Drug Facts

Type of Drug:

Endothelin receptor antagonist; pulmonary artery vasodilator.

How the Bosentan Works:

Endothelin-1 is a hormone that attaches to the blood vessels in the lung and causes them to constrict (narrow). This constriction causes blood pressure in the lungs to increase (pulmonary artery hypertension). Bosentan interferes with the attachment of endothelin-1 and results in a lowering of the elevated blood pressure in the lungs.

Uses of the Bosentan:

For the treatment of pulmonary arterial hypertension in patients with WHO Class III or IV symptoms, to improve exercise ability and decrease the rate of clinical worsening.

Precautions:

Pregnancy: Do not use during pregnancy. The risk of use in a pregnant woman clearly outweighs any possible benefit. Effective contraception must be used in women of child-bearing potential.

Breastfeeding: It is not known if bosentan appears in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness have not been established.

Lab Tests Lab tests will be required during treatment. Tests include liver enzymes, urine or serum pregnancy tests, or hemoglobin level tests.

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 this drug. Drug doses may need to be modified or a different drug prescribed. The following drugs and drug classes interact with this drug:

• Cyclosporine A (eg, Neoral)
• Glyburide (eg, Micronase)
• HMG-CoA reductase inhibitors (eg, lovastatin)
• Hormonal contraceptives (eg, Ortho-Novum)
• Ketoconazole (eg, Nizoral)
• Warfarin (eg,)

Side Effects:

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include: nasal and throat inflammation; flushing; abnormal liver function; swelling; low blood pressure; itching; headache; fatigue; indigestion; anemia; pounding in the chest (palpitations).

Guidelines for Use:

• Read the medication guide provided before starting therapy.
• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose, unless instructed by your doctor.
• May be taken with or without food. Take with food if stomach upset occurs.
• 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.
• Stop taking and notify your doctor immediately if you experience fever, persistent stomach pain, nausea, vomiting, yellowing of the skin or eyes, or unusual lethargy or fatigue.
• Contraceptive measures (birth control) are recommended during treatment to prevent pregnancy. Taking this medicine while pregnant can result in severe birth defects. Contact your doctor immediately if pregnancy is suspected.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature (59° to 86°F).

Type of Drug:

Calcium channel blockers (eg, slow channel blockers, calcium ion antagonists); drugs that inhibit the movement of calcium across the cell membrane of cardiac muscle and vascular smooth muscle.

How the Drug Works:

Calcium is involved in blood vessel and heart muscle contraction, nerve impulse transmission and energy storage, and energy use in the heart. Calcium channel blocking agents dilate arteries of the heart and other arteries, may increase or decrease heart rate, may decrease heart con­traction, slow ability of the heart to contract, and slow the rate at which nerve impulses are conducted through the heart.

Uses:

To treat angina due to coronary artery spasm (Prinzmetal angina) (amlodipine, nifedipine, nifedipine sustained-release, verapamil).

To treat chronic stable (stress-associated) angina in patients who cannot tolerate or are unresponsive to beta-adrenergic blockers or nitrates (amlodipine, bepridil, diltiazem, nicardipine, nifedipine, nifedipine sustained-release, verapamil only).

To treat unstable angina (verapamil only).

To treat arrhythmias (irregular heartbeats) at rest and during stress in association with digitalis (verapamil only).

To treat high blood pressure (amlodipine, diltiazem sustained-release, felodipine, isradipine, nicardipine, nifedipine sustained-release, nisoldipine, verapamil only).

To improve neurological deficiencies caused by spasms following subarachnoid hemorrhage (SAH) (ruptured vessels in the brain). Therapy must begin within 96 hours and continue for 21 days (nimodipine only).

Unlabeled Uses: Occasionally doctors may prescribe diltiazem to treat unstable angina, Raynaud syndrome, and tardive dyskinesia, and to prevent certain types of heart attack.

Isradipine may be useful in the treatment of chronic stable angina. Nicardipine may be useful in the treatment of congestive heart failure and in combination with aminocaproic acid for SAH.

Occasionally doctors may prescribe nifedipine to lower blood pressure in hypertensive emergencies; to prevent or treat migraine head­aches; and to treat primary pulmonary (lung) and pregnancy-associated hypertension, asthma, preterm labor, disorders of the esophagus, certain types of heart disorders, coronary artery disease, congestive heart failure, Raynaud syndrome, biliary and renal colic, and cardiomyopathy.

