Hypertension Drug Summary

Last updated: 06 May 2025

Content on this page:

ACE Inhibitors*

Content on this page:

ACE Inhibitors*

ACE Inhibitors*


Drug Dosage Remarks
Benazepril Initial dose: 10 mg PO 24 hourly
Maintenance dose: 20-40 mg/day PO
Max dose: 40-80 mg/day		 Adverse Reactions
  • CV effects (hypotension, angioedema); CNS effects (fatigue, headache); GI effects (taste disturbances, nausea/vomiting); Respiratory effects (persistent dry cough; upper respiratory tract symptoms); Dermatologic effects (skin rashes, erythema multiforme, toxic epidermal necrolysis); Hypersensitivity reactions; Renal effect (renal impairment); Electrolyte disturbances (hyperkalemia, hyponatremia); Blood disorders
Special Instructions
  • Patients with HF and those who may be salt or water depleted (taking diuretic or on dialysis) may experience hypotension during initial stages of ACE inhibitor therapy
    • Start treatment only under close medical supervision; in these patients use a low dose and have the patient in a supine position
  • Avoid in patients with SBP <100 mmHg, aortic stenosis or outflow tract obstruction and should generally be avoided in suspected or actual renovascular disease
  • Avoid in patients with history of hereditary or idiopathic angioedema and in those with history of angioedema related to previous treatment with ACE inhibitors
  • Renal function should be assessed prior to administration of ACE inhibitors, during therapy, and over the first few days after initiation
    • Patient with renal disease or taking high doses should be monitored regularly for proteinuria
Captopril Initial dose: 12.5 mg PO 12 hourly
May increase gradually at 2-4 weeks intervals
Maintenance dose: 50 mg PO 12 hourly  
Max dose: 150 mg/day
Cilazapril Initial dose: 1 mg PO 24 hourly
May adjust dose once every 2-4 weeks
Maintenance dose: 2.5-5 mg PO 24 hourly Max dose: 10 mg/day
Delapril Initial dose:  15 mg PO 24 hourly
Maintenance dose: 15-30 mg PO 12 hourly
Max dose: 120 mg/day
Enalapril Initial dose (patient taking diuretic):
2.5 mg PO 24 hourly
Initial dose (patient not on diuretic):
5 mg PO 24 hourly
Maintenance dose: 10-20 mg PO 24 hourly
Max dose: 40 mg/day or
As Enalaprilat: 1.25 mg IV 6 hourly
Fosinopril Initial dose (with or without diuretic):  10 mg PO 24 hourly
Maintenance dose: 10-40 mg PO 24 hourly
Max dose: 80 mg/day
Imidapril Initial dose: 5 mg PO 24 hourly
Maintenance dose: 10 mg PO 24 hourly Max dose: 20 mg/day
Lisinopril Initial dose (patient taking diuretic):
5 mg PO 24 hourly
Initial dose (patient not on diuretic):
5-10 mg PO 24 hourly
Maintenance dose: 20-40 mg PO 24 hourly
Max dose: 80 mg/day
Moexipril Initial dose (patient taking diuretic): 3.75 mg PO 24 hourly
Initial dose (patient not on diuretic):
7.5 mg PO 24 hourly
Maintenance dose:
7.5-15 mg PO 24 hourly
(May give dose 12 hourly if control is inadequate with single daily dose)
Max dose: 30 mg/day
Perindopril Initial dose:  4-5 mg PO 24 hourly
May increase to 8-10 mg PO 24 hourly after 1 month of treatment
Max dose: 8-10 mg/day
Quinapril Initial dose (patient taking diuretic):
5 mg PO 24 hourly
Initial dose (patient not on diuretic):
 10-20 mg PO 24 hourly
Maintenance dose: 20-40 mg PO 24 hourly
Max dose: 80 mg/day
Ramipril Initial dose: 1.25-2.5 mg PO 24 hourly
Maintenance dose: 2.5-5 mg PO 24 hourly
Max dose: 10 mg/day
Trandolapril Initial dose (patient taking diuretic):
0.5 mg PO 24 hourly
Initial dose (patient not on diuretic):
1 mg PO 24 hourly
Maintenance dose: 1-2 mg PO 24 hourly
Max dose: 4 mg/day
Zofenopril Initial dose: 15 mg PO 24 hourly
May increase dose at 4-week intervals 
Usual effective dose: 30 mg PO 24 hourly
Max dose: 60 mg/day, administered in single or two divided doses
If diuretic cannot be discontinued prior to initiation of therapy, initial dose should be 7.5 mg daily
*If possible, discontinue diuretics 2-3 days before initiating therapy with ACE inhibitors. Otherwise, monitor patient closely during therapy.

Angiotensin II Antagonists


Drug Dosage Remarks
Azilsartan medoxomil Initial dose: 40 mg PO 24 hourly
May increase up to 80 mg PO 24 hourly		 Adverse Reactions
  • Usually mild and transient: CNS effects (dizziness, headache); CV effect (dose-related orthostatic hypotension which may occur particularly in patients with volume depletion); Renal impairment
  • Rare effects: Rash, angioedema, elevated LFTs, myalgia
Special Instructions
  • Patients with volume depletion (eg high-dose diuretic therapy) may experience hypotension and should be started on low dose
  • Use with caution in patients with renal artery, aortic or mitral valve stenosis, renal or hepatic impairment
  • Serum K should be monitored especially in the elderly, patients with renal impairment, and K-sparing diuretics should be avoided
Candesartan Initial dose: 4-8 mg PO 24 hourly
Maintenance dose: 8-16 mg PO 24 hourly  
Max dose: 32 mg/day
Eprosartan 600 mg PO 24 hourly in the morning
Max dose: 800 mg/day
Fimasartan Initial dose: 60 mg PO 24 hourly
May increase to 120 mg PO 24 hourly
Irbesartan Initial dose:
150 mg PO 24 hourly
Maintenance dose:
150-300 mg PO 24 hourly
Max dose: 300 mg/day
Losartan Initial dose: 50 mg PO 24 hourly
Maintenance dose: 50-100 mg PO 24 hourly
Max dose: 100 mg/day
Olmesartan medoxomil Initial dose: 10-20 mg PO 24 hourly
May increase to 40 mg PO 24 hourly
Max dose: 40 mg/day
Telmisartan 20-40 mg PO 24 hourly
Max dose: 80 mg/day
Valsartan Initial dose:
80-160 mg PO 24 hourly
May increase to 320 mg PO 24 hourly
Angiotensin Receptor-Neprilysin Inhibitor (ARNI)
Sacubitril/Valsartan 200-400 mg PO 24 hourly

Adverse Reactions

  • GI effects (diarrhea, nausea, gastritis); CNS effects (dizziness, headache, syncope, asthenia); Metabolic effects (hyper- or hypokalemia, hypoglycemia); Other effects (hypotension, renal impairment, anemia, cough, fatigue)

Special Instructions

  • Not to be administered until 36 hours after last dose of ACE inhibitor
  • Contraindicated in patients with known history of angioedema related to previous ACE inhibitor or ARB therapy, hereditary or idiopathic angioedema, concomitant use with ACE inhibitors or ARBs, Aliskiren-containing medicinal products in patients with DM or renal impairment, severe hepatic impairment, biliary cirrhosis and cholestasis
  • Caution is required in patient with renal artery stenosis and monitoring of renal function is recommended
  • Temporary down-titration/discontinue administration in case of symptomatic hypotension, hyperkalemia or renal dysfunction
  • Check BP, renal function and electrolytes after initiation and during dose titration

