Medicines & You

= Chemical Compound
= Indications
= Dosage
= Contraindication
= Special Precautions
= Adverse Reactions
= Drug-Drug Interaction

Cardiovascular & Hematopoietic System

a) Cardiac Drugs

Amiodarone HCI
treatment of severe rhythm disorders eg atrial or nodal rhythm disorders, ventricular rhythm disorders, those associated w/ Wolff-Parkinson-White syndrome. Amp Where a rapid response is required or where oral administration is not possible.
AV or SA block, sinus bradycardia, sick sinus syndrome except when used in conjunction w/ a pacemaker; history of thyroid dysfunction; iodine intolerance, severe arterial hypotension, CV collapse, acute cardiac insufficiency. Combined therapy w/ drugs which may induce torrsades de pointes. Pregnancy, lactation.
Hypotension, severe resp failure, decompensated cardiomyopathy or severe heart failure.
Reversible corneal microdeposits; coloured halos; hyper or hypothyroidism. Rarely, photosensitization & pigmentation, resersible diffuse interstitial pneumopathy or peripheral neuropathy.
Antiarrthythmics, ß-blockers, stimulating laxatives, diuretics inducing hypokalemia, systemic corticosteroids, tetracosactide, amphotericin B, digitalis, anticoagulants, phenytoin, general anesth, cyclosporine.

Dobutamine HCI
Positive inotropic treatment of forward & backward failure in acutely decompensated chronic heart failure.
Mechanical impedence of ventricular filling &/or emptying eg in pericardial tamponade, constrictive pericarditis, hypertrophic obstructive cardiomyopathy & severe aortic stenosis. Severe hypovolaemic states. Concomitant administration of MAOIs.
Tolerance phenomena may develop w/ continuous administration for >72 hr, thereby necessitating an increase in dosage. Deterioration of clinical symptoms may occur in patients w/ severe CHD. Caution in ischaemic heart disease. Pregnancy & lactation.
Tachycardia, hypertension, hypotension, inducement or enhancement of ventricular arrhythmias, mild vasoconstriction. Headache, nausea, chest pains, palpitations & shortness of breath. Occasionally skin rash, fever, oesinophilia & bronchospasm. Lowering of serum K levels.
ß-blockers, venously acting vasodilators, ACE inhibitors, dopamine.

Amrinone lactate
Short-term management of CHF.
Severe aortic or pulmonary valvular disease in lieu of surgical relief of the obstruction.
Monitor BP & heart rate, fluid & electrolytes & renal function.
GI upsets; arrhythmia, hypotension; hypersensitivity; thrombocytopenia, hepatotoxicity.
Excessive hypotension w/ disopyramide.
Digoxin.
Whenever digitalis therapy is required for the treatment of CHF, atrial fibrillation; flutter & supraventricular tachycardia.
Supraventricular dysrhythmias caused by Wolff-Parkinson-white syndrome; hypersensitivity to cardiac glycosides.
Acute myocarditis w/ failure; renal failure (decrease dose & monitor closely); hypokalaemia;hypercalcaemia; hypomagnesaemia; hypothyroidism; w/hold Lanoxin for 24-48hrs before electroconversion.
Nausea, vomiting, anorexia, diarrhoea, abdominal pains, salivation, sweating; headache, facial pain, malaise, fatigue, drowsiness, depression, disorientation, mental confusion, delirium, hallucination, visual disturbance. Ventricular premature contractions, atrial or ventricular arrhythmias & conduction effects. Hypokalaemia.
Plasma conc increased by quinidine, verapamil, nifedipine, amiodarone. Hypokalemia may be associated w/ diuretics, lithium, carbenoxolone, corticosteroids. Antacids, neomycin may reduce serum level of digoxin.

b) Anti-Anginal Drugs

Isosorbide mononitrate.
Long-term treatment of CHD & CHF.
Acute MI w/ low filling pressures, acture circulatory failure, very low BP.
1st trimester of pregnancy. May impair ability to drive or operate machinery.
Nitrate headache. Manifestations of collapse may arise after the 1st dose in patients w/ circulatory lability.
Effects may be enhanced by alcohol & antihypertensives.

Isosorbide-5-mononitrate.
prophylactic treatment of angina pectoris.
Initiate at 30 mg once daily for 1st 2-4 days. Increase to 60 mg once daily thereafter. Max: 120mg once daily. Do not administer bd.
Cardiogenic shock, head trauma, cerebral hemorrhage, severe hypotension, severe hypovolemia.
Severe cerebral arteriosclerosis, hypotension.
Headache, dizziness, nausea.
Hypotensive effects enhanced by alcohol, antihypertensives, tricyclic antidepressants, narcotics.

Isosorbide dinitrate.
Prophylaxis of ischemic heart pain associated w/ coronary insufficiency.
5-30 mg bd-qds.
Hypersensitivity.
Tolerance & cross-tolerance to other nitrates & nitrites may occur. Pregnancy, lactation, childn. Patients prone to or affected by hypotension or vol depletion; severe hypotensive response; paradoxical bradycardia, increased angina may accompany nitrate induced hypotension, hypertrophic cardiomyopathy.
Flushing, vascular headache, cerebral ischemia associated w/ postural hypotension, nausea, vomiting, weakness, restlessness, pallor, perspiration & collapse; drug rash &/or exfoliative dermatitis.
Increased hypotensive effects w/ alcohol, ß-adrenergic blockers, phenothiazines, sildenafil.

