Cardiovascular drugs (medicine)
Sotalol
Sotalol

Dosage Forms:

  • 5 mg and 10 mg tablets

Dosage Forms

5 mg and 10 mg tablets

Drug Group

Non-Cardioselective Beta blocker

Mechanism

It is reported to lack both intrinsic sympathomimetic and membrane stabilizing properties. In addition to the class II antiarrhythmic activity of beta-blockers, sotalol lengthens the duration of the action potential resulting in class III antiarrhythmic activity

Indications

Sotalol is indicated for the treatment of documented ventricular arrhythmias, such as sustained ventricular tachycardia, that in the judgment of the physician are life-threatening. In patients with highly symptomatic atrial fibrilation/atrial flutter (AFIB/AFL) who are currently in sinus rhythm, sotalol is used to maintain the normal sinus rhythm

Dosage and Administration:

  • Initial: Oral, 40 mg two times a day, the dosage being increased gradually. Maintenance: Oral, 160 to 320 mg per day, given in two or three divided doses.

Precautions and Warnings

Renal Impairment: Sotalol is eliminated principally via the kidneys through glomerular filtration and to small degree by tubular secretion. There is a direct relationship between renal function and the elimination rate of sotalol.

Side Effects

As for Beta-blockers. Torsade de pointes have been reported in patients given sotalol, usually due to prolongation of the QT interval. Drowsiness, dizziness, light-headness, headache, stomach upset may occur the first several days. Other common side effects reported include cough, decreased sexual desire, trouble sleeping, reduced concentration, altered taste, dry skin and muscle aches.
Interactions: Sotalol should not be used with other drugs that prolong the QT interval due to the increased risk of precipitating ventricular arrhythmias (such as amiodarone, disopyramide, procainamide, or quinidine, also phenothiazine antipsychotics, tricyclic antidepressants, certain antihistamines (astemizole or terfenadine), cisapride, erythromycin, and pentamidine.

Pregnancy and Lactation

Pregnancy category B. Although there are no adequate and well controlled studies in pregnant women, sotalol has been shown to cross the placenta. Therefore, sotalol should be used during pregnancy only if the potential benefit outweighs the potential risk. Sotalol is distributed into breast milk but no clinical effects were found. So it is compatible with breast feeding.

Packaging

  • 10 tablets in one blister. 10 blisters in a box.

 
Carvedilol
Carvedilol

Dosage Forms:

  • 6.25 mg and 12.5 mg tablets

Drug Group

Non-selective beta receptors antagonist and selective alpha receptors antagonist.

Mechanism

arvedilol is a non-cardioselective beta-blocker. It has vasodilating properties, which are attributed mainly to its blocking activity at alpha receptors.

Indications

Carvedilol is used in the management of hypertension and angina pectoris, and as adjunct to standard therapy in symptomatic heart failure. It is also used to reduce mortality in patients with left ventricular dysfunction following myocardial infarction.

Dosage and Administration:

  • In hypertension, initial dose: 12.5mg once daily or 6.25mg twice daily. After two days: 25mg- 50mg once daily or twice daily. In angina pectoris, initial dose: 12.5mg twice daily. After two days: 25mg twice daily. In heart failure, initial dose: 3.125mg twice daily. After two weeks: 6.25mg twice daily. In patients with left ventricular dysfunction following myocardial infarction, initial dose: 6.25mg twice daily. After 3 to 10 days (if tolerated): 12.5mg twice daily.

Precautions and Warnings

Since carvedilol has beta-blocking activity, it should not be discontinued abruptly, particularly in patients with ischemic heart disease. At the first sign/symptom of liver dysfunction, perform laboratory testing. Carvedilol is contraindicated in patients with NYHA class IV decompensated cardiac failure, bronchial asthma or related bronchospastic conditions, 2nd or 3rd degree AV block, sick sinus syndrome, cardiogenic shock or severe bradycardia.

Side Effects

As for beta-blockers liver function abnormalities (reversible), acute renal failure & renal abnormalities.
Interactions:  Interaction of carvedilol with strong inhibitors of CYP2D6 (such as quinidine, fluoxetine, paroxetine and propafenone) has not been studied, but these drugs would be expected to increase blood levels of the carvedilol.

Pregnancy and Lactation

Pregnancy category C. Adequate and well-controlled studies in humans have not been done. It is not known whether carvedilol is distributed into breast milk.

