Supply:10MG/2ML/AMP(PERSANTINR), 25MG/F.C.TAB(PERSANTINR), 50MG/F.C.TAB(SANCINR)
& Fibrinolytics
Use:Management of chronic angina pectoris, thrombo-embolic disease.
Contraindication:Acute myocardial infarction
Adverse effect:Headache, dizziness, nausea, skin rash.
Usual dosage:As antithrombotics: 400-600mg/day AC.
For angina pectories: 50mg TID, maximum dose: 400mg/day
Special precautions:Rapidly progressing angina; subvalvular aortic stenosis; hemodynamic instability eg associated recent MI
ISOSORBIDE 5 MONONITRATE C
Supply:20MG/TAB(ISMO-20R)
Use:Long-term treatment of circulation disorders of the coronary blood vessels and for preventing attacks of angina pectoris, post-myocardial infarction therapy.
Contraindication:Patients with marked low blood pressure, circulatory collapse, states of shock and acute myocardial infarction with low filling pressure.
Adverse effect:Nitrate headaches, decrease blood pressure, slight states of dizziness, increase of the heart rate, temporary reddening of the face, weakness, nausea, vomiting.
Usual dosage:1 Tab BID.
Special precautions:Not suitable for treating attacks of angina pectoris. Pregnancy &lactation. May impair ability to drive or operate machinery.
Patient information:Dispense drug in easy-to open container; do not change brands without consulting your pharmacist or physician, extended release tablets should not be chewed or crushed and should be swallowed together with a half-glassful of fluid; headaches are sometimes a marker of the activity of the drug. the antianginal efficacy of tables can be maintained by carefully following the prescribed schedule of dosing(2 doses taken 7 hours apart)
Mechanism: Decreasing preload as measured by pulmonary capillary wedge pressure and left ventricular end diastolic volume and pressure; the average reduction in left ventricular end diastolic volume is 25% at rest, with a corresponding increase in ejection fraction of 50% to 60%. This effect improves congestive symptoms in heart failure and improves the myocardial perfusion gradient in patient with coronary artery disease
ISOSORBIDE DINITRATE C
Supply:5MG/SUBLINGUAL.TAB(ISODILR),10MG/TAB(ISORDILR), 10MG/10ML/AMP(ISOKETR)
Use:Prevention and treatment of angina pectoris; for congestive heart failure
Contraindication:Severe anemia, closed-angle glaucoma, postural hypotension, cerebral hemorrhage, head trauma
Adverse effect:Headache, transient dizziness, weakness, cutaneous flushing.
Usual dosage:2.5-10mg sublingual or oral with food Q2-6H for prompt relief or prophylaxis, 10-60mg TID-QID in patient with congestive heart failure.
Patient information:Do not chew or crush sublingual or sustained release physician; if no relief from sublingual tablet after 15 minutes, report to nearest emergency room or seek emergency help
Pharmacodynamics
Dosage form Onset of action Duration
Sublingual tab 2-10 min 1-2 h
Chewable tab 3 min 0.5-2 h
Oral tab 45-60 min 4-6 h
Sustained release tab 30 min 6-12 h
NICORANDIL
Supply:5MG/TAB(SIGMARTR)
Use:Anginal pectoris
Adverse effect:Palpitations, facial flash; throbbing headache, dizziness; rash; GI disturbances; increase in liver enzymes; cervical pain; diplopia.
Usual dosage:Usually 5 mg tid
Special precautions:Hepatic disorders; glaucoma; child elederly; pregnancy.
NITROGLYCERIN SUBLINGUAL C
Supply:0.6MG/SUBLINGUAL.TAB(NITROGLYCERINR)
Use:Prophylatic treatment and management of angina pectoris.
Contraindication:Patient with marked anemia, head trauma, or cerebral hemorrhage.
Adverse effect:Headache, vertigo, weakness, palpitation, dizziness, flushing, nausea, vomiting. tachycardia, postural hypotension.
Usual dosage:1 Tab sublingual every 5 minutes prn
Patient information: Go to hospital if no relief after 3 sublingual doses; do not swallow or chew sublingual form; take oral nitrates on an empty stomach; keep tightly closed; keep tablets and capsules in original container; a treatment-free interval of 8-12 hours is recommended each day; take 3 times/day rather than every 8 hours
Mechanism: Reduces cardiac oxygen demand by decreasing left ventricular pressure and systemic vascular resistance; dilates coronary arteries and improves collateral flow to ischemic regions
Diuretics
BUMETANIDE C
Supply:0.5MG/ML/4ML(BURINEXR), 1MG/TAB(BURINEXR)
Use:Edema associated with Chf, liver cirrhosis, renal disease. Acute pulmonary edema, drug-induced fluid retention, drug-poisoning that can be treated by forced diuresis. Hypertension.
