Cardiovascular Drugs
Protocols
Nifedipine:
Brand name; Nidipine SR(Square)
Nifin(ACME),Nificap(drug int)
Indications Nifedipine is indicated in the management of all types of
essential & renal hypertension. Also indicated in the management of
hypertension during pregnancy & during coronary by pass surgery. Pharmacology Nifedipine is an inhibitor of Calcium Channel Blocker that
blocks the transmembrane influx of Calcium ions into muscle cells. Nifedipine
has selective effects as a dilator of arterial vessels. Nifedipine dilates
main coronary and systemic arteries. As a result blood pressure falls and
this elicits a sympathetic reflex response causing tachycardia and an
increased cardiac output. Pulmonary arterial pressure also falls. Nifedipine
has direct negative inotropic effects on cardiac muscles and these effects
are seen at higher doses than dose which causes arterial vasodilatation. Dosage & Administration Nifedipine 10 mg:
Nifedipine 20 mg: The starting dose for
patients, not previously prescribed Nifedipine products is one tablet once
daily. The recommended dose in hypertension and angina prophylaxis is 20 mg
twice daily during or after food. Dosage may be adjusted within the range 10
mg twice daily to 40 mg twice daily.
Interaction
Contraindications Cardiogenic shock, advanced aortic stenosis, nursing mothers,
GI obstruction, inflammatory bowel disease, hypotension. Side Effects Headache, flushing, lethargy, gravitational oedema rash,
nausea, increased frequency of micturation, eye pain, gum hyperplasia,
depression, tremor, photosensitivity and few cases of jaundice have been
reported. These reactions may regress on discontinuation of therapy. Its
introduction may induce attacks of ischaemic pain in some patients with
angina pectoris. Pregnancy & Lactation There are no adequate and well controlled studies in pregnant
women. It should be used during pregnancy only if the potential benefit
justifies the potential risk to the fetus. Precautions & Warnings Tablets should be swallowed whole and should not be bitten,
chewed or broken up. It should be used with caution in patient whose cardiac
reserve is poor. Should be withdrawn if ischaemic pain occurs or existing
pain worsens shortly after initiating treatment. Use in diabetic patients
requires adjustment of their control. Since the absorption of the drug could
be modified by renal disease, caution should be exercised in treating such patients. Therapeutic Class Calcium-channel blockers |
Aspirin :
Brand name:Carva(square),ecosprin(ACME)
Disprin(reckitt)
Indications Aspirin is indicated in the following indications-
Pharmacology By decreasing platelet aggregation, Aspirin inhibits
thrombus formation on the arterial side of the circulation, where thrombi are
formed by platelet aggregation and anticoagulants have little effect. Aspirin
is the analgesic of choice for headache, transient musculoskeletal pain and
dysmenorrhoea. It has anti-inflammatory and antipyretic properties, which may
be useful. Enteric-coated Aspirin reduces intestinal disturbance and
gastrointestinal ulceration due to aspirin. Dosage & Administration Pain, inflammatory diseases and as antipyretic:
Aspirin 300 mg 1-3 tablets 6 hourly with a maximum daily dose of 4 gm.
Interaction Salicylates may enhance the effect of anticoagulants,
oral hypoglycaemic agents, phenytoin and sodium valporate. They inhibit the
uricosuric effect of probenecid and may increase the toxicity of
sulphonamides. They may also precipitate bronchospasm or induce attacks of
asthma in susceptible subjects. Contraindications Aspirin is contraindicated to the children (Reye's
syndrome) less than 12 years, in breast-feeding and active peptic ulcer. It
is also contraindicated in bleeding due to haemophilia, intracranial
haemorrhage and other ulceration. Side Effects Side effects for the usual dosage of Aspirin are mild
including nausea, dyspepsia, gastrointestinal ulceration and bronchospasm
etc. Pregnancy & Lactation It is especially important not to use aspirin during
the last 3 months of pregnancy unless specifically directed to do so by a
doctor because it may cause problems in the unborn child or complications
during delivery. Aspirin penetrates into breast milk. So, it should be
administered with caution to lactating mothers. Precautions & Warnings It should be administered cautiously in asthma,
uncontrolled blood pressure, and pregnant women. It should be administered
with caution to patients with a nasal polyp and nasal allergy. Overdose Effects Overdosage produces dizziness, tinnitus, sweating,
nausea and vomiting, confusion and hyperventilation. Gross overdosage may
lead to CNS depression with coma, cardiovascular collapse and respiratory
depression. If the overdosage is suspected, the patient should be kept under
observation for at least 24 hours, as symptoms and salicylate blood levels
may not become apparent for several hours. Treatment of overdosage consists
of gastric lavage and forced alkaline diuresis. Haemodialysis may be
necessary in severe cases. Therapeutic Class Anti-platelet drugs Storage Conditions Keep all medicines out of reach of children. Store in
a cool and dry place, protected from light. Price : 1
tab-1 tk |
Clopidogrel :
Brand: Clopid(drug int),lopirel(incepta),anclog(square)
|
Indications Acute Coronary Syndrome (ACS): It
is indicated to reduce the rate of myocardial infarction (MI) and stroke in
patients with non-ST-segment elevation ACS [unstable angina
(UA)/non-ST-elevation myocardial infarction (NSTEMI)]. It is indicated to
reduce the rate of myocardial infarction and stroke in patients with acute
ST-elevation myocardial infarction (STEMI). Pharmacology Clopidogrel is a prodrug. It inhibits platelet
activation and aggregation through the irreversible binding of its active
metabolite to the P2Y12 class of ADP receptors on platelets. Dose-dependent
inhibition of platelet aggregation can be seen 2 hours after single oral
doses. Repeated doses of 75 mg per day inhibit ADP-induced platelet
aggregation on the first day, and inhibition reaches steady state between Day
3 and Day 7. Dosage & Administration Acute Coronary Syndrome: In
patients who need an antiplatelet effect within hours, initiate clopidogrel
with a single 300 mg (4 tablets) oral loading dose and then continue at 75 mg
once daily. Initiating it without a loading dose will delay establishment of
an antiplatelet effect by several days. Interaction
Contraindications Clopidogrel is contraindicated in the following
conditions: Hypersensitivity to the drug substance or any component of the
product. Active pathological bleeding such as peptic ulcer or intracranial
hemorrhage. Side Effects Clopidogrel is generally well tolerated drug.
Pregnancy & Lactation There are no adequate and well-controlled studies in
pregnant women. It should be used during pregnancy only if clearly needed. It
is unknown whether clopidogrel is excreted in human breast milk. A decision
should be made whether to discontinue nursing or to discontinue the drug,
taking into account the importance of the drug to the mother. Precautions & Warnings
Use in Special Populations Safety and effectiveness in pediatric populations
have not been established. No dosage adjustment is necessary in elderly
patients. Overdose Effects Overdose following clopidogrel administration may
lead to bleeding complications. Based on biological plausibility, platelet
transfusion may restore clotting ability. Therapeutic Class Anti-platelet drugs |
Nitroglycerin:
Brand:GTN(SKF),ANRIL(square),nitrosol(beximco)
Indications Nitroglycerin sublingual spray is indicated for acute
relief of an attack or prophylaxis of angina pectoris due to coronary artery
disease. Description Nitroglycerin, an organic nitrate, is a vasodilator
which has effects on both arteries and veins. This is a metered dose spray
containing nitroglycerin. This product delivers nitroglycerin (400 mcg per
spray, 200 metered sprays) in the form of spray droplets under the tongue. Pharmacology The principal pharmacological action of nitroglycerin
is relaxation of vascular smooth muscle, producing a vasodilator effect on
both peripheral arteries and veins with more prominent effects on the latter.
