The Most Common Heart Disease Drugs

Brand Names: Norvasc
It is one of The Most Common Heart Disease Drugs
Therapeutic Category: calcium channel blocker
Dosage Forms: oral tablet
Use: Heart Disease Drugs
Labeled Indications: Chronic stable angina/ Hypertension/ Stable coronary artery disease with ongoing ischemic symptoms/ Vasospastic angina
Off-Label Indications: Raynaud phenomenon
Dosing:
Dosing Adult Oral: Initial: 2.5 to 5 mg once daily; titrate every 1 to 2 weeks as needed based on patient response; maximum: 10 mg/day
Geriatric: Elderly patients show decreased clearance of amlodipine.
Oral: Initial: 2.5 mg once daily
Pediatric: Oral: 2.5 to 5 mg once daily
Dose Adjustments
Renal Impairment: No dosage adjustment
Hepatic Impairment: Oral: Initial: 2.5 mg once daily; titrate slowly in patients with severe hepatic impairment.
Adverse Drug Interaction:
Peripheral oedema/ Pulmonary oedema
Pharmacodynamics/Kinetics:
Onset of action: 24 to 48 hours
Time to peak: Oral: 6 to 12 hours
Metabolism: Hepatic
Half-life elimination: 30 to 50 hours
Important Notes:
Symptomatic hypotension can occur
The most common side effect is peripheral oedema, which occurs within 2 to 3 weeks of starting therapy.
Use amlodipine with extreme caution in patients with severe aortic stenosis; it may reduce coronary perfusion resulting in ischemia.
Pregnancy & Lactation: Risk Factor C/ Present in breast milk
Drug safety issue:

AmLODIPine may be confused with aMILoride.

Norvasc may be confused with Navane, Norvir, or Vascor.

ِAtenolol

Brand Names: Tenormin
It is one of The Most Common Heart Disease Drugs
Therapeutic Category: Beta-Blocker
Dosage Forms: oral (Capsule/ tablet)/ IV solution
Use: Heart Disease Drugs
Labeled Indications: Acute myocardial infarction/ Angina pectoris caused by coronary atherosclerosis/ Hypertension
Off-Label Indications: Atrial fibrillation / Ventricular arrhythmias
Dosing:
Dosing Adult Initial: 50 mg once daily; may increase to 100 mg once daily. Some patients may require 200 mg once daily.
Geriatric: Refer to adult dosing
Pediatric: Hypertension: Oral: Children and Adolescents: Initial: 0.5 to 1 mg/kg/dose either once daily or divided into doses twice daily
Dose Adjustments
Renal Impairment: CrCl 15 to 35 mL/minute/1.73 m2: Maximum dose: 50 mg daily
CrCl <15 mL/minute/1.73 m2: Maximum dose: 25 mg daily
Hepatic Impairment: No dosage adjustments
Adverse Drug Interaction:
Hypotension/ cardiac failure/ Fatigue/ depression
Pharmacodynamics/Kinetics:
Onset of action: Oral: ≤1 hour
Time to peak: Oral: 2 to 4 hours
Metabolism: Limited hepatic
Half-life elimination: 6 to 7 hours, prolonged with renal impairment
Important Notes:
Following abrupt discontinuation of therapy with beta-blockers, exacerbations of angina pectoris and myocardial infarction (MI) have occurred
When discontinuing long-term administration, gradually reduce the dose over 1 to 2 weeks, monitor the patient, and advise the patient to limit physical activity to a minimum.
Pregnancy & Lactation: Risk Factor D/ Present in breast milk
Drug safety issue:

Atenolol may be confused with albuterol, Altenol, timolol, Tylenol

Tenormin may be confused with Imuran, Norpramin, thiamine, TrovanMetoprolol succinate may be confused with metoprolol tartrate

Benazepril

Brand Names: Lotensin
It is one of The Most Common Heart Disease Drugs
Therapeutic Category: Angiotensin-Converting Enzyme (ACE) Inhibitor
Dosage Forms: oral (Tablet)
Use: Heart Disease Drugs
Labeled Indications: Hypertension
Off-Label Indications: Heart failure/ Stable coronary artery disease
Dosing:
Dosing Adult: Oral: Initial: 5 to 10 mg once daily; titrate as needed based on patient response up to 40 mg daily in 1 or 2 divided doses
Geriatric: Consider lower initial doses
Pediatric : Children ≥6 years and Adolescents: Oral: Initial: 0.2 mg/kg once daily, maintenance: 0.1 to 0.6 mg/kg once daily
Dose Adjustments
Renal Impairment. CrCl <30 mL/minute Initial: 5 mg once daily; maximum dose: 40 mg/day
Hepatic Impairment: No dosage adjustments
Adverse Drug Interaction:
Hypotension/ Headache/ dizziness
Pharmacodynamics/Kinetics:
Onset of action: 1-2 hours
Metabolism: hepatic to its active metabolite, benazeprilat
Half-life elimination: Benazeprilat: Effective: 10 to 11 hours
Time to peak, serum: Parent drug: 0.5 to 1 hour
Active metabolite (benazeprilat): 1 to 2 hours
Important Notes:
When pregnancy is detected, discontinue as soon as possible. As it can cause injury and death to the developing fetus
ACE inhibitors may be preferred agents in elderly patients with CHF and diabetes mellitus.
Pregnancy & Lactation: Risk Factor D/ present in breast milk
Drug safety issue:

