Cardiovascular Drugs
Content
CARDIOVASCULAR DRUGS B1. ANTI-ANGINAL DRUGS
Nifedipine Adalat Capsules: 10 mg Capsules: 20 mg Adalat CC Tablets, extended-release: 30 mg Tablets, extended-release: 60 mg Tablets, extended-release: 90 mg Nifedical XL Tablets, extended-release: 30 mg Tablets, extended-release: 60 mg Procardia Capsules: 10 mg Capsules: 20 mg Procardia XL Tablets, extended-release: 30 mg Tablets, extended-release: 60 mg Tablets, extended-release: 90 mg Adalat PA Adalat PA 10 Adalat PA 20 Adalat XL Class: Calcium channel blocker Actions Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular
smooth muscle and myocardium. Increases CO and decreases peripheral vascular resistance. Minimal effect on sinoatrial and AV nodal conduction. Reduces myocardial oxygen demand; relaxes and prevents coronary artery spasm. Indications Treatment of vasospastic (Prinzmetal's or variant) angina, chronic stable angina, hypertension (sustained-release tablets only). Contraindications Sick sinus syndrome; second- or third-degree AV block, except with functioning pacemaker. Route/Dosage
Capsules: ADULTS: PO 10 mg tid (usual dose range, 10 to 20 mg tid); swallow whole. Some patients
(eg, coronary artery spasm) respond only to higher doses administered more frequently (eg, 20 to 30 mg tid to qid; max 180 mg/day). In hospitalized patients, under close observation, dose may be increased in
10 mg increments throughout 4- to 6-hr periods as required to control pain and arrhythmias caused by ischemia. A single dose rarely exceeds 30 mg. Extended-release tablets: ADULTS: PO Procardia XL CC with mg/day titrate dose 7- to 14-day (max, 90 mg/day). and (hypertension): Nifedical XL: 30Start or 60 mg30 once daily,and titrated over 7- over to 14-day period period (max, 120 mg/day). Adalat
Amlodipine Norvasc Class: Calcium channel blocker Action Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular smooth muscle. Indications Hypertension; chronic stable angina; vasospastic (Prinzmetal's or variant) angina. Contraindications Sick sinus syndrome; second- or third-degree atrioventricular (AV) block, except with a functioning pacemaker. Route/Dosage
ADULTS: PO 5 to 10 mg qd. ELDERLY: PO Initially 2.5 mg qd. HEPATIC IMPAIRMENT PO Initially 2.5 mg qd.
Acebutolol HCl Sectral, Apo-Acebutolol Monitan, Novo-Acebutolol, Nu-Acebutolol, Rhotral Class: Beta-adrenergic blocker Action Blocks beta-receptors, primarily affecting heart (slows rate), vascular musculature (decreases
BP) and lungs (reduces function). Indications Management of hypertension and premature ventricular contractions. Contraindications Hypersensitivity to beta-blockers; persistently severe bradycardia; greater than firstdegree heart block; CHF, unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure; sinus bradycardia; cardiogenic shock. Route/Dosage Hypertension
ADULTS: PO 400 mg qd initially in single or divided doses; usual response range is 200 to 1200 mg/day. ELDERLY PATIENTS: May require lower maintenance doses. Do not exceed 800 mg qd.
Ventricular Arrhythmia
ADULTS: PO 400 mg (200 mg bid); may be titrated up to 1200 mg qd.
Atenolol Tenormin, APO-Atenol, Gen-Atenolol, Med-Atenolol, Novo-Atenol, Nu-Atenol, Schein Pharm Atenolol, Taro Atenolol, Tenolin, Tenormin Class: Beta-adrenergic blocker Action Blocks beta receptors, primarily affecting heart (slows rate), vascular system (decreases BP) and, to lesser extent, lungs (reduces function). Indications Treatment of hypertension (used alone or in combination with other drugs), angina pectoris resulting from coronary atherosclerosis, acute MI. Unlabeled use(s): Migraine prophylaxis, alcohol
withdrawal syndrome, ventricular arrhythmias, supraventricular arrhythmias or tachycardias, esophageal varices rebleeding, anxiety. Contraindications Hypersensitivity to beta-blockers; sinus bradycardia; greater than first-degree heart
block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure; cardiogenic shock. Route/Dosage Hypertension
ADULTS: PO 50 to 100 mg/day. Angina Pectoris
May require up to 200 mg/day. Acute MIIV 5 mg over 5 min; second IV Follow with dose 10 min later. PO 50 to 100 mg/day.
Betaxolol HCl
Betoptic, Betoptic S Class: Beta-adrenergic blocker Action Blocks beta receptors, primarily affecting cardiovascular system (decreases heart rate, cardiac contractility and BP) and lungs (promotes bronchospasm). Ophthalmic use reduces intraocular pressure, probably by reducing aqueous production. Indications Hypertension. Ophthalmic preparation: Lowering IOP; ocular hypertension; chronic openangle glaucoma.
Contraindications Hypersensitivity to beta-blockers; sinus bradycardia; greater than first-degree heart block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure; cardiogenic shock. Route/Dosage Hypertension
ADULTS: PO 10 to 20 mg/day. ELDERLY: PO Reduce initial dose to 5 mg/day. Glaucoma
Adults: Ophthalmic 1 to 2 drops bid in affected eye(s). Consider concomitant therapy if IOP is not at satisfactory level.