Trimetazidine diHCI.
Treatment of angina pectoris. Adjuvant treatment of vertigo; tinnitus; decline in visual acuity & visual field disturbances of vascular origin.
Concomitant administration w/ MAOIs.
Pregnancy esp 1st trimester.
Rare cases of GI disorders.

c) ACE-Inhibitors/ other Antihypertensives

Quinapril.
Hypertension, CHF
Renal insufficiency, severe CHF.
Headache, dizziness, rhinitis, cough, upper resp tract infection, fatigue, nausea, vomiting, dyspepsia & paresthesia.
May reduce the absorption oftetracyclines. Serum K monitoring when used w/ K-sparing diuretics, K supplements, or K-containing salt substitutes.

Methyldopa.
Hypertension.
Active hepatic disease.
History of liver disease. +ve Coombs’ test. Phaeochromocytoma. Discontinuetherapy if unexplained persistent fever, liver dysfunction or jaundice occur. Crosses placental barrier & appears in breast milk.
Sedation (usually transient), headache, asthenia, oedema. Rarely, drug fever, CNS, CVS, hepatic effects, endocrine & GI disturbances, allergic & dermatologic reactions. Bone marrow depression (usually reversible), haemolytic anemia (stop drug), jaundice, involuntary choreoathetotic movements.
Antihypertensive drugs, lithium, MAOIs.

Irbesartan.
essential hypertension.
pregnancy, lactation.
Increased risk of severe hypotension in patients w/ rena; artery stenosis. Periodic monitoring of K & serum creation in patients w/ renal impairment. Monitoring of serum K in patients suffering from heart failure. Patients w/ recent kidney transplantation, primary aldosteronism, aortic or mitral stenosis, obstructive hypertrophic cardiomyopathy, ischaemic cardiopathy or ischaemic cardiovascular disease.
Flushing
Increased hypotensive effect w/ other hypotensive agents. K supplements & K-sparing diuretics may lead to increases in serum K. Monitor for possible increase in serum concentration of lithium.


Captopril.
Hypertension, Heart failure, MI, Diabetic nephropathy
Pregnancy. Hypersensitivity.
renal impairment, collagen vascular cisease, immunosuppressant therapy (neutropenia); bilateral renal artery stenosis; aortic steenosis.
Rash, pruritus, flushing; angioedema; loss of taste perception; stomatitis; GI irritation & abdominal pain; leucopenia; cough.
May increase serum K w/ K-sparing diuretics. Hypotensive effects enhanced by diuretics. Antihypertensive effect diminished by indomethacin, salicylates, NSAIDs.

Doxazosin mesylate.
Hypertension. Urinary outflow obstruction & symptoms associated w/ benign prostatic hyperplasia.
pregnancy, lactation. Impaired liver function.
Dizziness, headache, fatigue, postural dizziness, vertigo, oedema, asthenia.

Perindopril.
essential hypertension, CHF.
Pregnancy, lactation; childn.
Renal failure; renovascular hypertension; surgery/anesth; elderly. Hemodialysis: avoid combination w/ highly permeable membranes (polyacrylonitrile).
GI disorders; dizziness, headaches, mood &/or sleep disorders, asthenia; taste disorder; cramps, localized skin rashes; dry cough; angioneurotic edeme.
K supplements or K-sparing diuretics may induce hyperkalemia esp in renal failure. Neuroleptics or imipramine-like antidepressants increase risk of postural hypotension. Serum lithium conc may rise during lithium therapy.

Losartan.
Hypertension.
Pregnancy.
Intravascular vol depletion. Cirrhosis & hepatic impairment. Bilateral renal artery stenosis or stenosis of the artery to a solitary kidney. Changes in renal function. Lactation & childn.
Abdominal pain, asthenia/fatigue, chest pain, oedema/swelling, palpitation, tachycardia, diarrhoea, dyspepsia, nausea, back pain, muscle cramps, dizziness, headache, insomnia, cough, nasal congestion, pharyngitis, sinus disorder, upper resp infection, angioedema, hepatitis, liver function abnormalities, myalgia, migraine, urticaria, pruritus.
Concomitant use of K-sparing diuretics, K supplements/salt substitutes containing K may lead to increases in serum K.

Delapril HCI.
Essential, renal or renovascular hypertension.
Patients w/ a history of angioneuratic edema to other ACE inhibitors.
Patients w/ serious renal impairment or bilateral renal arteriostenosis; peptic ulcer or gastric disease; epilepsy or Huntington’s chorea. Patients should not be given w/ in 24 hr before surgical operation, pregnancy, lactation, childn. May impair ability to drive or operate machinery.
Occasionally, dizziness, lightheadedness, headache, insomia, stiff shoulder; nausea, vomiting, anorexia, coughing, hypersensitivity reactions; hot flushes, palpitations; hematological effects; malaise, diaphoresis, weakness, pharyngalgia.
May cause increase in serum K in combination w/ K-sparing diuretics. Enhancement of BP-lowering effects when used w/ other antihypertensive drugs.

Valsartan.
Hypertension.
Pregnancy.
severely Na or vol-depleted patients. Bilateral or unilateral renal artery stenosis. Hepatic insufficiency or biliary obstructive disorders. Caution when driving or operating machinery. Childn. Lactation.
Headache, dizziness, viral infection, upper resp tract infection, coughing, diarrhea, fatigue, rhinitis, sinusitis, back pain, abdominal pain, nausea, pharyngitis, arthralgia.
Concomitant use of K-sparing diuretics, K supplements or salt substitutes containing K may lead to increases in serum K.

