Hypertension Drug Summary

Last updated: 25 March 2025
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ACE Inhibitors*

Drug Dosage Remarks
Benazepril Initial dose (patient taking diuretic): 5 mg PO 24 hourly
Initial dose (patient not on diuretic): 10 mg PO 24 hourly
Maintenance dose: 20-40 mg/day PO in 1-2 divided doses
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-week intervals
Maintenance: 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 week
Maintenance dose: 2.5-5 mg PO 24 hourly
Max dose: 10 mg/day
Delapril Initial dose: 15 mg PO 24 hrly
Maintenance dose: 15-30 mg PO 12 hrly
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
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): 2.5-5 mg PO 24 hourly
Initial dose (patient not on diuretic): 10-20 mg PO 24 hourly
Usual dose: 10-80 mg/day in 1-2 divided doses
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 not on diuretic): 1 mg PO 24 hourly
Initial dose (patient taking diuretic): 0.5 mg PO 24 hourly
Maintenance dose: 1-4 mg PO 24 hourly
Max dose: 8 mg/day
Zofenopril Initial dose: 15 mg PO 24 hourly
May increase dose at 4-week intervals
Usual 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 PO 24 hourly
*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 week 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 after 2 weeks
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; not to be used as first-line treatment of HTN
  • 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 

Non Standard Section



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

Non Standard Section



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

Non Standard Section



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

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