Table 8

Pharmacokinetic Changes, Route of Elimination, and Dosage Adjustment of Selected Antihypertensive Drugs in the Elderly

Drug Class/DrugHalf–LifeVolume of DistributionClearancePrimary Route(s) of EliminationDosage Adjustment
Alpha-adrenergic agonists, centrally acting
 GuanfacineHepatic/renalInitiate at lowest dose; titrate to response
Alpha1 selective adrenergic antagonists, peripherally acting
 Doxazosin*HepaticInitiate at lowest dose; titrate to response
 PrazosinHepaticInitiate at lowest dose; titrate to response
 TerazosinHepaticInitiate at lowest dose; titrate to response
Angiotensin-converting enzyme inhibitors
 BenazeprilRenalNo adjustment needed
 CaptoprilNSRenalInitiate at lowest dose; titrate to response
 FosinoprilHepatic/renalNo adjustment needed
 LisinoprilRenalInitiate at lowest dose; titrate to response
 PerindoprilRenalInitiate at lowest dose; titrate to response
 RamiprilRenalInitiate at lowest dose; titrate to response
Angiotensin II receptor blockers
 CandesartanHepatic/renalNo adjustment needed
 EprosartanHepatic/biliary/renalNo adjustment needed
 IrbesartanNSHepaticNo adjustment needed
 LosartanHepaticNo adjustment needed
 ValsartanHepaticNo adjustment needed
Beta-adrenergic blockers
 Nonselective without ISA
  NadololNSRenalInitiate at lowest dose; titrate to response
  PropranololNSHepaticInitiate at lowest dose; titrate to response
 Beta1 selective without ISA
  AtenololNSRenalInitiate at lowest dose; titrate to response
  MetoprololNSNSNSHepaticInitiate at lowest dose; titrate to response
 Beta1 selective with ISA
  AcebutololHepatic/biliaryInitiate at lowest dose; titrate to response
 Dual acting
  CarvedilolHepatic/biliaryInitiate at lowest dose; titrate to response
  LabetalolNSHepaticInitiate at lowest dose; titrate to response
  NebivololHepatic/renalNo adjustment needed
Calcium antagonists
 AmlodipineHepaticInitiate at lowest dose; titrate to response
 DiltiazemNSHepaticInitiate at lowest dose; titrate to response
 FelodipineNSHepaticInitiate at lowest dose; titrate to response
 NicardipineNSHepaticNo initial adjustment needed
 NifedipineNSHepaticInitiate at lowest dose; titrate to response
 VerapamilNSHepaticInitiate at lowest dose; titrate to response
Diuretics
 Loop
  BumetanideNSRenal/hepaticNo initial adjustment needed
  FurosemideNSRenalNo initial adjustment needed
  TorsemideHepaticNo initial adjustment needed
 Potassium sparing
  EplerenoneHepaticNo initial adjustment needed
  TriamtereneHepatic/renalInitiate at lowest dose; titrate to response
  SpironolactoneHepatic/biliary/renalNo initial adjustment needed

Reprinted from Frishman (550).

Ellipses indicate no information is available. NS indicates nonsignificant; ↑, increase; and ↓, decrease.