Losartan K 50mg, hydrocholorothiazide 12.5mg.
treatment of hypertension, for patients in whom combination therapy is appropriate.
Intravascularly volume-depleted, severe renal impairment, hepatic impairment, anuria, hypersensitivity to other sulfonamide-derived drugs. Pregnancy.
Lactation. Childn.
Dizziness, angioedema, diarrhoe.
Concomitant use of K sparing diuretics, K supplements/salt substitutes containing K. Hydrochlorothiazide may interact w/ the following: alcohol, barbiturates, narcotics, antidiabetic agents, other antihypertensives, cholestyramine, colestipol resins, corticosteroids, ACTH, pressor amines, skeletal muscle relaxants, Lithium, NSAIDs.
Prazosin HCI.
Hypertension, benign prostatic hyperplasia
Left ventricular failure due to mechanical obstruction. Hypersensitivity. Childn <12 yr.
pregnancy & lactation.
Postural hypotension, headache. GI upsets, incontinence, edema, impotence, tinnitus, dry mouth, nasal congestion.
Additive hypotensive effect w/ diuretics or other antihypertensives.

Fosinopril Na.
Hypertension. Treatment of heart failure in combination w/ a diuretic.
Hypersensitivity. History of angioneurotic edema related to previous treatment w/ an ACE inhibitor. Pregnancy.
Impaired renal function. Hypotension, hyperkalaemia. Surgey/anesth.
dizziness, cough, upper resp symptoms, GI disturbances, palpitations/chest pain, rash/pruritus, musculoskeletal pain/paresthesia, fatigue, taste disturbance.
exaggerated hypotension response when used w/ diuretics. Absorption may be impaired by antacids. NSAIDs may interfere w/ the antihypertension effect of the drug. May increase serum lithium conc. Effects potentiated when used w/ other antihypertensives.

Indapamide.
essential hypertension.
Hypersensitivity to sulfonamides; severe hepatic or renal failure, hepatic, encephalopathy, hypokalemia.
Pregnancy & lactation. Serum monitoring of K & uric acid in those predisposed to hypokalaemia or gout. Patients w/ a history of allergy to sulfonamide derivatives should be closely monitored.
fatigue, orthostatic hypotension, hypokalaemia, allergic manifestations.
Lithium, nonarrhythmia (astemizole, bepridil, IV erythromycin, halofantrine, pentamidine, sultopride, terfenadine, vincamine).

Enalapril maleate.
Hypertension. Heart failure & prevention of coronary ischemic events in patient w/ left ventricular dysfunction. Prevention of symptomatic heart failure.
History of angioneurotic edema related to previous treatment w/ an ACE inhibitor.
Symptomatic hypotension may occur. Vol or salt-depleted patients & those w/ ischemic heart or cerebrovascular disease. Patients undergoing major surgery or during anesth w/ agents that produce hypotension. In patients w/ renal impairment or renal artery stenosis, lower doses &/or reduce frequency may be required. History of angioedema unrelated to ACE inhibitor may be at increased risk of angioedema. Use in pregnancy may lead to oligohydramnious & deformations. Lactation. Childn.
Dizziness, headache, diarrhea, fatigue, asthenia, cough, orthostatic hypotension; hyperkalemia; angioneurotic edema (discontinue therapy).
May have additive effects w/ other antihypertensives, K supplement, K-sparing diuretics, or K-containing salt substitutes. Lithium lenels may increase if used together w/ Renitec.

Atenolol 50mg, chlorthalidone 12.5mg.
Hypertension.
Presence of 2nd or 3rd degree heart block, cardiogenic shock. Bradycardia, hypotension, metabolic acidosis, severe peripheral circulatory disturbances, sick sinus syndrome, untreated phaeochromocytoma, uncontrolled heart failure.
Poor cardiac reserve, overt heart failure, COPD or asthma. W/drawal of ß-blockers should be gradual in patients w/ ischemic heart disease. Peripheral arterial circulatory disorders. History of anaphylaxis to a variety of allergens. Renal impairment, diabetes mellitus. Pregnancy & lactation. Monitor K levels. 1st degree heart block, Prinzmetal’s angina, thyrotoxicosis, hypoglycemia. May impair ability to drive or operate machinery. Hypokalaemia, hyperuricaemia.
Cold extremities, fatigue, GI disturbances bradycardia. Occasionally, deterioration of heart failure, headache, mood changes, confusion, nightmare, dizziness. Rarely sleep disturbances, alopecia, thrombocytopenia, purpura, psoriasiform skin reactions, exacerbation of psoriasis, visual disturbances, psychoses, hallucinations, heart block, postural hypotension which may be associated w/ syncope. Rashes & dry eyes (discontinue drug). Rashes, dry eyes have been reported w/ ß-blockers; chlorthalidone may cause nausea, dizziness; rarely idiosyncratic reaction eg thrombocytopenia & leucopenia. Hyperuricaemia, hypokalaemia, impaired glucose tolerance, intermittent claudication, Raynaud’s phenomenon. Paraesthesia.
Ca-channel blockers eg verapamil or diltiazem, lithium, digitalis or Class 1 antiarrhythmic agents. Diuretics may cause hyperuricaemia. Sympathomimentic agents, prostaplandin synthetase inhibitors, anesth agents. Concomitant use w/ dihydropyridine may increase risk of hypotension.