Calcium Antagonists



Drug Dosage Remarks
Benzothiazepine
Diltiazem Regular-release:
Initial dose:
30-60 mg PO 8 hourly or 60-120 mg PO 12 hourly
May increase to 180-360 mg/day PO divided 8 hourly Extended-release (once daily):
Initial dose:
90-180 mg PO 24 hourly
May increase dose at 14-day intervals to 240-360 mg PO 24 hourly
Max dose: 540 mg/day Extended-release (twice daily):
90-180 mg PO 12 hourly
Max dose: 360 mg/day		 Adverse Reactions
  • CV effects (depression of cardiac function, hypotension, worsening HF, edema, flushing, bradycardia, palpitations); GI effects (constipation, dry mouth, digestive problems, nausea/vomiting, diarrhea); CNS effects (headache, dizziness); Other effects (fatigue, rashes, hepatitis, transient elevation of liver enzymes)
Special Instructions
  • Contraindicated in patients with sick sinus syndrome, 2nd- or 3rd-degree AV block, acute MI, pulmonary congestion, hypotension
  • Use with caution in patients with CHF, impaired hepatic/renal function, 1st-degree AV block, bradycardia
Dihydropyridines
Amlodipine Initial dose: 5 mg PO 24 hourly
Max dose: 10 mg/day 		Adverse Reactions
  • CV effects (depression of cardiac function, hypotension, worsening HF, edema, flushing, bradycardia); GI effect (constipation); CNS effects (headache, dizziness)
  • Levamlodipine: Tachycardia, cough, breathing difficulty, vertigo, headache, facial puffiness, cheerlessness
  • Short-acting dihydropyridine agents should be avoided because they have the potential to enhance risk of adverse cardiac events

Special Instruction

  • Contraindicated in patients with overt decompensated HF, though vasoselective dihydropyridines (eg Amlodipine, Felodipine) are tolerated in patients with decreased LV ejection fraction
  • Use with caution in patients with HF, hepatic impairment, peripheral edema
  • Monitor for hypotension and reflex tachycardia
Barnidipine Initial dose: 5-10 mg PO 24 hourly
May be increased to 10-20 mg PO 24 hourly
Benidipine Initial dose:  2-4 mg PO 24 hourly
Max dose: 8 mg/day
Cilnidipine Initial dose:  5-10 mg PO 24 hourly 
Max dose: 20 mg/day
Felodipine Initial dose: 2.5-5 mg PO 24 hourly
Maintenance dose: 2.5-10 mg PO 24 hourly
Max dose: 10 mg/day
Isradipine Regular release:
Initial dose:  2.5 mg PO 12 hourly
May increase to 5 mg PO 12 hourly after 3-4 weeks
Max dose: 20 mg/day
Extended-release: 5 mg PO 24 hourly
Lacidipine Initial dose: 2 mg PO 24 hourly
May be increased to 4 mg, if necessary to 6 mg PO 24 hourly after at least 3-4 weeks interval
Lercanidipine Initial dose: 10 mg PO 24 hourly
May increase to 20 mg PO 24 hourly after 2 weeks
Levamlodipine besylate
(S-amlodipine)		 2.5 mg PO 24 hourly
May be increased up to 5 mg PO 24 hourly
Manidipine Initial dose: 5-10 mg PO 24 hourly
Maintenance dose: 10-20 mg PO 24 hourly
Nicardipine Regular release:
Initial dose: 10-20 mg PO 8 hourly
May be increased to 20-40 mg PO 8 hourly
Extended-release: 30-40 mg PO 12 hourly
May be increased to 60 mg PO 12 hourly
Nifedipine Regular release:
Initial dose: 5-10 mg PO 8 hourly
May increase gradually to 30-80 mg PO 24 hourly over 7-14 days
Max dose: 60-180 mg/day
Extended-release (once daily):
Initial dose: 30 or 60 mg PO 24 hourly
May increase dose gradually at 7-14 days interval
Maintenance dose: 30-60 mg/day PO
Max dose: 120 mg/day
Extended-release (twice daily):
Initial dose: 10-20 mg PO 12 hourly
Maintenance dose: 20 mg PO 12 hourly
May increase stepwise to 40 mg PO 12 hourly
Max dose: 90 mg/day
Nisoldipine Immediate-release:
Initial dose: 5-10 mg PO 12 hourly
May increase dose gradually at intervals of no less than 1 week 
Max dose: 20 mg PO 12 hourly
Modified-release:
Initial dose: 17 mg PO 24 hourly
May be increased by 8.5 mg/week or longer intervals
Max dose: 34 mg PO 24 hourly
Nitrendipine 20 mg PO 24 hourly or
10 mg PO 12 hourly
May be increased to 20 mg PO 12 hourly
Max dose: 40 mg/day
 Phenylalkylamines
Gallopamil 25-50 mg PO 6-12 hourly
Max dose: 200 mg/day 		Adverse Reactions
  • CV effects (depression of cardiac function, hypotension, worsening HF, edema, flushing, bradycardia); GI effect (constipation); CNS effects (headache, dizziness)
  • HR-modulating calcium antagonists (eg Diltiazem, Gallopamil and Verapamil): AV dissociation, AV block, bradycardia and sinus node dysfunction

Special Instruction

  • Contraindicated in patients with overt decompensated HF, though vasoselective dihydropyridines (eg Amlodipine, Felodipine) are tolerated in patients with decreased LV ejection fraction
  • HR-modulating calcium antagonists are contraindicated in patients with bradycardia, sinus node dysfunction and AV nodal block
Verapamil Regular release:
40-80 mg PO 6-8 hourly or
80-160 mg PO 8-12 hourly
Max dose: 480 mg/day Extended-release: 120-240 mg PO 24 hourly
May increase to 240 mg PO 12 hourly after 2 weeks
Max dose: 480 mg/day

Direct Renin Inhibitor



Drug Dosage Remarks
Aliskiren Initial dose: 150 mg PO 24 hourly
If BP is not adequately controlled, may increase up to 300 mg PO 24 hourly
Max dose: 300 mg/day
 Adverse Reactions
  • GI effects (diarrhea, abdominal pain, dyspepsia, GERD); CNS effects (headache, dizziness); Other effects (hypotension, rash, cough, hyperuricemia, fatigue, back pain, gout, renal calculi, hyperkalemia, decrease in Hb levels, seizures, angioedema)
Special Instructions
  • Avoid in patients with severe renal impairment or renovascular hypertension, and in patients with a history of angioedema (of any etiology)
  • Concomitant use of Aliskiren with ACE inhibitors or angiotensin II antagonists in diabetic patients is contraindicated
  • Avoid concomitant use of Aliskiren with ACE inhibitors or angiotensin II antagonists in patients with moderate to severe renal impairment (GFR <60 mL/min)
  • Contraindicated in pregnancy; discontinue use once pregnancy is detected
  • Symptomatic hypotension may be seen in patients starting Aliskiren therapy; prior to initiation of treatment, correction of hypovolemia and/or close monitoring of volume status is warranted, especially in patients on concurrent diuretics