Contraindication:Hepatic coma, severe electrolyte depletion, concurrent administration with lithium, anuria.
Adverse effect:Hypokalemia & hypochloremic alkalosis (long-term therapy); muscular cramps in patients with sever chronic renal failure; asymptomatic hyperuricemia. Rarely, skin rashes, depression of formed elements in the blood; abdominal discomfort.
Usual dosage:Amp Usually 1-2 mg IV or IM
Special precautions:Hepatic cirrhosis; patients on digitalis therapy; diabetes, electrolyte disturbances, prostatic hypertrophy; impaired micturition; renal insufficiency.
FUROSEMIDE C
Supply:20MG/2ML/AMP(LASIXR), 40MG/TAB(LASIXR)
Use:Hypertension, acute pulmonary edema, edema due to congestive heart failure, hepatic cirrhosis and renal disease.
Contraindication:Anuria, hypersensitive to furosemide.
Adverse effect:Dehydration, hypokalemia, glucose intolerance, hypochloremic alkalosis, hyperuricemia.
Usual dosage:40-500mg/day, maximum daily dose: 600mg.
Patient information:May be taken with food or milk; rise slowly from a lying or sitting position to minimize dizziness, lightheadeness, or fainting; also use extra care when exercising, standing for long periods of time, and during hot weather; take last dose of day early in the evening to prevent nocturia
HYDROCHLOROTHIAZIDE B
Supply:AnjalR(Triamterene50mg, hydrochlorothiazide25mg)
AmitonR(amiloride5mg, hydrochlorothiazide50mg)
Use:All forms of edema, hypertension, congestive heart failure, hepatic cirrhosis with ascites.
Contraindication:Anuria, hypersensitivity to hydrochlorothiazide.
Adverse effect:Thirst, epigastric pain, anorexia, nausea, vomiting, headache, hypokalemia.
Usual dosage:50-150mg/day
Patient information:May be taken with food or milk; take early in day to avoid nocturia; take the last dose of mulitple doses no later than 6 PM unless instructed otherwise. A few people who take this medication become more sensitive to sunlight and may experience skin rash, redness, itching, or severe sunburn, especially if sun block SPF?15 is not used on exposed skin areas. May increase blood glucose levels in diabetics.
METOLAZONE B
Supply:0.5MG/TAB(MYKROXR)
Use:Metolazone is an effective diuretic for edema and essential hypertension. It has been used in patients with renal failure and nephrotic syndrome.
Place in therapy: The only apparent advantage over other thiazides is its usefulness in patient with a decreased glomerular filtration rate.
Contraindication:Thiazide diuretics are contraindicated in patient with anuria, hypersensitivity to other thiazide diuretics, or sulfonamides and in use in pregnant women.
Adverse effect:Anemia, orthostatic hypotension, hypokalemia, hyperuricemia, and hyponatremia.
Usual dosage:Adults: Initial oral dose 2.5-10 mg/day, a lower range has been recommended (1.25-5 mg/day). Child: 0.2-0.4 mg/kg/day
SPIRONOLACTONE D
Supply:25MG/TAB(SPIRONOLACTONER)
Use:Hypertension, edema due to congestive heart failure, hepatic cirrhosis, or nephrotic syndrome.
Contraindication:Anuria, acute renal insufficiency, hyperkalemia.
Adverse effect:Hyperkalemia, hyponatremia, dehydration, GI syndrome, cramping, ataxia, skin rash, headache, drowsiness.
Usual dosage:Adults: 25-200mg/day, divided into 2-4 doses. Child: 3.3mg/kg/day
*ALDACTIDE 25 D
Content: Per tabSPIRONOLACTONE 25MG, HYDROFLUMETHIAZIDE 25MG
TRICHLORMETHIAZIDE C
Supply:2MG/TAB(FLUITRANR)
Use:Hypertension, edema due to congestive heart failure, hepatic cirrhosis, chronic renal disease and corticosteroid therapy.
Contraindication:Anuria, hypersensitivity to trichlormethiazide.
Adverse effect:Nausea, flushing of face, hypokalemia, hyponatremia, hypochloremic alkalosis.
Usual dosage:2-4mg/day.
Special precautions:Electrolyte imbalances; hepatic or renal impairment; pregnancy &lactation.