Ramipril.
Hypertension, Post MI
Hereditary angioneurotic edema. Pregnancy. Lactation.
Impaired renal or liver function.
Nausea, dizziness & headache, dry cough. Hypersensitivity reactions including pruritus, rash & fever.
Additive effects w/ other antihypertensives, increased serum K when used w/ K-sparing diuretics. Concomitant administration w/ lithium salts may increase serum lithium concentration.

Lisinopril dihydrate.
Hypertension, CHF, Acute MI, renal complications of diabetes mellitus.
Angioedema associated w/ ACE inhibitors & in patients w/ hereditary or idiopathic angioedema.
Symptomatic hypotension particularly in vol-depleted patients & CHF. Hypotension may occur during surgery/anesth. Patients w/ ischemic heart or cerebrovascular disease. Aortic stenosis or hypertrophic cardiomyopathy. Renal impairment. History of angioedema. Pregnancy, lactation. Anaphylactoid reactions reported in patients undergoing hemodialysis & desensitization treatments.
Dizziness, headache, diarrhoea, fatigue, cough, nausea, rash, orthostatic effects, asthenia. Rarely, angioedema, MI, CVA possibly secondary to excessive hypotension in high risk patients, palpitations, tachycardia, abdominal pain and indigestion, dry mouth, hepatitis, jaundice, vomiting, mood alterations, mental confusion, vertigo, urticaria, diaphoresis, uraemia, oliguria/anuria, renal dysfunction, acute renal failure, impotence, a symptom complex which may include fever, vasculitis, myalgia, arthralgia/arthritis, positive ANA, elevated ESR, eosinophilia & leukocytosis. Rash, photo-sensitivity or other dermatological manifestations. Increases (usually reversible) in blood urea, serum creatinine, liver enzymes & serum bilirubin. Small decreases in hemoglobin & hematocrit. Hyperkalemia, hyponatremia, leucopenia, thrombocytoprnia, bone marrow depression, manifest as anaemia, paraesthesia, pancreatitis. Rarely, haemolytic anaemia.
Risk of hyperkalemia w/ K-sparing diuretics, K supplements, K-containing salt substitutes. Antihypertensive effect may be diminished bu indomethacin. Additive antihypertensive effects w/ diuretics. May reduce lithium elimination. ACE inhibitors may potentiate the hypoglycaemic effect of insulin & oral anti-diabetic drugs.

d) Beta Blockers

metoprolol tartrate.
Hypertension, angina pectoris.
AV block II & III, uncompensated cardiac failure, cardiogenic shock, marked bradycardia.
Treatment should be w/ drawn graduallt. For patients undergoing elective surgery, employ a ß-blocker as premed. Cardiac decompensation. Pregnancy & lactation.
lassitude, GI & sleep pattern disturbances; rarely, non-specific skin reactions & coldness of extremities.
increased risk of myocardial depression w/ verapamil, diltiazem & Class I antiarrhythmics
Bisoprolol fumarate.
Hypertension, CHD (angina pectoris).
Untreated myocardial failure, shock, AV block grades II & III, sick sinus syndrome, SA block, dradycardia w/ <50 beat/min; bronchial asthma, hypotension, advanced stages of peripheral circulatory disturbance; pheochromocytoma w/o concomitant, adrenoceptor blocking therapy. Pregnancy, lactation; childn.
Diabetic patients w/ greatly fluctuating blood-sugar values, during prolonged periods of fasting; acidosis. Prior operation as cardiac output may be impaired under anaesth.
At start of treatment but generally recede w/in 1-2 wk treatment: rare: GI disturbances, skin reactions, decreased BP, slow pulse rate, AV conduction disturbance, cold extremities, muscle weakness/cramp & reduced lacrimation. May aggravate intermittent claudication & Raynaud’s phenomenon, intensify myocardial failure, increase airway resistance, impair glucose tolerance, mask signs of low sugar levels. Tiredness, dizziness, slight headache, perspiration, sleep disturbancesm vivid dreams & depressive moods.
Reserpine, methyldopa, clonidine, guanfacine, nifedipine, rifampicin, Ca-antagonist of the verapamil & diltiazem type, antiarrhythmics, insulin or oral bllod sugar-reducing drugs.

Propranolo HCI.
Hypertension, Angina, anxiety, migraine & essential tremor, dysrhythmias, anxiety, tachycardia, hypertrophic obstructive cardiomyopathy & thyrotoxicosis, LA Hypertension, thyrotoxicosis. Prophylaxis of angina pectoris & migraine. Prophylaxis after acute MI
2nd or 3rd degree heart block, cardiogenic shock, overt heart failure, history of bronchospasm, prolonged fasting, metabolic acidosis.
poor cardiac reserve be gradual in patients w/ ischemic heart disease. W/drawal of clonidine. Pregnancy & lactation. Caution in hepatic or renal impairment, decompensated cirrhosis, peripheral arterial circulatory disorders & in patients w/ history of anaphylaxis to a variety of allergens.
Cold extremities, GI & sleep disturbances; fatigue, lassitude. Deterioration in heart failure, mood changes, isolated cases of paraesthesia. Rarely, bradycardia, heart block, alopecia, thrombocytopenia, purpura, psoriasiform skin reactions, exacerbation of psoriasis. CNS symptoms including hallucinations.
Ca-channel blockers eg verapamil or diltiazem. Class I antiarrhythmic agents, ergotamine or dihydroergotamine, indomethacin, chlorproamazine or parenteral adrenaline or parenteral lignocaine.

