The dosage may be titrated upward until blood pressure is controlled or to a maximum of 40 mg daily.
Anaphylactoid reactions have been reported in patients dialysed with high-flux membranes (e. g., polyacrylonitrile [PAN] and treated concomitantly with an ACE inhibitor) (see PRECAUTIONS, Anaphylactoid Reactions during Membrane Exposure).
Dosage in the Elderly
In general, blood pressure response and adverse experiences were similar in younger and older patients given similar doses of PRINIVIL ® . Pharmacokinetic studies, however, indicate that maximum blood levels and area under the plasma concentration time curve (AUC) are doubled in older patients so that dosage adjustments should be made with particular caution.
Some patients with renovascular hypertension, especially those with bilateral renal artery stenosis or stenosis of the artery to a solitary kidney, may develop an exaggerated response to the first dose of PRINIVIL ® . Therefore, a lower starting dose of 2.5 or 5 mg is recommended. Thereafter, the dosage may be adjusted according to the blood pressure response.
Congestive Heart Failure
PRINIVIL ® is to be used in conjunction with a diuretic and where appropriate digitalis. Therapy must be initiated under close medical supervision, usually in a hospital. Blood pressure and renal function should be monitored, both before and during treatment with PRINIVIL ® , because severe hypotension and, more rarely, consequent renal failure have been reported (see WARNINGS, Hypotension and PRECAUTIONS, Renal Impairment).
Initiation of therapy requires consideration of recent diuretic therapy and the possibility of severe salt/ volume depletion. If possible, the dose of diuretic should be reduced before beginning treatment. The recommended initial dose is 2.5 mg per day. If required, the dose should be increased gradually, depending on the patient response. The usual effective dosage range is 5-20 mg per day administered in a single daily dose. Dose titration may be performed over a 2-4 week period, or more rapidly if indicated by the presence of residual signs and symptoms of heart failure.