Benazepril may be confused with Benadryl.

Lotensin may be confused with Lioresal, lorcaserin, and lovastatin.

Carvedilol

Brand Names: Coreg/ Carvid
Therapeutic Category: Beta-Blocker With Alpha-Blocking Activity
Dosage Forms: oral (Capsule/ tablet)
Use: Heart Disease Drugs
Labeled Indications: Heart failure with reduced ejection fraction (HFrEF)/ Hypertension/ Left ventricular dysfunction following MI
Off-Label Indications: Acute MI/ Atrial fibrillation/ Chronic stable angina/ Ventricular arrhythmias
Dosing:
Dosing Adult: hypertension: initial: 6.25 mg twice daily; titrate dose every 1 to 2 weeks as needed based on patient response up to a maximum of 25 mg twice daily
HFrEF: 3.125 mg twice daily for two weeks; if this dose is tolerated, may increase to 6.25 mg twice daily
Geriatric: Refer to adult dosing
Dose Adjustments
Renal Impairment: No dosage adjustment
Hepatic Impairment: Severe impairment: Use is contraindicated.
Adverse Drug Interaction:
Hypotension/ orthostatic hypotension / Fatigue/ dizziness
Pharmacodynamics/Kinetics:
Onset of action: Alpha-blockade: Within 30 minutes; Beta-blockade: Within 1 hour
Time to peak: 1 to 2 hours
Metabolism: Hepatic
Half-life elimination: 7 to 10 hours
Important Notes:
Should be taken with food to minimise the risk of orthostatic hypotension
Treatment of anaphylaxis (e.g., epinephrine) in patients taking beta-blockers may be ineffective or promote undesirable effects.
Pregnancy & Lactation: Risk Factor c/ Present in breast milk
Drug safety issue:

Carvedilol may be confused with atenolol, captopril, carbidopa, carteolol

Coreg may be confused with Corgard, Cortef, Cozaar

Chlorthalidone

Brand Names: Apo-Chlorthalidone
Therapeutic Category: Diuretic
Dosage Forms: oral (tablet)
Labeled Indications: Edema/ Hypertension
Off-label indication: Calcium nephrolithiasis
Dosing:
Edema: Oral: Initial: 50 to 100 mg once daily or 100 mg on alternate days; maximum: 200 mg/day
Hypertension: Oral: Initial: 12.5 to 25 mg once daily; titrate as needed based on patient response to 50 mg once daily
Renal Impairment: no dosage adjustments
Hepatic Impairment: no dosage adjustments
Adverse Drug Interaction:
Orthostatic hypotension, vasculitis, Dizziness, headache

Pharmacodynamics/Kinetics:

Onset of action: 2.6 hours
Peak effect: 2 to 6 hours
Half-life elimination: Single dose: 40 hours
Metabolism: Hepatic
Important Notes:
Hypokalemia, hypochloremic alkalosis, hypomagnesemia, and hyponatremia may occur.
Hypersensitivity reactions may occur. The risk increases in patients with a history of allergy or bronchial asthma.
Pregnancy & Lactation: Risk Factor B/ present in breast milk