Packaging:

  • 10 tablets in one blister. 3 blisters in a box.
Valsartan
Valsartan

Dosage Forms:

  • 80 mg and 160 mg capsules

Drug Group

Angiotensin II antagonists

Mechanism

Valsartan is an angiotensin receptor blocker drug (ARBs); it is specific angiotensin II antagonists that act on the AT1 receptor subtype.

Indications

Hypertension: Valsartan is indicated for the treatment of hypertension. It may be used alone or in combination with other anti-hypertensive agents. Heart Failure: Valsartan is indicated for the treatment of heart failure (NYHA class II-IV). In clinically stable patients with left ventricular failure or left ventricular dysfunction following myocardial infarction, Valsartan is indicated to reduce cardiovascular mortality.

Dosage and Administration:

  •  The usual dose of valsartan in patients with high blood pressure is 80 to 160 mg once daily. The maximum dose is 320 mg daily. Maximum blood pressure reduction occurs within 4 weeks. For congestive heart failure, the usual dose is 40 mg twice daily. The doses may be increased to 80-160 mg twice daily. The initial dose after a heart attack is 20 mg twice daily. The dose should be increased with a target of 160 mg twice daily if tolerated without side effects.

Precautions and Warnings

Valsartan is contraindicated in patients who are hypersensitive to any component of this product. Caution should be observed when initiating therapy in patients with heart failure or post-myocardial infarction patients. As the majority of valsartan is eliminated in the bile, patients with mild-to-moderate hepatic impairment, including patients with biliary obstructive disorders, showed lower valsartan clearance (higher AUCs). Care should be exercised in administering valsartan to these patients. In studies of ACE inhibitors in hypertensive patients with unilateral or bilateral renal artery stenosis, increases in serum creatinine or blood urea nitrogen have been reported. There has been no long-term use of valsartan in patients with unilateral or bilateral renal artery stenosis, but an effect similar to that seen with ACE inhibitors should be anticipated.

Side Effects

Valsartan is generally well-tolerated and side effects are rare. The most common side effects include headache, dizziness, fatigue, abdominal pain, cough, diarrhea and nausea. Patients may also experience hyperkalemia, impotence, reduced renal function, and allergic reactions. Rhabdomyolysis (inflammation and destruction of muscles) and angioedema (swelling of soft tissues including those of the throat and larynx) are rare but serious side effects of valsartan.
Interactions: Coadministration of valsartan and warfarin did not change the pharmacokinetics of valsartan or the time-course of the anticoagulant properties of warfarin. Concomitant use of valsartan with other agents that block the renin-angiotensin system, potassium sparing diuretics (e.g. spironolactone, triamterene, amiloride), potassium supplements, or salt substitutes containing potassium may lead to increases in serum potassium and in heart failure patients to increases in serum creatinine. If co-medication is considered necessary, monitoring of serum potassium is advisable. Valsartan may increase serum levels of Lithium.

Pregnancy and Lactation

Pregnancy categories C (first trimester) and D (second and third trimesters). It is not known whether valsartan is excreted in human milk, but valsartan was excreted in the milk of lactating rats. Because of the potential for adverse effects on the nursing infant, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Packaging:

  • 10 capsules in one blister. 3 blisters in a box.
Nitroglyserin

Nitroglyserin

Dosage Forms:

  • 2.6 mg and 6.4 mg sustained release tablets.

Drug Group

Cardiovascular drugs, Vasodilator

Mechanism

Nitroglycerin is a vasodilator that frequently is used in the management of angina pectoris. Additionally, in patients with angina, nitroglycerin preferentially dilates blood vessels that supply the areas of the heart where there is not enough oxygen; thereby delivering oxygen to the heart tissue that needs it most.

Indications

Nitroglycerin is indicated for the acute relief of an attack or acute prophylaxis of angina pectoris due to coronary artery disease.

Dosage and Administration:

  •  2.6-6.4 mg every 12 hours up to a maximum of 13 mg daily in divided doses every 8 or 12 hours.

Precautions and Warnings

Nitroglycerin should not be used in patients with severe hypotension, hypovolaemia, marked anaemia, heart failure due to obstruction (including constrictive pericarditis), or raised intracranial pressure due to head trauma or cerebral haemorrhage. Although it has been suggested that Nitroglycerin may increase intra-ocular pressure in patients with angle-closure glaucoma and should be avoided in such patients there appears to be no evidence for such a contra-indication. Nitroglycerin should be used with caution in patients with severe renal or severe hepatic impairment, hypothyroidism, malnutrition, or hypothermia. Metal-containing transdermal patches should be removed before cardioversion or diathermy.

