once daily; max 20mg/day enalapril and 50mg/day HCTZ. Titrate HTCZ after 2−3wks. Or, substitute for individually titrated components.
Children: Not established.
fosinopril sodium/
hydrochloro-
thiazide
10mg/
 
12.5mg, 20mg/
 
12.5mg
tabs Adults: Not for initial therapy. Give once daily. Usual range: fosinopril: 10−20mg; HCTZ: 12.5−50mg. Severe renal impairment (CrCl<30mL/min): not recommended.
Children: Not recommended.
lisinopril/
hydrochloro-
thiazide
Prinzide 10mg/
 
12.5mg, 20mg/
 
12.5mg+
tabs Adults: Not for initial therapy. Initially 10/12.5 or 20/12.5; titrate HCTZ dose after 2−3wks. Max 80/50mg daily. CrCl <30mL/min: not recommended.
Children: Not recommended.
Zestor-
etic
10mg/
 
12.5mg, 20mg/
 
12.5mg, 20mg/25mg
tabs Adults: Switching from monotherapy with either component: start 10/12.5 or 20/12.5 once daily; titrate HTCZ after 2−3wks. If on diuretic: if possible, suspend diuretic for 2−3 days, then adjust. Or, substitute for individually titrated components.
Children: Not established.
moexipril 
HCl/
hydrochloro-
thiazide
Uniretic 7.5mg/
 
12.5mg, 15mg/
 
12.5mg, 15mg/25mg
scored tabs Adults: Not for initial therapy. Take 1hr before a meal. Switching from monotherapy with either component: 1 tab once daily; adjust at 2−3wk intervals; usual max 30mg moexipril and 50mg HTCZ daily. Or, substitute for individually-titrated components.
Children: Not established.
quinapril HCl/
hydrochloro-
thiazide
Accuretic 10mg/
 
12.5mg+, 20mg/
 
12.5mg+, 20mg/25mg
tabs Adults: Not for initial therapy. Previously titrated: use same doses as individual components. Switching from quinapril monotherapy: initially one 10/12.5 tab or one 20/12.5 tab once daily; allow 2−3wks before increasing HTCZ component. Switching from HTCZ 25mg/day monotherapy: initially one 10/12.5 or 20/12.5 tab once daily. Adjust based on response and serum potassium. Renal impairment (CrCl ≤30mL/min): not recommended.
Children: Not established.
CALCIUM CHANNEL BLOCKER + ACE INHIBITOR
amlodipine besylate/
benazepril 
HCl
Lotrel 2.5mg/
 
10mg, 5mg/10mg, 5mg/20mg, 5mg/40mg, 10mg/20mg, 10mg/40mg
caps Adults: Not for initial therapy. Not controlled with dihydropyridine CCB, ACEI, amlodipine: initially 2.5/10 once daily; may titrate to 10/40 once daily if BP uncontrolled. Or, substitute for individually titrated components. CrCl ≤30mL/min: not recommended. Hepatic impairment, elderly: consider lower doses.
Children: Not recommended.
trandolapril/
verapamil 
HCl ER
Tarka 1mg/240mg, 2mg/180mg, 2mg/240mg, 4mg/240mg tabs ≥18yrs: Not for initial therapy. 1 tab daily. Titrate individual components. Take with food.
<18yrs: Not established.
NOTES

Key: + = scored

(Rev. 8/2014)

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