Hypertension Drug Summary

Last updated: 28 October 2025
Reviewed by

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: 40 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.

Alpha-Adrenoreceptor Antagonists


Drug Dosage Remarks
Doxazosin Regular release:
Initial dose: 1 mg PO 24 hourly
May increase dose at 1-2 weeks intervals to 2 mg PO 24 hourly and then to 4 mg PO 24 hourly
Max dose: 16 mg/day
Extended-release:
Initial dose: 4 mg PO 24 hourly
May increase dose after 4 weeks up to
Max dose: 8 mg/day		 Adverse Reactions
  • Postural hypotension which may be severe after first dose and can produce syncope which may be preceded by tachycardia
  • Effects which may diminish after continued therapy: CNS effects (dizziness, headache, lack of energy); GI effect (nausea); CV effect (palpitations)
  • Other CV effects (edema, chest pain, dyspnea); GI effects (constipation, diarrhea, vomiting; dry mouth); CNS effects (depression, nervousness, sleep disturbances, vertigo, hallucinations, paresthesia); GU effects (urinary frequency, incontinence); Ophthalmologic effect (blurred vision); Hepatic effects (abnormal LFTs, pancreatitis); Other effects (arthralgia, skin rashes, impotence, priapism)
Special Instructions
  • Start treatment with a low dose, preferably at night to avoid postural hypotension
  • Not recommended for HF treatment in patients with mechanical obstruction
  • Use with caution in the elderly, in patients with renal or hepatic failure or in patients with angina
Prazosin Initial dose:
0.5 mg PO 8-12 hourly x 3-7 days
Increase dose gradually every 3-7 days to:
Maintenance dose:
2-15 mg/day PO in divided doses 
Max dose: 20 mg/day
Terazosin Initial dose: 1 mg PO 24 hourly at bedtime
Increase dose at 1-week interval
Maintenance dose: 2-10 mg PO 24 hourly Max dose: 20 mg/day

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

Beta-Blockers


Drug Dosage Remarks
Acebutolol Initial dose: 200 mg PO 12 hourly or 400 mg PO 24 hourly
May increase to 800 mg PO 24 hourly or 400 mg PO 12 hourly after 2 weeks
Maintenance dose: 400-800 mg PO 24 hourly
Max dose: 1,200 mg/day		 Adverse Reactions
  • CNS effects (fatigue, depression, dizziness, confusion, sleep disturbances, headache); CV effects (HF, heart block, coldness of extremities, male impotence, hypotension); Respiratory effects (bronchospasm in susceptible patients and drugs with beta1 selectivity should be used with caution); GI effects (nausea/vomiting, diarrhea, constipation); Metabolic effects (can produce hyper- or hypoglycemia, changes in serum cholesterol and triglycerides)
  • Esmolol: Infusion site reactions, eg inflammation and induration
Special Instructions
  • Contraindicated in severe bradycardia, pre-existing high degree of AV block, sick sinus syndrome and severe unstable LV failure
  • Use with caution in patients with bronchospasm, asthma or obstructive airway diseases, renal impairment. Use with caution in 1st-degree block or depressed myocardial contractility, depression, patients with PVD and patients on Insulin