Diuretics



Drug Dosage Remarks
Aldosterone Antagonists

Eplerenone
50 mg PO 24 hourly
May increase up to 100 mg/day 
 Adverse Reactions
  • CNS effects (headache, dizziness); GI effects (diarrhea, nausea, abdominal pain); Endocrine and metabolic effects (gynecomastia, abnormal vaginal bleeding, hypercholesterolemia, hypertriglyceridemia, hyperkalemia); Other effects (hypotension, fatigue, influenza-like symptoms, renal function abnormality)
Special Instructions
  • Avoid in patients with type 2 diabetes with microalbuminuria, severe hepatic impairment; serum creatinine >2.0 mg/dL in males or >1.8 mg/dL in females; creatinine clearance ≤50 mL/min, serum potassium level >5.0 mmol/L
  • Avoid concomitant use of K-sparing diuretics and K supplements
  • Serum potassium should be measured before treatment and 1 month after starting treatment
Spironolactone 25-50 mg/day PO
May increase up to 100 mg/day 		Adverse Reactions
  • CNS effects (headache, drowsiness, ataxia, mental confusion); GI effects (cramps, diarrhea); Endocrine and metabolic effects (gynecomastia, hirsutism, menstrual irregularities, impotence, mild acidosis, hyponatremia, hyperkalemia and transient increases in BUN)
Special Instructions
  • Avoid in patients with acute renal insufficiency, hyperkalemia or severe renal impairment
  • Use with caution in patients at increased risk of developing hyperkalemia (eg DM, elderly, patients with renal or hepatic impairment)
  • Use with caution during concomitant use of other K-sparing diuretics, ACE inhibitors, NSAIDs, ARBs, aldosterone blockers, heparin and LMWH
  • Serum electrolytes and BUN should be measured periodically
Loop Diuretics
Bumetanide 1 mg PO 24 hourly
Max dose: 4 mg/day 		Adverse Reactions
  • Endocrine and metabolic effects (hyponatremia, hypokalemia and hypochloremic alkalosis especially after large doses or prolonged administration, hyperglycemia, glycosuria, hyperuricemia and may precipitate gout)
  • Signs of electrolyte imbalances: Headache, muscle cramps, dry mouth, hypotension, thirst, weakness, drowsiness, etc
  • Less common effects (blurred vision, dizziness, orthostatic hypotension, skin rashes and hypersensitivity reactions)

Special Instruction

  • Avoid in patients with anuria or in renal insufficiency caused by nephrotoxic or hepatotoxic drugs or caused by hepatic coma
  • Use with caution in patients with existing or in those at risk of fluid and electrolyte imbalances, in patients with prostatic hyperplasia or impairment of micturition, patients with hepatic cirrhosis are more likely to develop hypokalemia and patients with severe HF are more likely to suffer hyponatremia, use with caution in patients susceptible to gout
  • Monitor patient for signs of fluid or electrolyte imbalance
Furosemide 20-40 mg PO 12 hourly usually in the morning
Piretanide 6-12 mg PO 24 hourly
Torasemide Initial dose:  2.5-5 mg PO 24 hourly
Max dose: 10 mg/day
 Potassium-Sparing Diuretic

Amiloride
5-10 mg PO 24 hourly
Max dose: 20 mg/day
Adverse Reactions
  • Endocrine and metabolic effects (hyperkalemia especially in the elderly, patients with DM and patients with impaired renal function, hyponatremia has occurred in patients receiving combination diuretic therapy); GI effects (nausea/vomiting, abdominal pain, diarrhea, constipation, thirst); CNS effects (headache, dizziness, weakness, muscle cramps); Dermatologic effects (rash, pruritus)
Special Instructions
  • Usually used in conjunction with loop or thiazide diuretics
  • Avoid in patients with hyperkalemia or severe renal impairment
  • Use with caution in patients at increased risk of developing hyperkalemia (eg DM, elderly, patients with renal or hepatic impairment)
Thiazides & Related Diuretics
Chlorothiazide 500-1,000 mg/day PO or divided 12 hourly
Max dose: 2 g/day 		Adverse Reactions
  • Endocrine and metabolic effects (hyperuricemia and may precipitate gout in some patients, hypochloremic alkalosis, hyponatremia, hypokalemia, hyponatremia, hypomagnesemia, hyperglycemia and glucosuria in DM or other susceptible patients); GI effects (GI irritation, nausea/vomiting, constipation, anorexia, diarrhea); CNS effects (headache, dizziness); Other effects (photosensitivity reactions, postural hypotension, impotence, hypersensitivity reactions)
  • Signs of electrolyte imbalances: Headache, muscle cramps, dry mouth, hypotension, thirst, weakness, drowsiness, etc

Special Instruction

  • Avoid in patients with severe hepatic impairment since encephalopathy may be precipitated; in patients with severe renal impairment, anuria or pre-existing hypercalcemia
  • Use with caution in patients with existing or at risk of fluid and electrolyte imbalances (eg elderly), patients with hepatic cirrhosis are more likely to develop hypokalemia and patients with severe heart failure are more likely to suffer hyponatremia, use with caution in patients with renal impairment, in patients susceptible to gout and in DM patients
  • Monitor patient for signs of fluid or electrolyte imbalance
Chlortalidone
(Chlorthalidone) 		12.5-25 mg PO 24 hourly
May increase to 50 mg/day PO 
Cyclopenthiazide 0.25-0.5 mg PO 24 hourly
Hydrochlorothiazide
(Dihydrochlorothiazide) 		Initial dose:  12.5 mg PO 24 hourly
Usual dose: 25-100 mg PO 24 hourly 
Indapamide Regular release:  
2.5 mg PO 24 hourly
Extended release:
1.5 mg PO 24 hourly
Metolazone Initial dose: 1.25 mg PO 24 hourly
Usual dose: 2.5-5 mg PO 24 hourly
Enhanced bioavailability formulas: 0.5-1 mg PO 24 hourly
Trichlormethiazide 1-4 mg PO 24 hourly

Other Antihypertensives


Drug Dosage Remarks
Centrally Acting Agents
Clonidine Initial dose:
50-100 mcg PO 8 hourly or 100 mcg PO 12 hourly or 75-150 mcg PO 12 hourly Maintenance dose: 300-1,200 mcg/day PO in divided doses
Max dose: 2.4 mg/day or
0.1 mg/24 hr patch transdermally every 7 days Usual dose: 0.1-0.3 mg/24 hr every 7 days
Max dose: 0.6 mg/24 hr every 7 days		 Adverse Reactions
  • CNS effects (drowsiness, dizziness, headache, depression, anxiety, fatigue, sleep disturbances, impotence); GI effects (dry mouth, constipation, nausea, anorexia); GU effects (urinary retention, incontinence); CV effects (orthostatic hypotension, fluid retention)
  • Less common effects: Bradycardia, ECG disturbances, heart failure, hallucinations, etc
Special Instructions
  • Use with caution in patients with cerebrovascular disease, renal impairment, ischemic heart disease, MI, occlusive peripheral vascular disorders or in those with history of depression
  • Patients on long-term treatment should not discontinue abruptly
Methyldopa Initial dose:
250 mg PO 8-12 hourly
May increase or decrease dose not more frequently than 2-day intervals until desired effect is achieved
Maintenance dose: 500-2,000 mg/day in 2-4 divided doses
Max dose: 3 g/day