Metoprolol Lopressor Class: Beta-adrenergic blocker Action Blocks beta receptors, primarily affecting cardiovascular system (decreases heart rate, decreases contractility, decreases BP) and lungs (promotes bronchospasm). Indications Used alone or in combination withpectoris, other antihypertensive agents, for management of hypertension, long-term management of angina myocardial infarction (immediate-release tablets and injection). Contraindications Greater than first-degree heart block; congestive heart failure unless secondary to tachyarrhythmia treatable with beta-blockers; overt or moderate to severe cardiac failure; sinus bradycardia; cardiogenic shock; hypersensitivity to beta-blockers; systolic blood pressure < 100 mm/Hg; MI in patients with heart rate < 45 beats/min. Route/Dosage Hypertension
ADULTS: PO 100 mg/day in single or divided doses initially; maintenance: 100–450 mg/day. Angina
ADULTS: PO 100 mg/day in 2 divided doses initially; maintenance: 100–400 mg/day. Myocardial Infarction
ADULTS: bolus 5 mg15slowly; maylast repeat everycontinue 2 min upforto48 total 15 mg.by If tolerated, give PO 50IV mg q 6 injection hr beginning min after IV dose; hr of followed PO 100 mg
bid for 1–3 mo. If patient is intolerant of full IV dose, give PO 25–50 mg q 6 hr starting 15 min after last IV dose.
Nadolol Corgard, Alti-Nadolol, Apo-Nadol, Novo-Nadolol Class: Beta-adrenergic blocker Action Blocks beta-receptors, which primarily affect cardiovascular system (decreases heart rate, contractility and BP) and lungs (promotes bronchospasm). Indications Management of hypertension and angina pectoris. Contraindications Hypersensitivity to beta blockers; greater than first-degree heart block; CHF unless
secondary to tachyarrhythmia treatable with beta-blockers or untreated hypotension; overt cardiac failure; sinus bradycardia; cardiogenic shock; bronchial asthma or bronchospasm, including severe COPD. Route/Dosage Hypertension
ADULTS: PO Initiate withmg/day. 40 mg/day; titrate in 40 to 80 mg increments to desired response. Maintenance: 40 to 320 Angina
ADULTS: PO Initiate with 40 mg/day; titrate in 40 to 80 mg increments at 3 to 7 day intervals to desired response. Maintenance: 40 to 240 mg/day. Dosage intervals may need to be altered in patients with decreased renal function.
Pindolol Visken, Alti-Pindolol, APO-Pindol, Gen-Pindolol, Novo-Pindol, Nu-Pindol Class: Beta-adrenergic blocker Action Nonselectively blocks beta receptors, which primarily affect heart (slows rate), vascular musculature (decreases blood pressure) and lungs (reduces function). Indications Management of mild-to-moderate hypertension.
Contraindications Greater than first-degree heart block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure; sinus bradycardia; cardiogenic shock; hypersensitivity to beta-blockers; bronchial asthma or bronchospasm, including severe COPD. Route/Dosage
ADULTS: PO 5 mg bid. May be increased by 10 mg q 3 to 4 wk until desired response; maximum dose is 60 mg/day.
Propranolol HCl Betachron E-R, Inderal, Inderal LA, Propranolol Intensol, APO-Propranolol, Detensol, Detensol, Dom-Propranolol, Novo-Pranol, Nu-Propranolol, PMS-Propranolol Class: Beta-adrenergic blocker Action Blocks beta receptors, primarily affecting the cardiovascular system (decreased heartrate, decreased cardiac contractility and decreased BP) and lungs (promotes bronchospasm). Indications Treatment of hypertension; angina pectoris; hypertrophic subaortic stenosis; MI;
pheochromocytoma; migraine prophylaxis; essential tremor; some ventricular and supraventricular arrhythmias. Unlabeled use(s): Treatment of alcohol withdrawal syndrome; esophageal varices rebleeding; anxiety; thyrotoxicosis symptoms. Contraindications Hypersensitivity to beta-blockers; greater than first-degree heart block; CHF unless secondary to tachyarrhythmia or untreated hypertension treatable with beta-blockers; overt cardiac failure; sinus bradycardia; cardiogenic shock; untreated bronchial asthma or bronchospasm, including severe COPD. Route/Dosage Hypertension
ADULTS: PO Initial dose: 40 mg bid initially or 80 mg sustained-release medication/day; titrate to response. Maintenance: 120 to 240 mg/day in 2 to 3 divided doses or 120 to 160 mg/day sustainedrelease medication. Do not exceed 640 mg/day. CHILDREN: PO 0.5 mg/kg bid; titrate q 3 to 5 days to maximum dose of 1 mg/kg bid. Angina
ADULTS: PO 80 to 320 mg/day in 2 to 4 divided doses or 160 mg/day of sustained-release medication. Arrhythmias
ADULTS: PO 10 to 30 mg 3 to 4 times/day before meals and at bedtime. Hypertrophic Aortic Stenosis
ADULTS: PO 20 to 40 mg 3 to 4 times/day before meals and at bedtime or 80 to 160 mg sustainedrelease medication 1 time/day. MI
ADULTS: PO 180 to 240 mg/day in 3 to 4 divided doses up to 240 mg/day. Pheochromocytoma
ADULTS: PO 60 mg/day for 3 days prior to surgery, given with alpha-blocker. Migraine
ADULTS: PO 80 mg in divided doses daily or once daily (sustained release); titrate to response (maximum dose: 240 mg/day); discontinue after 6 wk if no response. Arrhythmias (Life Threatening)
ADULTS: IV 1 to 3 mg at rate of 1 mg/min; may repeat after 2 min; give subsequent doses q 4 hr. Essential Tremor
ADULTS: PO 40 mg bid initially; titrate to response. Maintenance: 120–320 mg/day in 2 to 3 divided doses.
