Indications for EXFORGE HCT:
Hypertension. Not for initial therapy.
One tab daily. Titrate at 2-week intervals; max one 10mg/320mg/25mg tab daily. Replacement therapy: may be substituted for individually titrated components. Add-on/switch therapy: may be used to provide additional BP lowering for patients not adequately controlled on doses of any two antihypertensive classes: ARBs, calcium channel blockers, and diuretics.
Anuria. Sulfonamide allergy. Concomitant aliskiren in patients with diabetes.
Fetal toxicity may develop; discontinue if pregnancy is detected. Correct salt/volume depletion, hypokalemia, hypomagnesemia prior to initiation. Heart failure. Recent MI. Severe obstructive coronary disease. Aortic or mitral stenosis, obstructive hypertrophic cardiomyopathy: not recommended. Monitor renal function in renal artery stenosis, CKD, severe CHF, or volume depletion. Monitor for hyperkalemia in renal insufficiency. Hepatic or severe renal impairment. Dialysis. Surgery. SLE. Diabetes. Gout. Acute myopia and secondary angle-closure glaucoma. Elderly. Neonates. Pregnancy: avoid. Nursing mothers: not recommended.
Calcium channel blocker (CCB) (dihydropyridine) + angiotensin II receptor blocker (ARB) + thiazide diuretic.
See Contraindications. Concomitant renin-angiotensin system (RAS) inhibitors, K+ supplements, K+ sparing diuretics, K+-containing salt substitutes or other drugs (eg, heparin) may cause hyperkalemia and, in heart failure patients to increases in serum creatinine. Potentiates simvastatin (limit simvastatin dose to 20mg daily), cyclosporine, or tacrolimus (monitor levels). May be potentiated by CYP3A4 inhibitors. Monitor BP if coadministered with CYP3A4 inducers (eg, rifampicin, St. Johns wort). Monitor for hypotension with concomitant sildenafil. May be antagonized by, and renal toxicity potentiated by, NSAIDs, including selective COX-2 inhibitors (monitor renal function periodically in elderly and/or volume depleted). Adjust antidiabetic, antigout medications. May increase lithium levels; monitor. Carbamazepine may lead to symptomatic hyponatremia. Cyclosporine may increase the risk of hyperuricemia and gout-type complications. Dual inhibition of the RAS with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely; in general, avoid combined use of RAS inhibitors. Avoid concomitant aliskiren in renal impairment (CrCl <60mL/min). Give at least 4hrs before or 4–6hrs after administration of ion exchange resins (eg, cholestyramine, colestipol). May interfere with parathyroid tests.
Dizziness, peripheral edema, headache, dyspepsia, fatigue, muscle spasms, back pain, nausea, nasopharyngitis; HCTZ: increased risk for non-melanoma skin cancer.