Nitroxel

Essential HTN. Stable mild & moderate chronic heart failure in addition to standard therapies in elderly ≥70 yr.

HTN Adult 5 mg daily preferably at the same time of the day, alone or concomitantly w/ other antihypertensives eg, hydrochlorothiazide 12.5-25 mg. Elderly >65 yr & renal impairment Initially 2.5 mg daily, may be increased to 5 mg daily. Chronic heart failure Initially 1.25 mg once daily, up-titrated at 1-2 wkly intervals based on tolerability to 2.5 mg once daily, 5 mg once daily & 10 mg once daily. Max: 10 mg once daily.

May be taken with or without food: Take tab w/ some water.

Hypersensitivity. Acute heart failure, cardiogenic shock or episodes of heart failure decompensation requiring IV inotropic therapy; sick sinus syndrome, including SA block; 2nd- & 3rd-degree heart block (w/o pacemaker); history of bronchospasm & bronchial asthma; untreated phaeochromocytoma; metabolic acidosis; bradycardia (heart rate <60 bpm prior to starting therapy); hypotension (systolic BP <90 mmHg); severe peripheral circulatory disturbances. Liver insufficiency or function impairment.

May increase sensitivity to allergens & severity of anaphylactic reactions. Not to be used in patients w/ untreated CHF. Discontinue use gradually in patients w/ ischemic heart disease if necessary replacement therapy should be initiated at the same time. May induce bradycardia. May mask certain symptoms of hypoglycemia; tachycardic symptoms in hyperthyroidism. Patients w/ peripheral circulatory disorders (Raynaud's disease or syndrome or intermittent claudication), 1st-degree heart block, Prinzmetal's angina; COPD; history of psoriasis. Discontinue use at least 24 hr prior to surgery. Regularly monitor during initiation of treatment for chronic heart failure. Not recommended to be stopped abruptly. Concomitant use w/ certain anesth that cause myocardial depression. Minor influence on ability to drive & use machines. Not recommended in patients w/ severe renal insufficiency (serum creatinine >250 mmol/L). Not to be used during pregnancy. Not recommended during lactation. Not to be used in childn & adolescents. Elderly >75 yr.

Headache, dizziness, paresthesia; dyspnea; constipation, nausea, diarrhea; tiredness, edema.

May potentiate effect on AV conduction time & increase -ve inotropic effect w/ class I antiarrhythmics (quinidine, hydroquinidine, cibenzoline, flecainide, disopyramide, lidocaine, mexiletine, propafenone). -ve influence on contractility & AV conduction w/ Ca channel antagonists of verapamil/diltiazem type. May lead to profound hypotension & AV block w/ IV verapamil. May worsen heart failure w/ centrally-acting antihypertensives (clonidine, guanfacine, moxonidine, methyldopa, rilmenidine). Effect on AV conduction time may be potentiated w/ class III antiarrhythmics (amiodarone). May attenuate reflex tachycardia & increase risk of hypotension w/ volatile halogenated anesth. May mask certain symptoms of hypoglycemia (palpitations, tachycardia) w/ insulin & oral antidiabetics. Increased fall in high BP w/ baclofen, amifostine. May increase AV conduction time w/ digitalis glycosides. May increase risk of hypotension w/ Ca antagonists of dihydropyridine type (amlodipine, felodipine, lacidipine, nifedipine, nicardipine, nimodipine, nitrendipine). Hypotensive effect may be enhanced w/ antipsychotics, antidepressants (tricyclics, barbiturates, & phenothiazines). Effect may be counteracted w/ sympathicomimetics. May lead to increased plasma levels w/ CYP2D6 inhibitors eg, especially paroxetine, fluoxetine, thioridazine & quinidine. Increased plasma levels w/ cimetidine. Slightly increased plasma levels w/ nicardipine.

Beta-Blockers

C07AB12 - nebivolol ; Belongs to the class of selective beta-blocking agents. Used in the treatment of cardiovascular diseases.

Rx