Indications: hypertension; symptomatic heart failure following myocardial infarction in patients with clinical evidence of heart failure; prevention of cardiovascular events in patients with atherosclerotic cardiovascular disease or with diabetes mellitus and at least one additional risk factor for cardiovascular disease; nephropathy.

Cautions: see ACE Inhibitors

Contra-indications: see ACE Inhibitors

Hepatic impairment: max. daily dose 2.5 mg.

Renal impairment: ; max. daily dose 5 mg if eGFR 30– 60 ml/minute/1.73 m2; max. initial dose 1.25 mg once daily (do not exceed 5 mg daily) if eGFR less than 30 ml/minute/1.73 m2

Side Effects: stomatitis, syncope, dyspnea, bronchitis, muscle cramps; less commonly dry mouth, arrhythmias, tachycardia, palpitations, angina, chest pain, myocardial infarction, peripheral oedema, flushing, loss of appetite, nervousness, depression, anxiety, impotence, decreased libido, visual disturbances, sweating; rarely confusion, tremor, conjunctivitis, impaired hearing, tinnitus, onycholysis; also reported cerebrovascular accident, precipitation or exacerbation of Raynaud's syndrome, sleep disturbance, gynaecomastia, hyponatraemia, skin reactions including erythema multiforme, pemphigoid exanthema, Stevens-Johnson syndrome, and toxic epidermal necrolysis, alopecia.

Dose: Hypertension, initially 1.25–2.5 mg once daily, increased at intervals of 2–4 weeks to max. 10 mg once daily; if used in addition to diuretic

- Heart failure (adjunct), initially 1.25 mg once daily under close medical supervision, increased gradually at intervals of 1–2 weeks to max. 10 mg daily if tolerated (preferably taken in 2 divided doses)

- Prophylaxis after myocardial infarction (started at least 48 hours after infarction), initially 2.5 mg twice daily, increased after 3 days to 5 mg twice daily.

Note: If initial 2.5-mg dose not tolerated, give 1.25 mg twice daily for 2 days before increasing to 2.5 mg twice daily, then 5 mg twice daily; withdraw if dose cannot be increased to 2.5 mg twice daily.

Prophylaxis of cardiovascular events, initially 2.5 mg once daily, increased after 1–2 weeks to 5 mg once daily, then increased after a further 2–3 weeks to 10 mg once daily.

Nephropathy, initially 1.25 mg once daily, increased after 2 weeks to 2.5 mg once daily, then increased after a further 2 weeks to 5 mg once daily if tolerated.