Clonidine

Brand Names: Catapres/ Kapvay
It is one of The Most Common Heart Disease Drugs
Therapeutic Category: Alpha2-Adrenergic Agonist
Dosage Forms: Solution, Epidural/ Tablet( Oral, Extended release)
Use: Heart Disease Drugs
Labeled Indications: Attention-deficit hyperactivity disorder (ADHD) (extended-release tablet)/ Hypertension (immediate-release tablet) / Pain management (epidural)
Off-Label Indications: Clozapine-induced sialorrhea/ Conduct disorder with or without (ADHD)
Dosing:
Dosing Adult: Initial dose: 0.1 mg twice daily; maximum amount: 2.4 mg/day
Pediatric : hypertension: Children ≥12 years: Immediate release: Initial: 0.2 mg/day in 2 divided doses , maximum: 2.4 mg/day
ADHD: Children ≤45 kg: Initial: 0.05 mg at bedtime; sequentially increase every 3 to 7 days by 0.05 mg increments twice daily, maximum daily dose: 0.2 mg/day
When discontinuing therapy, taper gradually over 1 to 2 weeks.
Dose Adjustments
Renal Impairment: Dosage adjustment according to the degree of renal impairment
Hepatic Impairment: No dosage adjustments
Adverse Drug Interaction:
Drowsiness/ headache/ fatigue/ dizziness
Pharmacodynamics/Kinetics:
Onset of action: Antihypertensive effect: Oral: Immediate release: 0.5 to 1 hour/ ADHD: Oral: Extended-release (Kapvay): Onset of action: 1 to 2 weeks
Half-life elimination: Adults:12 to 16 hours
Time to peak, serum: Oral: Immediate release: 1 to 3 hours; Extended-release (Kapvay): 7 to 8 hours
Important Notes:
Epidural clonidine is not recommended for obstetrical, postpartum, or perioperative pain management because of The risk of hemodynamic instability, especially hypotension and bradycardia.
Pregnancy & Lactation: Risk Factor c/ present in breast milk
Drug safety issue:

CloNIDine may be confused with Clomid, clomiPHENE, clonazePAM, cloZAPine, KlonoPIN, and quiNIDine.

Catapres may be confused with Cataflam, Combipres

Diltiazem

Brand Names: Diltiazem
It is one of The Most Common Heart Disease Drugs
Therapeutic Category: calcium channel blocker
Dosage Forms: oral (tablet/capsule)/ solution IV
Use: Heart Disease Drugs
Labeled Indications: Management of hypertension/ management of chronic stable angina
Off-Label Indications: Anal fissures/ Atrial fibrillation/ Hypertrophic cardiomyopathy/ Raynaud phenomenon
Dosing:
Dosing Adult : Initial: 60 to 120 mg twice daily; dose adjustment may be made after 14 days; usual dose range: 120 to 180 mg twice daily
Geriatric: Refer to adult dosing
Pediatric: Oral: Initial: 1.5 to 2 mg/kg/day in 3 to 4 divided doses
Dose Adjustments
Renal Impairment: No dosage adjustment
Hepatic Impairment: no dosage adjustments.
Adverse Drug Interaction:
Edema/ Headache/ Dizziness
Pharmacodynamics/Kinetics:
Onset of action: 30 to 60 minutes
Bioavailability: Oral: 40%
Metabolism: Hepatic
Half-life elimination: 3 to 4.5 hours
Time to peak: 2 to 4 hours
Important Notes:
May cause first-, second-, and third-degree AV block or sinus bradycardia
Transient dermatologic reactions have been observed with the use
Pregnancy & Lactation: Risk Factor C/ Present in breast milk
Drug safety issue:

Cardizem may be confused with Cardene, Cardene SR, Cardizem CD, Cardizem SR, and cortisone.

Cartia XT may be confused with Procardia XL.

DilTIAZem may be confused with Calan, diazePAM, Dilantin

Tiazac may be confused with Tigan, Tiazac XC [CAN], Ziac

Doxazosin

Brand Names: Cardura
It is one of The Most Common Heart Disease Drugs
Therapeutic Category: Alpha 1 Blocker
Dosage Forms: oral (tablet)
Use: Heart Disease Drugs
Labeled Indications: Benign prostatic hyperplasia/ Hypertension
Off-Label Indications: Pediatric hypertension/ Ureteral calculi
Dosing:
Dosing Adult : Initial: 1 mg once daily; may titrate (by doubling the daily dose [e.g., to 2 mg, then 4 mg, then 8 mg]) at 1- to 2-week intervals up to 8 mg once daily
Geriatric: In the management of hypertension, consider a lower initial dose
Pediatric: Initial: 1 mg once daily; maximum: 4 mg/day
Dose Adjustments
Renal Impairment: No dosage adjustment
Hepatic Impairment: Severe impairment: Use is not recommended.
Adverse Drug Interaction:
Dizziness /malaise /fatigue / headache
Pharmacodynamics/Kinetics:
Time to peak, serum: 2 to 3 hours
Metabolism: Hepatic
Half-life elimination: 22 hours
Time to peak: 2 to 3 hours
Important Notes:
May cause CNS depression, which may impair physical or mental abilities
Intraoperative floppy iris syndrome has been observed in cataract surgery patients who were on or were previously treated with alpha1-blockers
Pregnancy & Lactation: Doxazosin crosses the placenta / Present in breast milk
Drug safety issue:

Doxazosin may be confused with doxapram, doxepin, DOXOrubicin

Cardura may be confused with Cardene, Cordarone, Cordran, Coumadin, K-Dur, Ridaura

