Hypertension. Adults, initial: 25 mg b.i.d.-t.i.d. If unsatisfactory response after 1-2 weeks, increase to 50 mg b.i.d.-t.i.d.; if still unsatisfactory after another 1-2 weeks, thiazide diuretic should be added (e.g., hydrochloro-


thiazide, 25 mg/day). Dosage may be increased to 100—150 mg b.i.d.—t.i.d., not to exceed 450 mg/day.

Accelerated or malignant hypertension.

Stop current medication (except for the diuretic) and initiate captopril at a dose of 25 mg b.i.d.—t.i.d. The dose may be increased q 24 hr until a satisfactory response is obtained or the maximum dose reached. Furose-mide may be indicated.

Heart failure. Initial: 25 mg t.i.d.; then, if necessary, increase dose to 50 mg t.i.d. and evaluate response; maintenance: 50-100 mg t.i.d., not to exceed 450 mg/day.

NOTE: For adults, an initial dose of 6.25-12.5 mg (0.15 mg/kg t.i.d. in children) should be given b.i.d.-t.i.d. to clients who are sodium-and water-depleted due to diuretics, who will continue to be on diuretic therapy, and who have renal impairment.

Left ventricular dysfunction after MI.

Therapy may be started as early as 3 days after the MI. Initial dose: 6.25 mg; then, begin 12.5 mg t.i.d. and increase to 25 mg t.i.d. over the next several days. The target dose is 50 mg t.i.d. over the next several weeks. Other treatments for MI may be used concomitantly (e.g., aspirin, beta blockers, thrombolytic drugs).

Diabetic nephropathy. 25 mg t.i.d. for chronic use. Other antihypertensive drugs (e.g., beta blockers, centrally-acting drugs, diuretics, vasodilators) may be used with captopril if additional drug therapy is needed to reduce BP.

Hypertensive crisis. Initial: 25 mg; then, 100 mg 90-120 min later, 200-300 mg/day for 2-5 days (then adjust dose). Sublingual captopril, 25 mg, has also been used successfully.

Rheumatoid arthritis. 75-150 mg/day in divided doses.

NOTE: For all uses, doses should be reduced in clients with renal impairment.

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