Cardiac Pharmacology: Difference between revisions

!Indications

!Typical Dosage

!Side Effects (Prevalence %)

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|Oedema

|Furosemide: 20-40mg once daily

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|Resistant Hypertension

|Furosemide: 40-80mg once daily

|Mild gastro-intestinal disturbances, pancreatitis, hepatic encephalopathy, postural hypotension, temporary increase in serum-cholesterol and triglyceride concentration, hyperglycaemia, acute urinary retention, electrolyte disturbances, metabolic alkalosis, blood disorders, hyperuricaemia, visual disturbances, tinnitus and deafness, and hypersensitivity reactions (including rash, photosensitivity, and pruritus).<cite>Esc1</cite>

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|Hypertension

|Captopril: 12.5mg twice daily

|Hypotension (2.4%), renal impairment, persistent dry cough, angioedema, rash pancreatitis, upper respiratory-tract symptoms (2-10%), gastro-intestinal symptoms (1-2%), altered liver function tests, cholestatic jaundice, hepatitis, fulminant hepatic necrosis and failure, hyperkalaemia (2%), hypoglycaemia, blood disorders including thrombocytopenia, leucopenia, neutropenia, headache (3%), dizziness (2-12%), fatigue, malaise, taste disturbance, paraesthesia, bronchospasm, fever, serositis, vasculitis, myalgia (3%), arthralgia, positive antinuclear antibody, raised erythrocyte sedimentation rate, eosinophilia, leucocytosis, and photosensitivity.<cite>Esc2</cite><cite>Esc3</cite><cite>Esc4</cite>

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|Heart Failure

|Captopril: 12.5mg 3 times daily<cite>Esc5</cite><cite>Esc6</cite><cite>Esc7</cite>

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|Prophylaxis Following MI

|Captopril: 6.25mg once daily

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|Diabetic nephropathy

|Captopril: 75-100mg once daily

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|Hypertension

|Losartan: 50mg once daily

|Gastro-intestinal disturbances (<3%), dizziness (14%), angina, palpitation, oedema, dyspnoea, headache (14%), malaise, urticaria, pruritus, rash;<cite>Esc5</cite><cite>Esc8</cite><cite>Esc9</cite>

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|Left ventricular hypertrophy

|Losartan: 12.5-150mg daily<cite>Esc10</cite>

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|Diabetic nephropathy

|Losartan: 50mg daily

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|Prazosin, Doxazosin

|Hypertension

|Drowsiness, hypotension (notably postural hypotension) (10-70% initially), syncope (1%), asthenia, dizziness, depression, headache (8-18%), dry mouth, gastro-intestinal disturbances, oedema, blurred vision (<5%), intra-operative floppy iris syndrome, rhinitis (<4%), erectile disorders (including priapism), tachycardia and palpitations (7-14%), gastrointestinal side-symptoms (4-5%), hypersensitivity reactions including rash, pruritus and angioedema.

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|Congestive Heart Failure

|Prazosin: 4-20mg daily

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|Raynaud’s Syndrome

|Prazosin: 1-2mg daily

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|Hypertension

|Atenolol: 25-50mg daily

|Gastro-intestinal disturbances (2-4%); bradycardia, heart failure, hypotension, conduction disorders, peripheral vasoconstriction, bronchospasm, dyspnoea; headache, fatigue, sleep disturbances (2-5%), paraesthesia, dizziness (2-5%), vertigo, psychoses; sexual dysfunction; purpura, thrombocytopenia; visual disturbances; exacerbation of psoriasis, alopecia; rarely rashes and dry eyes  

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|Angina

|Atenolol: 100mg once/twice daily<cite>Esc11</cite><cite>Esc12</cite>

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|Arrhythmias

|Atenolol: 50-100mg daily<cite>Esc13</cite><cite>Esc14</cite><cite>Acc15</cite>

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|Migraine

|Atenolol: 50-200mg daily

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|Hypertension

|Nifedipine: 20-30mg once daily

|Gastro-intestinal disturbance (2-11%); hypotension (1-5%), oedema (7-29%), vasodilatation, palpitation; headache (7-35%), dizziness (3-27%), lethargy (4-6%), asthenia (10-12%); less commonly tachycardia (<1-7%), syncope (<1%), chills, nasal congestion, dyspnoea (<3%), anxiety, sleep disturbance (<2%), vertigo (<3%), migraine, paraesthesia, tremor (1-8%), polyuria, dysuria, nocturia, erectile dysfunction (<2%), epistaxis, myalgia, joint swelling, visual disturbance (<2%), sweating (<2%), hypersensitivity reactions (<1%); rarely anorexia, gum hyperplasia, mood disturbances, hyperglycaemia, male infertility, purpura (<1%), and photosensitivity reactions (<1%); also reported dysphagia, intestinal obstruction, intestinal ulcer, bezoar formation, gynaecomastia, agranulocytosis, and anaphylaxis;<cite>Esc16</cite>

