Combination Hypertension Treatments

COMBINATION HYPERTENSION TREATMENTS
Generic	Brand	Strength	Form	Usual Adult Dose
ACE INHIBITOR + THIAZIDE DIURETIC
benazepril/HCTZ	Lotensin HCT	10mg/12.5mg, 20mg/12.5mg, 20mg/25mg	scored tabs	Switching from monotherapy with either component: initially 10/12.5mg once daily; may increase after 2–3wks as needed up to max 20/25mg daily. Or, substitute for individually titrated components.
captopril/HCTZ	—	25mg/15mg, 25mg/25mg, 50mg/15mg, 50mg/25mg	scored tabs	Take 1hr before meals. As initial therapy: one 25/15 tab daily; adjust at 6wk intervals. Previously titrated: use same doses as individual components. Usual max 150mg captopril, 50mg HCTZ daily.
enalapril/HCTZ	Vaseretic	10mg/25mg	tabs	Switching from monotherapy with either component: start with 10/25 once daily, then adjust; max 20mg enalapril/day and 50mg HCTZ/day. Allow 2−3wks for titration of HCTZ component. Or, substitute for individually titrated components.
fosinopril/HCTZ	—	10mg/12.5mg, 20mg/12.5mg	tabs	Not for initial therapy. Give once daily. Usual range: fosinopril: 10–20mg; HCTZ: 12.5–50mg. CrCl<30mL/min: not recommended.
lisinopril/HCTZ	—	10mg/12.5mg, 20mg/12.5mg+	tabs	Not for initial therapy. Initially 10mg/12.5mg or 20mg/12.5mg; increase HCTZ dose 2−3wks after. Max 80mg/50mg daily. CrCl <30mL/min: not recommended.
lisinopril/HCTZ	Zestoretic	10mg/12.5mg, 20mg/12.5mg, 20mg/25mg	tabs	Switching from monotherapy with either component: initally 10/12.5 or 20/12.5 once daily, then after 2−3wks titrate HCTZ component. If on diuretic: if possible, suspend diuretic for 2−3 days, then adjust. Or, substitute for individually titrated components. CrCl ≤30mL/min: not recommended.
moexipril/ HCTZ	—	7.5mg/12.5mg, 15mg/12.5mg, 15mg/25mg	scored tabs	Not for initial therapy. Take 1hr before a meal. Switching from monotherapy with either component: 1 tab once daily; allow 2–3wks before titrating HCTZ component. Usual max 30mg/50mg per day. Or, substitute for individually-titrated components. CrCl≤40mL/min: not recommended.
quinapril/HCTZ	Accuretic	10mg/12.5mg+, 20mg/12.5mg+, 20mg/25mg	tabs	Not for initial therapy. Previously titrated: use same doses as individual components. Switching from quinapril monotherapy: initially one 10/12.5 tab or one 20/12.5 tab once daily; allow 2−3wks before increasing HCTZ component. Switching from HCTZ 25mg/day monotherapy: initially one 10/12.5 tab daily or one 20/12.5 tab once daily. Adjust based on response and serum potassium. CrCl ≤30mL/min: not recommended.
ACE INHIBITOR + CALCIUM CHANNEL BLOCKER (DIPHENYLALKYLAMINE)
trandolapril/verapamil (ext‑rel)	Tarka	1mg/240mg, 2mg/180mg, 2mg/240mg, 4mg/240mg	tabs	Titrate individual components. Take with food. 1 tab daily.
ANGIOTENSIN II RECEPTOR BLOCKER + CALCIUM CHANNEL BLOCKER (DIHYDROPYRIDINE) + THIAZIDE DIURETIC
olmesartan/amlodipine/HCTZ	Tribenzor	20mg/5mg/ 12.5mg, 40mg/5mg/ 12.5mg, 40mg/5mg/ 25mg, 40mg/10mg/ 12.5mg, 40mg/10mg/ 25mg	tabs	Not for initial therapy. 1 tab once daily. May titrate at 2-week intervals; max one 40/10/25mg tab daily. ≥75yrs or severe hepatic impairment: use individual components (amlodipine 2.5mg).
valsartan/amlodipine/HCTZ	Exforge HCT	160mg/5mg/ 12.5mg, 160mg/5mg/ 25mg, 160mg/10mg/ 12.5mg, 160mg/10mg/ 25mg, 320mg/10mg/ 25mg	tabs	Not for initial therapy. 1 tab daily. Titrate at 2‑week intervals; max one 320mg/10mg/25mg tab daily. 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, CCBs, and diuretics.
