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Anti-hypertensive (Other Agents)
Aliskiren (Tekturna®)
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Drug Category: Renin Inhibitor.
Indication: Treatment of hypertension, alone or in combination
with other antihypertensive agents. Dosing (Adults): Hypertension: Initial: 150 mg once daily; may increase to 300 mg once daily (maximum: 300 mg/day). Note: Prior to initiation, correct hypovolemia and/or closely monitor volume status in patients on concurrent diuretics during treatment initiation. Renal dosing: Mild-to-moderate impairment [GFR >30 mL/minute and/or Scr <1.7 mg/dL (women); Scr <2 mg/dL (men)]: No dose adjustment required. Severe impairment [GFR<30 mL/minute and/or Scr >1.7 mg/dL (women); Scr >2 mg/dL (men)]: Use caution; not studied in severe renal impairment. Administration: Administer at the same time daily; may take with or without a meal, but consistent administration with regards to meals is recommended. Avoid taking with high-fat meals. Supplied: Tablet: 150 mg, 300 mg |
bosentan (tracleer ®)
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Endothelin receptor antagonist. Adult (usual) Pulmonary arterial hypertension (PAH): initial, 62.5 mg po bid x 4 weeks. Maintenance (PAH): up to 125 mg po bid. Doses above 125 mg b.i.d. did not appear to confer additional benefit sufficient to offset the increased risk of liver injury. Monitoring: monitor liver function before and during therapy. Monitor hemoglobin levels after 1 and 3 months, then every 3 months monthly. [Supplied: 62.5, 125 mg tablets] |
epoprostenol (Flolan ®)
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Epoprostenol (PGI2, prostacyclin): a naturally occurring prostaglandin
with potent vasodilatory activity and inhibitory activity of platelet
aggregation. Indication: long-term intravenous treatment of primary
pulmonary hypertension and pulmonary hypertension associated with the
scleroderma spectrum of disease in NYHA Class III and Class IV patients
who do not respond adequately to conventional therapy. Dosage - Adult (usual) Pulmonary hypertension: initial, 2 ng/kg/min IV, titrate upward in increments of 2 ng/kg/min every 15 min or longer until dose-limiting pharmacological effects are elicited or until tolerance develops. Administration: reconstitute only with supplied diluent; do not give with other parenteral medications. Infuse continuous chronic infusion via a central venous catheter with an ambulatory infusion pump - may be administered peripherally until central catheter established. Avoid abrupt withdrawal. Anticipate need for periodic dose adjustments. |
fenoldopam (Corlopam ®)
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Indications: short-term (up to 48 hours) management of
severe hypertension when rapid, but quickly reversible, emergency
reduction of blood pressure is clinically indicated, including malignant
hypertension with deteriorating end-organ function. Dosage (adult): Hypertension: initial 0.03-0.1 mcg/kg/min IV; increase every 15 min by 0.05-0.1 mcg/kg/min based on response. Maximum: 1.6 mcg/kg/min. In clinical trials, doses from 0.01-1.6 µg/kg/min have been studied. Most of the effect of a given infusion rate is attained in 15 minutes. A bolus dose should not be used. Hypotension and rapid decreases of blood pressure should be avoided. The initial dose should be titrated upward or downward, no more frequently than every 15 minutes (and less frequently as goal pressure is approached) to achieve the desired therapeutic effect. The recommended increments for titration are 0.05-0.1 µg/kg/min. [Supplied: 10 mg/ml solution] |
hydralazine (Apresoline ®)
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Direct arteriolar vasodilator with little or no effect on the venous
circulation. Precautions are needed in patients with underlying coronary
disease or an aortic dissection. Beta-blocker should be given
concurrently to minimize reflex sympathetic stimulation. The hypotensive
response to hydralazine is less predictable than that seen with other
