What are the typical dosing regimens for medications used to treat hypertension, diabetes, and asthma?

Medication Dosing Regimens for Hypertension, Diabetes, and Asthma

Hypertension Treatment

For hypertension management, begin with ACE inhibitors/ARBs, thiazide-like diuretics, or calcium channel blockers, with dosing based on severity of hypertension and comorbidities. 1

Initial Therapy Based on Blood Pressure Level:

• BP 140-159/90-99 mmHg: Start with a single agent
• BP ≥160/100 mmHg: Start with two antihypertensive medications 1

First-Line Medications and Dosing:

ACE Inhibitors:

• Lisinopril:
  • Starting dose: 10 mg once daily
  • Maintenance dose: 20-40 mg once daily
  • Maximum dose: 80 mg daily 2
  • For patients on diuretics: Start with 5 mg daily
  • For renal impairment (CrCl ≤30 mL/min): Start with 5 mg daily

ARBs:

• Losartan: 25-50 mg daily, up to 100 mg daily
• Irbesartan: 150 mg daily, up to 300 mg daily
• Valsartan: 80-160 mg daily, up to 320 mg daily 1

Thiazide-like Diuretics:

• Chlorthalidone: 12.5-25 mg daily
• Indapamide: 1.25-2.5 mg daily 3

Calcium Channel Blockers:

• Amlodipine: 2.5-10 mg daily

Special Populations:

Patients with Diabetes:

• Target BP: <130/80 mmHg
• First-line: ACE inhibitor or ARB, particularly with albuminuria 1

Patients with CKD:

• Target BP: <130/80 mmHg
• First-line: ACE inhibitor or ARB at maximum tolerated dose for patients with albuminuria (UACR ≥30 mg/g) 1

Resistant Hypertension:

• Consider adding mineralocorticoid receptor antagonist (spironolactone 25-50 mg daily) when BP not controlled on three medications including a diuretic 1, 3

Diabetes Treatment

Oral Antihyperglycemics:

Metformin:

• First-line therapy for type 2 diabetes
• Starting dose: 500 mg once or twice daily
• Maintenance dose: 1000-2000 mg daily in divided doses
• Maximum dose: 2550 mg daily

SGLT-2 Inhibitors:

• Empagliflozin: 10 mg daily, can increase to 25 mg daily
• Dapagliflozin: 5-10 mg daily

GLP-1 Receptor Agonists:

• Semaglutide: 0.25 mg SC weekly for 4 weeks, then 0.5 mg weekly, can increase to 1 mg weekly
• Dulaglutide: 0.75 mg SC weekly, can increase to 1.5 mg weekly

DPP-4 Inhibitors:

• Sitagliptin: 100 mg daily (50 mg if eGFR 30-45,25 mg if eGFR <30)
• Linagliptin: 5 mg daily (no dose adjustment for renal impairment)

Insulin Therapy:

Basal Insulin:

• Glargine/Detemir: Start 0.1-0.2 units/kg daily, titrate by 2-4 units every 3-4 days
• NPH: 0.1-0.2 units/kg daily or twice daily

Prandial Insulin:

• Regular: 4-6 units or 10% of basal dose before meals
• Rapid-acting analogs: 4 units or 10% of basal dose before meals

Asthma Treatment

Controller Medications:

Inhaled Corticosteroids (ICS):

• Low dose:

  • Fluticasone propionate: 100-250 mcg twice daily
  • Budesonide: 180-400 mcg twice daily
  • Beclomethasone: 80-240 mcg twice daily

• Medium dose:

  • Fluticasone propionate: 250-500 mcg twice daily
  • Budesonide: 400-800 mcg twice daily
  • Beclomethasone: 240-480 mcg twice daily

• High dose:

  • Fluticasone propionate: >500 mcg twice daily
  • Budesonide: >800 mcg twice daily
  • Beclomethasone: >480 mcg twice daily

Long-Acting Beta Agonists (LABA):

• Salmeterol: 50 mcg twice daily
• Formoterol: 12 mcg twice daily

Combination ICS/LABA:

• Fluticasone/Salmeterol: 100/50,250/50, or 500/50 mcg twice daily
• Budesonide/Formoterol: 160/4.5 mcg, 1-2 inhalations twice daily

Rescue Medications:

Short-Acting Beta Agonists:

• Albuterol: 2 puffs (90 mcg/puff) every 4-6 hours as needed
• Levalbuterol: 1-2 puffs (45 mcg/puff) every 4-6 hours as needed

Oral Corticosteroids for Exacerbations:

• Prednisone: 40-60 mg daily for 5-7 days

Biological Therapies:

• Omalizumab: 150-375 mg SC every 2-4 weeks (based on weight and IgE level)
• Mepolizumab: 100 mg SC every 4 weeks
• Benralizumab: 30 mg SC every 4 weeks for 3 doses, then every 8 weeks

Monitoring Considerations

• For patients on ACE inhibitors, ARBs, or diuretics: Monitor serum creatinine/eGFR and potassium at least annually 1
• For patients with diabetes: Monitor HbA1c every 3-6 months
• For patients with asthma: Assess symptom control and inhaler technique at each visit

Common Pitfalls to Avoid

1. Hypertension: Avoid combining ACE inhibitors with ARBs or direct renin inhibitors due to increased risk of adverse events without additional benefit 1

2. Diabetes: Avoid metformin in patients with eGFR <30 mL/min/1.73m²

3. Asthma: Avoid using LABA monotherapy without ICS due to increased risk of severe exacerbations