Nimodipine appears to be beneficial in some patients with common and classic migraine and chronic cluster headache.

Occasionally doctors may prescribe verapamil to prevent migraine headache, cluster headache, and exercise-induced asthma; to treat manic-depressive states, night leg cramps, and hypertrophic cardiomyopathy. Verapamil has also been used for paroxysmal supraventricular tachycardia.

Precautions:

New serious arrhythmias: Bepridil has been associated with the occurrence of new serious arrhythmias. Use should be limited to patients in whom other antianginal drugs have failed.

Pregnancy: There are no adaquate and well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits to the mother outweigh the possible hazards to the fetus.

Breastfeeding: Bepridil, diltiazem, nifedipine, and verapamil appear in breast milk. It is not known if amlodipine, felodipine, isradipine, nicardipine, nimodipine, or nisoldipine appear in breast milk. Decide whether to discontinue nursing or the drug, taking into account the importance of the drug to the mother. Consult your doctor.

Children: Safety and effectiveness have not been eastablished in children.

Elderly: Felodipine , nifedipine, and verapamil may result in greater lowering of blooding pressure than younger patients.

Lab Tests: Lab tests may be required periodically during treatment. Tests may include electrocardiograms, serum potassium levels, liver and kidney function tests, blood pressure, and blood and platelet counts.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over the-counter or prescription medications or dietary supplements with calcium channel blocking agents. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed.The following drugs and drug classes interact with calcium channel blocking agents:

• Alcohol (verapamil only)
• Anesthetics antiarrhythmics (eg, flecainide) (verapamil only)
• Antihistamines, nonsedating (eg, loratadine) (bepridil only)
• Antihypertensives (eg, diuretics) (verapamil only)
• Azole antifungals (eg, ketoconazole, itraconazole) (felodipine, nisoldipine only)
• Barbiturates (eg, phenobarbital) (felodipine, nifedipine only)
• Benzodiapines (eg, midazolam) (diltiazem only)
• Beta-blockers (eg, propranolol) calcium salts (verapamil only)
• Carbamazepine (eg, Tegretol) (diltiazem, felodipine, verapamil only)
• Cardiac glycosides (eg, digoxin) (bepridil only)
• Cimetidine (eg, Tagamet)
• Cyclosporine (eg, Neoral) (diltiazem, nicardipine, verapamil only)
• Digoxin (eg, Lanoxin)
• Diltiazem (eg, Cardizem) (nifedipine only)
• Encainide (Enkaid) (diltiazem only)
• Erythromycin (eg, E-Mycin) (felodipine only)
• Fentanyl (eg, Duragesic)
• Grapefruit juice (felodipine, nifedipine, nisoldipine only)
• HMG-CoA reductase inhibitors (eg, lovastatin) (diltiazem, verapamil only)
• Lithium (eg, Eskalith) (verapamil only)
• Euromuscular blockers (eg, atracurium) (verapamil only)
• Nifedipine (eg, Procardia) (diltiazem only)
• Nondepolarizing muscle relaxants (eg, pancuronium) (verapamil only)
• Phenytoin (eg, Dilantin) (felodipine, nisoldipine only)
• Prazosin (eg, Minipress) (verapamil only)
• Primidone (eg, Mysoline) (nifedipine only)
• Procainamide (eg, pronesty) (bepridil only)
• Quinidine (eg, Quinora) (bepridil, nisoldipine, verapamil only)
• Rifampin (eg, Rifadin) (diltiazem, isradipine, nifedipine, verapamil only)
• Tacrolimus (Prograf) (diltiazem only)
• Theophyllines (eg, aminophylline)(diltiazem, verapamil only)
• Tricyclic antidepressants (eg, amitriptyline)(bepridil only)

Side Effects:

Every drug is capable of producing side effects. Many calcium channels blocking agent users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Nervous System: Headache; dizziness; giddiness (felodipine only); light­headedness; fainting; weakness; fatigue; nervousness; anxiety; tremor; general body discomfort; impaired movement; excessive movement (nicardipine only); confusion; irritability; drowsiness; sleep disturbances; difficulty sleeping; abnormal dreams; psychiatric disturbances (eg, depression, amnesia, paranoia, psychosis).