Enalapril

Brand Names: Vasotec
It is one of The Most Common Heart Disease Drugs
Therapeutic Category: Angiotensin-Converting Enzyme (ACE) Inhibitor
Dosage Forms: oral (Tablet/ solution)
Use: Heart Disease Drugs
Labeled Indications: Asymptomatic left ventricular dysfunction/Heart Failure/ Hypertension
Off-Label Indications: Non–ST-elevation acute coronary syndrome/ Stable coronary artery disease
Dosing:
Dosing Adult and geriatric: Heart failure: Oral: Initial: 2.5 mg twice daily (maximum: 40 mg/day); titrate slowly at 1- to 2-week intervals. Target dose: 10 to 20 mg twice daily
Hypertension: Oral: Initial: 5 mg once daily; titrate at 1- to 2-week intervals up to 40 mg daily in 1 or 2 divided doses
Pediatric : hypertension: Oral: Initial: 0.08 mg/kg once daily
Dose Adjustments
Renal Impairment: CrCl ≤30 mL/minute: Initial: 2.5 mg once daily; titrate upward (maximum: 40 mg/day)
Hepatic Impairment: No dosage adjustments
Adverse Drug Interaction:
Increased serum creatinine/ Hypotension/ Dizziness
Pharmacodynamics/Kinetics:
Onset of action: 1 hour
Peak effect: 4 to 6 hours
Duration: 12 to 24 hours
Half-life elimination: Enalapril :Adults: Healthy: 2 hours; CHF: 3.4 to 5.8 hours

Enalaprilat: adults: 35 hours

Time to peak, serum: Oral: Enalapril: 0.5 to 1.5 hours, Enalaprilat (active metabolite): 3 to 4.5 hours
Important Notes:
When pregnancy is detected, discontinue as soon as possible. As it can cause injury and death to the developing fetus
ACE inhibitors may be preferred agents in elderly patients with CHF and diabetes mellitus.
Pregnancy & Lactation: Risk Factor D/ present in breast milk
Drug safety issue:

Enalapril may be confused with Anafranil, Elavil, Eldepryl, or ramipril.

Furosemide

Brand Names: Lasix
It is one of The Most Common Heart Disease Drugs
Therapeutic Category: Diuretic
Dosage Forms: oral (tablet/ solution)/ Injection
Labeled Indications: Management of oedema associated with heart failure/ Hypertension
Dosing:
Oral: Initial: 20 to 80 mg/dose; if the response is not adequate, may repeat the same dose or increase dose in increments of 20 to 40 mg/dose at intervals of 6 to 8 hours
Heart failure: Initial: 20 to 40 mg once or twice daily; maximum 600 mg/day
IM, IV: Initial: 20 to 40 mg/dose
Hypertension: Usual dosage range: 20 to 80 mg/day in 2 divided doses
Renal Impairment: Acute renal failure: Doses up to 1 to 3 g daily may be necessary to initiate the desired response
Hepatic Impairment: Monitor effects, particularly with high doses.
Adverse Drug Interaction:
orthostatic hypotension/ Dizziness/ headache/ Abdominal cramps
Pharmacodynamics/Kinetics:
Onset of action: Oral, sublingual (SL): 30 to 60 minutes/ IM: 30 minutes
Bioavailability: Oral tablet: 47% to 64%
Peak effect: Oral/ IV: 0.5 hours
Half-life elimination: Normal renal function: 0.5 to 2 hours
Important Notes:
Furosemide is a potent diuretic that, if given excessively, can lead to a profound diuresis with water and electrolyte depletion.
Nephrotoxicity: Monitor fluid status and renal function in an attempt to prevent oliguria
Sulfonamide (“sulfa”) allergy: contraindicated in patients with a prior allergic reaction to sulfonamides.
Pregnancy & Lactation: Risk Factor C/ present in breast milk
Drug safety issue:

Furosemide may be confused with famotidine, finasteride, fluconazole, FLUoxetine, fosinopril, loperamide, torsemide

Lasix may be confused with Lanoxin, Lidex, Lomotil, Lovenox, and Luvox.