ANGIOTENSIN II RECEPTOR BLOCKER + THIAZIDE DIURETIC
azilsartan/chlorthalidone	Edarbyclor	40mg/12.5mg, 40mg/25mg	tabs	Initially 40/12.5mg once daily. May increase to 40/25mg after 2−4wks as needed. Max: 40/25mg. Patients titrated to the individual components: may give corresponding dose of Edarbyclor. See full labeling.
candesartan/HCTZ	Atacand HCT	16mg/12.5mg, 32mg/12.5mg, 32mg/25mg	scored tabs	Not for initial therapy. May be substituted for titrated components. BP not controlled on HCTZ 25mg once daily, or controlled but serum potassium decreased: one 16/12.5 tab once daily. BP not controlled on candesartan 32mg per day: initially one 32/12.5 tab once daily; may increase to 32/25 once daily. CrCl ≤30mL/min: not recommended.
irbesartan/ HCTZ	Avalide	150mg/12.5mg, 300mg/12.5mg	tabs	Take once daily. Not controlled on monotherapy: initially 150/12.5mg, titrate to 300/12.5mg then 300/25mg if needed. Initial therapy: start at 150/12.5mg for 1–2wks, then titrate as needed up to max 300mg/25mg. May be substituted for titrated components. CrCl ≤30mL/min: not recommended.
losartan/HCTZ	Hyzaar	50mg/12.5mg, 100mg/12.5mg, 100mg/25mg	tabs	Initially 50/12.5mg once daily (100/12.5mg if BP not controlled on losartan 100mg alone); may increase after 3wks as needed to max 100/25mg daily. HTN with LVH (BP not controlled on losartan alone): initially 50/12.5mg once daily; increase as needed to 100/12.5mg, then to max 100/25mg daily.
olmesartan/HCTZ	Benicar HCT	20mg/12.5mg, 40mg/12.5mg, 40mg/25mg	tabs	BP not controlled on olmesartan alone: initially 40/12.5mg once daily. Intolerant to or BP not controlled on HCTZ alone: initially 20/12.5mg once daily. Both: may titrate at 2–4wk intervals up to max 40mg/25mg once daily. May substitute for individually titrated components.
telmisartan/HCTZ	Micardis HCT	40mg/12.5mg, 80mg/12.5mg, 80mg/25mg	tabs	Not for initial therapy. May be substituted for titrated components. BP not controlled on telmisartan 80mg/day: 80mg/12.5mg once daily. BP not controlled on HCTZ 25mg/day or BP controlled but hypokalemic: 80mg/12.5mg once daily. Both: may titrate up to 160mg/25mg after 2–4wks. Hepatic insufficiency or biliary obstruction: initially 40mg/12.5mg once daily; monitor closely. Severe renal or hepatic impairment: not recommended.
valsartan/ HCTZ	Diovan HCT	80mg/12.5mg, 160mg/12.5mg, 160mg/25mg, 320mg/12.5mg, 320mg/25mg	tabs	Add-on or initial therapy and not volume-depleted: initially 160mg/12.5mg once daily; may increase after 1–2wks up to max 320mg/25mg daily. May be substituted for the titrated components.

Generic	Brand	Strength	Form	Usual Adult Dose
BETA-BLOCKER + THIAZIDE DIURETIC
atenolol/ chlorthalidone	Tenoretic	50mg/25mg+, 100mg/25mg	tabs	Switching from monotherapy: initially one 50mg/25mg tab daily; may increase to one 100mg/25mg tab daily. CrCl 15−35mL/min: max 50mg atenolol/day. CrCl <15mL/min: max 50mg atenolol every other day.
bisoprolol/HCTZ	Ziac	2.5mg/6.25mg, 5mg/6.25mg, 10mg/6.25mg	tabs	Initially one 2.5mg/6.25mg tab once daily. Adjust at 14‑day intervals; max 20mg/12.5mg once daily.
metoprolol tartrate/HCTZ	Lopressor HCT	50mg/25mg, 100mg/25mg	scored tabs	Titrate individual components. Give in 1–2 divided doses. Max 50mg/day HCTZ.
metoprolol succinate extended-release/HCTZ	Dutoprol	25mg/12.5mg, 50mg/12.5mg, 100mg/12.5mg	tabs	Individualize. Initially 25mg/12.5mg once daily; may titrate at 2-week intervals to max 200mg/25mg once daily. May substitute for individual titrated components. CrCl ≤30mL/min: not established.
nadolol/bendroflu– methiazide	Corzide	40mg/5mg, 80mg/5mg	scored tabs	Initially 40mg/5mg once daily; may increase to 80mg/5mg once daily. Renal impairment: increase dosing interval (see full labeling).
propranolol/ HCTZ	—	40mg/25mg, 80mg/25mg	scored tabs	Titrate individual components. Max 50mg/day HCTZ.