Digestive Tract: Nausea; vomiting; diarrhea; constipation; gas; stomach pain or cramps; indigestion; changes in taste perception; dry mouth; swollen gums (felodipine only); appetite changes (bepridil only).

Respiratory System: Congestion; runny nose; sinus infection; cough; short­ness of breath; wheezing; sore throat; sneezing; bronchitis; fluid retention in lungs.

Circulatory System: Fluid retention; low blood pressure; high blood pressure; anemia; pounding in the chest; chest pain; decreased heart rate; increased heart rate; abnormal heart rhythm; abnormal electrocardiogram readings; myocardial infarction; AV block; congestive heart failure.

Skin: Rash; skin irritation; flushing; sweating; acne (nimodipine only); itching; hives; abnormal skin sensations (eg, burning, prickling, tingling); hair loss.

Other: Fever; chills; flulike symptoms; muscle cramps or pain; joint stiff­ness or pain; back pain (felodipine only); weight loss; weight gain; nose­bleed; ringing in ears; pain; blurred vision; difficult urination; painful urination; frequent urination; sexual difficulties; infection (nicardipine only).

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not change the dose or stop taking this medicine unless advised to do so by your doctor. Abrupt withdrawal may result in increased angina attacks.
• All of the products listed are calcium channel blockers; however, they are not interchangeable. For example, diltiazem cannot be used for nimodipine.
• Extended- or sustained-release - Swallow whole; do not chew, crush, or divide. An empty tablet may appear in stool; this is no cause for concern.
• Amlodipine, felodipine, isradipine, nicardipine - May be taken with or without food. Do not take felodipine with grapefruit juice.
• Verapamil- Verapamil extended-release is usually taken at bedtime with or without food. Take verapamil sustained-release with food in the morning. If heart failure is not severe or rate-related, use digitalis and diuretics before verapamil.

• Oiltiazem sustained-release - The usual dose is taken in the morning on an empty stomach.
• Bepridil- If stomach upset occurs, take with meals or at bedtime. Notify any doctor who treats that you are taking bepridil, as well as any other medications you may be taking. Bepridil use has been associated with the occurrence of new arrhythmias. Use should be limited to patients in whom other anti anginal drugs have failed.
• Nimodipine - Take preferably less than 1 hour before or 2 hours after meals. Therapy to improve neurological deficiencies caused by spasms following SAH must begin within 96 hours and continue for 21 days. If capsule cannot be swallowed (eg, time of surgery, unconsciousness), a hole can be made in both ends of the capsule with an 18 gauge needle, and the contents extracted into a syringe for oral administration.
• Nisoldipine - Do not take with grapefruit juice or with high-fat meals.
• Adalat CC - Take once daily on an empty stomach.
• Felodipine - May cause swollen or bleeding gums. Good dental hygiene decreases incidence and severity of this condition.
• Calcium channel blockers may interfere with normal blood-clotting mechanisms. Contact your doctor if unusual bleeding or bruising of the skin occurs.
• Low blood pressure may occur, but is usually well tolerated. It is more likely to occur in patients who are also taking beta-blockers (eg, propranolol).
• Beta-blockers should be tapered slowly rather than stopped abruptly before starting nicardipine or nifedipine therapy. When starting nicardipine therapy, taper beta-blockers over 8 to 10 days with coadministration.
• Maintain use of potassium supplementation or potassium-sparing diuretics.
• 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 advised to do so 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.
• Notify your doctor if you experience irregular heartbeat, increased frequency or severity of angina, shortness of breath, swelling of hands and feet, dizziness, constipation, nausea, or low blood pressure (eg, light­headedness).
• Notify your doctor if you experience symptoms of an allergic reaction (eg, itching, rash, hives, difficulty breathing).
• Inform your doctor if you are pregnant, become pregnant, plan on becoming pregnant, or are breastfeeding.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at controlled room temperature (59 to 77 F) in a tightly sealed container. Keep away from light and moisture. Protect nimodipine from freezing.

Type of Drug:

Diuretics (water pills); antiglaucoma agents.

How the Drug Works:

Carbonic anhydrase inhibitors block the activity of the enzyme carbonic anhydrase. This reduces the rate of fluid formation in the inner eye, resulting in reduced pressure within the eye. These drugs also cause Increased amounts of electrolytes (sodium, potassium, bicarbonate) and water to be excreted by the kidneys (diuretic effect) and slows abnormal nerve conduction in the brain (anticonvulsant effect).