Circulation Agents
PENTOXIFYLLINE C
Supply:100mg/Amp(PENTOXILLINER, TRENTALR), 100mg/Tab(TRENTAL DRAGEER), 400mg/Tab(TRENTAL DRAGEER) 400mg/S.R.Tab(FORFLOWR), 400mg/S.R.F.C.Tab(PERILAXR, FYLIN RETARDR, IPENTOLR)
Use:Treatment of peripheral vascular circulatory disorder.
Contraindication:Recent myocardial infarction, severe hemorrhage
Adverse effect:Nausea, dizziness, flushing, headache
Usual dosage:PO initial dose: 200mg TID when improvement is seen reduce to 100mg TID. IV initial dose 100mg in 250-500ml N/S given over 1.5-3 hours, increased by 50mg every day until a daily dose of 300mg is reached.
BUFLOMEDIL HCL
Supply:150mg/F.C.Tab(LOFTYLR, LOMEDILR)
Use:Buflomedil is a vasoactive drug and seems to improve nutritional blood flow in ischemic tissue of patients with peripheral or cerebral vascular disease.
Contraindication:Woman in postpartum, severe arterial hemorrhage.
Adverse effect:GI disturbance, headache, nausea, dizziness, itching, flushing.
Usual dosage:PO 300-600mg/day
Special precautions:Impaired renal function; low body weight
Supply:1.5mg/Tab(SCAMINR, TRIROGINR)
Use:Confusion, dizziness, mood-depression, unsociability.
Contraindication:Hypersensitivity and in patient with acute or chronic psychosis regardless of etiology.
Adverse effect:Ergotism, sinus bradycardia, orthostatic hypotension, flushing, porphyria, transient nausea, nasal stuffiness, blurred vision.
Usual dosage:PO 1mg TID
FLUNARIZINE
Supply:5mg/Cap(SIBELIUMR, SUFUNIR), 10mg/Cap(FORKNOWR)
Use:Migraine, prophylaxis and treatment of vertigo and peripheral vascular disease.
Contraindication:Patient hypersensitive to flunarizine.
Adverse effect:Drowsiness, headache, insomnia, nausea, dry mouth.
Usual dosage:Migraine, headache prophylaxis and peripheral vascular disease: PO 10mg daily as a single dose.
Vertigo: PO 20mg TID.
Special precautions:Pregnancy
NICAMETATE
Supply:50mg/Tab(EUCLIDANR)
Use:Treatment of peripheral vascular disorders.
Contraindication:Peptic ulcer, severe hypotension, atrial hemorrhage, hepatic dysfunction, hyperuricemia.
Adverse effect:Transient palpitation, flushing of face.
Usual dosage:300mg/day
NICERGOLINE
Supply:5mg/Tab(SERMIONR)
Use:Intellective, affective, behavioural & somatic symptoms associated with cerebral decary (include dementia & Parkinsonism), memory disorders, reduced vigilance & conc, mood depression, apathy, unsociability, indifference to surroundings, loss of self-care, asthenia, anorexia and tinnitus. Adjuvant to neurological rehabilitation in after-stroke hemiplegic patients
Adverse effect:Slight GI disturbances; flushing; drowsiness; insomnia
Usual dosage:5-10 mg tid.
Vasoconstrictors
MIDODRINE HCL
Supply:2.5mg/Tab(GUTRONR)
Use:Orthostatic circulatory regulation disturbance & dysregulation, constitutional & symptoms hypotension. Management of side effects produced by hypnotics & urinary incontinence, psychotropic drugs, antihypertensives
Contraindication:Raised BP, severe organic heart diseases, acute nephritis, thyrotoxicosis, pheochromocytoma
Adverse effect:Bradycardia
Usual dosage:Adult & adolescent 1/2 tab. To be taken once or bid.
Special precautions:Impaired liver function
NOREPINEPHRINE BITARTRATE
Supply:2.3mg/ml 4ml/Amp(LEVOPHEDR)
Use:Hypotension, cardiac arrest and profound hypotension.
Contraindication: Hypotension with blood volume deficiency, mesenteric or peripheral vascular thrombosis, pregnancy, patient under cyclopropane anesthesia.
Adverse effect:Anxiety, transient headache, palpitation, respiratory difficulty, bradycardia, photophobia, sweating, vomiting, retrosternal pain, cardiac arrhythmia
Usual dosage:IV drip 8-12mg/min, according to the patient's blood pressure.
Special precautions:Hypertension, extravasation. Should be given into a large vein
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