Table 1.
Approved indications, usual starting and maintenance dosing,a and FDA approval dates for ARBs and aliskiren
| Drug | Adult hypertension dose and date of FDA approval | Post-MI dose and date of FDA approval | Heart failure (NYHA class II–IV) dose and date of FDA approval | CV risk reduction in ACEi intolerance dose and date of FDA approvalb | Stroke reduction in hypertensive LVH dose and date of FDA approval | Nephropathy in type 2 diabetes dose and date of FDA approval |
|---|---|---|---|---|---|---|
| Losartan27 | 50 mg/day startingc; 25–100 mg/day maintenance | Not indicated | Not indicated | Not indicated | 50 mg/day startingd; ↑ to 100 mg/day and/or add HCTZe per BP response | 50 mg/day starting; ↑ to 100 mg/day per BP response |
| April 14, 1995 | March 25, 2003 | September 17, 2002 | ||||
| Valsartan28 | 80 or 160 mg/day startingc; 80–320 mg/day maintenance | 20 mg bid startingf; ↑ to 40 mg bid within 7 days; titrate to target maintenance of 160 mg bid as toleratedg | 40 mg bid starting; ↑ to 80 mg bid and to target maintenance of 160 mg bid as tolerated | Not indicated | Not indicated | Not indicated |
| July 18, 2001 | August 03, 2005 | August 14, 2002 | ||||
| Candesartan61 | 8 mg/day startingc; 8 mg/day maintenance (usual); may ↑ to 16 or 32 mg/day | Not indicated | 4 mg/day starting; ↑ to target maintenance of 32 mg/day as tolerated | Not indicated | Not indicated | Not indicated |
| June 04, 1998 | February 22, 2005 | |||||
| Irbesartan62 | 150 mg/day startingc; ↑ to 300 mg/day if needed | Not indicated | Not indicated | Not indicated | Not indicated | Target maintenance of 300 mg/day |
| September 30, 1997 | September 17, 2002 | |||||
| Telmisartan63 | 40 mg/day startingc; 40–80 mg/day maintenance | Not indicated | Not indicated | 80 mg/day starting; 80 mg/day maintenance | Not indicated | Not indicated |
| November 10, 1998 | October 16, 2009 | |||||
| Eprosartan64 | 600 mg/day startingc; 400–800 mg/day maintenance | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated |
| December 22, 1997 | ||||||
| Olmesartan65 | 20 mg/day startingc; ↑ to 40 mg/day after 2 weeks if needed | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated |
| April 25, 2002 | ||||||
| Aliskiren60 | 150 mg/day starting; ↑ to 300 mg/day after 2 weeks if needed | Not indicated | Not indicated | Not indicated | Not indicated | Not indicated |
| March 05, 2007 |
Reprinted from Advances in Therapy®, volume 27, issue 5, Siragy, ‘Comparing angiotensin II receptors on benefits beyond blood pressure’, pp 257–284, Copyright 2010, with permission from Springer.20
Notes:
Based on United States’ product labeling;
For reduction of myocardial infarction, stroke, or death from CV causes in patients age ≥55 years at high risk of major CV events and unable to tolerate ACEis;
If not volume depleted, in which case a lower starting dose should be used;
Evidence suggests that stroke reduction benefits do not apply to black patients;
Initially 12.5 mg/day and then 25 mg/day subsequent to the losartan increase to 100 mg/day;
Specifically in clinically stable patients with LV failure or dysfunction, initiated as early as 12 hours post-MI;
Consider dose reduction for occurrence of symptomatic hypotension or renal dysfunction.
Abbreviations: ACEi, angiotensin-converting enzyme inhibitor; ARBs, angiotensin II receptor blockers; BP, blood pressure; bid, twice daily dose; CV, cardiovascular; FDA, Food and Drug Administration; HCTZ, hydrochlorothiazide; LVH, left ventricular hypertrophy; MI, myocardial infarction; NYHA, New York Heart Association.