Uses:

To treat chronic simple (open-angle) glaucoma and secondary glaucoma, and to lower intraocular pressure preoperatively for acute closed-angle glaucoma.

Acetazola.mide - To prevent mountain sickness in climbers who are attempting to climb rapidly and in climbers who climb gradually, but, who are prone to developing mountain sickness. Also used to treat flUid accumulation and swelling due to congestive heart failure or drugs and to treat some forms of epilepsy (eg, petit mal seizures).

Precautions:

Large doses: Taking larger than recommended doses does not increase the diuretic (water pill) activity of the drug. However, it will increase the risk of side effects.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if potential benefits to the mother out weight potential risks to the fetus.

Breastfeeding: Acetazolamide may appear in breast milk. It is not known if all carbonic anhydrase inhibitors appear in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness in children have not been established.

Lab Tests: Lab tests may be required during treatment. Tests may include electrolyte levels (eg, potassium) and blood counts.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or doetary supplements with carbonic anhydrase inhibitors. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs interact with carbonic anhydrase inhibitors.

• Cyclosporine (eg, Sandimmune)
• Salicylates (eg. Aspirin, Arthropan, Doan’s Tusal)
• Salsalate (eg, Disalcid)
• Steroid therapy (eg, prednisone)

Side Effects:

Every drug is capable of producing side effects. Many carbonic anhydrase inhibitor users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Appetite loss; nausea; vomiting; diarrhea; sore throat; taste changes.

Nervous System: Drowsiness; confusion; ringing in the ears; impaired coordination; headache; tingling in the hands or feet.

Skin: Rash; itching; unusual bleeding or bruising; sensitivity to light; red or purple spots under the skin.

Urinary and Reproductive Tract: Flank or loin pain; excessive urination; crystals in urine; kidney stones.

Other: Fever; weight loss; nearsightedness when decreasing or discontinuing the drug; abnormal blood counts; hearing dysfunction; severe allergic reaction.

Guidelines for Use:

• If stomach upset occurs, take with food .
• Drink plenty of water and other fluids.
• May cause drowsiness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Notify your doctor if sore throat, fever, unusual bleeding or bruising, tingling or tremors in the hands or feet, flank or loin pain, or skin rash occurs.
• May cause sensitivity to sunlight. Avoid prolonged exposure to the sun or ultraviolet (UV) light (eg, tanning beds).
• Store tablets, capsules, and injection at room temperature (59 0 to 86°F).

 

Acetazolamide:

• Tablets can be crushed and mixed with sweet foods to mask bitter taste.
• Do not crush or chew sustained release capsules. Capsules can be opened and contents sprinkled on food, if necessary.
• Acute Mountain Sickness - Dosage is 500 to 1000 mg daily, in divided doses, using tablets or sustained release capsules as appropiate. The higher dose level of 1000 mg is recommended with rapid ascent (eg, rescue or military operations). Dose should be initiated 24 to 48 hours before ascent and continued for 48 hours while at high altitude, or as long as necessary, to control symptoms. Gradual ascent is desirable to avoid acute moutain sickness. If rapid ascent is undertaken and acetazolamide used, prompt descent is still necessary if severe forms of altitude sickness (eg, lung edema or cerebral swelling) occur.
• Congestive Heart Failure - Starting dose is usually 250 to 375 mg once daily (5 mg/kg) in the morning. If the initial response fails, do not increase the dose, but allow the kidney to recover by skipping the medicine for a day.
• Acetazolamide yields the best diuretic results when given on alternate days or given for 2 days alternating with a day of rest.
• Drug-Induced Edema - Recommended dosage is 250 to 375 mg once a day for 1 to 2 days, alternating with a day of rest.
• Epilepsy - Suggested total daily dose is 8 to 30 mg/kg in divided doses. Optimum range appears to be from 375 to 1000 mg daily. When given in combination with other anticonvulsants, starting dose should be 250 mg once daily in addition to existing medicines.
• Glaucoma - Acetazolamide is used as an adjunct to the usual therapy. When using capsules, dosage is 500 mg (1 capsule) 2 times a day, usually given as 1 capsule in the morning and 1 capsule in the evening. Dosage for chronic simple (open-angle) glaucoma ranges from 250 to 1000 mg per 24 hours. Daily doses over 250 mg are usually taken in divided doses. For secondary glaucoma and in preoperative treatment of acute congestive (closed-angle) glaucoma, the preferred dosage is 250 mg every 4 hours.
• Doses larger than 1000 mg per 24 hours do not increase the effect and may increase drowsiness and other side effects.