Dilation of the post-capillary vessels, including large veins, promotes
peripheral pooling of blood and decreases venous return to the heart, thereby
reducing left ventricular enddiastolic pressure (pre-load). Arteriolar
relaxation reduces systemic vascular resistance and arterial pressure
(after-load). Dosage & Administration At the onset of an attack, 1 or 2 metered sprays
should be administered under the tongue. No more than 3 metered sprays are
recommended within a 15 minute period. If the chest pain persists, prompt
medical attention is recommended. Nitroglycerin spray may be used
prophylactically 5 to 10 minutes prior to engaging in activities which might
precipitate an acute attack.
Interaction Use of alcohol with Nitroglycerin may produce severe
hypotension and collapse. Oral Nitroglycerin may enhance the bioavailability
of dihydroergotamine. Orthostatic hypotension may occur with the combined use
of calcium channel blocker, phenothiazines and tricyclic antidepressants. Contraindications Hypersensitivity to nitrates or any constituents of
the formulation. Hypotension, hypovolaemia, severe anaemia, cerebral
haemorrhage and brain trauma, mitral stenosis and angina caused by
hypertrophic obstructive cardiomyopathy. Concomitant administration of
phosphodiesterase inhibitors used for the treatment of erectile dysfunction. Side Effects A number of nitrate related adverse effects may occur
including headache, facial flushing, dizziness, nausea, vomiting, feelings of
weakness, postural hypotension and reflex tachycardia . Pregnancy & Lactation Pregnancy Category C. There are no adequate and well
controlled studies in pregnant women. Nitroglycerin should be given to
pregnant women only if clearly needed. It is not known whether nitroglycerin
is excreted in human milk. Because many drugs are excreted in human milk,
caution should be exercised when Nitroglycerin spray is administered to a
nursing woman. Precautions & Warnings The use of Nitroglycerin during the early days of
acute myocardial infarction requires particular attention to monitoring
hemodynamics and clinical status. Nitroglycerin should be used with caution
in patients with severely impaired renal or hepatic function, hypothyroidism,
malnutrition or hypothermia. Use in Special Populations Safety and effectiveness of nitroglycerin in
pediatric patients have not been established. Overdose Effects Nitrate overdosage may result in: severe hypotension,
persistent throbbing headache, vertigo, palpitation, visual disturbance,
flushing and perspiring skin (later becoming cold and cyanotic), nausea and
vomiting (possibly with colic and even bloody diarrhea), syncope (especially
in the upright posture), methemoglobinemia with cyanosis and anorexia,
initial hyperpnea, dyspnea and slow breathing, slow pulse, heart block,
increased intracranial pressure with cerebral symptoms of confusion and
moderate fever, paralysis and coma followed by clonic convulsions and
possibly death due to circulatory collapse. Therapeutic Class Nitrates: Coronary vasodilators Price :
spray_ 270tk ,tab |
Indications This medication is used to help relieve
moderate to severe pain. Morphine belongs to a class of drugs known
as opioid (narcotic) analgesics. It works in the brain to
change how your body feels and responds to pain. Pharmacology Morphine is a phenanthrene derivative which acts
mainly on the CNS and smooth muscles. It binds to opiate receptors in the CNS
altering pain perception and response. Analgesia, euphoria and dependence are
thought to be due to its action at the mu-1 receptors while resp depression
and inhibition of intestinal movements are due to action at the mu-2
receptors. Spinal analgesia is mediated by morphine agonist action at the K
receptor. Dosage Oral- Moderate to severe
pain: 5-20 mg 4 hrly. Extended-release: 5-20 mg 12 hrly. Dosage is
dependent on the severity of pain.
Intravenous- Pain associated with
myocardial infarction:
Parenteral-
Administration May be taken with or without food. May be taken with
meals to reduce GI discomfort.
Interaction Additive depressant effects with other CNS
depressants (e.g. sedatives, hypnotics, general anaesth, phenothiazines,
other tranquilisers). May enhance the neuromuscular blocking action of
skeletal muscle relaxants. Reduced analgesic effect with mixed
agonist/antagonist opioid analgesics (e.g. pentazocine, nalbuphine,
buprenorphine). Increased plasma concentrations with cimetidine. May reduce
the efficacy of diuretics by inducing the release of antidiuretic hormone.
May delay the absorption of mexiletine. May antagonise the GI effect of
cisapride, domperidone and metoclopramide. May produce hyperpyrexia and CNS
toxicity with dopaminergics. Contraindications Resp depression, obstructive airway disease, delayed
gastric emptying, acute abdomen, heart failure secondary to chronic lung
disease, known or suspected paralytic ileus, phaeochromocytoma. Concurrent
admin with MAOIs or within 2 wk after treatment. Side Effects Nausea, vomiting, constipation, abdominal pain, dry
mouth, anorexia, taste disturbance, dyspepsia, resp depression, sedation,
dizziness, confusion, insomnia, headache, somnolence, involuntary muscle
contractions, hyperhidrosis, rash, pruritus, asthenic conditions, HTN,
bronchospasm, seizures, amenorrhoea, rhabdomyolysis, nystagmus. Pregnancy & Lactation Parenteral or oral: C, D (if prolonged use/high doses
at term) Precautions & Warnings Patient with impaired resp function, severe bronchial
asthma, convulsive disorders, acute alcoholism, delirium tremens, raised
intracranial pressure, hypotension with hypovolaemia, cardiac arrhythmias,
severe cor pulmonale, history of substance abuse, diseases of the biliary
tract, pancreatitis, inflammatory bowel disorders, prostatic hypertrophy,
adrenocortical insufficiency, toxic psychoses. Opioid dependent patients.
Renal and hepatic impairment. Pregnancy and lactation. Use in Special Populations Renal Impairment: Dosage may need to be reduced. Overdose Effects Symptoms: Resp depression,
pinpoint pupils, extreme somnolence progressing to stupor and coma, skeletal
muscle flaccidity, cold and clammy skin and sometimes bradycardia and
hypotension. Apnoea, circulatory collapse, and cardiac arrest may occur in
severe cases. Therapeutic Class Opioid analgesics |
Atorvastatin :
brand:atova(beximco)tiginor(incepta),ATV(delta)
|
Indications Atorvastatin is indicated as an adjunct to diet to
reduce elevated total cholesterol, LDL cholesterol, apolipoprotein B (Apo-B)
and triglycerides levels in following diseases when response to diet and
other non-pharmacological measures is inadequate.
Pharmacology Atorvastatin is a selective inhibitor of HMG-CoA
reductase. This enzyme is the rate-limiting enzyme responsible for the
conversion of HMG-CoA to mevalonate, a precursor of sterols, including
cholesterol. Atorvastatin lowers plasma cholesterol and lipoprotein levels by
inhibiting HMG-CoA reductase and cholesterol synthesis in the liver and
increases the number of hepatic LDL receptors on the cell surface for
enhanced uptake and catabolism of LDL. Dosage & Administration Primary hypercholesterolaemia and combined
hyperlipidaemia-
Familial hypercholesterolaemia-
Prevention of cardiovascular events-
Interaction The risk of myopathy during treatment with
Atorvastatin is increased with concurrent administration of cyclosporin,
fibric acid derivatives, erythromycin, azole antifungals and niacin. No
clinically significant interactions were seen when Atorvastatin was
administered with antihypertensives or hypoglycemic agents. Patients should
be closely monitored if Atorvastatin is added to digoxin, erythromycin, oral
contraceptives, colestipol, antacid and warfarin. Contraindications Atorvastatin should not be used in patient with
hypersensitivity to any component of this medication. Atorvastatin is
contraindicated in active liver disease or unexplained persistent elevations
of serum transaminases. It is also contraindicated in patient with history of
serious adverse reaction to prior administration of HMG-CoA reductase
inhibitors. Side Effects Atorvastatin is generally well-tolerated. The most
frequent side effects related to Atorvastatin are constipation, flatulence,
dyspepsia, abdominal pain. Other side effects includes infection, headache,
back pain, rash, asthenia, arthralgia, myalgia. Pregnancy & Lactation Pregnancy: Atorvastatin is
contraindicated during pregnancy. Safety in pregnant women has not been
established. No controlled clinical trials with atorvastatin have been
conducted in pregnant women. Rare reports of congenital anomalies following
intrauterine exposure to HMG-CoA reductase inhibitors have been received.