Betaxolol HCI
Arterial hypertension.
Cardiogenic shock, uncontrolled congestive cardiac failure, 2nd or 3rd degree AV block if no pacemaker is present. Marked bradycardia (heart rate <50 beats/minute).
1st degree AV block; asthma; Raynaud’s disease; hypertension due to pheochromocytoma; diabetics prone to hypoglycemia.
Lassitude, exacerbation of Raynaud’s disease or intermittenet claudication & paraesthesia of extremities. Marked bradycardia, hypertension, AV block, cardiac insufficiency & bronchospasm.
Myocardial depressants or drugs depressing AV conduction. Clonidine should not be continued until several days after w/drawal of ß-blocker.

Atenolol.
Hypertension, angina pectoris & cardiac dysrthythmias, MI
presence of 2nd or 3rd degree heart block; cardiogenic shock. Bradycardia, hypotension, metabolic acidosis, severe peripheral circulatory disturbances, sick sinus syndrome, untreated phaeochromocytoma, uncontrolled heart failure.
poor cardiac reserve, overt heart failure, COPD or asthma, avoid abrupt cessation of therapy in ischemic heart disease. May aggravate peripheral arterial circulatory disorders. History of anaphylactic reaction. Anaesth. W/drawal of clonidine. Pregnancy & lactation. Modifies tachycardia of hypoglycemia.
Cold extremities, nuscccular fatigue, GI disturbances, bradycardia, headache, mood changes, heart failure, sleep disturbances, alopecia, skin rashes, dry eyes, thrombocytopenia, purpura, psoriasiform skin reactions, exacerbation of psoriasis, heart block.
Combines use w/ Ca-channel blockers w/ -ve inotropic effects eg verapamil or diltiazem. Modifies the tachycardia of hypoglycaemia. Sympathomimetic agents, prostaglandin synthetase inhibitors, anesth agents. Concomitant use w/ dihydropyridine may increase risk of hypotension. Class I antiarrhythmic agents eg. disopyramide, digitalis glycosides.

e) Calcium Antagonists

Nifedipine.
Stable angina pectoris, post-infarct angina, hypertension.
CV shock; pregnancy & lactation.
Severe hypotension; close monitoring of dialysis patients w/ malignant hypertension; heart failure, severe aortic stenosis.
Initially mild & transient vasodilatation, hypotensive, rarely GI, skin & otherreactions. Very rarely: chest pain (if relationship established, discontinue therapy). Extremely rare: on prolonged use gingival hyperplasia, gynaecomastia (both regressing on discontinuation); temporary hyperglycarmia, liver function disturbances (including intrahepatic cholestasis). Ability to drive or operate machinery may be impaired.
Effect enhanced by antihypertensive agents, cimetidine & ß-receptor blockers. Digoxin, quinidine (monitor plasma level).

Verapamil HCI.
Chronic hypertension, Isoptin SR, Tab chronic stable & unstable angina, angina at rest including vasospastic angina; angina pectoris after IM; prophylaxis of supraventricular tachyarrhythmias, Amp Hypertensive crises, treatment of supraventricular tachyarrhythmias, acute coronary insufficiency(coronary spasms)
CV shock, complicated acute MI, severre conduction disorders (2nd & 3rd degree AV block, sinoatrial block), sick-sinus syndrome, heart failure, atrial fibrillation/ flutter & simultaneous pre-excitation syndrome. Myasthenia gravis.
1st degree AV block, bradycardia, hypotension. May impair ability to drive or operate machinery. Pregnancy, lactation. Severe impairment of liver function. Slows down markedly the elimination of alcohol & prolongs the duration of alcohol.
Constipation, dizziness, nausea. Rarely, vertigo, headache, hypotension, ankle edema, flushing, fatigue, nervousness, erythromelalgia, paraesthesia, neuropathy; bradycardiac arrhythmias, CHF, dyspnea, raised prolactin levels, single cases of galactorrhea. Very rarely. Myalgia, arthralgia, allergi skin reactions; purpura, photosensitization dermatitis, gynecomastia, reversible increase in transaminases &/or alkaline phosphatase, relevant impairment of glucose tolerance; gingival hyperplasia. Tachycardia, palpitations, impotence. Tinnitus, tremor. Caution should be taken in patients w/ a pacemaker or defibrillator (possible increase insensing, pacing & fibrillation threshold).
Effects enhanced by ß-blockers, antiarrhythmics or inhalation anesth. May intensify effects of other antihypertensives. Lithium (attenuated by verapamil, enhanced neurotoxicity). Increases plasma level of cyclosporine. Theophylline, digoxin, carbamazepine. Effects attenuated by rifampicin, phenytoin & Phenobarbital. Effects of muscle relaxants may be potentiated. Rise in plasma levels by grapefruit juice & cimetidine. May increase plasma conc of certain ß-blockers (atenolol, metoprolol, propranolol), quindine, prazosin, midazolam, aspirin (increased risk of bleeding), alcohol (reduced metabolism, increase in plasma levels).

Amlodipine besylate.
Hypertension & angina.
Known sensitivity to dihydropyridines.
Pregnancy & lactation; impaired liver function.
Headache, edema, fatigue, somnolence, nausea, abdominal pain, flushing, paipitations, dizziness.
Felodipine.
Hypertension, stable angina pectoris.
Pregnancy including the early stages, lactation, levercirrose.
Flushing, headache, palpitations, dizziness, fatigue, peripheral oedema.
Cimetidine, erythromycin, itraconazole cause an increase in plasma conc. Phenytoin, carbamazepine, barbiturates will cause a decrease in plasma conc.

g) Peripheral Vasodilators & Cerebral Activators

Cinnarizine diHCI.
Dizziness, imbalance, ear buzzing due to vestibular disorder, peripheral & cerebral circulatory disorders.
Pregnancy.
Rarely, somnolence & GI disturbances. Aggravation or appearance of extrapyramidal symptoms (prolonged use in elderly).