Nitroglycerin
Deponit, Minitran, Nitrek, Nitro-Bid, Nitro-Bid IV, Nitro-Dur, Nitro-Time, Nitrodisc, Nitrogard,
Nitroglyn, Nitrol, Nitrolingual, Nitrong, NitroQuick, Nitrostat, Transderm-Nitro, Tridil, SR Class: Antianginal
Nitrong
Action Relaxation of smooth muscle of venous and arterial vasculature. Indications Treatment of acute anginarelease, (SL, translingual, IV, transmucosal); of angina transmucosal, translingual, sustained transdermal, topical); controlprophylaxis of blood pressure in (SL,
perioperative or intraoperative hypertension (IV); CHF associated with MI (IV). unlabeled use(s): Reduce cardiac workload in patients with MI and in refractory CHF (SL, topical, oral, IV); adjunctive treatment of Raynaud's disease (topical); treatment of hypertensive crisis (IV). Contraindications Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma; orthostatic hypotension; early MI; pericarditis or pericardial tamponade; head trauma or cerebral hemorrhage; allergy to adhesives (transdermal); hypotension or uncorrected hypovolemia (IV); increased intracranial pressure or decreased cerebral perfusion (IV). Route/Dosage
Perioperative Hypertension
ADULTS IV 5 mcg/min using nonperipheral vein catheter (PVCP) IV administration set initially; titrate to response. Angina
ADULTS SL 0.15 to 0.6 mg dissolved under tongue or in buccal pouch at first sign of acute angina attack; repeat q 5 min (do not exceed 3 tablets in 15 min). Translingual 1 to 2 sprays onto or under tongue at first onset of attack. Transmucosal 1 mg every 3 to 5 hr during waking hours; tablet placed between lip or cheek and gum. PO 2.5 or 2.6 mg (sustained-release form) tid to qid initially; titrate to Topical 1 to 2 inches q 8 hr up to 4 to 5 inches spread over 3 x 4 inch area and cover with plastic wrap response. Transdermal 0.2 to 0.4 mg/hr patch initially applied once daily; titrate dose to response. to prevent staining of clothes or application q 4 hr prn. Allow a nitrate-free period of 10 to 12 hr/day. Refractory Angina, CHF Secondary to Acute MI
Adults IV 5 mcg/min initially; titrate according to hemodynamic readings (BP, heart rate, pulmonary capillary wedge pressure).
Isosorbide Mononitrate ISMO, Imdur, Monoket, Isotrate ER Class: Antianginal Action Relaxation of smooth muscle of venous and arterial vasculature. Indications Prevention of angina pectoris.
hypotension; head trauma or cerebral hemorrhage. Contraindications Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma; orthostatic Route/Dosage
ADULTS: PO 20 mg bid, given 7 hr apart. Extended release tablets are given as 30 (½ of 60 mg tablet) or 60 mg once daily. After several days dosage may be increased to 120 mg (given as two 60 mg tablets) once daily. Rarely, 240 mg may be required.
Isosorbide Dinitrate Dilatrate-SR, Isordil, Isordil Tembids, Isodril Titradose, Sorbitrate, Class: Antianginal
APO-ISDN, Cedocard-SR
Action Relaxation of smooth muscle of venous and arterial vasculature.
Indications Treatment and prevention of angina pectoris. Contraindications Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma; orthostatic hypotension; head trauma or cerebral hemorrhage. Route/Dosage Angina Pectoris
ADULTS: SL (sublingual tablets) 2.5 to 5 mg; PO (chewable tablets) 5 mg; PO (oral tablets) 5 to 40 mg q 6 hr; PO (sustained release tablets) 40 to 80 mg q 8 to 12 hr. Acute Prophylaxis
ADULTS: PO (sublingual or chewable tablets) 5 to 10 mg q 2 to 3 hr.
ADRENERGIC Dobutamine Dobutrex Class: Vasopressor Action Stimulates beta1-receptors in heart, causing more complete and forceful contractions (inotropy) without significantly increasing heart rate or BP. Indications Treatment of cardiac decompensation caused by organic heart disease or cardiac surgical
procedures. Unlabeled use(s): Congenital heart disease in children undergoing diagnostic cardiac catheterization. Contraindications Idiopathic hypertrophic subaortic stenosis. Route/Dosage
ADULTS: IV infusion 2.5 to 10 mcg/kg/min; titrate to desired response; increase in heart rate > 10% may develop in rate > 20 mcg/kg/min; rates up to 40 mcg/kg/min are rarely used. Duration of therapy up to 72 hr without decrease in clinical effectiveness may be used.
Dopamine HCl Intropin, Revimine Class: Vasopressor Action Stimulates beta1 receptors in heart, causing more complete effects. and forceful contractions (inotropy). Also acts on alpha receptors (dose dependent) and has dopaminergic
Route/Dosage
ADULTS: IV Initial dose: 2 to 5 mcg/kg/min with incremental changes of 5 to 10 mcg/kg/min at 10 to 15 min intervals until adequate response is noted. Most patients are maintained at < 20 mcg/kg/min. If dosage exceeds 50 mcg/kg/min, assess renal function frequently.