Adverse Reactions

  • Most adverse effects are transient or reversible
  • CNS effects (drowsiness, dizziness, lightheadedness, headache, weakness, fatigue, impotence, disturbed sleep, paresthesia, depression, etc); CV effects (postural hypotension, fluid retention, edema and may aggravate angina); GI effects (nausea/vomiting, diarrhea, constipation, rarely pancreatitis, colitis or sore tongue); Hematologic effects (thrombocytopenia, leukopenia, hemolytic anemia and granulocytopenia have occurred); Hypersensitivity reactions

Special Instructions

  • Avoid in patients with liver disease or depression
  • Use with caution in patients with impaired renal or hepatic function, history of hemolytic anemia, liver disease or depression and in patients with parkinsonism
  • CBC should be measured periodically during the first 6-12 weeks of therapy or if patient develops unexplained fever
 Moxonidine
 Initial dose:
0.2 mg PO 24 hourly
May increase after 3 weeks to 0.4 mg/day PO or divided 12 hourly
Max dose: 0.6 mg/day in 2 divided doses

Adverse Reactions

  • Similar to Clonidine but less sedation and dry mouth

Special Instructions

  • Avoid in patients with conduction disorders, severe arrhythmias, bradycardia, severe HF, severe ischemic heart disease, severe renal or hepatic impairment, intermittent claudication or Raynaud’s disease, Parkinson’s disease, epilepsy, glaucoma or depression and in patients with history of angioedema
  • Patients on long-term treatment should not discontinue abruptly
Rilmenidine Initial dose:
1 mg PO 24 hourly
May increase after 1 month to 1 mg PO 12 hourly

Adverse Reactions

  • Similar to Clonidine but less sedation and central effects

Special Instructions

  • Similar to Clonidine
 Direct Vasodilators
 Hydralazine Initial dose:
40-50 mg/day PO in divided doses
May increase by 10-25 mg/dose every 2-5 days
Max dose: 200 mg/day

Adverse Reactions

  • Typically subside with continued therapy: CV effects (tachycardia, palpitations, angina, flushing); GI effects (anorexia, nausea/vomiting, diarrhea); Other effects (dizziness, nasal congestion)
  • Other CV effects (postural hypotension, fluid retention, edema); Other effects (weight gain, tremor, conjunctivitis, muscle cramps, lacrimation)
  • Less common: Pyridoxine depletion resulting in peripheral neuropathy; Hematologic effects (blood dyscrasia, hemolytic anemia); Hepatic effect (hepatotoxicity); GU effects (difficulty in urinating, glomerulonephritis); CNS effects (depression, anxiety); GI effects (paralytic ileus, constipation); Hypersensitivity reactions; can also cause a condition resembling SLE when prolonged high doses are used & is more common in women and in patients with renal impairment

Special Instructions

  • Avoid in patients with severe tachycardia, HF with high cardiac output, dissecting aortic aneurysm, cor pulmonale or myocardial insufficiency due to mechanical obstruction, idiopathic SLE and related disorders
  • Use with caution in patients with ischemic heart disease, recent MI, heart failure, impaired renal or hepatic function
  • CBC, antinuclear antibody determinations and urinalysis should be done periodically during long-term therapy
Minoxidil Initial dose:
5 mg/day PO or in divided doses May increase dose gradually at 3-day intervals to 40 mg/ day PO or in divided doses
Max dose: 100 mg/day
  • Indicated only for severe hypertension that has not responded to other antihypertensive therapy
  • Minoxidil is usually given in combination with a beta-blocker to diminish cardiac-accelerating effects and with a diuretic to control edema

Adverse Reactions

  • CV effects (reflex tachycardia, fluid retention, edema, deterioration of existing heart failure, ECG changes, pericarditis with effusion, pericarditis, angina); hypertrichosis
  • Less common: CNS effect (headache); Endocrine and metabolic effects (gynecomastia, polymenorrhea); Other effects (nausea; allergic skin rashes, Stevens-Johnson syndrome, thrombocytopenia)

Special Instructions

  • Avoid in patients with pheochromocytoma
  • Use with caution in patients with recent MI, pulmonary hypertension, angina, CHF and significant renal impairment
Endothelin Receptor Antagonist
Aprocitentan 12.5 mg PO 24 hourly

Adverse Reactions

  • Hepatic effects (elevated liver enzymes, hepatotoxicity); Other effects (edema, fluid retention, anemia, decreased sperm counts, teratogenesis)
Special Instructions
  • Contraindicated in pregnancy
  • Intervention may be required for fluid retention
  • For women of child-bearing potential, pregnancy testing is required prior, every month during, and 1 month after stopping treatment; use of acceptable contraception is required for persons of reproductive potential prior to, during, and for 1 month after stopping treatment
  • Measure serum aminotransferase and total bilirubin levels prior to treatment initiation and repeat periodically during treatment and as clinically indicated
Peripherally Acting Agent
Reserpine Initial dose: 0.5 mg/day PO in divided doses x 2 weeks
Then reduce to
Maintenance dose: 0.1-0.25 mg/day PO
Max dose: 0.5 mg/day

Adverse Reactions

  • CNS effects (headache, depression, drowsiness, dizziness, lethargy, nightmares); Respiratory effect (nasal congestion); GI effects (increased GI motility eg diarrhea, abdominal cramps and increased gastric acid secretion and less commonly: Appetite changes, weight gain, dry mouth); CV effects (bradycardia, hypotension)
  • Less common effects: Galactorrhea, increased prolactin concentration, impotence, Na retention, edema, rash, thrombocytopenic purpura
Special Instructions
  • Avoid in patients with pheochromocytoma, Parkinson's disease, active peptic ulcer or ulcerative colitis, history of mental depression
  • Use with caution in patients with arrhythmias, MI, renal impairment, gallstones, epilepsy, allergic bronchial asthma and elderly


Peripheral Vasodilators & Cerebral Activators


Drug Dosage Remarks
Co-dergocrine mesylate (Dihydroergocryptine,
Dihydroergocristine and
Dihydroergocornine mesylates)		 1-2 mg PO 8 hourly

 Adverse Reactions
  • CNS effect (headache); Other effects (GI upset, blurred vision, skin rash, nasal stuffiness)
Special Instructions
  • Should be taken with food
  • Use with caution in patients with severe bradycardia
Nicergoline Adjuvant therapy:
5-10 mg PO 8 hourly or
30 mg PO 12 hourly 		Adverse Reactions
  • CNS effects (dizziness, drowsiness, insomnia); Other effects (slight GI disturbances, sensation of heat and cutaneous flushing, hypotension)
Special Instructions
  • Use with caution in patients with hyperuricemia or those with history of gout and/or in treatment with drugs that interfere with the metabolism and excretion of uric acid

Combination Products


Drug Available Strength Dosage Remarks
Aliskiren/Hydrochlorothiazide Aliskiren 150 mg/ Hydrochlorothiazide 12.5 mg
Aliskiren 150 mg/ Hydrochlorothiazide 25 mg
Aliskiren 300 mg/ Hydrochlorothiazide 12.5 mg
Aliskiren 300 mg/ Hydrochlorothiazide 25 mg

