Supply:100MG/CAP(SECTRALR), 400MG/TAB(SECTRALR)
Use:Acebutolol is effective in angina pectoris, hypertension and ventricular arrhythmias.
Place in therapy: All currently available b-blockers appear to be equally effective for the treatment of hypertension, however, b-blockers with cardioselectivity (i.e. atenolol, acebutolol) may be particularly effective in hypertension with asthma or diabetes. Since acebutolol has intrinsic sympathomimetic activity, it does not increase serum triglyceride levels or decrease HDL cholesterol, acebutolol may be useful in patients with dyslipidemia.
Contraindication:Persistently severe bradycardia, second degree and third degree heart block, overt cardiac failure, cardiogenic shock, avoid use with verapamil concomitantly.
Adverse effect:Hypotension, bradycardia, congestive heart failure, fatigue, headache, GI toxicity, decrease in FEV-1 in asthmatics, lupus-like reactions appear more commonly than with other b-blockers.
Usual dosage:Hypertension: 400-800mg QD or divided to BID use, Stable angina: 600-1600mg daily.
Patient information:Do not discontinue abruptly; consult pharmacist or physician before taking with other adrenergic drugs9eg. Cold medications); take at the same time each day; use with the caution while driving or performing takes requiring alertness
Special precautions:Abroupt withdrawal of beta-blockers may result in an exaggerated cardiac beta-adrenergic responsivenessSymptomatalogy has included reports of tachycardia, hypertension, ischemia, agina, myocardial infarction, and sudden death; abrupt withdrawal of the drug should be avoided; drug should be discontinued over 1-2 weeks
ATENOLOL C
Supply:50MG/F.C.TAB(ATENOLOLR), 50MG/TAB(MIROBECTR), 100MG/TAB(ATENOR, TENORMINR), 100MG/F.C.TAB(ATENOLOLR)
Use:Treatment of hypertension, alone or in combination with other agent; management of angina pectoris, postmyocardil infarction patients
Contraindication:Sinus bradycardia, cardiac shock, symptomatic CHF.
Adverse effect:Cold extremeties, muscular fatigue
Usual dosage:50-100mg QD.
Patient information:Adhere to dosage regimen; watch for postural hypotension; abrupt withdrawal of the drug should be avoided; take at the same time each day; use with the caution while driving or performing takes requiring alertness
Special precautions:abrupt withdrawal of the drug should be avoided; drug should be discontinued over 1-2 weeks; may potenitate hypoglycemia in a diabetic patient and mask signs and symptons; modify dosage in patients with reneal impairment
*SHPYNJA C
Content:Atenolol 100mg, chlorthalidone 25mg
CARVEDILOL C
Supply:25MG/TAB(DILATRENDR)
Use:Listed in Dosage.
Contraindication:Decompensated heart failure requiring IV inotropic support; asthma; COPD with bronchospastic component; clinically manifested liver dysfunction; 2nd & 3rd degree AV block; severe bradycardia(<50bpm); cardiogenic shock; sick sinus syndrome; severe hypotension (systolic BP<85 mmHg); pregnancy & lactation.
Adverse effect:Dizziness, headaches, fatigue, bradycardia, postural hypotension, hypotension, GI disturbances, flu-like symptoms, resp effects
Usual dosage:Essential hypertension Adult 12.5 mg once daily for the 1st 2 days. Thereafter 25 mg once daily. Max: 50 mg daily. CHF 3.125mg bid for 2 wks. Dosage may be increased at intervals of not <2 weeks, to 6.25 mg bid, followed by 12.5 mg bid thereafter 25 mg. Adult<85kg Max 25 mg bid, 85kg Max 50mg bid
LABETALOL HCL C
Supply:200MG/F.C.TAB(LABTALR), 5MG/ML,5ML/AMP(TRANDATER)
Use:All grades of hypertension.
Contraindication:Patients with digitalis resistant heart failure or atrioventricular block, asthma and prone to bronchospasm.
Adverse effect:Postural hypotension, scalp tingling, insomnia, GI discomfort, nasal stiffness, vivid dreams.
Usual dosage:PO : 200-400mg BID; IV : initial dose 50mg , if necessary, doses of 50mg may be repeated at 5 minutes interval until a satisfactory response occurs.