Side Effects

Abdominal pain, diarrhea, dyspepsia, flatulence, nausea, vomiting, constipation, accident household, edema, fall, pain, influenza-Like symptoms, dizziness, headache, pharyngitis, upper respiratory tract infection, coughing, pruritus, rash, Joint related signs and symptoms, musculoskeletal and connective tissue signs and symptoms, anemia, arthralgia, back pain, insomnia, micturition frequency, urinary tract infection
Interactions: Since nitroglycerin can cause hypotension, other medications which also cause hypotension may produce an unwanted additive effect. Such drugs might include medicines used to treat high blood pressure, some antidepressants; some anti-psychotics, quinidine, procainamide, benzodiazepines such as diazepam (Valium) or opiates (e.g. morphine). Alcohol also may intensify the blood pressure lowering effect of nitroglycerin. Ergot alkaloids (e.g. Cafergot) and Imitrex can oppose the vasodilatory actions of nitroglycerin and may precipitate angina. A similar effect can occur with ephedrine and the decongestants pseudoephedrine (Sudafed) and propanolamine. PDE5 inhibitors (Sildenafil, Vardenafil and Tadalafil) should not be used in patients who have taken nitroglycerin.

Pregnancy and Lactation

Nitroglycerin can be used during pregnancy if in the judgment of the physician the potential benefits justify the potential (though unknown) risks to the fetus. It is not known if nitroglycerin is secreted in breast milk.

Packaging:

  • Nitroglycerin 2.6: HDPE flacons of 100’s.
  • Nitroglycerin 6.4: HDPE flacons of 50’s.
Pentoxifylline

Pentoxifylline

 Dosage Forms:

  • 400 mg extended-release tablet

Drug Group

Blood Viscosity Reducer agent

Mechanism

Pentoxifylline is a xanthine derivative used in the treatment of peripheral vascular disease. Although often classified as a vasodilator, its primary action seems to be a reduction in blood viscosity, probably by effects on erythrocyte deformability and platelet adhesion and aggregation.

Indications

Pentoxifylline is reported to increase blood flow to ischaemic tissues and improve tissue oxygenation in patients with peripheral vascular disease and to increase oxygen tension in the cerebral cortex and in the cerebrospinal fluid; it has been used in cerebrovascular disorders. Pentoxifylline also inhibits production of the cytokine, tumour necrosis factor alpha (TNFα), and this property is under investigation in a number of diseases.

Dosage and Administration:

  •  In the treatment of peripheral vascular disease the usual dose is 400 mg three times daily by mouth in a modified-release formulation; this may be reduced to 400 mg twice daily for maintenance or if adverse effects are troublesome. Doses should be taken with meals to reduce gastrointestinal disturbances. In severe hepatic or renal impairment, doses may need to be reduced. Beneficial effects may not be evident until after 2 to 8 weeks of treatment. Pentoxifylline may also be administered parenterally.

Precautions and Warnings

Pentoxifylline should be avoided in cerebral haemorrhage, extensive retinal haemorrhage, severe cardiac arrhythmias, and acute myocardial infarction. It should be used with caution in patients with ischaemic heart disease or hypotension. The dose of pentoxifylline may need to be reduced in patients with hepatic or renal impairment.

Side Effects

Pentoxifylline can cause nausea, gastrointestinal disturbances, dizziness, and headache. Flushing, angina, palpitations, cardiac arrhythmias, and hypersensitivity reactions may also occur. Bleeding events have been reported rarely, usually in association with bleeding risk factors.
Interactions: Pentoxifylline may potentiate the effect of antihypertensives. High parenteral doses of pentoxifylline may enhance the action of insulin and oral hypoglycaemics in diabetic patients. Pentoxifylline should not be given concomitantly with ketorolac as there is reported to be an increased risk of bleeding and/or prolongation of the prothrombin time. There may also be an increased risk of bleeding during concomitant use with meloxicam. Serum levels of theophylline may be raised by pentoxifylline.

Pregnancy and Lactation

Pregnancy category C. Teratogenic effects were not observed in animal studies. There are no adequate and well-controlled studies in pregnant women. Enters breast milk/not recommended.

Packaging:

HDPE flacons of 100’s.