  • Beta-blockers may mask the symptoms of hyperthyroidism and hypoglycemia and may aggravate psoriasis
  • Patients on long-term treatment should not discontinue abruptly; should discontinue gradually over 1-2 weeks
Alprenolol 200 mg PO 24 hourly in divided doses
Atenolol Initial dose: 25-50 mg PO 24 hourly
May be gradually increased to 50-100 mg PO 24 hourly
Max dose: 100 mg/day
Betaxolol Initial dose: 5-10 mg PO 24 hourly
May be increased after 1-2 weeks to 20 mg/day
Max dose: 20 mg/day
Bisoprolol Initial dose:
2.5-5 mg PO 24 hourly
Maintenance dose: 5-10 mg PO 24 hourly
Max dose: 20 mg/day
Carteolol 2.5-30 mg PO 24 hourly
Adjust according to response
Carvedilol Initial dose: 12.5 mg PO 24 hourly x 2 days
Then increase to 25 mg PO 24 hourly or
Initial dose: 6.25 mg PO 12 hourly
May increase to 12.5 mg PO 12 hourly after 1-2 weeks
Dose may be increased, if necessary, at 2-week intervals to 50 mg 24 hourly or in divided doses
Max dose: 50 mg/day
Celiprolol Initial dose:
200 mg PO 24 hourly
May increase dose to 400 mg PO 24 hourly
Esmolol Intraoperative Hypertension
Loading dose: 80 mg (approximately 1 mg/kg) IV bolus over 30 seconds followed by 150 mcg/kg/min infusion, may be increased to 300 mcg/kg/min if necessary  
Postoperative Hypertension
Loading dose:
0.5 mg/kg IV over 1 minute followed by 4-minute infusion of 50 mcg/kg/min.
If effect is not observed within 5 minutes, repeat same loading dose and follow with a maintenance infusion increased to 100 mcg/kg/min
Labetalol Initial dose:  100 mg PO 12 hourly
May increase in increments of 100 mg 12 hourly at intervals of 2 weeks
Maintenance dose: 200-400 mg PO 12 hourly
Max dose: 2,400 mg/day
Metoprolol Regular release:
Initial dose: 100 mg PO in 1-2 divided doses
Maintenance dose: 100-200 mg PO 24 hourly
Max dose: 450 mg/day
Extended-release: 25-100 mg PO 24 hourly
Max dose: 400 mg/day
Nadolol Initial dose: 20-40 mg PO 24 hourly
May increase dose by 40-80 mg every 2-14 days until adequate response is achieved
Maintenance dose: 40-80 mg PO 24 hourly
Max dose: 240-320 mg/day
Nebivolol Initial dose: 5 mg PO 24 hourly
In renal insufficiency and in patients >65 years:
Recommended starting dose is 2.5 mg PO 24 hourly
Max dose: 40 mg/day
Oxprenolol Initial dose: 80-160 mg/day PO divided 8-12 hourly
May increase to 160-320 mg/day PO 1-2 weekly 
Max dose: 320 mg PO 24 hourly
Extended-release: ≤320 mg PO 24 hourly
Penbutolol  Initial dose: 20 mg PO 24 hourly
Max dose: 40-80 mg/day 
Pindolol Initial dose: 5 mg PO 8-12 hourly or 15 mg PO 24 hourly  
Maintenance dose: 15-45 mg PO 24 hourly in single or divided doses
Max dose: 60 mg/day
Propranolol Regular release:
Initial dose: 40-80 mg PO 12 hourly
May increase at weekly intervals to 160-320 mg/day
Max dose: 640 mg/day
Extended-release:
Initial dose: 80 mg PO 24 hourly
May increase to 120-160 mg PO 24 hourly
Max dose: 640 mg/day