Epinephrine
Adrenalin Chloride Solution: 0.1%, 1 mg/mL as HCl Ana-Kit AsthmaNefrin Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base) Epifrin Solution: 0.5%, 1%, 2% Epinal Solution: 0.5%, 1% Epipen Solution: 1 mg/mL as HCl Epipen Jr. Solution: 1 mg/mL as HCl Glaucon Solution: 1%, 2% MicroNefrin Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base) Nephron Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base) Primatene Mist Aerosol: 0.2 mg epinephrine per spray S-2 Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base) Sus-Phrine Suspension for injection: 5 mg/mL Bronkaid Mistometer Epi E•Z Pen Jr Class: Vasopressor Actions Stimulates both alpha-and beta-receptors (alpha-receptors at high doses; beta1 - and beta2 -receptors at moderate doses) within sympathetic nervous system. Relaxes smooth muscle of bronchi and iris and is antagonist of histamine. Indications Treatment and prophylaxis of cardiac arrest and attacks of transitory atrioventricular heart block; treatment of Adams-Stokes syndrome; treatment of hay fever; relief of bronchial asthma; treatment of syncope caused by heart block or carotid sinus hypersensitivity; symptomatic relief of
serum sickness, urticaria and angioedema; relaxation of uterine musculature; anaphylaxis; allergic reactions (eg, bronchospasm, urticaria, pruritus, angioneurotic edema, or swelling of the lips, eyelids,
tongue, and nasal mucosa) because of anaphylactic shock caused by stinging insects (primarily of the order Hymenoptera, which includes bees, wasps, hornets, yellow jackets, bumble bees, and fire ants); severe allergic or anaphylactoid reactions caused by allergy injections; exposures to pollens, dusts molds, foods, drugs, and exercise or unknown substances (so-called idopathic anaphylaxis); severe, lifethreatening asthma attacks characterized by wheezing, dysypena, and inability to breathe. Nasal Solution: Treatment of nasal congestion; relief of eustachian tube congestion. Inhalation:
Temporary relief from acute paroxysms of bronchial asthma and other states; treatment of postintubation and infectious croup. Ophthalmic Solution: Treatment of open-angle glaucoma. Contraindications Hypersensitivity to epinephrine; narrow-angle glaucoma; concomitant use during
general anesthesia with halogenated hydrocarbons or cyclopropane; cerebral arteriosclerosis or organic brain damage; use with anesthesia for fingers and toes; use during labor; phenothiazine-induced circulatory collapse; MAOI therapy; nonanaphylactic shock during general anesthesia with halogenated hydrocarbons or cyclopropane; organic heart disease. Route/Dosage Cardiac Arrest
ADULTS: IV/Endotracheal/Intracardiac 0.5 to 1 mg (5 to 10 mL of 1:10,000 solution) q 5 min prn. Myocardial injection usually given in left ventricular chamber by trained personnel at dose of 0.3 to 0.5 mg. Other IV Uses
ADULTS: IV 1 mg in 250 mL of D5W (4 mcg/mL) for infusion at 1 to 4 mcg/min (15 to 60 mL/hr). Intraspinal Use
ADULTS: Intraspinal 0.2 to 0.4 mL of 1:1000 solution added to anesthetic spinal fluid mixture. Epinephrine 1:100,000 to 1:200,000 is usual concentration employed with local anesthetics. Open-Angle Glaucoma
ADULTS: Ophthalmic 1 gtt in affected eye(s) 2 time/day. Nasal Congestion
ADULTS AND CHILDREN ≥ 6 yr: Nasal Apply as drops, spray, or with sterile swab as required. Asthma
ADULTS AND CHILDREN ≥ 4 yr (Asthma Nefrin ≥ 12 yr): Inhalation Hand pump nebulizer: Place 0.5 mL (≈ 8 to 10 drops) of racemic epinephrine into nebulizer reservoir. Squeeze bulb 1 to 3 times in partially opened mouth. If relief does not occur within 2 to 3 min, administer 2 to 3 additional
inhalations. Do not administer > q 3 hr. Aerosol-nebulizer: Add 0.5 mL (≈ 10 drops) racemic epinephrine to 3 mL of diluent or 0.2 to 0.4 mL (≈ 4 to 8 drops) of MicroNefrin to 4.6 to 4.8 mL water. Administer for 15 min q 3 to 4 hr. ADULTS SC/IM Solution (1:1000): 0.2 to 1 mL (0.2 to 1 mg); repeat q 4 hr. SC Suspension (1:200): 0.1 to 0.3 mL (0.5 to 1.5 mg). IV Solution (1:10,000): 0.1 to 0.25 mg (1 to 2.5 mL) injected slowly. INFANTS AND CHILDREN: SC Solution (1:1000): 0.01 mL/kg or 0.3 mL/m2 (0.01 mg/kg or 0.3 mg/m2); repeat q 20 min to 4 hr. Do not exceed 0.5 mL (0.5 mg) in single dose. Suspension (1:200): 0.005 mL/kg (0.025 mg/kg). Maximum single dose for children ≤ 30 kg is 0.15 mL (0.75 mg). IV Solution (1:10,000): 0.01mg/kg to 0.05 mg repeated at 20 to 30 min intervals.