Ginkgo biloba extr (EGB 761).
cerebral circulatory insufficiency. ENT, circulatory, neurosensory disorders (tinnitus, vertigo, dizziness). Peripheral vascular disorders.
Rarely, digestive disturbances; rashes; headache.

h) Migraine Drugs

Ergotamine tartrate 1 mg, caffeine 100mg.
Acute migraine attack & related types of vascular headache.
Impaired peripheral circulation, obliterative vascular disease, CHD; severe hypertension; renal or hepatic insufficiency, sepsis; pregnancy, lactation.
Avoid frequent & prolonged use, discontinue treatment in impaired peripheral circulation. During prolonged & uninterrupted treatment drug-induced headache & rare case of rectal or anal ulcer occurred.
Nausea, vomiting; paresthesia, pain & weakness in the extremities; peripheral vasoconstriction (discontinue drug). Precordial pain, myocardial ischaemia & infarction. Prolonged use may cause pleural or retroperitoneal fibrosis or fibrotic changes in the cardiac valves.
possible risk of peripheral ischemia w/ erythromycin, troleandomycin, josamycin. Enhanced risk of vasospastic reaction w/ propranolol (rare). Vasoconstrictor agents.

Sumatriptan succinate.
Acute relief of migraine w/ or w/o aura (tab/inj) & cluster headache (inj only).
Ischaemic heart disease, previous MI, Prinzmetal’s angina. Uncontrolled hypertension. MAOI therapy. Peripheral vascular disease or patients who have symptoms or signs consisitent w/ IHD. History of CVA or transient ischaemic attack. Severe hepatic impairment. Inj should not be given IV.
May impair ability to drive or operate machinery. Conditions predisposed to ischaemic heart disease. Hepatic or renal impairment. Controlled hypertension.
Transient pain at inj site. Sensations of tingling, heat, heaviness, pressure or tightness in any part of the body, flushing, dizziness & feeling of weakness. Fatigue & drowsiness. Nausea & vomiting. Transient increase in Bp. Visual disorders.
Ergotamine, MAOIs, 5-HT receptor inhibitors, lithium.

i) Anticoagulants, Antithrombotics & Fibrinolytics

Recombinant human tissue-type plasminogen activator.
Thrombolytic treatment in acute MI (AMI): 90 mins (accelerated dose regimen for patients in whom treatment can be started w/ in 6 hr of symptom onset; 3 hr dose regimen for patients in whom treatment can be started between 6-12 hr after symptom onset. Thrombolytic treatment in acute massive pulmonary embolism w/ haemodynamic instability.
Known haemorrhagic diathesis, patient receiving oral anticoagulants, manifest or recent severe or dangerous bleeding, history of stroke or CNS damage, haemorrhagic retinopathy, recent (< 10 days) traumatic external heart massage, obstetrical delivery, recent puncture of a non-compressible blood vessel, severe uncontrolled arterial hypertension, bacterial endocarditis, pericarditis acute pancreatitis, documented ulcerative GI disease during the last 3 mth, oesophageal varicosis, arterial aneurisms, arterial/ venous malformations. Neoplasm w/ increased bleeding risk, severe liver disease, including hepatic failure, cirrhosis, portal hypertension (oesophageal varices) & active hepatitis, major surgery or significant trauma in past 10 days
Smaller, recent traumas, such as biopsies, puncture of major vessel, IM inj, cardiac massage for resuscitation. Condition which increased bleeding tendencies & elderly patient.
Superficial & internal bleeding.
Anticoahulants & antiplatelet agents increase danger of bleeding.

Tirofiban HCI
used in combination w/ heparin for patients w/ unstable angina or non-Q-wave MI to prevent cardiac ischemic events & is also indicated for patients w/ coronary ischemic syndromes undergoing coronary angioplasty or atherectomy to prevent cardiac ischemic complications related to abrupt closure of the treated coronary artery.
Hypersensitivity; active internal bleeding; history of intracranial hemorrhage; intracranial neoplasm, arteriovenous malformation or aneurysm; patients who developed thrombocytopenia following prior exposure to Aggrastat.
Recent (<1yr) bleeding, including a history of GI bleeding or genitourinary bleeding of clinical significance; known coagulopathy, platelet disorder or history of thrombocytopenia; platelet count < 150,000 cells/mm3; history of cerebrovascular disease w/in 1 yr; major surgical procedure or severe physical trauma w/in 1 mth history, symptoms or findings suggestive of aortic dissection; severe uncontrolled hypertension (systolic BP > 180 mmHg &/or diastolic BP> 110 mmHg); acute pericarditis; hemorrhagic retinopathy; arterial access for femoral sheath placement; severe renal insufficiency (creatinine clearance <30 mL/Min). pregnancy, lactation, childn.
Risk of bleeding; nausea; fever; headache.
Drugs that affect hemostasis (eg warfarin).
Ticlopidine HCI.
Secondary prevention of cerebral & cardiovascular occlusive ischaemia in patients w/ thrombotic risk. Prevention of aorta-coronary bypass graft acclusion, in extracorporal circulation, in haemodialysis & in thrombosis of central vein of the retina.
Leucopenia, thrombocytopenia agranulocytosis, bleeding diatheses, haemostatic disorders, Active pathological bleeding (such as bleeding, GI ulcer, bleeding esophageal varices). Acute haemorrhagic cerebrovascular strokes. Severe hepatopathy. Pregnancy, lactation.
Every 15 days for the 1st 3 mths of treatment. To perform blood cell counting. Treatment should be immediately w/drawn when pharyngitis, ulcers of the buccal mucosa, angina, fever bleeding or hematomas occur. History of drug abuse.
Leucopenia, thrombocytopenia, GI discomfort, increase of transaminases & rarely cholestatic jaundice.
NSAIDs, anticoagulants.