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 increase in increments of 2 mg every 3-4 weeks according to response
Max dose: 6 mg/day
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
As a substitute for oral Nicardipine (individualized dose): 
Equivalent IV infusion rate: 0.5 mg/hr (for 20 mg PO 8 hourly); 1.2 mg/hr (for 30 mg PO 8 hourly); 2.2 mg/hr (for 40 mg PO 8 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 PO 24 hourly
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
2.5-10 mg PO 24 hourly
Max dose: 10 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: 1.25-2.5 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
Guanfacine  Initial dose: 1 mg PO 24 hourly at bedtime
Usual dose: 0.5 mg to 2 mg PO 24 hourly
Max dose: 3 mg/day 

Adverse Reactions

  • CV effects (orthostatic hypotension, syncope, bradycardia, AV block); CNS effects (headache, drowsiness, insomnia, sedation); Other effects (aggressive behavior, increased BMI, withdrawal syndrome)

Special Instructions

  • Use with caution in patients with renal and hepatic impairment, severe coronary insufficiency, history of hypotension, syncope, or QT prolongation, cerebrovascular disease
  • Avoid abrupt withdrawal
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
Dual 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
ACE Inhibitor/Beta-Blocker 
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
ACE Inhibitor/Calcium Antagonist 
Benazepril/Amlodipine1  Benazepril 10 mg/Amlodipine 2.5 mg
Benazepril 10 mg/Amlodipine 5 mg 
Benazepril 20 mg/Amlodipine 5 mg
Benazepril 20 mg/Amlodipine 10 mg
Benazepril 40 mg/Amlodipine 5 mg
Benazepril 40 mg/Amlodipine 10 mg		 Benazepril 10-40 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 arginine 3.5 mg/Amlodipine 2.5 mg
Perindopril arginine 7 mg/Amlodipine 5 mg
Perindopril arginine 14 mg/Amlodipine 10 mg
Perindopril arginine 5 mg/Amlodipine 5 mg
Perindopril arginine 5 mg/Amlodipine 10 mg
Perindopril arginine 10 mg/Amlodipine 5 mg
Perindopril arginine 10 mg/Amlodipine 10 mg
Perindopril tert-butylamine (erbumine) 4 mg/Amlodipine 5 mg
Perindopril tert-butylamine (erbumine) 4 mg/Amlodipine 10 mg
Perindopril tert-butylamine (erbumine) 8 mg/Amlodipine 5 mg
Perindopril tert-butylamine (erbumine) 8 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 1 mg/Verapamil 240 mg
Trandolapril 2 mg/Verapamil 180 mg
Trandolapril 2 mg Verapamil 240 mg
Trandolapril 4 mg/Verapamil 240 mg 		 1 tab PO 24 hourly
Max dose: Trandolapril 4 mg/Verapamil 240 mg/day 
ACE Inhibitor/Calcium Antagonist/Statin 
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 ProcainamideIncreased risk of hypotension, hyperkalemia, decreased renal function; interstitial lung disease on long-term therapy
  • Monitor glycemic control and LFTs periodically
ACE Inhibitor/Diuretic 
Captopril/Hydrochlorothiazide  Captopril 25 mg/Hydrochlorothiazide 12.5 mg
Captopril 25 mg/Hydrochlorothiazide 15 mg
Captopril 25 mg/Hydrochlorothiazide 25 mg
Captopril 50 mg/Hydrochlorothiazide 15 mg
Captopril 50 mg /Hydrochlorothiazide 25 mg		 Captopril 25 mg/Hydrochlorothiazide 15 mg PO 24 hourly
Max dose: Captopril 50 mg/Hydrochlorothiazide 50 mg/day 

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
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 
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 arginine 10 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 
ACE Inhibitor/Diuretic/Calcium Antagonist 
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
Angiotensin II Antagonist/Calcium Antagonist/Diuretic 
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 5 mg/Hydrochlorothiazide 25 mg
Olmesartan medoxomil 40 mg/Amlodipine 10 mg/Hydrochlorothiazide 12.5 mg 
Olmesartan medoximil 40 mg Amlodipine 10 mg/Hydrochlorothiazide 25 mg		 1 tab PO 24 hourly
Max dose: Olmesartan medoxomil 40 mg/Amlodipine 10 mg/Hydrochlorothiazide 25 mg 
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  
Angiotensin II Antagonist/Diuretic 
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 Aliskiren-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
Candesartan/Hydrochlorothiazide  Candesartan 8 mg/Hydrochlorothiazide 12.5 mg
Candesartan 16 mg/Hydrochlorothiazide 12.5 mg
Candesartan 32 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 
Angiotensin II Antagonist/Statin 
Telmisartan/Rosuvastatin Telmisartan 40 mg/Rosuvastatin 10 mg
Telmisartan 40 mg/Rosuvastatin 20 mg
Telmisartan 80 mg/Rosuvastatin 10 mg
Telmisartan 80 mg/Rosuvastatin 20 mg  		 Telmisartan 40 mg PO 24 hourly
May be increased to 80 mg PO 24 hourly  

Adverse Reactions

  • Metabolic effects (increased ALT, AST, creatine phosphokinase and potassium); Other effects (dyspepsia, nasopharyngitis, musculoskeletal stiffness, acne, pruritus, vertigo)

Special Instructions

  • Avoid in patients with cholestasis, biliary obstructive disorders, severe hepatic and renal impairment, myopathy, hereditary angioedema
    • Rosuvastatin 40 mg: Predisposing factors for myopathy/rhabdomyolysis, Asian patients, alcohol abuse, concomitant use of fibrates
  • Use with caution in patients with CV disease, CVA, gastroduodenal diseases, severe hypotension, proteinuria, genetic polymorphism
Beta-Blocker/Calcium Antagonist 
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 
Beta-Blocker/Diuretic 
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 (second tab to be taken with midday meal) 
Calcium Antagonist/Angiotensin II Antagonist 
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 
Amlodipine 5 mg/Valsartan 320 mg
Amlodipine 10 mg/Valsartan 320 mg
 1 tab PO 24 hourly
Max dose: Amlodipine 10 mg/ Valsartan 320 mg/day 
Calcium Antagonist/Diuretic 
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 
Calcium Antagonist/Statin 
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
Direct Renin Inhibitor/Diuretic 
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
Reserpine and Diuretics, Combination with Other Drugs 
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
Thiazide-Type Diuretic/Potassium-Sparing Diuretic 
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  
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.  

Related MIMS Drugs