Available at: https://www.healthquality.va.gov/guidelines/CD/CKD/ Drug Usual Dose Range Commentsa Angiotensin II Receptor Blockers (ARB) Azilsartand Candesartand Eprosartand Irbesartand Losartanb Olmesartand Telmisartand Valsartanb,e 40-80 mg daily (40 mg with diuretic) 8-32 mg daily 400-800 mg/daily (daily or divided bid) 75-300 mg daily 25-100 mg/day (daily or divided bid) 20-40 mg daily 20-80 mg daily 80-320 mg daily Avoid in women who are planning to become pregnant or who are pregnant; when pregnancy is contemplated or detected, discontinue as soon as possible; drugs that act directly on the renin angiotensin system can cause injury and death to the developing fetus; patients of child-bearing potential should also be educated about the risks Avoid concomitant use of ACEI with an ARB or direct renin inhibitor due to increased risk of hypotension, syncope, increased K+, and changes in kidney function (see Recommendation 26) In general, the lower doses should be considered in patients receiving diuretics Monitor K+ and kidney function; use caution if combined with, K+ sparing diuretic, or K+ supplement Consider interruption or discontinuation in patients who develop clinically significant decline in kidney function after initiation of therapy, until further work-up, as indicated (e.g., kidney artery stenosis) Compelling indications include: CKD with albuminuria (refer to VA/DoD CKD ); HFrEF; recent MI Long-Acting Calcium Channel Blockers (CCB) DHP CCBs Amlodipineb Felodipine Nifedipine sustained releaseb Non-DHP CCBs Verapamil sustained releaseb Diltiazem sustained releaseb 2.5-10 mg daily 2.5-10 mg daily 30-120 mg daily 120-480 mg divided daily- bid 120-540 mg daily Monitor AEs (DHP CCBs may cause ankle edema, dizziness, flushing, headache, constipation) Use with caution in patients with hepatic (CCBs) or kidney (non-DHP CCBs) dysfunction Non-DHP CCBs may be considered for rate control in supraventricular tachycardia or atrial fibrillation/flutter Verapamil may cause constipation; verapamil is contraindicated 2nd or 3rd degree AV block, severe LV dysfunction Diltiazem may decrease sinus rate; diltiazem is contraindicated in 2nd degree AV block; use with caution in LV dysfunction Verapamil or diltiazem should not usually be used with a beta-blocker due to risk of severe bradycardia or heart block 2 See the VA/DoD Clinical Practice Guideline for the Management of Chronic Kidney Disease. 