Animal studies have shown toxicity to reproduction. Maternal treatment with
atorvastatin may reduce the fetal levels of mevalonate which is a precursor
of cholesterol biosynthesis. Atorvastatin should not be used in women who are
pregnant, trying to become pregnant or suspect they are pregnant. Treatment
with atorvastatin should be suspended for the duration of pregnancy or until
it has been determined that the woman is not pregnant Precautions & Warnings Liver effects: Liver function tests should be
performed before the initiation of treatment and periodically thereafter.
Atorvastatin should be used with caution in patients who consume substantial
quantities of alcohol or have a history of liver disease. Atorvastatin
therapy should be discontinued if markedly elevated CPK levels occur or
myopathy is diagnosed or suspected. Use in Special Populations Hepatic impairment: Atorvastatin should
be used with caution in patients with hepatic impairment. Overdose Effects Specific treatment is not available for atorvastatin
overdose. The patient should be treated symptomatically and supportive
measures instituted, as required. Liver function tests should be performed
and serum CK levels should be monitored. Due to extensive atorvastatin
binding to plasma proteins, hemodialysis is not expected to significantly
enhance atorvastatin clearance. Therapeutic Class Other Anti-anginal & Anti-ischaemic drugs,
Statins Price:
12-20tk unit price |
|
Indications Trimetazidine Dihydrochloride is indicated in adults
as add-on therapy for the symptomatic treatment of patients with stable
angina pectoris who are inadequately controlled by or intolerant to
first-line antianginal therapies. Pharmacology Trimetazidine Dihydrochloride is the first 3- keto
acyl CoA thiolase inhibitor (KAT), a metabolic anti-ischemic agent with
proven benefits for all coronary patients. Trimetazidine Dihydrochloride
inhibits fatty acid pathway by inhibiting 3-keto acyl CoA thiolase enzyme and
transfers oxygen to glucose pathway. Since glucose pathway is more efficient
in producing energy, the same oxygen produces more energy and makes the heart
more active. Moreover, the aerobic oxidation of glucose stops production of
lactic acid, which prevents angina pectoris. Dosage & Administration The recommended dose of Trimetazidine is 35 mg twice
daily or 20 mg tablet thrice daily during meals. The benefit of the treatment
should be assessed after three months and Trimetazidine should be
discontinued if there is no treatment response.
Interaction No drug interaction so far has been reported. In
particular, no interaction has been reported with beta-blockers, calcium
antagonists, nitrates, heparin, hypolipidemic agents or digitalis
preparation. Contraindications Trimetazidine is contraindicated in patients who have
hypersensitivity to the active substance or to any of the excipients. It is
also is contraindicated in patients with Parkinson’s disease, parkinsonian
symptoms, tremors, restless legs movement disorders, severe renal impairment. Side Effects Trimetazidine is safe and well tolerated. The Common
side effects associated with Trimetazidine are dizziness, headache, abdominal
pain, diarrhoea, dyspepsia, nausea, vomiting, rash, pruritus, urticaria and
asthenia Pregnancy & Lactation There is no data on the use of Trimetazidine in
pregnant women. Animal studies do not indicate direct or indirect harmful
effects with respect to reproductive toxicity. As a precautionary measure, it
is preferable to avoid the use of Trimetazidine during pregnancy. It is
unknown whether Trimetazidine is excreted in human milk. A risk to the
newborns/infants cannot be excluded. Trimetazidine should not be used during
breast-feeding. Precautions & Warnings Trimetazidine is not a curative treatment for angina
attacks, nor an initial treatment for unstable angina pectoris. It is also
not a treatment for myocardial infarction. Therapeutic Class Other Anti-anginal & Anti-ischaemic drugs Price : 6-10
tk unit price |
|
Indications Acute Coronary Syndrome (ACS): It
is indicated to reduce the rate of Myocardial Infarction (MI) and Stroke in
patients with non-ST-segment elevation ACS [unstable angina
(UA)/non-ST-elevation Myocardial Infarction (NSTEMI)] and acute ST-segment
elevation ACS [ST-elevation Myocardial Infarction (STEMI)]. Pharmacology Clopidogrel is a prodrug. It inhibits platelet
activation and aggregation through the irreversible binding of its active
metabolite to the P2Y12 class of ADP receptors on platelets. Dose-dependent
inhibition of platelet aggregation can be seen at 2 hours after single oral
doses. Repeated doses of 75 mg per day inhibit ADP-induced platelet
aggregation on the first day, and inhibition reaches steady state between Day
3 and Day 7. Dosage & Administration The recommended oral dose is one tablet daily.
Interaction Oral anticoagulants, NSAIDs, Metamizole, SSRIs,
CYP2C19 inhibitors increase the risk of bleeding. It shows interaction with
Tonofovir, Valproic acid, Varicella vaccine, Acetazolamide and Nicorandil. Contraindications This combination is contraindicated in the following
conditions: Hypersensitivity to the drug substance or any component of the
product. Active pathological bleeding such as peptic ulcer or intracranial
hemorrhage. Side Effects This combination is generally well tolerated. Pregnancy & Lactation There are no adequate and well-controlled studies in
pregnant women. It should be used during first and second trimesters of
pregnancy only if clearly needed. It is contraindicated during the third
trimester of pregnancy. It is unknown whether Clopidogrel is excreted in
human breast milk but Aspirin is known to be excreted in human milk. This
Drug should be discontinued during the breast feeding. Precautions & Warnings
Use in Special Populations It should not be given to children, particularly
those under 12 years, unless the expected benefits outweight the possible
risks. Aspirin may be a contributory factor in the causation of Reye’s
syndrome in some children. Overdose Effects Clopidogrel overdose may lead to bleeding
complications. Based on biological plausibility, platelet transfusion may
restore clotting ability. In moderate aspirin intoxication dizziness,
headache, tinnitus, confusion, and gastrointestinal symptoms may occur which
can be treated by inducing vomiting followed by gastric lavage if needed. In
severe Aspirin intoxication respiratory alkalosis respiratory acidosis,
metabolic acidosis, hyperthermia, perspiration, dehydration can occur. It can
be treated with haemodialysis and other symptomatic treatment. Therapeutic Class Anti-platelet drugs |
Digoxin :
Brand:Agoxin(aristopharma),Centoxin(opsonin)
|
Indications Digoxin is indicated in:
Pharmacology Digoxin is a cardiac glycoside used in the management
of particularly atrial fibrillation and in heart failure.The principal
actions of digoxin are an increase in the force of myocardial contraction
(positive inotropic activity and a reduction in the conductivity of the heart
particularly in conduction through the atrioventricular node. Digoxin also
has a direct action on vascular smooth muscle and indirect effects mediated
primarily by the autonomic nervous system and particularly by an increase in
vagal activity. Dosage & Administration By oral administration:
Interaction Potassium-depleting diuretics increase the effects of
digitalis. Calcium particularly if administered rapidly by the intravenous
route, may produce serious arrhythmia in digitalized patients. Quinidine,
verapamil, amiodarone, propafenone, indomethacin, itraconazole, alprazolam,
spironolactone, erythromycin, clarithromycin (and possibly other macrolide
antibiotics) and tetracycline increase digoxin serum level. Besides antacids,
kaolinpectin, sulfasalazine, neomycin, penicillamine, calestipol,
metoclopramide, rifampin may interfere with intestinal absorption of digoxin
resulting low serum concentrations of the drug. Contraindications
Side Effects Usually associated with excessive dosage include
anorexia, nausea, vomiting, diarrhoea, abdominal pain, visual disturbance,
headache, fatigue, drowsiness, confusion, delirium, hallucination,
depression, arrhythmia, heart block, intestinal ischaemia, gynaecomastia on
long term use, thrombocytopenia reported. Digoxin can be safely used in
pregnancy Pregnancy & Lactation Digoxin is excreted in breast milk but in
concentration below those found in plasma and therefore poses no hazard to
the breast-fed infant. Use in Special Populations Neonates: Digoxin can be used
in neonates. Therapeutic Class Positive Inotropic drugs Price: 1 unit 1-3tk |
Ramipril:
Brand: Ramoril(incepta),Ramil(popular)
|
Indications Ramipril indicated in the following cases:
Pharmacology Ramipril is an angiotensin converting enzyme (ACE)
inhibitor, which after hydrolysis to ramiprilat, blocks the conversion of
angiotensin I to the vasoconstrictor substance, angiotensin II. So,
inhibition of ACE by ramipril results in decreased plasma angiotensin II,
which leads to decreased vasopressor activity and decreased aldosterone
secretion. Thus ramipril exerts its antihypertensive activity. It is also
effective in the management of heart failure and reduction of the risk of
stroke, myocardial infarction and death from cardiovascular events. It is
long acting and well tolerated; so, can be used in long term therapy. Dosage Dosage of Ramipril must be adjusted according to the
patient tolerance and response.