Patient information:Do not stop medication without aid of physician; may mask signs and symptoms of diabetes
Special precautions:Paradoxical increase in blood pressure has been reported with treatment of pheochromocytoma or clonidine withdrawal syndrome; use with caution in patients with hyper-reactive airway disease, congestive heart failure, diabetes mellitus, hepatic dysfunction; orthostatic hypotension may occur with I.V. administration
METOPROLOL
Supply:100MG/TAB(BETALOCR)
Use:Hypertension angina pectoris, cardiac arrhythmias, maintenance treatment of MI, functional heart disorders with palpitation. Migraine prophylaxis.
Contraindication:AV block II & III, uncompensated cardiac failure, cardiogenic shock & marked bradycardia
Adverse effect:Exertional tiredness, GI disturbances, slleep patterm disturbances. Cold extremities.
Usual dosage:100-200mg daily as a single dose
PROPRANOLOL C
Supply:10MG/TAB(INDERALR), 40MG/TAB(CARDOLOLR)
Use:Hypertension, angina pectoris, cardiac arrhythmia, prophylaxis of migraine, hypertrophic subaortic stenosis.
Contraindication:Second to third degree heart block, bronchial asthma, cardiogenic shocks, sinus bradycardia, allergic rhinitis during the pollen season, hypoglycemia, metabolic acidosis.
Adverse effect:Severe bradycardia, congestive heart failure, hypotension, bronchospasm
Usual dosage:PO 10-40mg TID or QID, maintenance dose: 160-480mg/day. For emergency of cardiac arrhythmia: IV 1-3mg (less than 1mg/min), maximum dose: 10mg.
Patient information:Do not discontinue abruptly; notify physician if CHF symptoms become worse or side effects develop; take at the same time each day; use with the caution while driving or performing takes requiring alertness
Special precautions:Administer very cautiously to patients with CHF, asthma, diabetes mellitus, hyperthyroidism. Abrupt withdrawal of the drug should be avoided, drug should be discontinued over 1-2 weeks; may potentiate hypoglycemia in a diabetic patient and mask signs and symptoms
Mechanism: Nonselective beta-adrenergic blocker(class II antiarrhythmic); competitively blocks response to beta1- and beta2-adrenergic stimulation
Angiotensin-I converting enzyme inhibitors
CAPTOPRIL
Supply:12.5MG/TAB(CAPTOPRIR), 25MG/TAB(CABUDANR, CAPOMILR)
Use:Severe hypertension, renovascular hypertension, congestive heart failure.
Contraindication:Patients with severe autoimmune disease, impaired renal function
Adverse effect:Skin rash, pruritus, taste disturbance, proteinuria (renal disease history); serum potassium concentration may be raised.
Usual dosage:Adults: Usual dose: 25-150mg TID, 1 hour AC; maximum dose: 450 mg/day. Child: Usual dose: 1mg/kg/day; maximum dose: 6 mg/kg/day.
Special precautions:Use with caution and decrease dosagein patients with reanal impairment(especially renal artery stenosis), sever congestive heart failure, or with coadministered diuretic therapy; experience in children is limited.
Patient Information:Take 1 hour befor meals; do not stop therapy except under prescriber advice; notify physician if you develop sore throat, fever, swelling, rash, difficult breathing, irregular heartbeats, chest pain,or cough. May cause dizziness, fainting, and lightheadedness, especially in first week of therapy; sit and stand up slowly
CILAZAPRIL
Supply:2.5MG/TAB(INHIBACER)
Use:Listed in Dosage
Contraindication:Patients with ascites. Pregnancy.
Adverse effect:Headache, dizziness. Fatigue, hypotension, dyspepsia, nausea, coughing. Rarely, angioneurotic edema.
Usual dosage:Essential hypertension,severe heart failure First 2 days half 2.5 mg tab omce daily, then 2.5-5 mg once daily. Renovascular hypertension Initially 0.5 mg or less. Heart failure Initially 1 mg up to 5 mg daily.
Special precautions:Symptomatic hypotension, liver cirrhosis, impaired renal function, surgery, anesth.
DOXAZOSIN MESYLATE
Supply:2MG/TAB(DOXABENR), 4MG/TAB(GENZOSINR)
Use:Doxazosin is a selective long-acting a-1-adrenergic antagonist, with a similar structure to prazosin. Once daily dose is effective alone or in combination with other antihypertensive agents in controlling mild to moderate essential hypertension.
Contraindication:Hypersensitivity to quinazolines such as prazosin and terazosin
Adverse effect:Orthostatic hypotension, dizziness, vertigo, and headaches are the most common adverse effects.
Usual dosage:Initial: 1mg daily and slowly titrated up to a maximum of 16mg QD or until blood pressure is adequately controlled. No dosing adjustments are required in elderly or renal failure patients.