Methazolamide:

• Effective therapeutic dose varies from 50 to 100 mg 2 to 3 times daily.
• May be used with miotic (eg, Pilocarpine) and osmotic (eg, mannitol) agents.

Dichlorphenamide:

• Usually given in conjunction with topical ocular antiglaucoma agents.
• In acute angle-closure glaucoma, it may be used together with miotic and osmotic agents in an attempt to reduce internal pressure rapidly. If this is not relieved quickly, surgery may be mandatory.
• Dose must be adjusted carefully to each individual.
• A usual initial dose is 100 to 200 mg (2 to 4 tablets), followed by 100 mg (2 tablets) every 12 hours until the desired response has been obtained.
• Recommended maintenance dosage for adults is 25 to 50 mg (V2 to 1 tablet) 1 to 3 times daily.

Type of Drug:

Antihypertensive; blood pressure-lowering agent.

How the Drug Works:

Angiotensin II is a chemical transmitter that combines with chemical receptors in blood vessels and other tissues and causes blood vessels to constrict (narrow) and the kidneys to retain sodium and fluids. Angiotensin II receptor antagonists inhibit the action of angiotensin II and allow the blood vessels to dilate (widen) and the kidneys to eliminate extra sodium and fluids. These actions combine to help lower elevated blood pressure.

Uses:

To lower blood pressure. May be used alone or in combination with other antihypertensive agents.

Precautions:

Irbesartan, losartan: To treat diabetic nephropathy (kidney damage) in patients with type 2 diabetes and hypertension.

Valsartan: To treat heart failure in patients who cannot tolerate angiotensin­converting enzyme (ACE) inhibitors.

Race: Angiotensin II receptor antagonists may not be as effective in black patients.

Pregnancy:

First Trimester When pregnancy is detected, the patient should discontinue use as soon as possible. Use only if clearly needed and the potential benefits outweigh the possible risks to the fetus.

Second and Third Trimesters - Studies have shown a potential adverse effect on the fetus.

Breastfeeding: It is not known if angiotensin II receptor antagonists are excreted in breast milk. Because of the potential for adverse effects, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness of irbesartan in children younger than 6 years of age have not been established. Safety and effectiveness of other agents in children younger than 18 years of age have not been established.

Elderly: Older patients may be more sensitive to the blood pressure-lowering effects of these agents.

Lab Tests: Lab tests may be required to monitor therapy. Tests include blood pressure readings, kidney function tests, liver function tests, and blood tests for electrolytes (eg, potassium).

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over- the-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:

• Digoxin (eg, Lanoxin) (telmisartan only)
• Indomethacin (eg, Indocin) (Iosnrtnn only)
• Potassium-containing salt substitutes
• Potassium-sparing diuretics (eg, spironolactone)
• Potassium supplements (eg, K-Our)

Side Effects:

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Indigestion; diarrhea; nausea; heartburn; stomach pain; vomiting.

Nervous System: Headache; dizziness; fatigue; nervousness; anxiety; sleeplessness; depression.

Respiratory System: Upper respiratory tract infection; cough; nasal congestion; sinus irritation; runny nose; sore throat; bronchitis.

Other: Rapid heartbeat; changes in blood pressure; chest, muscle, back, leg, or joint pain; muscle cramps; viral infection; swelling (fluid retention); trauma; weakness; flu; urinary tract infection; rash; protein in the urine; dizziness when rising from a sitting or lying position (orthostatic hypotension).

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose, unless instucted by your doctor.
• May be taken without regard to food. Take with food if stomach upset occurs.
• Telmisartan - Do not remove tablets from blister pack until just before taking.
• May be taken with other blood pressure-lowering agents prescribed by your doctor.
• Maximum blood pressure-lowering effect is generally attained after 2 to 4 weeks.
• 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.
• May cause dizziness or drowsiness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity until tolerance is determined.
• Dehydration (eg, excess sweating, vomiting, diarrhea) may increase the blood pressure-lowering effect, causing dizziness or fainting. Notify your doctor if dizziness develops.
• A low dose of a diuretic may be added by your doctor if blood pressure is not controlled.
• Inform your doctor immediately if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.
• Lifestyle changes (eg, stop smoking, lose weight, exercise, limit salt in diet) also help to reduce blood pressure.
• Lab tests may be required to monitor therapy. Be sure to keep appointments.
• Store at room temperature (68° to 77° F for eprosartan and olmesartan; 59° to 86°F for other agents) in a tightly closed container. Protect from light and moisture.