Administration Ramipril tablets have to be swallowed with sufficient
amounts of liquid. The tablets must not be chewed or crushed. Absorption of
Ramipril is not significantly affected by food. Ramipril may, therefore, be
taken before, during or after a meal.
Interaction Concomitant administration with diuretics may lead to
serious hypotension and in addition dangerous hyperkalemia with potassium
sparing diuretics. Concomitant therapy with lithium may increase the serum
lithium concentration. Reduction in BP may affect the ability to drive and
operate machinery and this may be exacerbated by alcohol. NSAIDs may reduce
the antihypertensive effect of Ramipril and cause deterioration of renal
function. Contraindications Ramipril must not be used
Concomitant use of ACE inhibitors and extracorporeal
treatments leading to contact of blood with negatively charged surfaces must
be avoided, since such use may lead to severe anaphylactoid reactions. Such
extracorporeal treatments include dialysis or haemofiltration with certain
high-fux (e.g. polyacrylonitril) membranes and low-density lipoprotein
apheresis with dextran sulfate. Side Effects Ramipril is generally well tolerated. Dizziness,
headache, fatigue and asthenia are commonly reported side effects. Other side
effects occurring less frequently include symptomatic hypotension, cough,
nausea, vomiting, diarrhoea, rash, urticaria, oliguria, anxiety, amnesia etc.
Angioneurotic oedema, anaphylactic reactions and hyperkalaemia have also been
reported rarely. Pregnancy & Lactation Ramipril must not be taken during pregnancy.
Therefore, pregnancy must be excluded before starting treatment. Pregnancy
must be avoided in cases where treatment with ACE inhibitors is
indispensable. If the patient intends to become pregnant, treatment with ACE
inhibitors must be discontinued, i.e. replaced by another form of treatment.
If the patient becomes pregnant during treatment, medication with Ramipril
must be replaced as soon as possible by a treatment regimen without ACE inhibitors.
Otherwise, there is a risk of harm to the fetus. Ramipril is not recommended
during breastfeeding. Precautions & Warnings Ramipril should be used with caution in patients with
impaired renal function, hyperkalaemia, hypotension, and impaired hepatic
function. Use in Special Populations Elderly: A reduced initial
dose of 1.25 mg Ramipril daily must be considered. Overdose Effects Sign and symptom: Overdosage may cause
excessive peripheral vasodilatation (with marked hypotension, shock),
bradycardia, electrolyte disturbances, and renal failure. Therapeutic Class Angiotensin-converting enzyme (ACE) inhibitors |
Atenolol :
Brand:Tenoloc(ACME),Betaloc(ACI)
|
Indications Atenolol is indicated-
Pharmacology The synthesis of atenolol resulted from attempts to
produce a β-adrenoceptor antagonist that would competitively block β1
(cardiac) receptors but have no effect on β2-receptors. It is classified as a
β1 selective (cardioselective) β-adrenergic receptor antagonist with no
membranestability activity and no partial agonist activity. It is markedly
the most hydrophilic of the currently available β- blockers and thus
penetrates the lipid of cell membranes poorly Dosage & Administration Hypertension: The initial dose of
Atenolol is 50 mg given as one tablet a day either alone or added to diuretic
therapy. The full effect of this dose will usually be seen within one to two
weeks. If an optimal response is not achieved, the dosage should be increased
to Atenolol 100 mg given as one tablet a day. Increasing the dosage beyond
100 mg a day is unlikely to produce any further benefit.
Interaction
Contraindications Atenolol is contraindicated in-
Side Effects In a series of investigations in the treatment of
acute myocardial infarction, bradycardia and hypotension occurred more
commonly, as expected for any beta blocker. In addition, a variety of adverse
efects has been reported with other beta-adrenergic blocking agents, and may
be considered potential adverse efects of Atenolol.
Pregnancy & Lactation Pregnancy Category D. Caution should be exercised
when Atenolol is administered to a nursing woman. Clinically significant
bradycardia has been reported in breast-fed infants. Premature infants, or
infants with impaired renal function, may be more likely to develop adverse
effects. Precautions & Warnings General: Patients already on a beta blocker must be
evaluated carefully before Atenolol is administered. Initial and subsequent
Atenolol dosages can be adjusted downward depending on clinical observations
including pulse and blood pressure. Atenolol may aggravate peripheral
arterial circulatory disorders.
Use in Special Populations Elderly Patients or Patients with Renal Impairment:
Atenolol is excreted by the kidneys; consequently dosage should be adjusted
in cases of severe impairment of renal function. In general, dose selection
for an elderly patient should be cautious, usually starting at the low end of
the dosing range, refecting greater frequency of decreased hepatic, renal, or
cardiac function, and of concomitant disease or other drug therapy. The
following maximum oral dosages are recommended for elderly, renal impaired
patients and for patients with renal impairment due to other causes:
Some renal impaired or elderly patients being treated
for hypertension may require a lower starting dose of Atenolol: 25 mg given
as one tablet a day. Patients on hemodialysis should be given 25 mg or 50 mg
after each dialysis; this should be done under hospital supervision as marked
falls in blood pressure can occur. Overdose Effects Overdosage with Atenolol has been reported with
patients surviving acute doses as high as 5 g. One death was reported in a
man who may have taken as much as 10 g acutely. The predominant symptoms
reported following Atenolol overdose are lethargy, disorder of respiratory drive,
wheezing, sinus pause and bradycardia. Additionally, common efects associated
with overdosage of any beta-adrenergic blocking agent and which might also be
expected in Atenolol overdose are congestive heart failure, hypotension,
bronchospasm and/or hypoglycemia. Treatment of overdose should be directed to
the removal of any unabsorbed drug by induced emesis, gastric lavage, or
administration of activated charcoal. Atenolol can be removed from the
general circulation by hemodialysis. Based on the severity of symptoms,
management may require intensive support care and facilities for applying
cardiac and respiratory support. Therapeutic Class Beta-adrenoceptor blocking drugs, Beta-blockers |
Metoprolol:
Brand: Betaloc(drug int),Metaloc(renata)
Indications ln the management of hypertension and angina
pectoris. Cardiac arrhythmias, especially supraventricular tachyarrhythmias.
Adjunct to the treatment of hyperthyroidism. Early intervention with
Metoprolol in acute myocardial infarction reduces infarct size and the
incidence of ventricular fibrillation. Pain relief may also decrease the need
for opiate analgesics. Metoprolol has been shown to reduce mortality when
administered to patients with acute myocardial infarction. Pharmacology Metoprolol is a selective beta1-blocker. Metoprolol
reduces or inhibits the agonistic effect on the heart of catecholamines
(which are released during physical and mental stress). This means that the
usual increase in heart rate, cardiac output, cardiac contractility and blood
pressure, produced by the acute increase in catecholamines, is reduced by
Metoprolol. Metoprolol interferes less with Insulin release and carbohydrate
metabolism than do non-selective beta-blockers. Metoprolol interferes much
less with the cardiovascular response to hypoglycaemia than do non-selective
beta-blockers. Dosage & Administration Film-coated tablet-
Extended-release tablet-
IV Injection-
Interaction Catecholamine‐depleting drugs (e.g. Reserpine, Monoamine Oxidase
(MAO) inhibitors) may have an additive effect when given with beta‐blocking agents. Drugs
that inhibit CYP2D6 such as quinidine, fluoxetine, paroxetine and propafenone
are likely to increase Metoprolol concentration. These increases in plasma
concentration would decrease the cardioselectivity of Metoprolol. Concomitant
use of digitalis glycosides and beta‐blockers can increase the risk of bradycardia. Beta‐blockers may
exacerbate the rebound hypertension which can follow the withdrawal of
clonidine. Contraindications AV block, Uncontrolled heart failure, severe
bradycardia, sick-sinus syndrome, cardiogenic shock and severe peripheral
arterial disease. Known hypersensitivity to Metoprolol or other B-blockers.