Enoxaparin Na.
prophylaxis & treatment of thromboembolic disorders of venous origin, particularly in moderate to high risk orthopedic or general surgery. Prevention of thrombosis in extracorporeal circulation during hemodialysis.
History of thrombocytopenia during enoxaparin therapy. Hemorrhagic tendencies, organic lesion w/tendency to bleed, major blood clotting disorder. Acute infectious endocarditis, hemorrhagic stroke syndrome, acute GI ulcer.
Liver or kidney failure, uncontrolled arterial hypertension, history of GI ulcer, vascular diseases of the choroids & retina. Post-op period following surgery of brain & spainal cord. History of thrombocytopenia occurring w/ another heparin. 1st trimester of pregnancy. Do not give by IM route.
Hemorrhagic symptoms, thrombocytopenia (rare0, hematomes & skin necrosis at inj site; skin allergies or systemic allergic reactions.
Increased risk of hemorrhage when used w/ NSAIDs, ticlopidine, corticosteroids, dextran 40. May potentiate effects of oral anticoagulants. Vit K antagonists, anti-platelet drugs.

Warfarin Na.
Venous thrombosis 7 its extension, atrial fibrillation w/ embolization, pulmonary embolism & as adjunct in treatment of coronary occlusion.
Pregnancy; haemorrhagic tendency or blood dyscrasias; recent or contemplated surgery of CNS, eye; traumatic surgery resulting in large open surfaces; bleeding tendencies associated w/ active ulceration or overt bleeding; threatened abortion; spinal puncture.
Haemorrhage. Periodic determination or prothrombin time is essential. Necrosis &/or gangrene of skin & other tissue. Known or suspected hereditary, familial or clinical deficiency in protein has been associated w/ an increased risk of developing necrosis during warfarin administration. Also see lit.
Harmorrhage, necrosis of skin or other tissues. Infrequently, alopecia, urticaria, dermatitis, fever, GI disturbances, abdominal cramps, ‘purple toes’ syndrome, cholestatic hepatic injury. Hypersensitivity reactions.
Effects diminished by barbiturates, cholestyramine, glutethimide, rifampicin, vit K, griseofulvin, carbamazepine, ethchlorvynol. Effects enhanced by phenylbutazone, anabolic steroids, chloral hydrate, cimetidine, clofibrate, d-thyroxine, diflunisal, disulfiram, mefenamic acid, metronidazole, quinidine. Interferes w/ metabolism or excretion of hypoglycemic agents & anticonvulsants.

Nadroparin Ca low molecular wt.
prophylaxis & treatment of thromboembolic disorders.
previous thrombocytopenia w/ nadroparin therapy, signs or increased risk of hemorrhage associated w/ hemostasis disorders except for disseminated intravascular coagulation not induced by heparin, organic lesion likely to bleed, hemorrhagic CVA, acute infective endocarditis.
hepatic or renal insufficiency, uncontrolled arterial hypertension, history of peptic ulceration, vascular chorioretinal disorder; post-opbrain, spinal cord or eye surgery.
Overt or concealed hemorrhage; rarely, severe thrombocytopenia, small hematoma, cutaneous necrosis at inj site; raised transaminases, hypoaldosteronism.
NSAIDs, aspirin, oral anticoagulants, antiplatelet agents, dextrans.

Heparin Na.
prophylaxis & treatment of venous thrombosis & pulmonary embolism. Treatment of MI & arterial embolism. For prevention of clotting in arterial & heart surgery & prevention of cerebral thrombosis. As an anticoagulant in blood transfusions, extracorporal circulation, dialysis & for lab purposes.
Hemorrhagic diseases, thrombocytopenia, hemoplilia; subacute bacterial endocarditis; peptic ulcer; severe hypertension; patient who has recently undergone surgery at site where hemorrhage is a special risk.
Elderly, pregnancy. Increased resistance is frequently encountered in thrombosis, thrombophlebitis infected w/ thrombotic tendencies, cancer, post-surgical patients, advanced renal or hepatic disease, jaundice.
Transient alopecia, diarrhea; osteoporosis w/ spontaneous fractures. Occasionally, febrile or allergic reactions.
Drugs that interfere w/ platelet-aggregation reaction may induce bleeding. Digitalis, tetracyclines, nicotine or antihistamines may partially counteract the anticoagulant actions

Purified streptokinase.
Acute MI, deep venous thrombosis, pulmonary embolism, arterial occlusions, intrapleural adhesions, thrombosis of tricuspid valve prosthesis & in haemodialysis shunts.
Recent trauma or traumatic procedures; cerebral arterial disease; potential or active bleeding; potential cardiac emboli; recent strepto-kinase therapy; severe uncontrolled hypertension; hypertensive or diabetic nephropathy, recent CV events w/in last 2 mth; haemorrhagic diathesis.
Advanced age; IM inj.
Febrile & allergic reactions; hemorrhage; hypotension, bradycardia.
Anticoagulant & antiplatelet agents increase risk of bleeding.