Nifedipine Adalat Capsules: 10 mg Capsules: 20 mg Adalat CC Tablets, extended-release: 30 mg Tablets, extended-release: 60 mg Tablets, extended-release: 90 mg Nifedical XL Tablets, extended-release: 30 mg Tablets, extended-release: 60 mg Procardia Capsules: 10 mg Capsules: 20 mg Procardia XL Tablets, extended-release: 30 mg Tablets, extended-release: 60 mg Tablets, extended-release: 90 mg Adalat PA Adalat PA 10 Adalat PA 20 Adalat XL Class: Calcium channel blocker Actions Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular
smooth muscle and myocardium. Increases CO and decreases peripheral vascular resistance. Minimal effect on sinoatrial and AV nodal conduction. Reduces myocardial oxygen demand; relaxes and prevents coronary artery spasm. Indications Treatment of vasospastic (Prinzmetal's or variant) angina, chronic stable angina, hypertension (sustained-release tablets only). Contraindications Sick sinus syndrome; second- or third-degree AV block, except with functioning pacemaker. Route/Dosage
Capsules: ADULTS: PO 10 mg tid (usual dose range, 10 to 20 mg tid); swallow whole. Some patients
(eg, coronary artery spasm) respond only to higher doses administered more frequently (eg, 20 to 30 mg tid to qid; max 180 mg/day). In hospitalized patients, under close observation, dose may be increased in
10 mg increments throughout 4- to 6-hr periods as required to control pain and arrhythmias caused by ischemia. A single dose rarely exceeds 30 mg. Extended-release tablets: ADULTS: PO Procardia XL CC with mg/day titrate dose 7- to 14-day (max, 90 mg/day). and (hypertension): Nifedical XL: 30Start or 60 mg30 once daily,and titrated over 7- over to 14-day period period (max, 120 mg/day). Adalat
Amlodipine Norvasc Class: Calcium channel blocker Action Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular smooth muscle. Indications Hypertension; chronic stable angina; vasospastic (Prinzmetal's or variant) angina. Contraindications Sick sinus syndrome; second- or third-degree atrioventricular (AV) block, except with a functioning pacemaker. Route/Dosage
ADULTS: PO 5 to 10 mg qd. ELDERLY: PO Initially 2.5 mg qd. HEPATIC IMPAIRMENT PO Initially 2.5 mg qd.
Acebutolol HCl Sectral, Apo-Acebutolol Monitan, Novo-Acebutolol, Nu-Acebutolol, Rhotral Class: Beta-adrenergic blocker Action Blocks beta-receptors, primarily affecting heart (slows rate), vascular musculature (decreases
BP) and lungs (reduces function). Indications Management of hypertension and premature ventricular contractions. Contraindications Hypersensitivity to beta-blockers; persistently severe bradycardia; greater than firstdegree heart block; CHF, unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure; sinus bradycardia; cardiogenic shock. Route/Dosage Hypertension
ADULTS: PO 400 mg qd initially in single or divided doses; usual response range is 200 to 1200 mg/day. ELDERLY PATIENTS: May require lower maintenance doses. Do not exceed 800 mg qd.
Ventricular Arrhythmia
ADULTS: PO 400 mg (200 mg bid); may be titrated up to 1200 mg qd.
Atenolol Tenormin, APO-Atenol, Gen-Atenolol, Med-Atenolol, Novo-Atenol, Nu-Atenol, Schein Pharm Atenolol, Taro Atenolol, Tenolin, Tenormin Class: Beta-adrenergic blocker Action Blocks beta receptors, primarily affecting heart (slows rate), vascular system (decreases BP) and, to lesser extent, lungs (reduces function). Indications Treatment of hypertension (used alone or in combination with other drugs), angina pectoris resulting from coronary atherosclerosis, acute MI. Unlabeled use(s): Migraine prophylaxis, alcohol
withdrawal syndrome, ventricular arrhythmias, supraventricular arrhythmias or tachycardias, esophageal varices rebleeding, anxiety. Contraindications Hypersensitivity to beta-blockers; sinus bradycardia; greater than first-degree heart
block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure; cardiogenic shock. Route/Dosage Hypertension
ADULTS: PO 50 to 100 mg/day. Angina Pectoris
May require up to 200 mg/day. Acute MIIV 5 mg over 5 min; second IV Follow with dose 10 min later. PO 50 to 100 mg/day.
Betaxolol HCl
Betoptic, Betoptic S Class: Beta-adrenergic blocker Action Blocks beta receptors, primarily affecting cardiovascular system (decreases heart rate, cardiac contractility and BP) and lungs (promotes bronchospasm). Ophthalmic use reduces intraocular pressure, probably by reducing aqueous production. Indications Hypertension. Ophthalmic preparation: Lowering IOP; ocular hypertension; chronic openangle glaucoma.
Contraindications Hypersensitivity to beta-blockers; sinus bradycardia; greater than first-degree heart block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure; cardiogenic shock. Route/Dosage Hypertension
ADULTS: PO 10 to 20 mg/day. ELDERLY: PO Reduce initial dose to 5 mg/day. Glaucoma
Adults: Ophthalmic 1 to 2 drops bid in affected eye(s). Consider concomitant therapy if IOP is not at satisfactory level.