Metoprolol is also contra-indicated when myocardial infarction is complicated
by significant bradycardia, first-degree heart block, systolic hypotension
(<100mmHg) and/or severe heart failure. Side Effects Tiredness, dizziness, depression, diarrhea, itching
or rash, shortness of breath, slow heart rate, mental confusion, headache,
somnolence, nightmares, insomnia, dyspnea, Nausea, dry mouth, gastric pain,
constipation, flatulence, digestive tract disorders, heartburn, pruritus,
musculoskeletal pain, blurred vision, decreased libido, and tinnitus have
also been reported, intensification of AV block. Pregnancy & Lactation Pregnancy Category C. There are no adequate and well‐controlled studies in
pregnant women. This drug should be used during pregnancy only if clearly
needed. Metoprolol is excreted in breast milk in very small quantities.
Caution should be exercised when Metoprolol is administered to a nursing
woman. Precautions & Warnings Bronchospastic Diseases:
Because of its relative beta 1 ‐selectivity, however, Metoprolol may be used with
caution in patients with bronchospastic disease who do not respond to, or
cannot tolerate other antihypertensive treatment. Use in Special Populations Hepatic impaired patient:
Metoprolol should be used with caution in patients with impaired hepatic
function. Overdose Effects Poisoning due to an overdose of metoprolol may lead
to severe hypotension, sinus bradycardia, atrioventricular block, heart
failure, cardiogenic shock, cardiac arrest, bronchospasm, impairment of
consciousness, coma, nausea, vomiting, cyanosis, hypoglycaemia and,
occasionally, hyperkalaemia. The first manifestations usually appear 20
minutes to 2 hours after drug ingestion. Treatment: Treatment should
include close monitoring of cardiovascular, respiratory and renal
function, and blood glucose and electrolytes. Further absorption may
be prevented by induction of vomiting, gastric lavage or administration
of activated-charcoal if ingestion is recent. Cardiovascular
complications should be treated symptomatically, which may require the
use of sympathomimetic agents (e.g. noradrenaline, metaramionl), atropine
or inotropic agents (e.g. dopamine, dobutamine). Temporary pacing may be
required for AV block. Glucagon can reverse the effects of excessive
B-blockade, given in a dose of 1-10 mg intravenously. Intravenous
B2-stimulants e.g. terbutaline may be required to relieve bronchospasm.
Metoprolol cannot be effectively removed by haemodialysis. Storage Conditions Store in a cool and dry place, protected from light. |
Losartan:
Brand : Angilock(square),osartil(incepta),Losart(acme)
Prosan(beximco)
|
Indications Hypertension: Losartan Potassium
is indicated for the treatment of hypertension. It may be used alone or in
combination with other antihypertensive agents (eg. thiazide diuretics). Pharmacology Losartan Potassium is the first non-peptide orally
active angiotensin II receptor blocker. It binds to the AT1 receptor found in
many tissues (e.g. vascular smooth muscle, adrenal gland, kidneys and the
heart) and reduces several important biological actions including
vasoconstriction and the release of aldosterone responsible for hypertension. Dosage &
Administration The usual starting and maintenance dose is 50 mg once
daily for most patients. If the antihypertensive effect using 50 mg once
daily is inadequate, 25 mg twice daily is recommended prior to increasing the
dose. For patients with intravascular volume-depletion (e.g., those treated
with high-dose diuretics), a starting dose of 25 mg once daily should be
considered. Losartan Potassium can be administered once or twice daily. The
total daily dose ranges from 25 mg to 100 mg.
Interaction Rifampicin and fluconazole reduce levels of active
metabolite of Losartan Potassium. Concomitant use of Losartan Potassium and
hydrochlorothiazide may lead to potentiation of the antihypertensive effects.
Concomitant use of potassium-sparing diuretics (eg, spironolactone,
triamterene, amiloride), potassium supplements or salt substitutes containing
potassium may lead to increases in serum potassium. The antihypertensive
effect of losartan may be attenuated by the non-steroidal anti-inflammatory
drug indomethacin. The use of ACE-inhibitor, angiotensin receptor antagonist,
an anti-inflammatory drug and a thiazide diuretic at the same time increases
the risk of renal impairment. Contraindications Losartan Potassium is contraindicated in pregnant
women and in patients who are hypersensitive to any component of this
product. Losartan Potassium should not be administered with Aliskiren in
patients with diabetes. Side Effects The side effects with the use of Losartan Potassium
are mild and transient in nature. The most common side effects are dizziness,
diarrhea, nasal congestion, cough, upper respiratory infection. Other side
effects are fatigue, oedema, abdominal pain, chest pain, nausea, headache
& pharyngitis. Pregnancy &
Lactation Pregnancy Category D. The risk to the fetus increases
if Losartan Potassium is administered during the second or third trimesters
of pregnancy. It is not known whether Losartan Potassium is excreted in human
milk, as many drugs are excreted in human milk and because of the potential
for adverse effects on the nursing infant, a decision should be made whether
to discontinue nursing or discontinue the drug, taking into account the
importance of the drug to the mother. Precautions &
Warnings Use of Losartan Potassium during the second and third
trimesters of pregnancy reduces fetal renal function and increases fetal and
neonatal morbidity and death. In patients who are intravascularly
volume-depleted (e.g., those treated with high-dose diuretics), symptomatic
hypotension may occur. Plasma concentration of Losartan Potassium is
significantly increased in cirrhotic patients. Changes in renal function
including renal failure have been reported in renal impaired patient. Therapeutic Class Angiotensin-ll receptor blocker Storage Conditions keep in a dry place away from light and heat. Keep
out of the reach of children. Price:
25mg-6tk,50mg-10tk,100mg-12tk |
Amlodipine:
Brand: Amdocal(beximco)camlpdin(square)
|
Indications Essential hypertension:
Amlodipine is efficacious as monotherapy in the treatment of hypertension. It
may be used in combination with other antihypertensive agents. Pharmacology Amlodipine is a dihydropyridine calcium-channel
blocker, with a long duration of action, used for the treatment of
hypertension and angina pectoris. Amlodipine influences the myocardial cells,
the cells within the specialized conducting system of the heart, and the
cells of vascular smooth muscle. Administration of Amlodipine results
primarily in vasodilation, with reduced peripheral resistance, blood pressure
and afterload, increased coronary blood flow and a reflex increase in
coronary heart rate. This in turn results in an increase in myocardial oxygen
supply and cardiac output. Dosage & Administration Hypertension: Usual dose is 5 mg
once daily. The maximum dose is 10 mg once daily. Elderly patients with
hepatic insufficiency may be started on 2.5 mg once daily; this dose may also
be used when adding Amlodipine to other antihypertensive therapy.
Interaction Drug Interactions-
Other Significant Interactions-
Contraindications Hypersensitivity to dihydropyridine derivatives.
