Adults

For hypertension, the usual initial dose is 8 mg once daily. The dose may be increased to 16 mg or 32 mg once daily depending on the blood pressure response. For heart failure, the initial dose is typically 4 mg once daily, titrated up to 16 mg or 32 mg once daily.

Elderly

No specific dose adjustment is required for elderly patients, but careful monitoring is advised.

Renal_impairment

For mild to moderate renal impairment, no initial dose adjustment is necessary. For severe renal impairment (CrCl < 30 mL/min), a lower initial dose of 4 mg once daily may be considered.

Onset

Antihypertensive effects usually within 2 hours; maximal effect within 2-4 weeks.

Excretion

Primarily excreted via feces (60-70%) and urine (30-40%), both as unchanged drug and metabolites.

Half life

Approximately 6-9 hours.

Absorption

Rapidly absorbed from the gastrointestinal tract; absolute bioavailability is approximately 25-30%. Peak plasma concentrations are reached within 2-4 hours.

Metabolism

Primarily metabolized by CYP2C9 and UGT enzymes, forming an active metabolite (M1) and inactive metabolites.

Lithium

Increased serum lithium concentrations and toxicity. Monitor lithium levels carefully.

Aliskiren

Contraindicated in patients with diabetes or renal impairment due to increased risk of hypotension, hyperkalemia, and renal impairment.

Diuretics (Potassium-sparing)

Increased risk of hyperkalemia.

NSAIDs (Non-steroidal anti-inflammatory drugs)

May attenuate the antihypertensive effect and increase the risk of renal impairment, especially in dehydrated or elderly patients.