Metoprolol Lopressor Class: Beta-adrenergic blocker Action Blocks beta receptors, primarily affecting cardiovascular system (decreases heart rate, decreases contractility, decreases BP) and lungs (promotes bronchospasm). Indications Used alone or in combination withpectoris, other antihypertensive agents, for management of hypertension, long-term management of angina myocardial infarction (immediate-release tablets and injection). Contraindications Greater than first-degree heart block; congestive heart failure unless secondary to tachyarrhythmia treatable with beta-blockers; overt or moderate to severe cardiac failure; sinus bradycardia; cardiogenic shock; hypersensitivity to beta-blockers; systolic blood pressure < 100 mm/Hg; MI in patients with heart rate < 45 beats/min. Route/Dosage Hypertension
ADULTS: PO 100 mg/day in single or divided doses initially; maintenance: 100–450 mg/day. Angina
ADULTS: PO 100 mg/day in 2 divided doses initially; maintenance: 100–400 mg/day. Myocardial Infarction
ADULTS: bolus 5 mg15slowly; maylast repeat everycontinue 2 min upforto48 total 15 mg.by If tolerated, give PO 50IV mg q 6 injection hr beginning min after IV dose; hr of followed PO 100 mg
bid for 1–3 mo. If patient is intolerant of full IV dose, give PO 25–50 mg q 6 hr starting 15 min after last IV dose.
Nadolol Corgard, Alti-Nadolol, Apo-Nadol, Novo-Nadolol Class: Beta-adrenergic blocker Action Blocks beta-receptors, which primarily affect cardiovascular system (decreases heart rate, contractility and BP) and lungs (promotes bronchospasm). Indications Management of hypertension and angina pectoris. Contraindications Hypersensitivity to beta blockers; greater than first-degree heart block; CHF unless
secondary to tachyarrhythmia treatable with beta-blockers or untreated hypotension; overt cardiac failure; sinus bradycardia; cardiogenic shock; bronchial asthma or bronchospasm, including severe COPD. Route/Dosage Hypertension
ADULTS: PO Initiate withmg/day. 40 mg/day; titrate in 40 to 80 mg increments to desired response. Maintenance: 40 to 320 Angina
ADULTS: PO Initiate with 40 mg/day; titrate in 40 to 80 mg increments at 3 to 7 day intervals to desired response. Maintenance: 40 to 240 mg/day. Dosage intervals may need to be altered in patients with decreased renal function.
Pindolol Visken, Alti-Pindolol, APO-Pindol, Gen-Pindolol, Novo-Pindol, Nu-Pindol Class: Beta-adrenergic blocker Action Nonselectively blocks beta receptors, which primarily affect heart (slows rate), vascular musculature (decreases blood pressure) and lungs (reduces function). Indications Management of mild-to-moderate hypertension.
Contraindications Greater than first-degree heart block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure; sinus bradycardia; cardiogenic shock; hypersensitivity to beta-blockers; bronchial asthma or bronchospasm, including severe COPD. Route/Dosage
ADULTS: PO 5 mg bid. May be increased by 10 mg q 3 to 4 wk until desired response; maximum dose is 60 mg/day.
Propranolol HCl Betachron E-R, Inderal, Inderal LA, Propranolol Intensol, APO-Propranolol, Detensol, Detensol, Dom-Propranolol, Novo-Pranol, Nu-Propranolol, PMS-Propranolol Class: Beta-adrenergic blocker Action Blocks beta receptors, primarily affecting the cardiovascular system (decreased heartrate, decreased cardiac contractility and decreased BP) and lungs (promotes bronchospasm). Indications Treatment of hypertension; angina pectoris; hypertrophic subaortic stenosis; MI;
pheochromocytoma; migraine prophylaxis; essential tremor; some ventricular and supraventricular arrhythmias. Unlabeled use(s): Treatment of alcohol withdrawal syndrome; esophageal varices rebleeding; anxiety; thyrotoxicosis symptoms. Contraindications Hypersensitivity to beta-blockers; greater than first-degree heart block; CHF unless secondary to tachyarrhythmia or untreated hypertension treatable with beta-blockers; overt cardiac failure; sinus bradycardia; cardiogenic shock; untreated bronchial asthma or bronchospasm, including severe COPD. Route/Dosage Hypertension
ADULTS: PO Initial dose: 40 mg bid initially or 80 mg sustained-release medication/day; titrate to response. Maintenance: 120 to 240 mg/day in 2 to 3 divided doses or 120 to 160 mg/day sustainedrelease medication. Do not exceed 640 mg/day. CHILDREN: PO 0.5 mg/kg bid; titrate q 3 to 5 days to maximum dose of 1 mg/kg bid. Angina
ADULTS: PO 80 to 320 mg/day in 2 to 4 divided doses or 160 mg/day of sustained-release medication. Arrhythmias
ADULTS: PO 10 to 30 mg 3 to 4 times/day before meals and at bedtime. Hypertrophic Aortic Stenosis
ADULTS: PO 20 to 40 mg 3 to 4 times/day before meals and at bedtime or 80 to 160 mg sustainedrelease medication 1 time/day. MI
ADULTS: PO 180 to 240 mg/day in 3 to 4 divided doses up to 240 mg/day. Pheochromocytoma
ADULTS: PO 60 mg/day for 3 days prior to surgery, given with alpha-blocker. Migraine
ADULTS: PO 80 mg in divided doses daily or once daily (sustained release); titrate to response (maximum dose: 240 mg/day); discontinue after 6 wk if no response. Arrhythmias (Life Threatening)
ADULTS: IV 1 to 3 mg at rate of 1 mg/min; may repeat after 2 min; give subsequent doses q 4 hr. Essential Tremor
ADULTS: PO 40 mg bid initially; titrate to response. Maintenance: 120–320 mg/day in 2 to 3 divided doses.