Type of Drug:

A drug used for specific types of severe irregular heartbeats.

How the Amiodarone Works:

Amiodarone corrects and prevents the occurrence of various types of irregular heart rhythms that may lead to life-threatening situations.

Uses of The Amiodarone:

To treat certain life-threatening heart rhythm disturbances (eg, recurrent ventricular fibrillation, recurrent hemodynamically unstable ventricular tachycardia) that are not affected by other antiarrhythmics or when other drugs are not tolerated.

Unlabeled Uses: Sometimes used to treat refractory sustained or paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia, and symptomatic atrial flutter. May improve left ventricular ejection fraction, exercise tolerance, and ventricular arrhythmias in patients with congestive heart failure.

Precautions:

Potentially fatal toxicities: Amiodarone has caused pulmonary toxicity (eg, hypersehsitivity pneumonitis or interstitial/alveolar pneumonitis). Overt liver disease has been reported, resulting in a few deaths. Significant heart block or sinus bradycardia has also been reported.

Heart effects: A worsening of heart rhythm irregularities is unusual while under treatment but can occur. Amiodarone can also cause slow heart rates or occasional pauses in the heart rhythm.

Sensitivity to sunlight: Amiodarone has caused sensitivity of the skin to sun­light and to ultraviolet light. During long-term treatment, exposed skin may appear blue-gray. Risk is increased in patients with a bit with a fail complexion and in those with excessive exposure to the sun and wear protective clothing.

Pregnancy: Amiodarone can cause fetal harm when administered to a pregnant woman. There have been some reports of congenital goiter/ hypothyroidism and hyperthyroidism. Use only if clearly needed and potential benefits to the mother outweigh the possible hazards to the fetus.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements with amiodarone. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with amiodarone:

• Antiarrhythmics, other (eg, procainamide)
• Anticoagulants (eg, warfarin)
• Calcium channel blockers (eg, verapamil)
• Cimetidine (eg, Tagamet)
• Cyclosporine (eg, Neoral)
• Digoxin (eg, Lanoxin)
• Disopyramide (eg, Norpace)
• Fentanyl (eg, Sublimaze)
• Flecainide (Tambocor)
• Methotrexate (eg, Rheumatrex)
• Hydantoins (eg, phenytoin)
• Quinidine (eg, Quinora)
• Quinolones (eg, sparfloxacin)
• Ritonavir (Norvir)

Side Effects:

Every drug is capable of producing side effects, Many amiodaro ne users experience no, or minor, side effects, The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. possible side effects include:

Eyes or Ocular: Appearance of halos around lights; sensitivity to light; blurred or spotty vision; dry eyes’, sensitivity to light; permanent blindness; eye discomfort; fluid accumulation at the optic disc; other vision disturbances; eye degeneration; optic nerve disease.

Digestive Tract: Nausea; vomiting; constipation; diarrhea; loss of appetite; stomach pain.

Nervous System: Tremors; twitches; fatigue; loss of coordination; unsteady walking; dizziness; numbness and tingling in hands and feet; difficulty sleeping; headache; general discomfort·, abnormal gait.

Circulatory System: Slowing of heartbeat (rhythm); worsening of irregular heart rhythm; decrease in blood pressure; decrease in blood platelets; coagulation abnormalifies; heart failure; heart block.

Respiratory System: Difficulty breathing (shortness of breath); coughing; abnormal x-ray or biopsy; fibrosis.

Skin: Sensitivity to sunlight; blue-gray skin color; rash; dermatitis; unexplained bruising; hair loss; flushing; abnormal skin sensations (eg, burning, prickling, tingling).

Other: Disturbances in thyroid, respiratory, kidney and liver function (cirrhosis, hepatitis); abnormal taste and smell; edema (fluid retention); abnormal salivation; loss of sex drive; abnormal blood tests.

