Initial dose: 50 mg orally once a day with or without food.
Maintenance dose: The initial dose may be titrated upward to 100 mg orally once a day as needed and tolerated.
No clinically relevant changes in the pharmacokinetic disposition of mibefradil have been observed in patients with liver disease. However, because this drug is completely metabolized by the liver and eliminated by the biliary system, caution is recommended when using this drug or advancing doses in this patient with liver disease. In general, periodic monitoring of the heart rate and blood pressure is recommended, particularly in patients with severe liver disease.
Be cognizant of the increased risk of hypotension if this drug is given too soon after hemodialysis sessions. On the days this patient is dialyzed, it is recommended that mibefradil be given at some time after hemodialysis when the patient is hemodynamically stable.