TABLE 4.
Agents for renin–angiotensin–aldosterone blockade, their doses, contraindicated drugs, and dosage modification in CKD.
| Class | Drug | Usual dose, range (mg/d)* | Contraindicated | Dose adjustments based on GFR (mL/min/1.73 m2) (percentage of usual dosage) | Remarks for prescription in CKD | ||
|---|---|---|---|---|---|---|---|
| 30–59 | 10–29 | <10 | |||||
| Benazepril | 10–40 mg/day (divided q12–24h) | Aliskiren sacubitril/valsartan | 75% | 50% | 25% | An increased risk of hyperkalemia is associated with CKD patients. Not recommended in combination with ARBs or direct renin inhibitor. Avoid during pregnancy. | |
| Captopril | 25–50 mg q8–12h | Aliskiren sacubitril/valsartan | 75% | 50%–75% | 50% | ||
| Enalapril | 5–40 mg/day (divided q12–24h) | Aliskiren protein a column sacubitril/valsartan | 50%–100% | 50% | 25% | ||
| Fosinopril | 10–40 mg/day (divided q12–24h) | Aliskiren protein a column sacubitril/valsartan | — | — | 75%–100% | ||
| Lisinopril | 10–40 mg q24h | Aliskiren protein a column sacubitril/valsartan | 50%–75% | 50% | 25%–50% | ||
| Moexipril | 7.5–30 mg/day (divided q12–24h) | Aliskiren protein a column sacubitril/valsartan | 50% | 50% | 50% | ||
| Perindopril | 4–16 mg q24h | Aliskiren protein a column sacubitril/valsartan | 50% | Max dose of 2 mg q48h | Max dose of 2 mg q48h | ||
| Quinapril | 10–80 mg/day (divided q12–24h) | Aliskiren protein a column sacubitril/valsartan | 50% | 25%–50% | 25% | ||
| Ramipril | 2.5–20 mg/day (divided q12–24h) | Aliskiren protein a column sacubitril/valsartan | 50% | 25%–50% | 25% | ||
| Trandolapril | 1–4 mg/day (divided q12–24h) | Aliskiren protein a column sacubitril/valsartan | — | 50% | 50% | ||
| ARBs | Azilsartan | 40–80 | Aliskiren | — | — | — | CKD patients are at an increased risk of hyperkalemia. Not recommended in patients with a history of angioedema with ARBs. Avoid during pregnancy. Not recommended in combination with ACE inhibitors or direct renin inhibitor. |
| Candesartan | 16–32 mg/day (divided q12–24h) | Aliskiren | — | — | — | ||
| Eprosartan | 600–800 | Aliskiren | — | — | — | ||
| Irbesartan | 150–300 mg q24h | Aliskiren | — | — | — | ||
| Losartan | 50–100 mg q24h | Aliskiren | — | — | — | ||
| Olmesartan | 20–40 mg q24h | Aliskiren | — | — | 50% | ||
| Telmisartan | 40–80 mg q24h | Aliskiren elagolix | — | — | — | ||
| Valsartan | 80–320 mg q24h | Aliskiren | — | — | — | ||
| Direct renin inhibitor | Aliskiren | 150–300 | Azilsartan, benazepril, candesartan, captopril, enalapril, eprosartan, fosinopril, irbesartan, lisinopril, losartan, moexipril, olmesartan, perindopril, quinapril, ramipril, sacubitril/valsartan, telmisartan, trandolapril, and valsartan | — | — | — | Not recommended in combination with ACE inhibitors or ARBs. A higher risk of hyperkalemia in CKD patients. Avoid during pregnancy. |