ENALAPRIL MALEATE
Supply:5MG/TAB(RENITECR, SINTECR), 10MG/TAB(PERISAFER), 20MG/TAB(RENITECR, SYNBOTR)
Use:Enalapril is an angiotensin converting enzyme inhibitor. It has been used in hypertension, chronic heart failure. Theoretically, enalapril has advantages over captopril with respect to increase potency, longer duration of action, and possibly a reduction in side effects due to a lack of sulfhydryl moeity.
Contraindication:Hypersensitivity to enalapril or enalaprilat and other ACE inhibitors.
Adverse effect:The most frequent adverse effects are headache (4.8%), dizziness (4.6%), and fatigue (2.8%). Other adverse effects include diarrhea, rash, hypotension, cough, nausea, and orthostasis.
Usual dosage:Usual dosage:Hypertension: 5mg QD, blood pressure control: 10-40 mg daily; the dosage should be adjusted in patients with renal failure; maximum dose: 40mg/day
Dosage adjustment : according to CrCl (ml/min)
> 30 : 2.5mg QD
< 30 : initial dose 0.625mg
Patient Information:Notify physican if vomiting, diarrhea, excessive perspiration, or dehydration should occur; also if swelling of face, lips, tongue, or difficulty in breathing occurs or if persisten cough develops
HYDRALAZINE HCL C
Supply:25MG/S.C.TAB(APRESLOINER)
Use:Moderate to severe hypertension.
Contraindication:Coronary artery disease, hypersensitivity, mitral valve rheumatic heart disease.
Adverse effect:GI disturbance, anorexia, palpitation, tachycardia, angina pectoris, headache.
Usual dosage:PO : Adults: 10-50mg QID, up to 300mg/day may need, Child: 187.5-250mg/kg QID. IM, IV : Adults: 20-40mg, repeated as needed Q4-6H. Child: 425mg/kg QID.
Supply:10MG/TAB(GENOPRILR, ZESTRILR), 20MG/GENOPRILR)
Use:Lisinopril is effective in reducing blood pressure in patients with essential or renovascular hypertension, and is indicated as adjunctive therapy in patients with congestive heart failure.
Contraindication:Hypersensitivity, history of angioedema induced by other ACE inhibitors and pregnancy.
Adverse effect:Blood dyscrasias, hypotension, headache, fatigue, insomnia, hyperkalemia, nausea, diarrhea, taste disturbances, renal dysfunction, dry cough.
Usual dosage:5-10mg daily ; max. 80mg/day.
Dosage adjustment : according to CrCl (ml/min)
> 30 : initial dose 10 mg/day
10 - 30 : initial dose 5mg/day
< 10: initial dose 2.5 mg/day
depending on blood pressure response
METHYLDOPA B
Supply:250MG/TAB(ALDOMETR)
Use:Moderate to severe hypertension.
Contraindication:Active hepatic disease, eg: acute hepatitis, active cirrhosis, phaeochromocytoma.
Adverse effect:Drowsiness, sedation, headache, dizziness, asthenia, weakness, bradycardia, abnormal liver function tests.
Usual dosage:Initial dose: 250mg BID or TID, maintenance dose: 0.5-2.0g/day, maximum daily dose: 3g
Supply:10MG/TAB(LONITENR)
Use:Severe hypertension.
Contraindication:Pheochromocytoma.
Adverse effect:Sodium and water retension, hypertrichosis.
Usual dosage:Adults:Initial dose: 5mg/day to start, may be increase to 50 mg/day(QD or BID); usual maintenance dose: 10-40mg/day; maximum dose: 100mg/day. Child:Initial dose: 0.2mg/kg/ day, maximum dose: 1mg/kg/day
PERINDOPRIL D
Supply:4MG/TAB(ACERTILR)
Use:Severe hypertension.
Contraindication:Pheochromocytoma.
Adverse effect:Sodium and water retension, hypertrichosis.
Usual dosage:Adults:Initial dose: 5mg/day to start, may be increase to 50 mg/day(QD or BID); usual maintenance dose: 10-40mg/day; maximum dose: 100mg/day. Child:Initial dose: 0.2mg/kg/ day, maximum dose: 1mg/kg/day
Special precautions:Renal failure; renovascular hypertension; surgery/anesth; elderly. Hemodialysis: avoid combination with highly permeable membranes (polyacrylonitrile).
PHENOXYBENZAMINE HCL C
Supply:10MG/CAP(DIBENYLINER, LIMYR)
Use:Used to control or prevent paroxysmal hypertension and sweating in patients with pheochromocytoma.