Pregnant woman. Side Effects The most common adverse effects of amlodipine are
associated with vasodilatory action, such as dizziness, flushing, headache,
hypotension and peripheral edema. Gastrointestinal disturbances, increased
micturition frequency, lethargy, eye pain and mental depression may also
occur. A paradoxical increase in ischaemic chest pain may occur at the start
of the treatment and in a few patients excessive fall in blood pressure has
led to cerebral or myocardial ischaemia or transient blindness. Rashes, fever
and abnormalities in liver function due to hypersensitivity reaction of
Amlodipine may occur. Pregnancy & Lactation Pregnancy Category C. There are no adequate and
well-controlled studies of Amlodipine in pregnant women. Amlodipine should be
used during pregnancy only if the potential benefit justifies the potential
risk to the fetus. It is not known whether Amlodipine is excreted in human
milk. In the absence of this information, it is recommended that nursing be
discontinued while Amlodipine is administered. Precautions & Warnings Precaution should be taken in patients with hepatic
impairment and during pregnancy and breast feeding. Use in Special Populations Children with hypertension from 6 years to 17 years
of age: 2.5 mg once daily as a starting dose, up-titrated
to 5 mg once daily if blood pressure goal is not achieved after 4 weeks.
Doses in excess of 5 mg daily have not been studied in pediatric patients. Overdose Effects Symptoms: Available data
suggest that large overdosage could result in excessive peripheral
vasodilatation and possibly reflex tachycardia. Marked and probably prolonged
systemic hypotension up to and including shock with fatal outcome have been
reported. Therapeutic Class Calcium-channel blockers Storage Conditions Keep all medicines out of reach of children. Store in
a cool & dry place, protected from light. |
Amlodipine Besilate + Olmesartan Medoxomil:
brand:bizoran(beximco),ABecap(aci)
Camlosart(square)
|
Indications Indicated for the treatment of hypertension alone or
with other antihypertensive agents, to lower blood pressure. This combination
drug is indicated as initial therapy in patients likely to need multiple
antihypertensive agents to achieve their blood pressure goals. The decision to use a combination as initial therapy
should be individualized and shaped by considerations such as baseline blood
pressure, the target goal, and the incremental likelihood of achieving goal
with a combination compared to monotherapy. Individual blood pressure goals
may vary based upon the patient’s risk.
Pharmacology Amlodipine is a dihydropyridine calcium channel
blocker that inhibits the transmembrane influx of calcium ions into vascular
smooth muscle and cardiac muscle. Amlodipine has a greater effect on vascular
smooth muscle cells than on cardiac muscle cells. Amlodipine is a peripheral
arterial vasodilator that acts directly on vascular smooth muscle to cause a
reduction in peripheral vascular resistance and reduction in blood pressure. Dosage & Administration Substitute individually titrated components for
patients on Amlodipine and Olmesartan Medoxomil. This combination may also be
given with increased amounts of Amlodipine, Olmesartan Medoxomil, or both, as
needed.
Interaction The antihypertensive effect of angiotensin II
receptor antagonists, including Olmesartan Medoxomil may be attenuated by
NSAIDs including selective COX-2 inhibitors. Blood pressure, renal function
and electrolytes should be closely monitored in patients on combination
therapy and other agents that affect the RAS. Contraindications Cannot be co-administered with Aliskiren in patients
with diabetes. Side Effects The most common side effects include peripheral
edema, headache, flushing, and dizziness. It can also cause Intestinal
problems known a sprue-like enteropathy. Pregnancy & Lactation Pregnancy Category D. Amlodipine and Olmesartan
Medoxomil combination should not be used in 2nd and
3rd trimester
because it can cause fetal death. When pregnancy is detected this combination
should be discontinued as soon as possible. It is not known whether
Olmesartan and Amlodipine are excreted in human milk. Because of the potential
for adverse effects on the nursing infant, a decision should be made whether
to discontinue nursing or discontinue the drug, taking into account the
importance of the drug to the mother. Precautions & Warnings Amlodipine and Olmesartan Medoxomil combination
should be used with caution because there is a risk for-
Use in Special Populations Pediatric use: The safety and
effectiveness have not been established in pediatric patients. Overdose Effects There is no information on over dosage in humans. Therapeutic Class Combined antihypertensive preparations Storage Conditions Do not store above 30°C. Keep away from light and out
of the reach of children. |
Losartan Potassium + Hydrochlorothiazide:
Brand: Angilock plus(square),osartil plus(incepta)
|
Indications This is indicated for the treatment of hypertension.
It is also indicated to reduce the risk of stroke in patients with
hypertension and left ventricular hypertrophy. Pharmacology Angiotensin II formed from angiotensin I in a
reaction catalyzed by angiotensin converting enzyme (ACE), is a potent
vasoconstrictor, the primary vasoactive hormone of the renin-angiotensin
system and an important component in the pathophysiology of hypertension. It
also stimulates aldosterone secretion by the adrenal cortex. Losartan and its
principal active metabolite block the vasoconstrictor and
aldosterone-secreting effects of angiotensin II by selectively blocking the
binding of angiotensin II to the AT1 receptor
found in many tissues, (e.g. vascular smooth muscle, adrenal gland). In vitro
binding studies indicate that losartan is a reversible, competitive inhibitor
of the AT1 receptor. Neither
Losartan nor its active metabolite inhibits ACE (kinase II, the enzyme that
converts angiotensin I to angiotensin II and degrades bradykinin); nor do
they bind to or block other hormone receptors or ion channels known to be
important in cardiovascular regulation. Dosage Hypertension-
Severe Hypertension:
Administration This preparation may be administered with other
antihypertensive agents. This may be administered with or without food.
Interaction Losartan Potassium: No significant
drug-drug pharmacokinetic interactions have been found in interaction studies
with Hydrochlorothiazide, Digoxin, Warfarin, Cimetidine and Phenobarbital. As
with other drugs that block angiotensin II or its effects, concomitant use of
potassium-sparing diuretics (e.g. Spironolactone, Triamterene, Amiloride),
potassium supplements, or salt substitutes containing potassium may lead to
increase in serum potassium. As with other antihypertensive agents, the
antihypertensive effect of Losartan may be blunted by the non-steroidal
anti-inflammatory drug Indomethacin. Contraindications The combination of Losartan and Hydrochlorothiazide
is contraindicated in patients who are hypersensitive to any component of
this product. Because of the Hydrochlorothiazide component, this product is
contraindicated in patients with anuria or hypersensitivity to other
sulfonamide-derived drugs. Side Effects Side-effects are usually mild. Symptomatic
hypotension including dizziness may occur, particularly in patients with
intravascular volume depletion (e.g. those taking high-dose diuretics). Hyperkalaemia
occurs occasionally; angioedema has also been reported with some
angiotensin-II receptor antagonists. Vertigo; less commonly gastro-intestinal
disturbances, angina, palpitation, oedema, dyspnoea, headache, sleep
disorders, malaise, urticaria, pruritus, rash; rarely hepatitis, atrial
fibrillation, cerebrovascular accident, syncope, paraesthesia; also reported
pancreatitis, anaphylaxis, cough, depression, erectile dysfunction, anaemia,
thrombocytopenia, hyponatraemia, arthralgia, myalgia, renal impairment,
rhabdomyolysis, tinnitus, photosensitivity, and vasculitis (including
Henoch-Schonlein purpura) Pregnancy & Lactation Angiotensin-II receptor antagonists should be avoided
in pregnancy unless essential. They may adversely affect fetal and neonatal blood
pressure control and renal function; skull defects and oligohy dramnios have
also been reported. Information on the use of angiotensin-II receptor
antagonists in breastfeeding is limited. They are not recommended in
breastfeeding and alternative treatment options, with
better-established safety information during breastfeeding, are
available. Precautions & Warnings
Use in Special Populations Use in Patients with Renal Impairment:
The usual regimens of therapy with 50/12.5 may be followed as long as the
patient's creatinine clearance is >30 ml/min. In patients with more severe
renal impairment, loop diuretics are preferred to thiazides. In that case,
hydrochlorothiazide is not recommended. Overdose Effects Losartan Potassium: Limited data are
available in regard to overdosage in humans. The most likely manifestation of
overdosage would be hypotension and tachycardia; bradycardia could occur from
parasympathetic (vagal) stimulation. If symptomatic hypotension should occur,
supportive treatment should be instituted. Neither losartan nor its
metabolite can be removed by hemodialysis. Therapeutic Class Combined antihypertensive preparations Price: 8-12tk |
Prazosin:
Brand: Alphapress(Renata),Prazopress(unimed)
Prazolok(square)
|
Indications Hypertension: Prazosin is
indicated in the treatment of all grades of essential (primary) hypertension
and of all grades of secondary hypertension of variec etiology. It can be
used as the initial and sole agent or it may be employed in a treatment
program in combination with a diuretic and/or other antihypertensive drugs as
needed for proper patient response. Renal blood flow and glomerular
filtration rate are not impaired by long-term oral administration and thus
Prazosin can be used with safety in hypertensive patients with impaired
renal function. Pharmacology Prazosin causes a decrease in total peripheral
vascular resistance through selective inhibition of postsynaptic
alpha-1-adrenoreceptors in vascular smooth muscle. In hypertensive patients,
blood pressure is lowered in both the supine and standing positions; this
effect is more pronounced on the diastolic blood pressure. Rebound elevation
of blood pressure does not occur following abrupt cessation of Prazosin
therapy. Dosage & Administration Prazosin Tablet: There is evidence
that toleration is best when therapy is initiated with a low starting dose.
