Indications

Hypertension, Heart failure, Post myocardial infarction, Prophylaxis of cardiovascular events in high-risk patients

Contraindication

History of angioedema (hereditary, idiopathic or due to previous angioedema w/ ACE inhibitors). Concomitant use w/ aliskiren in patients w/ diabetes or renal impairment. Pregnancy and lactation.

Special Precautions

Patients w/ bilateral renal artery stenosis or a single kidney w/ unilateral renal artery stenosis; at risk for hypotension (e.g. patients w/ volume or salt depletion); aortic or mitral valve stenosis. Renal and hepatic impairment. Patient Counselling Inform patients to refrain from activities involving mental alertness and physical coordination after drug intake. Monitoring Parameters Correct volume and/or salt depletion prior to treatment. Monitor BP, serum creatinine and K levels. Monitor renal function during the 1st few wk of treatment and periodically thereafter.

Side Effects

Laryngeal stridor, angioedema of the face and tongue, glottis; intestinal angioedema. Cholestatic jaundice. Asthenia/fatigue, headache, dizziness, hypotension, persistent and non-productive cough, syncope, nausea, vomiting, vertigo, abnormal kidney function, and diarrhoea. Hyperkalemia. Anaemia, neutropenia/agranulocytosis, pancytopenia, leukopenia, thrombocytopenia. Increased BUN and serum creatinine levels.

Drug Interactions

May enhance hypotensive effect w/ diuretics and other antihypertensives. May increase risk of renal function deterioration w/ NSAIDs. May increase serum levels and toxicity of lithum. May increase hyperkalaemic effect w/ K-sparing diuretics and supplements.

Route of Administration

Oral

Dosage

As directed by the physician