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SIZE:
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GENERIC NAME:
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MANUFACTURER:
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MERCK SHARP & DOHME INTERNATIONAL
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UNIT:
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ADMINISTRATION ROUTE:
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FDA PREGNANCY GROUP:
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C
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INDICATIONS:
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Heart failure, congestive |
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Hypertension, essential |
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Left ventricular dysfunction, asymptomatic |
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SIDE EFFECTS:
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acute generalized exanthematous pustulosis (AGEP) |
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agranulocytosis |
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anaphylactoid reactions |
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angioedema |
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aplastic anemia |
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azotemia |
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cholestasis |
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cough |
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dizziness |
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fatigue |
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glomerulonephritis |
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hemolytic anemia |
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hepatic failure |
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hepatic necrosis |
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hepatitis |
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hyperkalemia |
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hypotension |
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jaundice |
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maculopapular rash |
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neutropenia |
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orthostatic hypotension |
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pancytopenia |
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pneumonitis |
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renal tubular necrosis |
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sinus tachycardia |
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syncope |
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teratogenesis |
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thrombocytopenia |
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ABSOLUTE
CONTRAINDICATIONS :
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RELATIVE
CONTRAINDICATIONS : |
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aortic stenosis |
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autoimmune disease |
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black patients |
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bone marrow suppression |
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breast-feeding |
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cardiomyopathy |
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cerebrovascular disease |
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children |
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collagen-vascular disease |
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coronary artery disease |
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desensitization procedures |
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dialysis |
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elderly |
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heart failure |
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hepatic disease |
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hyperkalemia |
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hyponatremia |
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hypotension |
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hypovolemia |
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immunosuppression |
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infants |
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low-density lipoprotein apheresis |
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neonates |
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pregnancy |
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renal artery stenosis |
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renal disease |
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renal failure |
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renal impairment |
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ADULT DOSE:
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Antihypertensive-Initial: Oral, 5 mg once a day, the dosage being adjusted after one or two weeks according to clinical response.
Maintenance: Oral, 10 to 40 mg per day, as a single dose or in two divided doses.
Note: An initial dose of 2.5 mg should be used in patients who are sodium- and water-depleted as a result of prior diuretic therapy, patients continuing to receive diuretic therapy, or patients with renal failure (creatinine clearance less than 30 mL per minute). Such patients should be kept under medical supervision for at least two hours after this initial dose (and for an additional hour after blood pressure has stabilized ), to watch for excessive hypotension .
Vasodilator, congestive heart failure -Initial: Oral, 2.5 mg once or twice a day , the dosage being adjusted after a few days or weeks according to clinical response.
Maintenance: Oral, 5 to 40 mg per day, as a single dose or in two divided doses .
Left ventricular dysfunction, asymptomatic -Oral, 2.5 mg two times a day titrated as tolerated up to a target dose of 20 mg a day in divided doses.
Note: Patients should be kept under medical supervision for at least two hours and until blood pressure has stabilized for an additional hour after the initial dose .
In patients with hyponatremia (serum sodium concentration less than 130 mEq per liter) or serum creatinine greater than 1.6 mg per deciliter, an initial dose of 2.5 mg once a day is recommended .
If possible, the dose of the diuretic should be reduced to decrease the likelihood of hypotension. |
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MAXIMUM ADULT DOSE:
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40 mg per day .
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PEDIATRIC DOSE:
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Safety and efficacy have not been established.
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MAXIMUM PEDIATRIC
DOSE:
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ELDERLY DOSE:
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