Hydralazine

Brand Names: Apresoline
Therapeutic Category: Vasodilator
Dosage Forms: oral (tablet)/ Injection (solution)
Use: Heart Disease Drugs
Labeled Indications: Hypertension
Off-Label Indications: Heart failure with reduced ejection fraction (HFrEF)/ Hypertensive emergency in pregnancy or postpartum
Dosing:
Dosing Adult : Oral: Initial: 25 to 50 mg 3 or 4 times daily in combination with isosorbide dinitrate 3 or 4 times daily.
Hypertensive emergency in pregnancy: IM, IV: Initial: 5 or 10 mg; repeat with 5 to 10 mg doses every 20 minutes if blood pressure continues to exceed
Pediatric: Hypertension, chronic: Oral: Initial: 0.75 mg/kg/day in 2 to 4 divided doses
Dose Adjustments
Renal Impairment: No dosage adjustment
Hepatic Impairment: no dosage adjustments.
Adverse Drug Interaction:
Angina pectoris/ Anxiety/ depression/ dizziness
Pharmacodynamics/Kinetics:
Onset of action: IV: 10 to 80 minutes
Bioavailability: Increased with food
Metabolism: Hepatic
Half-life elimination: 3 to 7 hours
Important Notes:
Drug-induced lupus-like syndrome: This may cause a drug-induced lupus-like syndrome, including glomerulonephritis, especially in patients receiving higher doses.
Hydralazine has been associated with peripheral neuritis.
Use is contraindicated in patients with coronary artery disease (CAD)
Pregnancy & Lactation: Risk Factor C/ Present in breast milk
Drug safety issue:

HydrALAZINE may be confused with hydrOXYzine.

Isosorbide Dinitrate

Brand Names: Dilatrate-SR/ Isordil Titradose
Therapeutic Category: Vasodilator
Dosage Forms: oral (tablet/ capsule)
Use: Heart Disease Drugs
Labeled Indications: Prevention of angina pectoris
Off-Label Indications: Achalasia/ Heart failure with a reduced ejection fraction
Dosing:
Dosing Adult: Achalasia (off-label use): Sublingual: Immediate release: 5 mg administered 10 to 15 minutes before meals
Angina pectoris (prevention): Immediate release: Initial: 5 to 20 mg 2 to 3 times daily
Dose Adjustments
Renal Impairment: No dosage adjustment
Hepatic Impairment: no dosage adjustments.
Adverse Drug Interaction:
Hypotension, orthostatic hypotension, Dizziness
Pharmacodynamics/Kinetics:
Onset of action: Sublingual tablet: 2 to 5 minutes
Bioavailability: Highly variable (10% to 90%)
Metabolism: Hepatic
Half-life elimination: Parent drug: 1 hour
Important Notes:
Severe hypotension can occur
Nitrates may precipitate or aggravate increased intracranial pressure and subsequently may worsen clinical outcomes in patients with neurologic injury
Pregnancy & Lactation: Risk Factor C/ Not known if present in breast milk
Drug safety issue:

Isordil may be confused with Inderal, Isuprel, and Plendil.

Lisinopril

Brand Names: Zestril
Therapeutic Category: Angiotensin-Converting Enzyme (ACE) Inhibitor
Dosage Forms: oral (Tablet/ solution)
Use: Heart Disease Drugs
Labeled Indications: Heart failure with reduced ejection fraction(HFrEF /ST-elevation myocardial infarction/ Hypertension
Off-Label Indications: Non–ST-elevation acute coronary syndrome/ Stable coronary artery disease/ Proteinuric chronic kidney disease
Dosing:
Dosing Adult : (HFrEF): Oral: Initial: 2.5 to 5 mg once daily; target dose40 mg once daily
Hypertension: Oral: Initial: 5 to 10 mg once daily
Could be combined with another antihypertensive drug
Pediatric : Children ≥6 years: Oral: Initial: 0.07 to 0.1 mg/kg once daily (maximum initial dose: 5 mg/day); increase dose at 1- to 2-week intervals; maximum: 0.6 mg/kg/day or 40 mg/day
Dose Adjustments
Renal Impairment: (HFrEF): CrCl 10 to 30 mL/minute: Initial: 2.5 mg once daily (maximum: 40 mg/day)
Hypertension: CrCl 10 to 30 mL/minute: Initial: 5 mg once daily (maximum: 40 mg/day)
Hepatic Impairment: No dosage adjustments
Adverse Drug Interaction:
Hypotension/ Dizziness/ Increased serum creatinine
Pharmacodynamics/Kinetics:
Onset of action: 1 hour
Peak effect: 6 hours
Duration: 24 hours
Half-life elimination: 12 hours
Time to peak, serum: 7 hours
Important Notes:
When pregnancy is detected, discontinue as soon as possible. As it can cause injury and death to the developing fetus
ACE inhibitors may be preferred agents in elderly patients with CHF and diabetes mellitus.
Pregnancy & Lactation: Risk Factor D/ present in breast milk
Drug safety issue:

Lisinopril may be confused with fosinopril, Lioresal, Lipitor, RisperDAL

Zestril may be confused with Desyrel, Restoril, Vistaril, Zegerid, Zerit, Zetia, Zostrix, ZyPREXA

