Drug Facts

Type of Drug:

Antihypertensives; drugs used to lower high blood pressure.

Uses of The Combinations:

To treat high blood pressure. Used with other drugs when adequate control is not achieved by a single drug.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose, unless instructed by your doctor.
• May cause stomach upset. Check with your doctor or pharmacist to see if your medicine can be taken with food or milk.
• Diuretics may increase urination. Take combinations containing diuretics early in the day.
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless instructed by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• ACEls may cause a persistent dry cough. Recovery is rapid when the medicine is stopped .
• Dizziness, fainting, or light-headedness is most likely to occur after the first dose or in the first days of therapy. Avoid sudden changes in posture. If dizziness persists, contact your doctor.
• Do not take other prescription or OTC medications, dietary supplements, or salt substitutes unless instructed by your doctor or pharmacist.
• May cause sensitivity to sunlight. Avoid prolonged exposure to the sun and ultraviolet (UV) light (eg, tanning beds). Use sunscreens and wear protective clothing until tolerance is determined.
• Diuretics may increase blood sugar levels in diabetics.
• Many of these medications cause drowsiness or dizziness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity until tolerance is determined.
• Contact your doctor if significant, sudden joint pain occurs while taking combinations containing hydralazine
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant or if you are breastfeeding.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature in a tightly sealed container away from light.

Type of Drug:

Angiotensin converting enzyme inhibitors (ACEls); drugs used to lower blood pressure.

How the Drug Works:

Angiotensin converting enzyme (ACE) is involved in certain chemical reactions that constrict (narrow) blood vessels and cause sodium and fluid retention by the kidney. This can cause an increase in blood pressure. ACEls lower blood pressure by interfering with ACE, which causes blood vessels to relax (widen). Blow flows more freely and at a lower pressure. ACEls also increase the heart’s ability to pump blood in some types of heart failure.

Uses:

To treat high blood pressure alone or in combination with other blood pressure-lowering medications.

Captopril, Enalapril, Fosinopril, Lisinopril, Quinapril, Ramipril, Trandolapril: To treat certain types congestive of heart failure, usually in combination with other medications (eg, diuretics, digitalis).

CaptopriL: To treat diabetic nephropathy (kidney damage) in patients with Type I (insulin-dependent) diabetes mellitus and retinopathy.

Lisinopril: To improve survival in patients who have had a heart attack within 24 hours.

Unlabeled Uses: Occasionally, doctors may prescribe captopril for the management of specific types of hypertension crises or neonatal and childhood hypertension, treatment of rheumatoid arthritis, certain types of edema, Batter and Raynaud syndromes, and diagnosis of primary aldosteronism and certain kidney disorders. Enalapril has been used to treat diabetic nephropathy.

Precautions:

Low blood pressure: Dizziness and fainting due to lowered blood pressure may OCcur early in therapy. This effect is more likely to OCcur with concurrent diuretic treatment and when arising from a seated or lying position, but can OCcur at any time early in therapy. This effect can also OCcur if several doses are missed and then the medicine is restarted, if the dosage is increased rapidly, or if other blood pressure medications re added.

Potassium: Elevated serum potassium levels have occurred. Use with caulion in the presence of kidney disease, diabetes, and with potassium­ontaining products (eg, salt substitutes, potassium supplements

Cough: A persistent, dry, nonproductive cough can be caused by ACELs. The cough is more likely to OCCur in women and at low doses. Recovery is rapid and complete in 1 to 4 days when the drug has been discontinued.

Race: ACEls may not be as effective in black patients.

Pregnancy: Report pregnancy or suspected pregnancy to your doctor immediately.

First trimester: Fetal exposure to ACEls only during the first trimester usually causes no problems, but the drug should be stopped as soon as possible. Continue use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

Second and third trimesters: Studies have shown a potential adverse effect on the fetus. When used during the second and third trimesters, ACEls can cause fetal harm or even death. Discontinue the drug as soon as possible.

Breastfeeding: Several ACEls appear in breast milk. It is not known if lisinopril, moexipril, perindopril, or ramipril appear in breast milk. Do not take fosinopril, ramipril, or trandolapril while breastfeeding. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness have not been established. There is limited experience with the use of captopril in children. Unpredictable decreases in blood pressure and associated complications have occurred. Use catopril in children only when other measures for control­ling blood pressure have not been effective.

Lab Tests: Lab tests will be required periodically during treatment. Tests include urine protein, liver function, kidney function, blood cell counts, and sodium and potassium levels.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­the-counter or prescription medications or dietary supplements while taking these drugs. Drug doses may need to be modified or a different drug prescribed. The following drugs and drug classes interact with these drugs:

• Allopurinol (eg, Zyloprim) (captopril only)
• Antacids (eg, Maalox)
• Capsaicin (eg, Capsin)
• Diuretics (eg, furosemide)
• Lithium (eg, Eskalith)
• NSAIDs (eg, indomethacin)
• Phenothiazines (eg, promethazine)
• Potassium-containing salt substitutes (eg, Nu Salt)
• Potassium-sparing diuretics (eg, triamterene)
• Potassium supplements (eg, potassium chloride)
• Probenecid (captopril only)
• Rifampin (eg, Rifadin) (enalapril only)
• Tetracyclines (eg, oxytetracyline) (quinapril only)

laxatives promote bowel emptying. Nonprescription laxatives are frequently misued due to lack of understanding of normal bowel function. Restrict self ­ medication to short-term therapy of constipation. Chronic use of laxatives (particularly stimulants) may lead to dependence. Prior to laxative use, consider living habits affecting bowel function including disease state and drug history. Rational therapy and prevention of constipation include: Adequate fluid intake (4 to 6 glasses of water daily), proper dietary habits including sufficient bulk or roughage, responding to the urge to defecate and daily exercise.

Uses

To treat constipation

For more information on laxative ingredients, see the Laxatives ­ Stimulant and Laxatives - Stool Softeners monographs in this site. Casanthranol is a stimulant laxative used in laxative combinations.

Guidelines for Use

• Use exactly as prescribed.
• Take 5 to 45 ml at bedtime with a full glass of water.
• Do not use in the presence of abdominal pain, nausea or vomiting.
• Laxative use if only a temporary measure do not use. longer than 1 week. When regularity returns, discontinue use. Prolonged, frequent or excessive use may tesult in dependence or electrolyte imbalance.
• Contact your doctor if relieved constipation rectal bleeding or symptoms of electrolyte imbalance (e.g, muscle cramps or pain, weakness, dizziness) occurs.
• Pink-red, red-violet or red-brown. discoloration of alkaline urine may occur with cascara sagrada, phenolphthalein or senna.
• Some of these products may contain the dye tartrazine (FD&C Yellow No.5) which can cause allergic reactions in certain individuals. Check package label when available or consult your doctor or pharmacist.
• Prevention of constipation includes: Adequate fluid intake (4 to 6 glasses of water daily), proper dietary habits including sufficient bulk or rough age, responding to the urge to defecate and daily exercise.
• Store at room temperature.