Contraindication:Patients with marked cerebral or coronary arteriosclerosis or renal damage, and decrease in blood pressure is undesirable.
Adverse effect:Nasal congestion, miosis, postural hypotension with dizziness and tachycardia.
Usual dosage:PO, initial adult dosage: 10mg BID, then increased every other day, usually to 20-40mg 2 or 3 times daily, until an adequate response is achieved.
Special precautions:Elderly; ischaemic heart disease; marked arteriosclerosis; renal damage.
PRAZOSIN HCL C
Supply:1MG,2MG/TAB(MINIPRESSR)
Use:All grades of hypertension.
Adverse effect:Dizziness, headache, drowsiness, lack of energy, weakness, palpitations, postural hypotension, nasal congestion.
Usual dosage:Initial: 0.5-1.0mg BID or TID. Maximum dose: 20mg/day.
Note: Adrenaline should not be given to antagonize the hypotensive effects of prazosin in overdosage.
RAMIPRIL D
Supply:2.5MG/CAP(TRITACER)
Use:Hypertension
Adverse effect:Nausea, dizziness &headache, dry cough. Hypersensitivity reactions including pruritus, rash &fever.
Usual dosage:2.5 mg once daily. Patients on diuretics or with impaired renal function Initially 1.25 mg once a day. Usual dosage range: 2.5-10 mg
TERAZOSIN C
Supply:2MG/TAB(TERASRINR, TEZOPINR)
Use:Hypertension, benign prostatic hypertrophy, and heart failure.
Place in therapy: All of the available selective a-1-receptor blockers appear to be equally effective for the treatment of hypertension. Since a -1-adrenergic blockers may be safely used in patients with diabetes, congestive heart failure, asthma, and hyperlipidemia, they may be preferred initial agents.
For benign prostatic hyperplasia, surgical (transurethral prostatectomy) treatment is associated with an 85% improvement in symptoms, a-blockers reduce symptoms by 51%, and treatment with the 5-a-reductase inhibitor finasteride improves symptoms by 31%.
Contraindication:Hypersensitivity.
Adverse effect:The first-dose syncope and postural hypotension frequently occur. Other adverse effects include dizziness, faintness, fatigue and headache; tachycardia has also been observed.
Usual dosage:Adults: Initial dose 1mg PO HS, then titrate to 5mg PO QD; some patients may require 10-20mg PO QD. Dosing adjustments are not required in elderly patients but escalation should be slower.
Special precautions:Orthostatic hypotension
VALSARTAN D
Supply:80MG/CAP(DIOVANR)
Use:Hypertension
Contraindication:Pregnancy &lactation.
Adverse effect:Headache, dizziness, viral infection, upper resp tract infection, coughing, diarrhea, faigue, rhinitis, sinusitis, back pain, abdominal pain, nausea, pharyngitis, arthralgia.
Usual dosage:80 mg once daily. May be increased to 160 mg daily.
Special precautions:Severely Na-depleted vol-depleted patients, renal artery stenosis, severely impaired renal function, severe hepatic impairment, biliary obstruction.
Calcium antagonists
AMLODIPINE
Supply:5MG/TAB(NORVASCR)
Use:Traetment of hypertension and angina(chronic stable or Prinzmetal's)with or without other therapy
Contraindication:Hypersensitivity to amlodipine
Adverse effect:Dose related peripheral edema; headache, flushing, palpitations and GI disturbances
Usual dosage:5 to 10mg QD. Dose reductions may be indicated in the elderly or those with hepatic failure, but are not necessary in renal impairment.
Special precautions:Use with caution and titrate dosages for patient with impaired renal or hepatic function; use caution when treating patients with congestive heart failure, sick-sinus syndrome, sever left ventricular dysfunction, hypertrophic cardiomyopathy
Patient information:Do not discontinue abruptly; report any dizziness, shortness of breath, palpitation or, edema
Mechanism: Inhibits calcium ion from entering the' slow channels'or select voltage-sensitive areas of vascula smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle andcoronary vasodilation; increases myocardial oxygen delivery in patients with vasospastic angina
DILTIAZEM
Supply:30MG/TAB(ANGELTENSIONR, CARTILR), 60MG/TAB(CARTILR)
Use:Treatment of coronary artery spasm, angina pectoris, essential hypertension, supraventricular arrhythmia.