Metoprolol

Brand Names: Lopressor/ Betaloc
Therapeutic Category: Beta-Blocker
Dosage Forms: oral (Capsule/ tablet)/ IV solution
Use: Heart Disease Drugs
Labeled Indications: Angina / Heart failure with reduced ejection fraction (HFrEF)/ Hypertension/ Myocardial infarction
Off-Label Indications: Atrial fibrillation / Migraine prophylaxis/ Ventricular arrhythmias
Dosing:
Dosing Adult Oral: Initial: 50 mg twice daily; may increase the dose at weekly intervals to the desired effect, usual dosage range: 50 to 200 mg twice daily, maximum dose: 400 mg/day
Geriatric: Refer to adult dosing
Pediatric: Children ≥1 year of age and Adolescents ≤17 years of age (off-label population): Initial: 0.5 to 1 mg/kg/dose (maximum initial dose: 25 mg/dose) twice daily
Dose Adjustments
Renal Impairment: No dosage adjustments
Hepatic Impairment: No dosage adjustments
Adverse Drug Interaction:
Hypotension, bradycardia, dizziness
Pharmacodynamics/Kinetics:
Onset of action: Within 1 hour
Metabolism: Hepatic
Bioavailability: Oral: 40% to 50%
Half-life elimination: 3 to 4 hours
Important Notes:
Following abrupt discontinuation of therapy with beta-blockers, exacerbations of angina pectoris and myocardial infarction (MI) have occurred
When discontinuing long-term administration, gradually reduce the dose over 1 to 2 weeks and monitor the patient
Pregnancy & Lactation: Risk Factor C/ Present in breast milk
Drug safety issue:

Lopressor may be confused with Lyrica.

Metoprolol may be confused with metaproterenol, metoclopramide, metOLazone, and miSOPROStol.

Metoprolol succinate may be confused with metoprolol tartrate.

Nebivolol

Brand Names: Bystolic
It is one of The Most Common Heart Disease Drugs
Therapeutic Category: Beta-Blocker
Dosage Forms: oral ( tablet)
Use: Heart Disease Drugs
Labeled Indications: Hypertension
Dosing:
Dosing Adult: Hypertension Oral: Initial: 5 mg once daily; titrate as needed at 2-week intervals based on patient response to a maximum dose of 40 mg once daily
Geriatric: Refer to adult dosing
Dose Adjustments
Renal Impairment: CrCl <30 mL/minute: Initial: 2.5 mg once daily; if the initial response is inadequate, it may increase cautiously.
Hepatic Impairment: Severe impairment: Use is contraindicated.
Adverse Drug Interaction:
Headache/ dizziness/ fatigue
Pharmacodynamics/Kinetics:
Bioavailability: 12% (extensive metabolizers); 96% (poor metabolizers)
Time to peak: 1.5 to 4 hours
Metabolism: Hepatic
Half-life elimination: 12 hours (extensive metabolisers) or 19 hours (poor metabolites)
Important Notes:
In general, patients with bronchospastic disease should not receive beta-blockers
Treatment of anaphylaxis (e.g., epinephrine) in patients taking beta-blockers may be ineffective or promote undesirable effects.
Pregnancy & Lactation: Risk Factor C/ not known if is present in breast milk.

Nifedipine

Brand Names: Adalat
It is one of The Most Common Heart Disease Drugs
Therapeutic Category: calcium channel blocker
Dosage Forms: oral (tablet/capsule)
Use: Heart Disease Drugs
Labeled Indications: Angina/ Hypertension
Off-Label Indications: Achalasia/ High altitude pulmonary edema/ Hypertensive emergency in pregnancy/ Preterm labor/ Raynaud phenomenon
Dosing:
Dosing Adult : angina: Initial: 10 mg 3 times daily; usual dose: 10 to 20 mg 3 times daily
Hypertension emergency in pregnancy: Oral: Immediate release: 10 mg; may repeat with a 20 mg dose in 20 minutes if needed.
Geriatric: Refer to adult dosing
Pediatric: 5 mg/kg/dose (maximum: 20 mg/dose) every 8 hours
Dose Adjustments
Renal Impairment: No dosage adjustment
Hepatic Impairment: no dosage adjustments.
Adverse Drug Interaction:
Flushing/ Dizziness/ headache/ Heartburn / nausea
Pharmacodynamics/Kinetics:
Onset of action: 20 minutes
Bioavailability: Capsule: 40% to 77%
Metabolism: Hepatic
Half-life elimination: 2 to 5 hours
Important Notes:
Symptomatic hypotension with or without syncope can rarely occur
Reflex tachycardia may occur, resulting in angina
The most common side effect is peripheral oedema.
Pregnancy & Lactation: Risk Factor C/ Present in breast milk
Drug safety issue:

NIFEdipine may be confused with niCARdipine, niMODipine, nisoldipine

Procardia XL may be confused with Cartia XT.