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|Raynaud’s Syndrome

|Nifedipine: 5-20mg 3 times daily

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|Angina (prophylaxis)

|Nifedipine: 5-20mg 3 times daily<cite>Esc17</cite>

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|Ventricular Arrhythmias

|Flecainide: 50-100mg twice daily

|Oedema, pro-arrhythmic effects (1-13%); dyspnoea; nervous-system side-effects including dizziness, asthenia, fatigue, fever; visual disturbances (13-28%); rarely pneumonitis, hallucinations, depression, confusion, amnesia, dyskinesia, convulsions, peripheral neuropathy; also reported gastro-intestinal disturbances (1-4%), anorexia, hepatic dysfunction, flushing, syncope, drowsiness, tremor, vertigo, headache, anxiety, insomnia, ataxia, paraesthesia, anaemia, leucopenia, thrombocytopenia, corneal deposits, tinnitus, increased antinuclear antibodies, hypersensitivity reactions (including rash, urticaria, and photosensitivity), increased sweating.<cite>Esc18</cite><cite>Acc19</cite>

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|(See above)

|(See above)

|(See above)

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*Arrhythmias

|Amiodarone: 200mg 2-3 times daily

|Gastro-intestinal disturbances (2-20%)), taste disturbances, hepatic disturbances (up to 50%); bradycardia; pulmonary toxicity (1-17%); tremor (9-59%), sleep disorders; hypothyroidism (5-10%), hyperthyroidism (5-10%); reversible corneal microdeposits (up to 98%); phototoxicity, persistent slate-grey skin discoloration (1-7%), injection-site reactions; less commonly onset or worsening of arrhythmia, conduction disturbances, peripheral neuropathy (1-105) and myopathy; very rarely sinus arrest, bronchospasm, ataxia (2-37%), benign intracranial hypertension, headache, vertigo, epididymo-orchitis, impotence, haemolytic or aplastic anaemia, thrombocytopenia, rash, hypersensitivity including photosensitivity (2-20%), anaphylaxis on rapid injection, hypotension (10-30%), respiratory distress syndrome, sweating, and hot flushes<cite>Esc20</cite><cite>Esc21</cite><cite>Acc22</cite>

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|(See above)

|(See above)

|(See above)

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*Acute: 0.75-1.5mg over 24 hours

*Maintenance: 125-150µg daily

|Gastro-intestinal disturbances (vomiting, diarrhoea, anorexia, abdominal pain) (25%); arrhythmias (up to 50%), AV conduction disturbances (50%); nervous system disturbances (dizziness, apathy, confusion, headache, fatigue, weakness) (25%); blurred or yellow vision; rash, eosinophilia, depression, anorexia, intestinal ischaemia and necrosis, psychosis, gynaecomastia on long-term use, and thrombocytopenia.<cite>Acc23</cite>

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|Heart Failure

|62.5-125 µg daily<cite>Esc24</cite><cite>Esc25</cite>

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|Prevention of thrombotic cerebro- or cardio-vascular disease

|75mg once/day

|Bronchospasm (10-30% in asthmatics); gastro-intestinal irritation (up to 83%), gastro-intestinal haemorrhage (occasionally major), also other haemorrhage (e.g. intracranial (0.5%), subconjunctival), chest pain (8.3%), oedema (4.5%), hypertension (4.3%).<cite>Esc26</cite><cite>Esc27</cite><cite>Esc28</cite><cite>Esc29</cite>

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|Pain / pyrexia

|300-600mg every 4-6 hours as necessary

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|Prevention of thrombotic events (esp. when warfarin not tolerated)

|75mg once/day

|Dyspepsia (5.2%), abdominal pain (5.6%), diarrhoea (4.5%); bleeding disorders including gastro-intestinal (2.0%) and intracranial (0.4%), nausea (3.4%), vomiting, gastritis, flatulence, constipation, gastric and duodenal ulcers, headache (7.6%), epistaxis (2.9%), dizziness (6.2%), paraesthesia, leucopenia, decreased platelets (very rarely severe thrombocytopenia), eosinophilia, rash (4.2%), pruritus (3.3%), vertigo, colitis, pancreatitis, hepatitis (<1%), acute liver failure, hypertension (4.3%), chest pain (8.3%), oedema (4.1%), vasculitis, confusion, hallucinations, taste disturbance, cough (3.9%), fatigue (4.8%) stomatitis, bronchospasm, interstitial pneumonitis, pyrexia (2.2%), blood disorders including thrombocytopenic purpura (5.3%), agranulocytosis, neutropenia (0.04%) and pancytopenia and hypersensitivity-like reactions (<0.1%)including fever, glomerulonephritis, arthralgia, Stevens-Johnson syndrome, toxic epidermal necrolysis, lichen planus.<cite>Esc30</cite><cite>Esc31</cite><cite>Esc32</cite>