Clopidogrel.
Reduction of artherosclerotic events (MI, stroke & vascular death) in patients w/ artherosclerosis documented by recent stroke, recent MI or established peripheral arterial disease.
Severe liver impairment. Peptic ulcer & intracranial haemorrhage. Lactation.
Patients who may be a risk of increased bleeding from trauma, surgery or other pathological conditions. Patients w/ moderate hepatic disease who may have bleeding diatheses. Pregnancy.
GI bleeding, purpura, bruising, haematoma, epistaxis, haematuria, eye bleeding, intracranial bleeding, abdominal pain, dyspepsia, gastritis * constipation, rash, pruritus.
Warfarin, aspirinm heparin, thrombolytics or NSAIDs.

Abciximab.
Adjunct to heparin & aspirin for: the prevention of ischemic cardiac complications in patients undergoing percutaneous coronary intervention (balloon angioplasty, atherectomy & bail out stent); the short-term (1 mth) reduction o9f the risk of MI, in patients w/ unstable angina, not responding to full conventional therapy who have been scheduled for percutaneous coronary intervention.
Active internal bleeding; history of CVA w/in 2 yr; recent intracranial or intraspinal surgery or trauma; recent major surgery; interacranial neoplasm, arteriovenous malformation or aneurysm; know bleeding diathesis or severe uncontrolled hypertension; pre-existing thrombocytopenia; vasculitis; hypertensive or diabetic retinopathy; severe hepatic or renal failure.
In case of bleeding or thrombocytopenia, discontinue therapy. Puncture of major vessels, IM inj. Pregnancy, lactation.
Bleeding, thrombocytopenia; human anti-chimeric antibody (HACA) development; hypotension; nausea & vomiting; back pain; chest pain; headache; bradycardia; fever, puncture site pain.
Increased risk of bleeding w/ heparin, other anticoagulants, thrombolytics & antiplatelet agents.

j) Haemorrhoidal, Phlebitis & Varicose Preparations

Micronised purified flavonoidic fraction (diosmin 450mg, heperidin 50 mg).
Organic & functional chronic venous insufficiency of the lower limbs; heavy legs, pain, nocturnal cramps. Hemorrhoidal disease, acute hemorrhoidal attracks.
Lactation
Minor GI & neurovegetative disorders.

Standardized ginkgo bilooba extr containing 24% of Ginkgo glycosides & 6% of Ginkgolides-bilobalide 0.014g, heptaminol HCI 0.3g, troxerutin 0.3g.
Symptoms related to venolymphatic insufficiency eg varicose veins, oedema, cramps, heavy legs, pain, restless legs. Functional signs related to acute haemorrhoidal attack.
Hyperthyroidism; associated use w/ MAOIs (risk of hypertension).
Avoid simultaneous administration w/ MAOIs.

Per g oint Lupinus albus 71mg, vateria indica 71mg, menthe piperita 56.7mg, Aloe vera 142mg. Per supp Lupinus albus 107 mg, vateria indica 107mg, menthe piperita 85mg. Aloe vera 214mg.
Relief of pain & itch of haemorrhoids.
Pregnancy.
Rarely, minor transient anal itching.

Per supp Tribenoside 400mg, lidocaine 40mg. cream tribenoside 5%, lidocaine HCI 2%.
External & internal haemorrhoids.
Pregnancy & lactation.
Slight burning sensation, pain, increased intestinal motility.

Oint Hydrocortisone 0.5%, cinchocaine HCI 0.5%, framycetin sulfate 1%, aesculin 1%. Supp Hydrocortisone 5mg, cinchocaine HCI 5mg, framycetin sulfate 10mg, aesculin 10mg.
Haemorrhoids, anal fissure, inflammatory, pruritus.
Extensive use in infants or pregnancy.

Pentoxifylline.
Peripheral occlusive arterial disease, cerebrovascular disorders, circulatory disorders of the inner ear.
pregnancy. Massive bleeding, extensive retinal bleeding. Hypersensitivity to methylxanthines.
Severe cardiac arrhythmias, MI, hypotension, severely impaired renal/liver function, increased bleeding tendency. Lactation. Childn.
Flushes, GI discomfort, cardiac arrhythmias at high dose. Pruritus, reddening of the skin, urticaria. Dizziness, headache, agitation, sleep disturbances. Rarely, angina pectoris, hypotension, increased bleeding tendency.
Antihypertensive agents, nitrates, insulin, oral antidiabetics, theophylline, ketorolac.

k) Haematopoietic Agents

Recombinant human erythropoietin (r-Hu-Epo) or epoetin alfa.
Treatment of symplomatic or transfusion required anaemia associated w/ chronic renal failure (CRF). Treatment of anaemia in cancer.
Uncontrolled hypertension, ischemic vascular disease, history of seizures. Changes in Hb, BP & serum electrolytes. Hb levels should be measured wkly until a stable level of 10-12g/dL is achieved & periodically monitored thereafter. Hyperkalemia. Increased protein intake & clotting.
Increased BP, thrombosis of vascular access sites. Flu-like symptoms, bone pain & chills after inj. Seizures. Skin reactions, palpebral edema.
Potentiated by hematinic agents.

l) Other Cardiovascular Drugs

Ubidecarenone coenzyme Q10.
Stmptoms associated w/ mild & moderate CHF in patient w/ standard treatment.
Infrequently, gastric discomfort, anorexia, diarrhea, nausea, skin rash.