Contraindication:Severe hypotension or second and third degree heart block except with a functioning pacemaker; hypersensitivity to diltiazem; sick sinus syndrome, acute myocardial infarction, and pulmonary congestion
Adverse effect:A-V nodal block, hypotension, headache, and GI disturbance.
Usual dosage:30-50mg TID, maximum dose: 360 mg/day in 3-4 doses.
Patient information:Sustained release products should be taken in the morning; do not crush or chew, limit caffeine intake; avoid alcohol; notify phyician if angina pain is not reduced when taking this drug
FELODIPINE
Supply:5MG/TAB(PLENDILR)
Use:Felodipine is effective as monotherapy in mild to moderate hypertension. It may be useful in angina, congestive heart failure, and pulmonary hypertension.
Place in therapy: Felodipine produces less disruption of left ventricular function than do verapamil and diltiazem and may be preferred in patients with concomitant sinus bradycardia, conduction disturbances and compromised cardiac function. As monotherapy, response was seen in 60% to 65% of patients on felodipine 5 to 10mg daily or nifedipine 10mg twice daily.
Contraindication:Hypersensitivity to calcium channel antagonist, symptomatic hypotension, any degree of A-V block, use caution in patient with previous left ventricular dysfunction.
Adverse effect:Dizziness, headache, peripheral edema (worse than with verapamil and diltiazem), flushing, rash, and gingival hyperplasia.
Usual dosage:Adults: Initial PO 5 mg QD; adjusted at 2 week intervals; 20mg QD has been used; for elderly and impaired liver function, should not receive more than 10mg/day.
Child: PO 0.18 to 0.56mg/kg QD were used to control hypertension or renal artery stenosis.
NICARDIPINE
Supply:20MG/S.C.TAB(COPONENTR)
Use:Hypertension
Contraindication:Incomplete hemostasis following intracranial hemorrhage, acute apoplexy, elevated intracranial pressure.
Adverse effect:Infrequentyl, anorexia, nausea, vomiting, flushing, palpitation, headache. Rarely granulocytopenia, dry mouth, constipation, peripheral edema, rash.
Usual dosage:10-20 mg tid
Special precautions:Liver or kidney impairment, hypotension, glaucoma, pregnancy.
NIFEDIPINE
Supply:5MG/SOFT.CAP/(AJULATER, ADALATR), 10MG/SOFT.CAP(AJULATER, RONIANR), 20MG/CAP(CORACTENR), 30MG/OROS.TAB
Use:Treatment and prophylaxis of angina pectoris, hypertension
Adverse effect:Transient headache, flushing bradycardia, hypotension, palpitation, tachycardia, chest pain.
Usual dosage:10mg TID
Patient education: Sustained release products should not be crushed or chewed; AdalatR CC should be taken on an empty stomach; limit caffeine intake; avoid alcohol; notify phyician if angina pain is not reduced when taking this drug
Special precautions:The routine use of short-acting nifedipine capsule in hypertensive emergencies and pseudoemergencies is not recommended
NISOLDIPIN
Supply:5MG/F.C.TAB(SYSCOR 5R)
Use:Nisoldipine is a dihydropyridine calcium channel blocking agent similar in structure to nifedipine.
Place in therapy: At present, available data do not suggest significant clinical advantages of the drug over nifedipine.
Contraindication:Hypersensitivity to this or other calcium channel antagonists.
Adverse effect:Dizziness, headache, peripheral edema (worse than with verapamil and diltiazem), flushing, rash, and gingival hyperplasia are the most common adverse events.
Usual dosage:Hypertension: 5-10 mg PO QD, titrate to response, range between 20-40 mg; stable angina: 10-20 mg daily, divide into two doses.
Dosage adjustment: 1. No adjustment in patient with renal failure 2. Dose reductions are suggested in liver dysfunction, with initial doses limited to 10 mg or less 3. No dose adjustment is recommended with hemodialysis.
VERAPAMIL
Supply:120/S.R.CAP(VERELANR)
Use:Control of supraventricular arrhythmia, angina pectoris, chronic coronary insufficiency, hypertension.
Contraindication:Hypotension, associated with cardiac shock, patients in digitalis intoxication, marked bradycardia, partial of complete A-V block, acute myocardial infarction, concomitant use with ß-blockers and cardiac depressants.
Adverse effect:Severe hypotension, bradycardia, constipation, flushing, bronchospasm.
Usual dosage:PO : 40-120mg TID AC, maximal dose 480mg /day ; IV infusion : 75-150mg/kg in normal saline or dextrose solution at a rate of 5-10mg/hr.
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