During the first week, the dosage of Prazosin should be adjusted according to
the patient's individual toleration. Thereafter the daily dosage is to be
adjusted on the basis of the patient's response. The response is usually seen
within one to 14 days if it is to occur at any particular dose. When a
response is seen, therapy should be continued at that dosage until the degree
of response has reached optimum before the next dose increment is added.
Left Ventricular Failure:
The recommended starting dose is 0.5 mg two, three or four times a day,
Dosage should be titrated according to the patent's clinical response, based
on careful monitoring of cardiopulmonary signs and symptoms, and when
indicated, hemodynamic studies. Dosage titration steps may be performed as
often as every two or three days in patients under close medical supervision.
In severely ill, decompensated patients, rapid dosage titiration over one to
two days may be indicated and is best done when hemodynamic- monitoring is
available In dininai studies, the therapeutic dosages ranged from 4 mg to
20mg daily in divided doses. Adjustment of dosage may be required in the
course of Prazosin therapy in some patients to maintain optimal clinical
improvement.
Interaction Prazosin XR has been administered without any adverse
drug interaction in clinical experience to date with the following:
Contraindications Prazosin is contraindicated in patients with a known
sensitivity to quinazolines. Side Effects The most common reactions associated with Prazosin
therapy are dizziness, headache, drowsiness, lack of energy, weakness,
palpitations and nausea. In most instances, side effects have disappeared
with continued therapy or have been tolerated with no decrease in the dosage
of the drug. In addition, the following reactions have been associated with
Prazosin therapy; vomiting diarrhea, constipation, abdominal discomfort
and/or pain, liver function abnormalities, pancreatitis, edema, orthostatic
hypotension, dyspnea, faintness, tachycardia, nervousness, vertigo, hallucinations,
depression, paresthesia, rash, pruritus alopecia, lichen planus, urinary
frequency, impotence, incontinence, priapism, blurred vision, reddened
solera, epistaxis, tinnitus, dry mouth, nasal congestion, diaphoresis, fever,
positive ANA liter, and arthralgia. Some of these reactions have occurred
rarely, and in many instances, the exact causal relationships have not been
established. Literature reports exist associating Prazosin, therapy with a
worsening of pre-existing narcolepsy. A causal relationship is uncertain in
these cases. The following have been observed in parents being managed for
left ventricular failure with Prazosin when used in conjunction with cardiac
glycosides and diuretics; drowsiness, dizziness, postural hypotension,
blurred vision, edema, dry mouth, palpitations, nausea, diarrhea, impotence,
headache, and nasal congestion. In most instances, these occurrences have
been mild to moderate in severity and have resolved with continued therapy or
have been tolerated with no decrease in drug dosage. The most commonly
although infrequently reported side effect in the treatment of Raynaud's
Phenomenon/Disease was mild dizziness. Pregnancy & Lactation Although no teratogenic effects were seen in animal
testing; the safety of Prazosin use during. pregnancy has not yet been
established. The use of prazosin and a beta-blocker for the control of sever
hypertension of 44 pregnant women revealed no drug-related fetal
adnormalities or adverse effects. Therapy with prazosin was continued for as
long as 14 weeks. Prazosin has also been used alone or in combination with
other hypotensive agents in severe hypertension or pregnancy. No fetal or
neonatal abnormalities have been reported with the use of Prazosin. There are
no adequate and well controlled studies that establish the safety of Prazosin
in pregnant women. Prazosin should be used during pregnancy only if in
the opinion of the physician the potential benefit justifies the potential
risk to the mother and fetus. Prazosin has been shown to be excreted in small
amounts in human milk. Caution shold be exercised when Prazosin is
adminsitered to nursing mothers. Precautions & Warnings Hypertension: A very small
percentage of patients have responded in an abrupt and exaggerated manner to
the initial dose of Prazosin. Postural hypotension evidenced by dizziness and
weakness, or rarely loss of consciousness, has been reported, particularly
with the commencement of therapy, but this effect is readily avoided by
initiating treatment with a low dose of Prazosin XR and with small increases
in dosage during the first one to two weeks of therapy. The effect when
observed is not related to the severity of hypertension is self-limiting and
in most patients does not recur after the initial period of therapy or during
subsequent dose titration steps. When instituting therapy with any effective
antihypertensive agent, the patient should be advised how to avoid symptoms
resulting from postural hypotension and what measures to take should they
develop. The patient should be cautioned to avoid situations where injury
could result should dizziness or weakness occur during the initiation of
Prazosin therapy. Use in Special Populations Children: Prazosin is not
recommended for the treatment of children under the age of 12 years since
safe conditions for its use have not been established. Overdose Effects Accidental ingestion of at least 50 mg of Prazosin in
a two-year child resulted in profound drowsiness and depressed reflexes, No
decrease in blood pressure was noted. Recovery was uneventful. Should
overdosage lead to hypotension, support of the cardiovascular system is of
first importance. Restoration of blood pressure and normalization of heart
rate may be accomplished by keeping the patient in the supine position. If
this measure is inadequate, shock should first be treated with volume
expanders. If necessary, vasopressors should then be used. Renal function
should be monitored and supported as needed. Laboratory data indicate
Prazosin is not dialyzable because it is protein bound. Therapeutic Class Alpha adrenoceptor blocking drugs Price:
1mg-4tk ,2mg-6tk |
|
Indications Edema associated with congestive heart failure,
hepatic cirrhosis, premenstrual tension and oedema due to various forms of
renal dysfunction (i.e. nephrotic syndrome, acute glomerulonephritis, chronic
renal failure). Hypertension, either alone or as an adjunct to other
antihypertensive drugs. Pharmacology Thiazides such as hydrochlorothiazide promote water
loss from the body (diuretics). They inhibit Na+/Cl- reabsorption
from the distal convoluted tubules in the kidneys. Thiazides also cause loss
of potassium and an increase in serum uric acid. Thiazides are often used to
treat hypertension, but their hypotensive effects are not necessarily due to
their diuretic activity. Thiazides have been shown to prevent
hypertension-related morbidity and mortality although the mechanism is not
fully understood. Thiazides cause vasodilation by activating
calcium-activated potassium channels (large conductance) in vascular smooth
muscles and inhibiting various carbonic anhydrases in vascular tissue. Dosage & Administration Edema: initially 25 to 50
mg daily, reduced for maintenance if possible; maximum 100 mg daily.
Interaction Alcohol, barbiturates or narcotics:
Co-administration may potentiate orthostatic hypotension. Oral and parenteral
antidiabetic drugs may require adjustment of dosage with concurrent use.