Nitroglycerin

Brand Names: Nitrostat/ Nitronal
It is one of The Most Common Heart Disease Drugs
Therapeutic Category: Vasodilator
Dosage Forms: oral (tablet/ capsule)/ Aerosol Solution, Translingual/ Ointment/ Transdermal patch/ solution (IV, Translingual)
Use: Heart Disease Drugs
Labeled Indications: Treatment or prevention of angina pectoris/ Treatment of moderate-to-severe pain associated with chronic anal fissure
Off-Label Indications: Esophageal spastic disorders/ Gastroesophageal variceal haemorrhage/ Uterine relaxation
Dosing:
Dosing Adult: Oral: Initial: 2.5 to 6.5 mg 3 to 4 times daily; may titrate up to 26 mg 4 times daily
Topical 2% ointment: 1/2” upon rising and 1/2” 6 hours later; if necessary, the dose may be doubled to 1” and subsequently doubled again to 2” if the response is inadequate
Dose Adjustments
Renal Impairment: No dosage adjustment
Hepatic Impairment: no dosage adjustments.
Adverse Drug Interaction:
Headache/ Hypotension/ Dizziness/ syncope
Pharmacodynamics/Kinetics:
Onset of action: Sublingual tablet: 1 to 3 minutes
Peak effect: Sublingual tablet: 5 minutes
Metabolism: Hepatic
Half-life elimination: 1 to 4 minutes
Important Notes:
Headache: Dose-related headaches may occur, especially during initial dosing.
Hypotension/bradycardia: Severe hypotension and shock may occur (even with small doses)
Increased intracranial pressure: Nitroglycerin may precipitate or aggravate increased intracranial pressure
Pregnancy & Lactation: Risk Factor C/ Not known if present in breast milk
Drug safety issue:

Nitroglycerin may be confused with nitrofurantoin, nitroprusside

Nitro-Bid may be confused with Macrobid

Nitroderm may be confused with NicoDerm

Nitrol may be confused with Nizoral

Nitrostat may be confused with Nilstat, nystatin

Propranolol

Brand Names: Inderal
Therapeutic Category: Beta-Blocker
Dosage Forms: oral (Capsule/solution/tablet)/ IV solution
Use: Heart Disease Drugs
Labeled Indications: Cardiac arrhythmias/ Essential tremor/ Hypertension/ Migraine headache prophylaxis/ Pheochromocytoma/ Stable angina
Off-Label Indications: Performance anxiety/ Supraventricular tachycardia/ Thyroid storm/ antipsychotic-induced Akathisia
Dosing:
Dosing Adult : Initial: 10 mg twice daily or 10 mg 3 times daily; adjust dose based on response and tolerability up to 120 mg/day
Hypertension: 40 mg twice daily/ maximum dose: 640 mg/day
Geriatric: Consider lower initial doses
Pediatric: hypertension:oral: Immediate-release formulations: Initial: 1 to 2 mg/kg/day divided in 2 to 3 doses/day; titrate dose to effect; maximum dose: 4 mg/kg/day up to 640 mg/day
Dose Adjustments
Renal Impairment: No dosage adjustments
Hepatic Impairment: No dosage adjustments
Adverse Drug Interaction:
Cold extremities/ Sleep disorder/ agitation/ fatigue
Pharmacodynamics/Kinetics:
Onset of action: 1-2 hours
Metabolism: hepatically metabolised to active and inactive compounds
Bioavailability: 25% reaches systemic circulation
Half-life elimination: 3 to 6 hours
Time to peak, serum: 1 to 4 hours
Important Notes:
Following abrupt discontinuation of therapy with beta-blockers, exacerbations of angina pectoris and myocardial infarction (MI) have occurred
When discontinuing long-term administration, gradually reduce the dose over 1 to 2 weeks and monitor the patient
Pregnancy & Lactation: Risk Factor C/ Present in breast milk
Drug safety issue:

Propranolol may be confused with prasugrel, Pravachol, Propulsid

Inderal may be confused with Adderall, Enduron, Imdur, Imuran, Inderide, Isordil, Toradol