1 tab PO 24 hourly
Max dose: Aliskiren 300 mg/ Hydrochlorothiazide 25 mg/day

Adverse Reactions

  • Metabolic effects (hypercholesterolemia, hypertriglyceridemia, altered glucose tolerance, hyperuricemia, hyper or hypokalemia, hypomagnesemia, hyponatremia, hypercalcemia); Ophthalmologic effects (acute transient myopia, acute angle-closure glaucoma); Other effects (urticaria, gout, hypotension, syncope, acute renal failure, SLE activation or exacerbation)
Special Instructions
  • Avoid in patients with anuria, volume depletion, history of angioedema, severe renal and hepatic impairment; concomitant use with ACE inhibitors or angiotensin II antagonists in patients with DM or renal impairment
  • Use with caution in patients with prediabetes or diabetes, history or risk for gout, history of allergy or bronchial asthma, volume or salt depletion, renal artery stenosis, CV disease, post MI, hypercalcemia, moderate or high cholesterol levels, parathyroid disease, SLE, mild to moderate renal and hepatic impairment
Amlodipine/Atorvastatin Amlodipine 5 mg/ Atorvastatin 10 mg Amlodipine 5 mg/ Atorvastatin 20 mg Amlodipine 5 mg/ Atorvastatin 40 mg Amlodipine 10 mg/ Atorvastatin 10 mg
Amlodipine 10 mg/ Atorvastatin 20 mg
Amlodipine 10 mg/ Atorvastatin 40 mg

Amlodipine 5 mg/ Atorvastatin 10 mg PO 24 hourly
Max dose: Amlodipine 10 mg/ Atorvastatin 80 mg/ day

Adverse Reactions

  • CV effects (hypotension, peripheral edema, flushing); CNS effects (dizziness, headache); GI effects (nausea, abdominal discomfort, diarrhea, constipation); Other effects (fatigue, weakness, myalgia, elevated liver enzymes, hyperglycemia)
Special Instructions
  • Avoid in patients with active liver disease, pregnancy, lactation
  • Use with caution in patients with severe kidney disease, hypothyroidism, elderly, history of liver dysfunction
  • Monitor BP, HR, lipid panel, and renal and hepatic function regularly
Amlodipine/Candesartan Amlodipine 5 mg/ Candesartan 8 mg

1 tab PO 24 hourly

Adverse Reactions

  • CV effects (hypotension, edema, flushing); CNS effects (dizziness, headache); GI effects (nausea, diarrhea, abdominal discomfort); Other effects (hyperkalemia, muscle cramps, weakness, back or joint pain)
Special Instructions
  • Avoid in patients with severe hypotension, severe aortic stenosis, severe bilateral renal artery stenosis or kidney disease, severe liver disease, pregnancy
  • Use with caution in patients with CHF, severe dehydration or volume depletion, hyperkalemia, elderly patients
  • Monitor BP, HR, electrolytes, renal and hepatic function regularly

 
Amlodipine/Irbesartan Amlodipine 5 mg/ Irbesartan 150 mg Amlodipine 10 mg/ Irbesartan 150 mg Amlodipine 5 mg/ Irbesartan 300 mg Amlodipine 10 mg/ Irbesartan 300 mg