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not change the dose or stop taking unless advised by your doctor.
• High doses of amiodarone are usually required for the first 1 to 3 weeks of treatment.
• Take with meals, especially if stomach upset Occurs.
• 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 advised 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.
• Inform your doctor if you are pregnant, become pregnant, planning to become pregnant, or are breastfeeding before beginning therapy.
• May cause photosensitivity (sensitivity to sunlight). Use sunscreen and wear protective clothing until tolerance is determined.
• Shortness of breath, coughing and abnormal diagnostic tests (eg, chest x-ray, lung biopsy) can occur. Report changes in breathing or vision, or any coughing to your doctor and have a routine chest x-ray.
• Loss of vision can occur. Inform your doctor if your vision changes or your peripheral vision decreases.
• Store at room temperature (59 0 to 86°F). Keep in a tight container away from light.

Type of Drug:

Beta-blockers; antihypertensives; drugs used to lower high blood pressure; antianginal drugs; antiarrhythmic drugs.

How the Drug Works:

Beta-adrenergic blocking agents interfere with the action of adrenalin and similar chemicals on heart muscle contraction (heart may beat with less force and pump out less blood) and nerve conduction in the heart (heart may beat more slowly and regularly). Beta-adrenergic blocking agents reduce the amount of work the heart has to do (reduces angina chest pain) and the amount of blood the heart pumps out (lowers elevated blood pressure) and stabilize heart rhythm in conditions in which the heart is beating too fast or irregularly (antiarrhythmic effects).

Precautions:

Discontinuing therapy: When discontinuing these medications, slowly reduce the dose over 1 to 2 weeks. Sudden discontinuation of these drugs has caused worsening of angina (chest pain), heart attacks, irregular heartbeats, and death. Other serious withdrawal symptoms include: sweating, palpitations (pounding in the chest), headache, tremulous­ness, discomfort, and allergy to catecholamines. If discontinued suddenly, beta-blockers may mask the signs of hyperthyroidism (overactive thyroid). If thyroid patients stop taking these medications too suddenly, symptoms of hyperthyroidism (eg, a rapid pulse) may occur.

Diabetes: These products can mask some of the signs of hypoglycemia (low blood sugar) such as rapid heart rate and tremors, and alter blood sugar levels. It may be necessary for your doctor to alter your dose of diabetic medications while taking beta-blockers.

Proarrhythmia: Betapace AF can cause or worsen ventricular arrhythmias, a different type of heartbeat that can be dangerous and even cause death. To minimize the risk of this heartbeat, patients should be placed in a medical facility that can provide cardiac resuscitation, continuous ECG monitoring, and calculations of creatinine clearance for a minimum of 3 days when starting or restarting therapy.

Allergic reaction: Patients with a history of allergic reactions to various allergens may be unresponsive to the usual doses of epinephrine used to treat the allergic reaction.

Pregnancy: There are no adequate or well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits to the mother outweigh the possible hazards to the fetus.

Atenolol acebutlolol and sotalol Acebutolol crosses the placenta; reduced birth weight and decreased blood pressure and heart rate have occurred.

Breastfeeding: Acebutolol, atenolol, betaxolol, metoprolol, nadolol, pindolol, propranolol, sotalol, and timolol appear in breast milk. It is not known if carteolol, bisoprolol, or penbutolol appear in breast milk. Discontinue nursing when taking any beta-blockers.

Children: Safety and effectiveness have not been established.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over the-counter or prescription medications or dietary supplements with beta­blockers. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with beta-blockers:

Classes interact with beta-blockers:

• Alltacids (eg, aluminum carbonate)
• Antiarrhythmics (eg, quinidine)
• Antidiabetic drugs, oral (eg, glipizide)
• Calcium channel blockers (eg, verapamil)
• hydantoins (eg, phenytoin)
• hydralazine (eg, Apresoline)
• insulin lidocaine (eg, Xylocaine)
• NSAIDs (eg, ibuprofen)
• penicillins (eg, ampicillin)
• phenothiazines (eg, chlorpromazine)
• Cimetidine (eg, tagamet)
• Clonidine (eg, Catapres)
• Colestipol (eg, Colestid)
• Epinephine (eg, Adrenalin)
• Ergot alkaloids (eg, ergotamine)
• Prazosin (eg, Minipress)
• Propafenone (eg, Rythmol)
• Rifamycins (eg, rifampin)
• Selective serotonin reuptake inhibitors (eg, paroxetine)
• Theophyllines (eg, aminophylline)
• Thioamines (eg, methimazole)

Side Effects:

Every drug is capable of producing side effects. Many beta-blocker users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Nausea; vomiting; stomach pain; gas; bloating; diarrhea; constipation; heartburn; indigestion; stomach cramping; appetite changes; dry mouth; colon or rectal problems.