Ramipril

Brand Names: Altace, Ramipril
It is one of The Most Common Heart Disease Drugs
Therapeutic Category: Angiotensin-Converting Enzyme (ACE) Inhibitor
Dosage Forms: oral (Capsule)
Use: Heart Disease Drugs
Labeled Indications: Heart failure post-myocardial infarction/ Hypertension/ Reduction in risk of MI, stroke, and death from cardiovascular causes
Off-Label Indications: Stable coronary artery disease/ Heart failure with a reduced ejection fraction
Dosing:
Dosing Adult and Geriatric: Heart failure: Initial: 2.5 mg twice daily for one week, then titrate every three weeks upward to a target dose of 5 mg twice daily.
Hypertension:: Initial: 2.5 mg once daily; titrate after 2 to 4 weeks up to 20 mg daily
Dose Adjustments
Renal Impairment:CrCl <40 mL/minute: Administer 25% of normal dose. Hepatic Impairment: No dosage adjustments
Adverse Drug Interaction:
Hypotension/ Increased cough/ Angina pectoris
Pharmacodynamics/Kinetics:
Onset of action: 1-2 hours
Metabolism: Hepatic to the active form, ramiprilat
Bioavailability: Ramipril: 28%; Ramiprilat: 44%
Half-life elimination: Ramiprilat: Effective: 13-17 hours
Time to peak, serum: Ramipril: ~1 hour; Ramiprilat: 2-4 hours
Important Notes:
When pregnancy is detected, discontinue ramipril as soon as possible. As it can cause injury and death to the developing fetus
ACE inhibitors may be preferred agents in elderly patients with CHF and diabetes mellitus.
Pregnancy & Lactation: Risk Factor D/ not detected in breast milk
Drug safety issue:

Ramipril may be confused with enalapril, Monopril, Amaryl

Altace may be confused with Altace HCT, alteplase, Amaryl, Amerge, Artane

Spironolactone

Brand Names: Aldactone
It is one of The Most Common Heart Disease Drugs
Therapeutic Category: Diuretic
Dosage Forms: oral (tablet/ suspension)
Labeled Indications: Management of oedema for cirrhosis of the liver

Heart failure/ Hypertension

Off-label indication: Acne vulgaris (females)/ Hirsutism

Dosing:

Adult: Edema: Tablet: Oral: Initial: 100 mg daily in single or divided doses; dosage range: 25 to 200 mg daily in single or divided doses.

Hypertension: Oral: Initial: Tablet: 25 to 50 mg daily in 1 or 2 divided doses; may titrate every two weeks as needed based on patient response up to 100 mg daily

Renal Impairment: Treating Heart failure: eGFR 30 to 50 mL/minute/1.73 m2: Initial: 25 mg every other day.
Hepatic Impairment: no dosage adjustments
Adverse Drug Interaction:
Gynecomastia/ Vasculitis/ confusion/ dizziness/ drowsiness/ headache
Pharmacodynamics/Kinetics:
Duration: Tablet: 2 to 3 days
Bioavailability: High-fat/calorie meal increased the bioavailability of spironolactone by 90%
Time to peak, serum: Tablet: 2.6 to 4.3 hours
Half-life elimination: Tablet: Spironolactone: 1.4 hours
Important Notes:
Gynecomastia: May occur; risk increases based on dose, and onset is variable (after 1 to 2 months to over a year of therapy); usually reversible following treatment discontinuation.
Hyperkalemia may occur; the risk of hyperkalemia is increased with renal impairment
Pregnancy & Lactation: Risk Factor C/ The active metabolite of spironolactone (canrenone) is present in breast milk.
Drug safety issue:

Aldactone may be confused with Aldactazide.

Terazosin

Brand Names: Hytrin
It is one of The Most Common Heart diseases Drugs
Therapeutic Category: Alpha 1 Blocker
Dosage Forms: oral (Capsule)
Use: Heart Disease Drugs
Labeled Indications: Benign prostatic hyperplasia/ Hypertension
Off-Label Indications: Pediatric hypertension/ Ureteral calculi
Dosing:
Dosing Adult : Oral: Initial: 1 mg at bedtime; most patients require 10 mg once daily; if no response after 4 to 6 weeks of 10 mg/day, may increase to 20 mg/day
Geriatric: In the management of hypertension, consider a lower initial dose
Pediatric: Initial: 1 mg once daily, typically administered at bedtime; slowly increase the dose to achieve desired blood pressure as tolerated; maximum daily dose: 20 mg/day
Dose Adjustments
Renal Impairment: No dosage adjustment
Hepatic Impairment: Severe impairment: Use is not recommended.
Adverse Drug Interaction:
Dizziness /myasthenia /Peripheral oedema / orthostatic hypotension
Pharmacodynamics/Kinetics:
Onset of action: 15 minutes
Time to peak, serum: 2 to 3 hours
Metabolism: Hepatic
Half-life elimination: 12 hours
Time to peak: 1 hour
Important Notes:
May cause CNS depression, which may impair physical or mental abilities
Intraoperative floppy iris syndrome has been observed in cataract surgery patients who were on or were previously treated with alpha1-blockers
Inappropriate medication in patients 65 years and older due to its high risk of orthostatic hypotension.
Pregnancy & Lactation: Risk factor C / not known if present in breast milk

The Most Common Heart Disease Drugs

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