1 tab PO 24 hourly
Max dose:
Amlodipine 10 mg/ Irbesartan 300 mg/day
 Amlodipine/Losartan Amlodipine 5 mg/ Losartan 50 mg
Amlodipine 5 mg/ Losartan 100 mg
Amlodipine 10 mg/ Losartan 100 mg		 1-2 tab PO 24 hourly
 Amlodipine/Olmesartan Amlodipine 5 mg/ Olmesartan 20 mg Amlodipine 10 mg/ Olmesartan 20 mg Amlodipine 5 mg/ Olmesartan 40 mg Amlodipine 10 mg/ Olmesartan 40 mg 1 tab PO 24 hourly
Max dose:
Amlodipine 10 mg/ Olmesartan 40 mg/day
 Amlodipine/Telmisartan Amlodipine 5 mg/ Telmisartan 40 mg Amlodipine 10 mg/ Telmisartan 40 mg Amlodipine 5 mg/ Telmisartan 80 mg Amlodipine 10 mg/ Telmisartan 80 mg 1 tab PO 24 hourly
Max dose:
Amlodipine 10 mg/ Telmisartan 80 mg/day
 Amlodipine/Valsartan Amlodipine 5 mg/ Valsartan 80 mg Amlodipine 5 mg/
Valsartan 160 mg Amlodipine 10 mg/ Valsartan 160 mg		 1 tab PO 24 hourly
Max dose:
Amlodipine 10 mg/ Valsartan 320 mg/day
 Amlodipine/ Hydrochlorothiazide Amlodipine 5 mg/ Hydrochlorothiazide 12.5 mg
Amlodipine 10 mg/ Hydrochlorothiazide 12.5 mg		 1 tab PO 24 hourly  Adverse Reactions
  • CV effects (hypotension, peripheral edema, flushing, palpitations, tachycardia); CNS effects (dizziness, headache); Metabolic effects: (hypokalemia, hyponatremia, hypercalcemia, hyperglycemia, hyperuricemia); GI effects (nausea, constipation, abdominal discomfort); Other effects (fatigue, weakness)
Special Instructions
  • Avoid in patients with severe hypotension, renal failure or liver disease, anuria
  • Use with caution in patients with HF with reduced ejection fraction, uncontrolled DM, gout, severe dehydration or volume depletion, pregnancy, elderly patients
  • Monitor BP, HR, electrolytes, uric acid level and renal function regularly
 Amlodipine/Indapamide Amlodipine 5 mg/ Indapamide 1.5 mg Amlodipine 10 mg/ Indapamide 1.5 mg 1 tab PO 24 hourly preferably in the morning
 Atenolol/Chlortalidone Atenolol 50 mg/ Chlortalidone 12.5 mg Atenolol 50 mg/ Chlortalidone 25 mg Atenolol 100 mg/ Chlortalidone 25 mg 1 tab PO 24 hourly
Max dose:
Atenolol 100 mg/ Chlortalidone 25 mg/day		  Adverse Reactions
  • CV effects (bradycardia, hypotension, heart block); Metabolic effects (hypo and hyperkalemia, hyponatremia, hyperglycemia, hyperuricemia); CNS effects (dizziness, headache, depression); GI effects (nausea, abdominal discomfort); Other effects (fatigue, weakness, worsening of asthma or COPD)
Special Instructions
  • Avoid in patients with severe bradycardia or hypotension, 2nd- or 3rd-degree heart block, decompensated HF, cardiogenic shock, severe asthma or COPD, anuria
  • Use with caution in patients with uncontrolled diabetes, gout, severe liver disease, peripheral artery disease, pregnancy
  • Monitor BP, HR, electrolytes, blood glucose and uric acid levels, and renal and hepatic function regularly
Bisoprolol/ Hydrochlorothiazide Bisoprolol 2.5 mg/ Hydrochlorothiazide 6.25 mg
Bisoprolol 5 mg/ Hydrochlorothiazide 6.25 mg
Bisoprolol 10 mg/ Hydrochlorothiazide 6.25 mg		 1 tab PO 24 hourly
Max dose:
Bisoprolol 20 mg/ Hydrochlorothiazide 12.5 mg/day
Metoprolol/Chlortalidone Metoprolol 200 mg/ Chlortalidone 25 mg 1 tab PO 24 hourly
Metoprolol/ Hydrochlorothiazide Regular-release:
Metoprolol tartrate 50 mg/ Hydrochlorothiazide 25 mg
Metoprolol tartrate 100 mg/ Hydrochlorothiazide 12.5 mg
Metoprolol tartrate 100 mg/ Hydrochlorothiazide 25 mg
Metoprolol tartrate 100 mg/ Hydrochlorothiazide 50 mg		 Metoprolol tartrate 100-200 mg/ Hydrochlorothiazide 25-50 mg PO 24 hourly
Extended-release: Metoprolol succinate 25 mg/ Hydrochlorothiazide 12.5 mg
Metoprolol succinate 50 mg/ Hydrochlorothiazide 12.5 mg
Metoprolol succinate 100 mg/ Hydrochlorothiazide 12.5 mg		 1 tab PO 24 hourly
Max dose:
Metoprolol succinate 200 mg/ Hydrochlorothiazide 25 mg/day
Pindolol/Clopamide Pindolol 10 mg/
Clopamide 5 mg		 ½-1 tab PO 24 hourly with breakfast
May increase to 2 tab after 2-3 weeks (2nd tab to be taken with midday meal)
Atenolol/Nifedipine  Atenolol 50 mg/ Nifedipine 20 mg 1 cap PO 12-24 hourly Adverse Reactions
  • CV effects (bradycardia, hypotension, heart block, peripheral edema); CNS effects (dizziness, headache); GI effects (nausea, constipation, abdominal discomfort); Other effects (fatigue, weakness, shortness of breath, hyperglycemia, weight gain)
Special Instructions
  • Avoid in patients with severe bradycardia or hypotension, 2nd- or 3rd-degree heart block, decompensated HF, cardiogenic shock, severe asthma or COPD
  • Use with caution in patients with diabetes, peripheral artery disease, mild to moderate renal and hepatic impairment, bronchospastic disease, thyroid disease, myasthenia gravis
  • Monitor BP, heart rate and rhythm, lipid profile, blood glucose and renal and hepatic function regularly
Bisoprolol/Amlodipine  Bisoprolol 5 mg/ Amlodipine 5 mg
Bisoprolol 5 mg/ Amlodipine 10 mg Bisoprolol 10 mg/ Amlodipine 5 mg
Bisoprolol 10 mg/ Amlodipine 10 mg		 1 tab PO 24 hourly
Metoprolol/Felodipine Metoprolol 47.5 mg/ Felodipine 5 mg 1 tab PO 24 hourly in the morning
Nebivolol/Amlodipine Nebivolol 5 mg/ Amlodipine 5 mg
Nebivolol 5 mg/ Amlodipine 10 mg		 1 tab PO 24 hourly
Max dose:
Nebivolol 5 mg/ Amlodipine 10 mg/day
Azilsartan/Chlortalidone Azilsartan 40 mg/ Chlortalidone 12.5 mg 1 tab PO 24 hourly
May increase to Azilsartan 40 mg/ Chlortalidone 25 mg PO 24 hourly after 2-4 weeks		 Adverse Reactions
  • Dizziness, fatigue
    • Azilsartan: Diarrhea, nausea, asthenia, muscle spasm, dizziness, cough
    • Chlortalidone: Rash, headache, GI upset and elevations of uric acid and cholesterol
Special Instructions
  • Avoid in patients with anuria; do not co-administer with Aliskire-containing products in patients with DM or renal impairment
  • Use with caution in patients with volume or salt depletion, hyperuricemia; concomitant use with ACE inhibitors or angiotensin II receptor blockers in patients with diabetic nephropathy
  • Monitor electrolytes and renal function regularly
Benazepril/Amlodipine1 Benazepril 10 mg/ Amlodipine 5 mg Benazepril 10-80 mg/Amlodipine 2.5-10 mg PO 24 hourly  Adverse Reactions
  • CNS effects (headache, dizziness); GI effects (nausea, abdominal pain, dyspepsia, constipation); Other effects (hypotension, hyperkalemia, acute renal failure, neutropenia, dyspnea, cough, muscle spasms, fatigue, asthenia, rash, angioedema)
Special Instructions
  • Avoid in patients with history of idiopathic angioedema, severe hypotension, cardiogenic shock, HF, concomitant use with neprilysin inhibitors or Aliskiren in patients with diabetes or renal impairment
  • Use with caution in patients with renal and hepatic impairment, hypertrophic cardiomyopathy, aortic or mitral stenosis, ischemic heart disease, cerebrovascular disease, collagen vascular disease, salt or volume depletion, unstented unilateral or bilateral renal artery stenosis, patients undergoing surgery or desensitization treatment