Nitroglycerin
Deponit, Minitran, Nitrek, Nitro-Bid, Nitro-Bid IV, Nitro-Dur, Nitro-Time, Nitrodisc, Nitrogard,
Nitroglyn, Nitrol, Nitrolingual, Nitrong, NitroQuick, Nitrostat, Transderm-Nitro, Tridil, SR Class: Antianginal
Nitrong
Action Relaxation of smooth muscle of venous and arterial vasculature. Indications Treatment of acute anginarelease, (SL, translingual, IV, transmucosal); of angina transmucosal, translingual, sustained transdermal, topical); controlprophylaxis of blood pressure in (SL,
perioperative or intraoperative hypertension (IV); CHF associated with MI (IV). unlabeled use(s): Reduce cardiac workload in patients with MI and in refractory CHF (SL, topical, oral, IV); adjunctive treatment of Raynaud's disease (topical); treatment of hypertensive crisis (IV). Contraindications Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma; orthostatic hypotension; early MI; pericarditis or pericardial tamponade; head trauma or cerebral hemorrhage; allergy to adhesives (transdermal); hypotension or uncorrected hypovolemia (IV); increased intracranial pressure or decreased cerebral perfusion (IV). Route/Dosage
Perioperative Hypertension
ADULTS IV 5 mcg/min using nonperipheral vein catheter (PVCP) IV administration set initially; titrate to response. Angina
ADULTS SL 0.15 to 0.6 mg dissolved under tongue or in buccal pouch at first sign of acute angina attack; repeat q 5 min (do not exceed 3 tablets in 15 min). Translingual 1 to 2 sprays onto or under tongue at first onset of attack. Transmucosal 1 mg every 3 to 5 hr during waking hours; tablet placed between lip or cheek and gum. PO 2.5 or 2.6 mg (sustained-release form) tid to qid initially; titrate to Topical 1 to 2 inches q 8 hr up to 4 to 5 inches spread over 3 x 4 inch area and cover with plastic wrap response. Transdermal 0.2 to 0.4 mg/hr patch initially applied once daily; titrate dose to response. to prevent staining of clothes or application q 4 hr prn. Allow a nitrate-free period of 10 to 12 hr/day. Refractory Angina, CHF Secondary to Acute MI
Adults IV 5 mcg/min initially; titrate according to hemodynamic readings (BP, heart rate, pulmonary capillary wedge pressure).
Isosorbide Mononitrate ISMO, Imdur, Monoket, Isotrate ER Class: Antianginal Action Relaxation of smooth muscle of venous and arterial vasculature. Indications Prevention of angina pectoris.
hypotension; head trauma or cerebral hemorrhage. Contraindications Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma; orthostatic Route/Dosage
ADULTS: PO 20 mg bid, given 7 hr apart. Extended release tablets are given as 30 (½ of 60 mg tablet) or 60 mg once daily. After several days dosage may be increased to 120 mg (given as two 60 mg tablets) once daily. Rarely, 240 mg may be required.
Isosorbide Dinitrate Dilatrate-SR, Isordil, Isordil Tembids, Isodril Titradose, Sorbitrate, Class: Antianginal
APO-ISDN, Cedocard-SR
Action Relaxation of smooth muscle of venous and arterial vasculature.
Indications Treatment and prevention of angina pectoris. Contraindications Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma; orthostatic hypotension; head trauma or cerebral hemorrhage. Route/Dosage Angina Pectoris
ADULTS: SL (sublingual tablets) 2.5 to 5 mg; PO (chewable tablets) 5 mg; PO (oral tablets) 5 to 40 mg q 6 hr; PO (sustained release tablets) 40 to 80 mg q 8 to 12 hr. Acute Prophylaxis
ADULTS: PO (sublingual or chewable tablets) 5 to 10 mg q 2 to 3 hr.
ADRENERGIC Dobutamine Dobutrex Class: Vasopressor Action Stimulates beta1-receptors in heart, causing more complete and forceful contractions (inotropy) without significantly increasing heart rate or BP. Indications Treatment of cardiac decompensation caused by organic heart disease or cardiac surgical
procedures. Unlabeled use(s): Congenital heart disease in children undergoing diagnostic cardiac catheterization. Contraindications Idiopathic hypertrophic subaortic stenosis. Route/Dosage
ADULTS: IV infusion 2.5 to 10 mcg/kg/min; titrate to desired response; increase in heart rate > 10% may develop in rate > 20 mcg/kg/min; rates up to 40 mcg/kg/min are rarely used. Duration of therapy up to 72 hr without decrease in clinical effectiveness may be used.
Dopamine HCl Intropin, Revimine Class: Vasopressor Action Stimulates beta1 receptors in heart, causing more complete effects. and forceful contractions (inotropy). Also acts on alpha receptors (dose dependent) and has dopaminergic
Route/Dosage
ADULTS: IV Initial dose: 2 to 5 mcg/kg/min with incremental changes of 5 to 10 mcg/kg/min at 10 to 15 min intervals until adequate response is noted. Most patients are maintained at < 20 mcg/kg/min. If dosage exceeds 50 mcg/kg/min, assess renal function frequently.