parenteral agents. Dosing (Adult): Initial (Acute hypertension): 10 mg slow IV bolus ( maximum dose being 20 mg) every 4 to 6 hours as needed. May increase to 40 mg/dose. Change to oral therapy as soon as possible. The fall in blood pressure begins within 10 to 30 minutes and lasts 2 to 4 hours. May also be given IM. Hypertension (Oral): Initial: 10 mg 4 times/day. Increase by 10-25 mg/dose every 2-5 days (maximum: 300 mg/day). Usual dose range (JNC 7): 25-100 mg/day in 2 divided doses. Pre-eclampsia/eclampsia: 5 mg/dose (IM, IV) then 5-10 mg every 20-30 minutes as needed. CHF: Initial dose: 10-25 mg orally 3-4 times/day. Dosage must be adjusted based on individual response. Target dose: 75 mg 4 times daily in combination with isosorbide dinitrate (40 mg 4 times daily). Range: Typically 200-600 mg daily in 2-4 divided doses. Dosages as high as 3 grams per day have been used in some patients for symptomatic and hemodynamic improvement. Renal dosing: crcl 10-50 ml/min: Administer every 8 hours. crcl <10 ml/min: Administer every 8 to 16 hours in fast acetylators and every 12-24 hours in slow acetylators. Supplied: Injection (soln): 20 mg/ml (1 ml vial). Tablet: 10 mg, 25 mg, 50 mg, 100 mg. |
minoxidil (Loniten ®)
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Severe Hypertension: initial, 5 mg/day orally as single
dose or 2 divided doses. Maintenance (HTN): 10-40 mg/day orally daily in
1-2 divided doses (Maximum: 100 mg/day) . Acts directly on vascular
smooth muscle with selective vasodilatation of the arteriolar resistance
vessels and little or no effects on venous capacitance vessels and does
not effect the functioning of the carotid or aortic baroreceptors. [Supplied: 2.5, 5, 10mg tablet] |
nitroprusside (Nipride ®)
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Arteriolar and venous dilator. Considered to be the most effective
parenteral drug for most hypertensive emergencies (except myocardial
ischemia or renal impairment). It dilates both arteries and veins, and
it reduces afterload and preload. Onset: within seconds. Duration: 2-3
minutes. Constant monitoring of the blood pressure is required. Alternatives to nitroprusside include intravenous labetalol, nicardipine, and fenoldopam. Hypotension is uncommon with these drugs and cyanide toxicity is not an issue. Dosing (Adults): Initial: 0.3-0.5 mcg/kg/minute. Increase in increments of 0.5 mcg/kg/minute -- titrating to the desired hemodynamic effect or the appearance of headache or nausea. Usual dose: 3 mcg/kg/minute (rarely need >4 mcg/kg/minute). Maximum: 10 mcg/kg/minute. When treatment is prolonged (>24 to 48 hours) or when renal insufficiency is present, the risk of cyanide and thiocyanate toxicity is increased. Doses > 2 mcg/kg/min exceed the capacity of the body to detoxify cyanide. Maximum doses of 10 mcg/kg/min should never be given for more than 10 minutes. An infusion of sodium thiosulfate can be used in affected patients to provide a sulfur donor to detoxify cyanide into thiocyanate. Supplied: Injection (Soln): 25 mg/ml - 2 ml (vial). |
phentolamine (regitine ®)
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Extravasation - norepinephrine: 5-10 mg in 10
mL saline SC infiltrated within 12 hours into area of extravasation.
Hypertensive crisis: 5-20 mg IV. Pheochromocytoma (diagnosis): 5 mg IV or IM. Tissue necrosis prevention: 10 milligrams may be added to each liter of solution containing norepinephrine to prevent dermal necrosis and sloughing associated with intravenous administration of norepinephrine. |
treprostinil (Remodulin ®)
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Indications: Pulmonary arterial hypertension
(PAH) in patients with NYHA Class II-IV symptoms. Dosage: Pulmonary arterial hypertension: initial, 1.25 ng/kg/min continuous SC infusion; decrease to 0.625 ng/kg/min if initial dose cannot be tolerated. Pulmonary arterial hypertension: adjustments, increase dose in increments of no more than 1.25 ng/kg/min per week for the first 4 weeks and then no more than 2.5 ng/kg/min per week for remaining duration. Administration: administer by continuous subcutaneous infusion to diminish symptoms associated with exercise. avoid abrupt cessation of infusion. Chronic dosage adjustments should establish a dose at which PAH symptoms are improved, while minimizing side effects. Minimal experience with doses greater than 40 ng/kg/min. [Supplied (20 ml vials) 1, 2.5 , 5, and 10 mg/ml solution] |
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kind for the information and data accessed through the Service or for
any diagnosis or treatment made in reliance thereon. David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc. |
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