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|Acute myocardial infarction

|300mg daily initially then 75mg once/day<cite>Esc33</cite>

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|Acute coronary syndrome

|300mg daily initially then 75mg once/day<cite>Esc34</cite>

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|Prevention of thrombotic events.

|60mg bolus then 5-10mg once daily

|Haemorrhage (11.3%) (including gastro-intestinal (1.5%) and intracranial), haematoma, haematuria, hypertension (7.5%), hypotension (3.9%), headache (5.5%), back pain (5.0%), dyspnoea (4.9%), nausea (4.6%), dizziness (4.1%), cough (3.9%), fatigue (3.7%), chest pain (3.1%), arrhythmias including atrial fibrillation (2.9%) and bradycardia (2.9%), rash (2.8%), pyrexia (2.7%), oedema (2.7%), diarrhoea (2.3%), hypercholesterolaemia/hyperlipidaemia (7.5%), anaemia, rash,hypersensitivity reactions including angioedema (0.06%), thrombocytopenia (0.06%), thrombotic thrombocytopenic purpura.<cite>Esc35</cite><cite>Esc36</cite>

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|Prevention of thrombotic events.

|180mg bolus then 90mg twice daily

|Dyspnoea (13.8%), haemorrhage, bruising; nausea (4.3%), vomiting, diarrhoea (3.7%), hypertension (3.8%), hypotension (3.2%), back pain (3.6%), abdominal pain, dyspepsia, gastritis, dizziness (4.5%), chest pain (3.7%), headache (6.5%), cough (4.9%), rash, pruritus, fatigue (3.2%),  constipation, arrhythmias including atrial fibrillation (4.2%), paraesthesia, confusion, hyperuricaemia, raised serum creatinine (7.4%), vertigo.<cite>Esc37</cite><cite>Esc38</cite>

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|Prevention of thrombotic/ embolic events (esp. after prosthetic valve insertion)

|5-10mg initially then tailored to individual (usually 3-9mg once daily at the same time)

|Haemorrhage, nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, rash, ‘purple toes’, skin necrosis (increased risk in patients with protein C or protein S deficiency)

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|Acenocoumarol

|Prevention of thrombotic/ embolic events (esp. after prosthetic valve insertion)

|Haemorrhage, nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, rash, ‘purple toes’, skin necrosis (increased risk in patients with protein C or protein S deficiency)

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|Primary hyper-cholesterolaemia, combined hyperlipidaemia

|Simvastatin: 10-20mg once daily

|Oedema (2.7%), abdominal pain (5.9%), nausea (5.4%), atrial fibrillation (5.7%), constipation (2.2%), gastritis (4.9%), diabetes mellitus (4.2%), myalgia (3.7%), headache (2.5%), insomnia (4.0%), vertigo (4.5%), bronchitis (6.6%), sinusitis (2.3%), eczema (4.5%), urinary tract infection (3.2%)<cite>Esc39</cite><cite>Esc40</cite>

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|Familial hyper-cholesterolaemia

|Simvastatin: 40mg once daily<cite>Esc41</cite>

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|Prevention of cardiovascular events

|20-40mg once daily<cite>Esc42</cite>

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|Gemfibrozil

|Hyperlipidaemias of types IIa, IIb, III, IV and V

|Gastro-intestinal disturbances including dyspepsia (19.6%), nausea (4%), abdominal pain (9.8%), diarrhoea (7.2%), vomiting (1.2%); headache (1.2%), fatigue (3.8%), vertigo (1.5%), eczema, rash (1.7%), atrial fibrillation (0.7%), pancreatitis, appendicitis, disturbances in liver function including hepatitis and cholestatic jaundice, dizziness, paraesthesia, sexual dysfunction, thrombocytopenia, anaemia, leucopenia, eosinophilia, bone-marrow suppression, myalgia, myopathy, myasthenia, myositis accompanied by increase in creatine kinase, blurred vision, exfoliative dermatitis, alopecia, and photosensitivity<cite>Esc43</cite>

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|Ezetimibe

|Primary and familial hyper-cholesterolaemia

|Gastro-intestinal disturbance including diarrhoea (4.1%) and abdominal pain (3.0%); headache, fatigue (2.4%); myalgia, arthralgia (3.0%), sinusitis (3.6%), pharyngitis (2.3%), viral infection (2.2%), coughing (2.3%), hypersensitivity reactions including rash, angioedema, and anaphylaxis, hepatitis,pancreatitis, cholelithiasis, cholecystitis, thrombocytopenia, raised creatine kinase, myopathy, and rhabdomyolysis<cite>Esc44</cite>

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