Nervous System: Depression; anxiety; nervousness; disorientation; confusion; fainting; weakness; dizziness; catatonia; vertigo (feeling of whirling motion); lightheadedness; fatigue; sleeplessness; drowsiness; lethargy; sleep disturbances; nightmares; abnormal, vivid dreams; hallucinations; short-term memory loss; decreased concentration; sedation; headache; emotional lability; mood changes; behavior changes; slurred speech.

Circulatory System: Changes in heart rate; decreased heart rate; irregular heart rate; heart rhythm abnormalities; chest pain; palpitations (pounding in the chest); cold extremities; changes in blood pressure; heart arrest; heart block; congestive heart failure; abnormal ECG; decreased blood platelets; decreased white blood cells; blood clot; vein inflammation; stroke.

Respiratory System: Shortness of breath or difficulty breathing; cough; nasal congestion; wheezing; upper respiratory infection; sinus infection; fluid in the lungs; bronchitis; asthma; bronchospasm; sore or inflamed throat; throat spasms.

Skin: Rash; swelling; flushing or paleness; abnormal skin sensations (eg, burning, prickling, tingling); increased or decreased skin sensitivity to stimulation; itching and irritation; hair loss; sweating; dry skin; numbness of the hands.

Muscular System: Aching or painful joints and muscles; back pain; limb pain; shoulder pain; muscle weakness; muscle cramps or twitching; tremor.

Urinary and Reproductive Tract: Painful urination; inability to urinate; frequent urination; urinary tract infection; excessive urination at night; sexual problems; decreased sex drive; impotence.

Other: Fever; weight changes; changes in blood sugar levels; infection; swelling of arms and legs; general body discomfort; decreased exercise tolerance; gout; cold - or flulike symptoms

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose unless directed by your doctor. Abrupt withrawal has resulted in worsening of angina and ventricular arrhythmias and can cause myocardial infarction and death.
• 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 advised to do so 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.
• Do not chew or crush sustained-release or extended-release products.
• Diabetes - May mask some signs of low blood sugar (eg, rapid heart rate, tremors) or alter blood glucose levels.
• Glaucoma - May reduce intraocular pressure and interfere with the glaucoma screening test.
• Consult your pharmacist or doctor before using dietary supplements or other prescription or nonprescription products including nasal decongestants, diet aids, and nonprescription cold preparations.
• May cause drowsiness, dizziness, lightheadedness, or blurred vision. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Notify your doctor if you experience difficulty breathing (especially on exertion or when lying down), night cough, swelling of the extremities, slow pulse rate, dizziness, light-headedness, fainting, confusion, depression, rash, fever, sore throat, unusual bleeding or bruising, fatigue with exertion, cough, fast heartbeat, severe diarrhea, or unusual bleeding.
• Inform your doctor or dentist of therapy before any type of surgery.
• Inform your doctor if you are pregnant, become pregnant, plan on becoming pregnant, or are breastfeeding.
• Brand interchange - Do not change from one brand of this drug to another without consulting your pharmacist or doctor. For example, Betapace and Betapace AF are not interchangeable.
• Nadolol, pindolol, acebutolol, atenolol, carteolol, bisoprolol, betaxolol, and
• May be taken without regard to meals.
• Metoprolol and propranolol - Take consistently with or without food at the same time each day.
• Propranolollntensol- Mix prescribed dose with liquid or semi-solid food such as water, juices, soda or soda-like beverages, applesauce, or pudding. Use calibrated dropper to measure dose. Administer entire amount of mixture immediately after mixing. Do not store mixture after mixing.
• Sotalol- Food may reduce absorption. Take on an empty stomach.
• Sotalol - To reduce the risk of induced arrhythmias, patients should be placed in a medical facility that can provide cardiac resuscitation, continuous ECG monitoring, and calculations of creatine clearance for a minimum of 3 days when starting or restarting therapy.
• Store at room temperature (59° to 86°F). Avoid excessive heat. Protect from light, moisture, and freezing.