Other antihypertensive drugs may have an additive effect. Discontinuation of
diuretic therapy 2-3 days before the initiation of treatment with an ACE
inhibitor may reduce the likelihood of first-dose hypotension. The antihypertensive
effect of the drug may be enhanced in the post-sympathectomy patient. Contraindications Anuria, hypersensitivity to Hydrochlorothiazide or to
other sulphonamide-derived drugs, severe renal or hepatic failure, Addison’s
disease, hypercalcemia, concurrent lithium therapy. Side Effects Gastro-intestinal system:
Anorexia, gastric irritation, nausea, vomiting, cramps, diarrhoea,
constipation, jaundice (intrahepatic cholestatic jaundice), pancreatitis,
salivary gland inflammation. Pregnancy & Lactation Use in pregnancy: Thiazides cross the
placental barrier and appear in cord blood. The use of Hydrochlorothiazide
when pregnancy is present or suspected requires, therefore, that the benefits
of the drug be weighed against possible hazards to the fetus. These hazards
include fetal or neonatal jaundice, thrombocytopenia, and possibly other
adverse reactions, which have occurred in the adult. The routine use of
diuretics in otherwise healthy pregnant women with or without mild oedema is
not recommended, because their use may be associated with hypovolaemia,
increased blood viscosity and decreased placental perfusion. Precautions & Warnings Patients should be carefully monitored for signs of
fluid and electrolyte imbalance (hyponatraemia, hypochloraemic alkalosis,
hypokalaemia and hypomagnesaemia). It is particularly important to make serum
and urine electrolyte determinations when the patient is vomiting excessively
or receiving parenteral fluids. Warning signs or symptoms of fluid and electrolyte
imbalance include: dryness of mouth, thirst, weakness, lethargy, drowsiness,
restlessness, seizures, confusion, muscle pains or cramps, muscle fatigue,
hypotension, oliguria, tachycardia, and gastro-intestinal disturbances such
as nausea and vomiting. Hypokalaemia may develop, especially with brisk
diuresis, when severe cirrhosis is present, or after prolonged therapy.
Hypokalaemia can sensitise or exaggerate the response of the heart to the
toxic effects of digitalis (e.g. increased ventricular irritability).
Sensitivity reactions may occur in patients with or without history of
allergy or bronchial asthma. Hypokalaemia may be avoided or treated in the
adult by concurrent use of amiloride hydrochloride, a potassium conserving
agent. It may also be avoided by giving potassium chloride or foods with a
high potassium content. Diuretic-induced hyponatraemia is usually mild and
asymptomatic. Dilutional hyponatraemia may occur in oedematous patients in
hot weather; and, except in rare instances when hyponatraemia is
life-threatening, appropriate therapy is water restriction rather than
administration of salt. Thiazides may decrease serum protein bound iodine
levels without signs of thyroid disturbances. Thiazides may decrease urinary
calcium excretion, and may also cause intermittent and slight elevation of
serum calcium in the absence of known disorders of calcium metabolism.
Thiazides should be discontinued before carrying out tests for parathyroid
function. When creatinine clearance falls below 30ml/min, thiazide diuretics
become ineffective. Uraemia may be precipitated or increased by
chlorothiazide. Cumulative effects of the drug may develop in patients with
impaired renal function. If increasing uraemia and oliguria occur during
treatment of renal disease, Hydrochlorothiazide should be discontinued.
Thiazides should be used with caution in patients with impaired hepatic
function or progressive liver disease, since minor alterations of fluid and
electrolyte balance may precipitate hepatic coma. Hyperuricaemia may occur,
or gout may be precipitated, in certain patients receiving thiazide therapy.
Thaizide therapy may impair glucose tolerance. Increases in cholesterol and
triglyceride levels may be associated with thiazide diuretic therapy. The
possibility of exacerbation or activation of systemic lupus erythematosus has
been reported. Latent diabetes may become manifest during thiazide
administration. Overdose Effects The most common signs and symptoms observed are those
caused by electrolyte depletion (hypokalaemia, hypochloraemia, hyponatraemia)
and dehydration resulting from excessive diuresis. If digitalis has also been
administered, hypokalaemia may accentuate cardiac arrhythmias. In the event
of overdosage, symptomatic and supportive measures should be employed. If
ingestion is recent, emesis should be induced or gastric lavage performed.
Dehydration, electrolyte imbalance, hepatic coma and hypotension should be
corrected by established methods. If required, give oxygen or artificial
respiration for respiratory impairment. Therapeutic Class Thiazide diuretics & related drugs Price: unit
price-1tk |
|
Indications Indapamide is indicated in the treatment of essential
hypertension . It is effective in treating hypertension in patients with
renal function impairment, although its diuretic effect is reduced.
Indapamide is also indicated for the treatment of salt and fluid retention
associated with congestive heart failure. Pharmacology Indapamide is a diuretic antihypertensive. It appears
to cause vasodilation, probably by inhibiting the passage of calcium and
other ions (sodium, potassium) across membranes. It has an extra-renal
antihypertensive action resulting in a decrease in vascular hyperreactivity
and a reduction in total peripheral and arteriolar resistance. Dosage & Administration One tablet daily preferably in the morning. In more
sever case Indapamide can be combine with other categories of
anti-hypertensive agent. The safety and effectiveness in pediatric patients
have not been established
Interaction Other antihypertensive: Indapamide
may add to or potentiate the action of other antihypertensive drugs. Contraindications This drug must not be taken in the following
conditions:
Side Effects Side effects of Indapamide include headache,
anorexia, gastric irritation,nausea, vomiting, constipation, diarrhoea etc. Pregnancy & Lactation There are no adequate and well-controlled studies in
pregnant women and so Indapamide is not recommended. Mothers taking
Indapamide should not breast feed. Precautions & Warnings Monitoring of potassium and uric acid serum levels is
recommended, especially in subjects with a predisposition or sensitivity to
hypokalemia and in patients with gout. Although no allergic manifestations
have been reported during clinical trials, patients with a history of allergy
to sulfonamide derivatives should be closely monitored. Overdose Effects Symptoms: These could
include: allergies, skin rashes, epigastric pain, nausea, photosensitivity,
dizziness, weakness and paraesthesia. Therapeutic Class Thiazide diuretics & related drugs Price: unit
price-6-9tk |
|
Indications Rosuvastatin is indicated in-
Pharmacology Rosuvastatin is a selective and competitive inhibitor
of HMG-CoA reductase, the rate-limiting enzyme that converts
3-hydroxy-3-methyl glutaryl coenzyme A to mevalonate, a precursor of
cholesterol. Rosuvastatin produces its lipid-modifying effects in two ways.
First, it increases the number of hepatic LDL receptors on the cell surface
to enhance uptake and catabolism of LDL. Second, Rosuvastatin inhibits
hepatic synthesis of VLDL, which reduces the total number of VLDL and LDL
particles. Dosage Dose range: 5-40 mg once daily.
Use 40 mg dose only for patients not reaching LDL-C goal with 20 mg
Administration Rosuvastatin can be taken with or without food, at
any time of day.
Interaction Remarkable drug interactions of Rosuvastatin are-
Contraindications Rosuvastatin is contraindicated if-
Side Effects Rosuvastatin is generally well tolerated. The most
frequent adverse events thought to be related to Rosuvastatin were headache,
myalgia, constipation, asthenia, abdominal pain and nausea. Pregnancy & Lactation The safety in pregnant women has not been established.
It is not known whether Rosuvastatin is excreted in human milk or not. Precautions & Warnings Skeletal muscle effects (e.g., myopathy and
rhabdomyolysis): Risks increase with use of 40 mg dose, advanced age
(>65 year), hypothyroidism, renal impairment and combination use with
cyclosporine, lopinavir/ritonavir, atazanavir/ritonavir or certain other
lipid-lowering drugs. Patients should be advised to promptly report
unexplained muscle pain, tenderness or weakness. Rosuvastatin can be
discontinued if signs or symptoms appear. Use in Special Populations Use in children: The safety and
effectiveness in pediatric patients have not been established. Therapeutic Class Other Anti-anginal & Anti-ischaemic drugs,
Statins |