Perindopril/Amlodipine1 Perindopril 3.5 mg/ Amlodipine 2.5 mg Perindopril 7 mg/ Amlodipine 5 mg
Perindopril 14 mg/ Amlodipine 10 mg Perindopril 5 mg/ Amlodipine 5 mg
Perindopril 5 mg/ Amlodipine 10 mg Perindopril 10 mg/ Amlodipine 5 mg
Perindopril 10 mg/ Amlodipine 10 mg		 1 tab PO 24 hourly preferably in the morning Max dose:
Perindopril 14 mg/ Amlodipine 10 mg/day
Trandolapril/ Verapamil1 Trandolapril 2 mg/ Verapamil 180 mg Trandolapril 4 mg/ Verapamil 240 mg 1 tab PO 24 hourly
Max dose:
Trandolapril 4 mg/Verapamil 240 mg/day
Candesartan/ Hydrochlorothiazide Candesartan 8 mg/Hydrochlorothiazide 12.5 mg
Candesartan 16 mg/Hydrochlorothiazide 12.5 mg
Candesartan 32 mg/Hydrochlorothiazide 25 mg
 1 tab PO 24 hourly
Max dose:
Candesartan 32 mg/Hydrochlorothiazide 50 mg/day
  Adverse Reactions
  • CV effect (hypotension); Metabolic effects (hypo and hyperkalemia, hyponatremia, hyperuricemia, hyperglycemia, increased BUN and creatinine); CNS effects (headache,dizziness); GI effects (nausea/vomiting,diarrhea); Other effects (fatigue, weakness, rash, photosensitivity)
Special Instructions
  • Avoid in patients with anuria, severe renal impairment, bilateral renal artery stenosis, hypersensitivity to sulfonamides, thiazides or ARBs, pregnancy
  • Use with caution in patients with volume depletion, HF, uncontrolled diabetes, gout, kidney and liver disease
  • Monitor BP, electrolytes, uric acid, blood glucose, renal and hepatic function regularly
Eprosartan/Hydrochlorothiazide Eprosartan 600 mg/Hydrochlorothiazide 12.5 mg 1 tab PO 24 hourly in the morning
Irbesartan/Hydrochlorothiazide Irbesartan 150 mg/Hydrochlorothiazide 12.5 mg
Irbesartan 300 mg/Hydrochlorothiazide 12.5 mg
Irbesartan 300 mg/Hydrochlorothiazide 25 mg
 1 tab PO 24 hourly
Max dose:
Irbesartan 300 mg/Hydrochlorothiazide 25 mg/day
Losartan/Hydrochlorothiazide Losartan 50 mg/Hydrochlorothiazide 12.5 mg
Losartan 100 mg/Hydrochlorothiazide 12.5 mg
Losartan 100 mg/Hydrochlorothiazide 25 mg
Losartan 100 mg/Hydrochlorothiazide 50 mg		 1 tab PO 24 hourly
Olmesartan/Hydrochlorothiazide Olmesartan 20 mg/Hydrochlorothiazide 12.5 mg
Olmesartan 40 mg/Hydrochlorothiazide 12.5 mg
Olmesartan 40 mg/Hydrochlorothiazide 25 mg		 1 tab PO 24 hourly
Max dose:
Olmesartan 40 mg/Hydrochlorothiazide 25 mg/day
Telmisartan/Hydrochlorothiazide Telmisartan 40 mg/Hydrochlorothiazide 12.5 mg
Telmisartan 80 mg/Hydrochlorothiazide 12.5 mg
Telmisartan 80 mg/Hydrochlorothiazide 25 mg 		 1 tab PO 24 hourly
Valsartan/Hydrochlorothiazide Valsartan 80 mg/Hydrochlorothiazide 12.5 mg
Valsartan 160 mg/Hydrochlorothiazide 12.5 mg
Valsartan 160 mg/Hydrochlorothiazide 25 mg
Valsartan 320 mg/Hydrochlorothiazide 12.5 mg
Valsartan 320 mg/Hydrochlorothiazide 25 mg
 1 tab PO 24 hourly
Max dose:
Valsartan 320 mg/Hydrochlorothiazide 25 mg/day
Enalapril/Hydrochlorothiazide Enalapril 5 mg/Hydrochlorothiazide 12.5 mg
Enalapril 10 mg/Hydrochlorothiazide 12.5 mg
Enalapril 10 mg/Hydrochlorothiazide 25 mg
Enalapril 20 mg/Hydrochlorothiazide 12.5 mg
 Enalapril 5-40 mg/Hydrochlorothiazide 12.5-50 mg PO 24 hourly
  Adverse Reactions
  • Metabolic effects (hypo and hyperkalemia, hyponatremia, hyperuricemia, hyperglycemia); Other effects (cough, hypotension, angioedema, kidney dysfunction, dizziness, fatigue, photosensitivity)
Special Instructions
  • Avoid in patients with hypersensitivity to sulfonamides, severe electrolyte imbalance, history of angioedema, severe liver disease, severe renal impairment, bilateral renal artery stenosis, pregnancy
  • Use with caution in elderly patients, patients with DM, gout, moderate kidney disease, HF, or history of low BP, patients on NSAIDs, potassium supplements or potassium-sparing diuretics
Fosinopril/Hydrochlorothiazide Fosinopril 10 mg/Hydrochlorothiazide 12.5 mg 1-2 tab PO 24 hourly
Imidapril/Hydrochlorothiazide Imidapril 10 mg/Hydrochlorothiazide 12.5 mg
 1 tab PO 24 hourly 
Lisinopril/Hydrochlorothiazide Lisinopril 10 mg/Hydrochlorothiazide 12.5 mg
Lisinopril 20 mg/Hydrochlorothiazide 12.5 mg
Lisinopril 20 mg/Hydrochlorothiazide 25 mg
 Lisinopril 10-20 mg/Hydrochlorothiazide 12.5 mg PO 24 hourly
Max dose:
Lisinopril 80 mg/Hydrochlorothiazide 50 mg/day
Perindopril/Indapamide Perindopril arginine 2.5 mg/Indapamide 0.625 mg
Perindopril arginine 5 mg/Indapamide 1.25 mg
Perindopril arginine10 mg/Indapamide 2.5 mg
Perindopril tert-butylamine (erbumine) 2 mg/Indapamide 0.625 mg Perindopril tert-butylamine (erbumine) 4 mg/Indapamide 1.25 mg
 1 tab PO 24 hourly preferably in the morning
Quinapril/Hydrochlorothiazide
 Quinapril 10 mg/Hydrochlorothiazide 12.5 mg
Quinapril 20 mg/Hydrochlorothiazide 12.5 mg
Quinapril 20 mg/Hydrochlorothiazide 25 mg
 Quinapril 10-20 mg/Hydrochlorothiazide 12.5 mg PO 24 hourly
Max dose:
Quinapril 40 mg/Hydrochlorothiazide25 mg/day
Ramipril/Hydrochlorothiazide Ramipril 5 mg/Hydrochlorothiazide 25 mg
 Ramipril 2.5 mg/Hydrochlorothiazide 12.5 mg PO 24 hourly in the morning
Max dose:
Ramipril 10 mg/Hydrochlorothiazide 50 mg/day
Hydrochlorothiazide/Amiloride
 Hydrochlorothiazide 25 mg/Amiloride 2.5 mg
Hydrochlorothiazide 50 mg/Amiloride 5 mg
 1-2 tab PO 24 hourly
Max dose:
Hydrochlorothiazide 50-100 mg/Amiloride 5-10 mg/day
 Adverse Reactions
  • Metabolic effects (hyperkalemia, hyponatremia, hypomagnesemia); CNS effects (headache, dizziness); Other effects (nausea/vomiting, muscle cramps, weakness, fatigue, increased urination)
Special Instructions
  • Avoid use in patients with hypersensitivity to sulfonamides or drug components, hyperkalemia, severe renal impairment, severe liver dysfunction, adrenal insufficiency; concomitant use of other potassium-sparing agents and potassium supplements
  • Use with caution in patients with mild to moderate renal impairment, cirrhosis, hypotension; may increase uric acid and blood sugar levels
  • Monitor fluid and electrolyte balance regularly
Hydrochlorothiazide/Triamterene


