Protocol for Treatment with ACE Inhibitors
1. If possible, use well-studied agents with known target dosages; e.g., captopril 50 mg tid, or enalapril maleate 10 mg bid.
2. Record baseline renal function before initiating therapy so changes can be appreciated.
3. Start at one-fourth to one-half the target dosage and titrate upwards weekly as clinical symptoms, blood pressure, and laboratory results allow.
4. Monitor blood pressure and clinical symptoms, such as dizziness and cough, weekly. Also evaluate electrolyte and blood urea nitrogen or creatine levels weekly. If the creatine level rises significantly, discontinue the angiotensin converting enzyme (ACE) inhibitor. If potassium level rises, try increasing loop diuretic.
5. After achieving ACE-inhibitor target dosage, patient can be seen monthly.
6. If patient does not tolerate agent used because of rash or cough, try another ACE inhibitor before using other forms of afterload therapy.
7. Other forms of afterload therapy include hydralazine HCl plus nitrates. The target dosage of hydralazine is 300 mg to 400 mg/day; the target dosages for nitrates are 40 mg tid for isosorbide dinitrate and 120 mg/day for long-acting nitrates. Titrate drug dosages in the same way as for ACE inhibitors (steps 3 and 4).
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content