CALCIUM CHANNEL BLOCKER (DIHYDROPYRIDINE) + ACE INHIBITOR
amlodipine/benazepril	Lotrel	2.5mg/10mg, 5mg/10mg, 5mg/20mg, 5mg/40mg, 10mg/20mg, 10mg/40mg	caps	Not adequately controlled with dihydropyridine CCB, ACE inhibitor, unable to achieve BP control with amlodipine without developing edema: Initially 2.5mg/10mg once daily; may titrate up to 10mg/40mg once daily if BP remains uncontrolled. Replacement therapy: may be substituted for titrated components. CrCl ≤30mL/min: not recommended.
amlodipine/perindopril	Prestalia	2.5mg/3.5mg, 5mg/7mg, 10mg/14mg	tabs	Initially 3.5mg/2.5mg once daily. Adjust at 7−14 day intervals; max 14mg/10mg once daily. Renal impairment: (CrCl 30–80mL/min): max 7mg/5mg; (CrCl <30mL/min): not recommended.
CALCIUM CHANNEL BLOCKER (DIHYDROPYRIDINE) + ANGIOTENSIN II RECEPTOR BLOCKER
amlodipine/olmesartan	Azor	5mg/20mg, 5mg/40mg, 10mg/20mg, 10mg/40mg	tabs	Individualize. Initially 5mg/20mg once daily; may increase after 1–2 weeks up to max 10mg/40mg daily. ≥75yrs or hepatic impairment: initial therapy not recommended.
amlodipine/telmisartan	Twynsta	5mg/40mg, 5mg/80mg, 10mg/40mg, 10mg/80mg	tabs	Take once daily. Initial therapy: 5/40mg or 5/80mg; may titrate at 2‑week intervals to max 10/80mg. Add‑on therapy: may be used if not controlled on monotherapy; if dose-limiting adverse reactions with amlodipine 10mg, switch to 5/40mg tab. Replacement therapy: may be substituted for the titrated components. Severe renal impairment: titrate slower. ≥75yrs, or hepatic impairment: not for initial use (initially use amlodipine alone, or add amlodipine 2.5mg to telmisartan; titrate slowly).
amlodipine/valsartan	Exforge	5mg/160mg, 5mg/320mg, 10mg/160mg, 10mg/320mg	tabs	Take once daily. Initial therapy and not volume depleted: Initially 5/160mg; may increase after 1−2wks up to max 10/320mg. Add‑on therapy: may be used if not controlled on monotherapy; if inadequate response after 3−4wks, may titrate up to max 10/320mg. Replacement therapy: may be substituted for the titrated components. Maximum effects within 2wks after dose change. Elderly, hepatic impairment: initial therapy not recommended.
CENTRAL ALPHA-AGONIST + THIAZIDE DIURETIC
methyldopa/HCTZ	—	250mg/15mg, 250mg/25mg	tabs	Titrate individual components. Initially one 250mg/15mg tab 2–3 times daily or one 250mg/25mg tab 2 times daily. Max 3g/day methyldopa and 50mg/day HCTZ.
DIRECT RENIN INHIBITOR + THIAZIDE DIURETIC
aliskiren/HCTZ	Tekturna HCT	150mg/12.5mg, 150mg/25mg, 300mg/12.5mg, 300mg/25mg	tabs	Take consistently with regard to meals. 1 tab once daily. Add‑on or initial therapy and not volume-depleted: initially 150mg/12.5mg; may increase after 2−4wks up to max 300mg/25mg. Replacement therapy: substitute for the titrated components.
K⁺ SPARING DIURETIC + THIAZIDE DIURETIC
amiloride/HCTZ	—	5mg/50mg	scored tabs	Initially 1 tab daily with food. May increase to 2 tabs daily in single or divided doses.
spirono–lactone/HCTZ	Aldactazide	25mg/25mg, 50mg/50mg+	tabs	Not for initial therapy. Usual maintenance: 50–100mg each of spironolactone and HCTZ daily in single or divided doses.
triamterene/HCTZ	Dyazide	37.5mg/25mg	caps	1−2 caps once daily.
triamterene/HCTZ	Maxzide	37.5mg/25mg, 75mg/50mg	scored tabs	1−2 tabs of 37.5/25 daily or 1 tab of 75/50 daily.
NOTES
Key: HCTZ = hydrochlorothiazide; + = scored. Not an inclusive list of medications, official indications, and/or dosing details. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 11/2019)

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