 Hydrochlorothiazide 25 mg/Triamterene 37.5 mg
Hydrochlorothiazide 25 mg/Triamterene 50 mg
 1-2 tab or cap PO 24 hourly
Hydrochlorothiazide 50 mg/Triamterene 75 mg  1 tab PO 24 hourly 
Losartan/Amlodipine/Hydrochlorothiazide
 Losartan 50 mg/Amlodipine 5 mg/Hydrochlorothiazide 12.5 mg
Losartan 100 mg/Amlodipine 5 mg/Hydrochlorothiazide 12.5 mg
Losartan 100 mg/Amlodipine 10 mg/Hydrochlorothiazide 12.5 mg
 1 tab PO 24 hourly, individualize dose
 Adverse Reactions
  • CNS effects (dizziness,headache); GI effects (nausea, diarrhea); Other effects (fatigue, edema, rash)
Special Instructions
  • Avoid in patients with hypersensitivity to Losartan, Olmesartan medoxomil, Valsartan, Amlodipine, Hydrochlorothiazide and other sulfonamide-derived drugs, anuria; concomitant use with Aliskiren in patients with diabetes
  • Use with caution in hypotensionin volume- and salt-depleted patients, patients with severe aortic and mitral valve stenosis, severe obstructive CAD, obstructive hypertrophic cardiomyopathy, CHF, renal and hepatic impairment, renal transplantation, electrolyte imbalances, metabolic and endocrine effects, history of allergy or bronchial asthma; activation of SLE
Olmesartan medoxomil/Amlodipine/Hydrochlorothiazide  Olmesartan medoxomil 20 mg/Amlodipine 5 mg/Hydrochlorothiazide 12.5 mg
Olmesartan medoxomil 40 mg/Amlodipine 5 mg/Hydrochlorothiazide 12.5 mg
Olmesartan medoxomil 40 mg/Amlodipine 10 mg/Hydrochlorothiazide 12.5 mg
 Individualize dose 
Valsartan/Amlodipine/Hydrochlorothiazide Valsartan 160 mg/Amlodipine 5 mg/Hydrochlorothiazide 12.5 mg
Valsartan 160 mg/Amlodipine 5 mg/Hydrochlorothiazide 25 mg
Valsartan 160 mg/Amlodipine 10 mg/Hydrochlorothiazide 12.5 mg
Valsartan 160 mg/Amlodipine 10 mg/Hydrochlorothiazide 25 mg
Valsartan 320 mg/Amlodipine 10 mg/Hydrochlorothiazide 25 mg		 1 tab PO 24 hourly 
Perindopril/Amlodipine/Atorvastatin  Perindopril 5 mg/Amlodipine 5 mg/Atorvastatin 10 mg
Perindopril 5 mg/Amlodipine 5 mg/Atorvastatin 20 mg
Perindopril 10 mg/Amlodipine 5 mg/Atorvastatin 20 mg
Perindopril 10 mg/Amlodipine 10 mg/Atorvastatin 20 mg
Perindopril 10 mg/Amlodipine 10 mg/Atorvastatin 40 mg 		 1 tab PO 24 hourly
  Adverse Reactions
  • GI effects (constipation, dyspepsia, nausea/vomiting, diarrhea); CNS effects (headache, dizziness, paresthesia, asthenia); Musculoskeletal effects (myalgia, arthralgia, back pain, joint and ankle swelling); Metabolic effects (hyperglycemia, abnormal LFT, increased blood creatinine); CV effects (palpitations, hypotension); Other effects (nasopharyngitis, hypersensitivity, epistaxis, flushing, edema, visual impairment, tinnitus, cough, dyspnea, rash, pruritus)
Special Instructions
  • Avoid in patients with hypersensitivity, liver disease, severe hypotension, hemodynamically unstable heart failure, history of angioedema, significant bilateral renal arterystenosis; on Sacubitril/Valsartan
  • Use with caution in patients with collagen vascular disease, on immunosuppressant therapy, Allopurinol or Procainamide
  • Increased risk of hypotension, hyperkalemia, decreased renal function; interstitial lung disease on long-term therapy
  • Monitor glycemic control and LFTs periodically
 Perindopril/Bisoprolol1 Perindopril 5 mg/Bisoprolol 5 mg
Perindopril 10 mg/Bisoprolol 5 mg
Perindopril 5 mg/Bisoprolol 10 mg
Perindopril 10 mg/Bisoprolol 10 mg
 1 tab PO 24 hourly  Adverse Reactions
  • GI effects (abdominal pain, constipation, diarrhea, nausea/vomiting); Other effects (headache, dizziness, hypotension, asthenia)
Special Instructions
  • Avoid in patients with history of angioedema, severe bradycardia, cardiogenic shock, acute heart failure, severe hypotension, severe asthma or COPD, bilateral renal artery stenosis, severe renal impairment, severe liver disease, untreated pheochromocytoma, pregnancy
  • Use with caution in patients with DM, mild to moderate kidney disease, peripheral vascular disease, patients on NSAIDs or potassium-sparing diuretics
Perindopril/Indapamide/Amlodipine
 Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 5 mg
Perindopril 5 mg/Indapamide 1.25 mg/Amlodipine 10 mg
Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 5 mg
Perindopril 10 mg/Indapamide 2.5 mg/Amlodipine 10 mg
 1 tab PO 24 hourly
 Adverse Reactions
  • CNS effects (severe dizziness, fainting, headache, cramps, somnolence, lightheadedness); Respiratory effects (cough, shortness of breath); Other effects (vision disturbances, tinnitus, GI disorders, allergic reactions, ankle swelling, palpitations, flushing)
Special Instructions
  • Avoid in patients with symptoms of angioedema with previous ACE inhibitor treatment or hereditary/idiopathic angioedema, severe liver disease, untreated decompensated heart failure, non-antiarrhythmic medicines causing torsade de pointes, aortic stenosis or cardiogenic shock, heart failure after a heart attack, severe hypotension, low blood K, severe renal impairment, dialysis; patients with DM and kidney problems treated with Aliskiren
  • Use with caution in patients with hypertrophic cardiomyopathy, heart failure, hypertensive crisis, hepatic impairment, collagen diseases, atherosclerosis, gout, diabetes, photosensitivity reactions, renal impairment, metabolic acidosis, cerebral circulatry insufficiency, hypovolemia; patients undergoing hemodialysis, anesthesia and/or surgery, desensitization treatment, race (black patients)
  • Combination with Lithium, Aliskiren, K-sparing drugs, K supplements or K-containing salt substitutes is not recommended
  • Monitor regularly plasma electrolytes, K, Ca levels; if angioedema occurs, stop treatment immediately
Reserpine/Clopamide/Dihydroergocristine
mesilate
 Reserpine 0.1 mg/Clopamide 5 mg/Dihydroergocristine mesilate 0.5 mg
 1 tab PO 24 hourly
May increase to 2-3 tab daily in severe cases
 Adverse Reactions
  • Muscle weakness, fatigue, GI disturbances, nasal congestion, thrombocytopenia
Special Instructions
  • Avoid in patients with hypersensitivity to components and to sulfonamides, severe coronary insufficiency, history of mental depression, active peptic ulcer, pregnancy and lactation
  • Use with caution in the elderly, patients with renal impairment, diabetes, gout
Reserpine/Hydralazine/Hydrochlorothiazide
 Reserpine 0.1 mg/Hydralazine 25 mg/Hydrochlorothiazide 15 mg
 1 tab PO 8 hourly
 Adverse Reactions
  • GI effects (diarrhea, GI disorder); CV effects (bradycardia, palpitations, arrhythmias, orthostatic hypotension); Metabolic effects (hypokalemia, hyperuricemia, impaired glucose metabolism); Other effects (nasal congestion, depression, lightheadedness, muscle weakness, dizziness, cramps, rash, fatigue, paresthesia)
Special Instructions
  • Avoid in patients with history of depression, active peptic ulcer, ulcerative colitis, parkinsonism, pheochromocytoma, anuria, renal decompensation, patients recently treated with MAOIs, patients under Lithium therapy
  • Use with caution in anesthesia; patients with coronary and/or cerebral arteriosclerosis, electro shock therapy, electrolyte imbalance, hepatic or renal impairment
1If possible, discontinue diuretics 2-3 days before initiating therapy with ACE inhibitors. Otherwise, monitor patient closely during therapy.

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women and non-elderly adults with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

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