Epinephrine
Adrenalin Chloride Solution: 0.1%, 1 mg/mL as HCl Ana-Kit AsthmaNefrin Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base) Epifrin Solution: 0.5%, 1%, 2% Epinal Solution: 0.5%, 1% Epipen Solution: 1 mg/mL as HCl Epipen Jr. Solution: 1 mg/mL as HCl Glaucon Solution: 1%, 2% MicroNefrin Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base) Nephron Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base) Primatene Mist Aerosol: 0.2 mg epinephrine per spray S-2 Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base) Sus-Phrine Suspension for injection: 5 mg/mL Bronkaid Mistometer Epi E•Z Pen Jr Class: Vasopressor Actions Stimulates both alpha-and beta-receptors (alpha-receptors at high doses; beta1 - and beta2 -receptors at moderate doses) within sympathetic nervous system. Relaxes smooth muscle of bronchi and iris and is antagonist of histamine. Indications Treatment and prophylaxis of cardiac arrest and attacks of transitory atrioventricular heart block; treatment of Adams-Stokes syndrome; treatment of hay fever; relief of bronchial asthma; treatment of syncope caused by heart block or carotid sinus hypersensitivity; symptomatic relief of
serum sickness, urticaria and angioedema; relaxation of uterine musculature; anaphylaxis; allergic reactions (eg, bronchospasm, urticaria, pruritus, angioneurotic edema, or swelling of the lips, eyelids,
tongue, and nasal mucosa) because of anaphylactic shock caused by stinging insects (primarily of the order Hymenoptera, which includes bees, wasps, hornets, yellow jackets, bumble bees, and fire ants); severe allergic or anaphylactoid reactions caused by allergy injections; exposures to pollens, dusts molds, foods, drugs, and exercise or unknown substances (so-called idopathic anaphylaxis); severe, lifethreatening asthma attacks characterized by wheezing, dysypena, and inability to breathe. Nasal Solution: Treatment of nasal congestion; relief of eustachian tube congestion. Inhalation:
Temporary relief from acute paroxysms of bronchial asthma and other states; treatment of postintubation and infectious croup. Ophthalmic Solution: Treatment of open-angle glaucoma. Contraindications Hypersensitivity to epinephrine; narrow-angle glaucoma; concomitant use during
general anesthesia with halogenated hydrocarbons or cyclopropane; cerebral arteriosclerosis or organic brain damage; use with anesthesia for fingers and toes; use during labor; phenothiazine-induced circulatory collapse; MAOI therapy; nonanaphylactic shock during general anesthesia with halogenated hydrocarbons or cyclopropane; organic heart disease. Route/Dosage Cardiac Arrest
ADULTS: IV/Endotracheal/Intracardiac 0.5 to 1 mg (5 to 10 mL of 1:10,000 solution) q 5 min prn. Myocardial injection usually given in left ventricular chamber by trained personnel at dose of 0.3 to 0.5 mg. Other IV Uses
ADULTS: IV 1 mg in 250 mL of D5W (4 mcg/mL) for infusion at 1 to 4 mcg/min (15 to 60 mL/hr). Intraspinal Use
ADULTS: Intraspinal 0.2 to 0.4 mL of 1:1000 solution added to anesthetic spinal fluid mixture. Epinephrine 1:100,000 to 1:200,000 is usual concentration employed with local anesthetics. Open-Angle Glaucoma
ADULTS: Ophthalmic 1 gtt in affected eye(s) 2 time/day. Nasal Congestion
ADULTS AND CHILDREN ≥ 6 yr: Nasal Apply as drops, spray, or with sterile swab as required. Asthma
ADULTS AND CHILDREN ≥ 4 yr (Asthma Nefrin ≥ 12 yr): Inhalation Hand pump nebulizer: Place 0.5 mL (≈ 8 to 10 drops) of racemic epinephrine into nebulizer reservoir. Squeeze bulb 1 to 3 times in partially opened mouth. If relief does not occur within 2 to 3 min, administer 2 to 3 additional
inhalations. Do not administer > q 3 hr. Aerosol-nebulizer: Add 0.5 mL (≈ 10 drops) racemic epinephrine to 3 mL of diluent or 0.2 to 0.4 mL (≈ 4 to 8 drops) of MicroNefrin to 4.6 to 4.8 mL water. Administer for 15 min q 3 to 4 hr. ADULTS SC/IM Solution (1:1000): 0.2 to 1 mL (0.2 to 1 mg); repeat q 4 hr. SC Suspension (1:200): 0.1 to 0.3 mL (0.5 to 1.5 mg). IV Solution (1:10,000): 0.1 to 0.25 mg (1 to 2.5 mL) injected slowly. INFANTS AND CHILDREN: SC Solution (1:1000): 0.01 mL/kg or 0.3 mL/m2 (0.01 mg/kg or 0.3 mg/m2); repeat q 20 min to 4 hr. Do not exceed 0.5 mL (0.5 mg) in single dose. Suspension (1:200): 0.005 mL/kg (0.025 mg/kg). Maximum single dose for children ≤ 30 kg is 0.15 mL (0.75 mg). IV Solution (1:10,000): 0.01mg/kg to 0.05 mg repeated at 20 to 30 min intervals.
