Category: high blood pressure

Holistic Health Pillars

What is Holistic Health? Holistic health practitioners work with clients to achieve specific health goals. This may include improving athletic performance, disease prevention, and the treatment of symptoms. Holistic nutritionists may help implement anti-inflammatory diets. Holistic health practitioners work with both medical professionals and the public to implement a personalized plan of action. Holistic health…

What is Holistic Health? Holistic health practitioners work with clients to achieve specific health goals. This may include improving athletic performance, disease prevention, and the treatment of symptoms. Holistic nutritionists may help implement anti-inflammatory diets. Holistic health practitioners work with both medical professionals and the public to implement a personalized plan of action. Holistic health practitioners are available in many locations, and many practices are affiliated with local hospitals and clinics.

Eight pillars that support holistic health

A balanced diet is a key component of the physical wellness pillar. In addition to eating more fruits and vegetables, you should also be eating a variety of whole grains. Avoid foods with high amounts of sodium, cholesterol, or added sugar. Likewise, you should avoid fried foods. These foods can contribute to high cholesterol levels, which can have negative effects on your overall health. A healthy diet can improve many of the other pillars.

The physical and emotional aspects of health go hand in hand. Holistic health acknowledges the role of mental, spiritual, and social aspects of health. As a result, it takes the whole person into account, focusing on the connections between the body, mind, and environment. Emotional wellness is an important component of holistic health, and it can be cultivated through the eight pillars of holistic health. Listed below are the eight pillars of holistic health.

Physical health: Exercise, diet, sleep habits, hygiene, and personal hygiene are important aspects of physical health. Physical health requires adequate exercise, good rest, and a clean environment. Physical health is just the tip of the iceberg, though. It also requires that you understand your body’s chemistry and how to balance it. Nutrition is an essential part of physical health, and it gets its own pillar. Taking care of your body’s chemistry is important when making dietary and lifestyle decisions.

Cost control

There are two methods of cost control in holistic health care. One is to measure the cost of an entire system and implement changes in management based on results. Cost control in holistic health care is often difficult to achieve because costs vary according to the type of treatment provided. The other method is to identify the cost of an individual patient, and to measure the proportion of that patient who will need further care. Although holistic health care is more expensive than usual medical care, it is cost effective and can reduce mortality.

The first strategy is a health share plan, which requires the members to pay a portion of the cost of their care. These plans are more expensive than traditional medical care, but are often more effective because they treat the whole person and encourage preventative care. This approach also keeps costs low and satisfaction high, leaving more money for major medical events. The most common holistic health care costs are due to chronic illnesses and other conditions. The costs of a health share plan are shared by all members.

Another strategy for cost control in holistic health care is to use health policy commissions. The Maryland commission, for example, has been focusing on the total cost of care and hospital budgets. It has a history, and stakeholders have a vested interest in working with it. In Maryland, a Medicare waiver encourages health care providers to offer services to all payers, such as Medicare and Medicaid. These charges are then offset by increases in commercial rates.

Prevention of disease

The American Holistic Health Association advocates for the prevention of chronic disease. The emphasis on holistic health entails treating the entire person, incorporating the mind, body, and spirit into a health-promoting lifestyle. The most difficult aspects of incorporating holistic practices into the client’s life are often changes to food, which can be hard for clients to accept. However, the benefits of holistic health far outweigh the negative effects.

One of the most significant benefits of preventive medicine is lower healthcare costs. The Centers for Disease Control and Prevention report that the practice of prevention can reduce costs by more than $1 trillion annually. In fact, 90 percent of healthcare expenditures are related to chronic conditions. Preventive care focuses on the prevention of chronic disease by emphasizing long-term health, healthy pregnancy, and aging. Health screenings are an important component of this holistic approach.

The benefits of holistic medicine are numerous. First, holistic doctors focus on the whole person, rather than simply treating the symptoms of an illness. Holistic physicians believe that the mind-body connection is the key to healing. As such, holistic doctors help patients develop an understanding of their entire health profile. By integrating complementary therapies and Western medicine, holistic physicians can treat the whole person and prevent or improve disease symptoms. In addition to reducing disease risk, holistic health also emphasizes a strong doctor-patient relationship.

Medicinal plants

Medicinal plants can be used to treat various illnesses and diseases. Using them can be a natural way to improve your overall health and well-being. Here are some tips for maximizing their benefits. Read on to learn how to use medicinal plants in your daily life. We are going to go over a few examples of the most popular ones and how they can improve your health. Listed below are some of their most important benefits.

Traditional medicines have their place, but plants play a vital role in drug development. Modern scientific techniques have helped verify the ancient knowledge of the healer. These traditional remedies incorporate many aspects of the body, including their chemical composition and their psychological effects. As a result, the study of traditional medicine is helping to discover future drug leads. Medicinal plants are used in many countries and have played a vital role in traditional healthcare systems for thousands of years. Today, about 50% of all drugs that are used in clinical practice are made from natural products.

Besides examining their properties, medicinal plants can also be used for cancer treatment. The research study documented the different plant species used in cancer management among Tswana speakers. The study also provided baseline data for further studies. Future studies will focus on the phytochemical and pharmacological profiles of these plants. The findings of this study have opened the door to further investigation into the effects of these plants on the human body. It also highlights the growing popularity of natural products.

Dietary supplements

The goal of dietary supplements for holistic health is to help people improve their health and well-being by addressing the root causes of the disease. Researchers and practitioners of holistic nutrition know that the body’s chemical processes are continuously occurring. They are affected by synthetic chemicals, which disrupt these processes. They also know that abnormal substances can interfere with decision-making and brain functions. Consequently, these substances may cause long-term damage. Instead of taking synthetic chemicals, holistic nutritionists recommend natural foods and herbal supplements.

A good source for dietary supplements is the Office of Dietary Supplements. This organization helps consumers find information on dietary supplements and answers questions about their efficacy. You can also contact the manufacturers to find out more about the supplement’s ingredients and efficacy. In addition, you can visit the National Center for Complementary and Integrative Health (NCCIH) or Office of Dietary Supplements, which have websites designed to help consumers make informed choices.

Some people have tried using dietary supplements for holistic health. However, their use is not recommended for everyone. These supplements are not meant to diagnose or treat diseases and are not as safe as medicines. However, they are effective in enhancing the current routine of a person. They are not a replacement for good eating habits. A healthy diet and exercise are important factors for holistic health. And you should not neglect your diet and your health if you want to see significant results from dietary supplements.

Alternative medicine

Holistic health is all about using the correct methods to achieve optimal health. Alternative medicine attempts to achieve the same effects as medicine, but is not scientifically proven. It has no biological plausibility and has been proven ineffective. Nonetheless, many people swear by it and use it for a wide variety of conditions. Below are some common examples of complementary and alternative medicine. Read on to learn more about the benefits and limitations of alternative medicine.

A holistic philosophy views the mind, body, and spirit as one. A dysfunction in one area affects the whole person. Complementary medicine is guided by this philosophy. Many Australians seek out alternative medicine after feeling dissatisfied with conventional medical care. They don’t believe in the harsh side effects of conventional drugs. It may be more gentle and safer. In addition, it involves a collaborative approach with both the patient and provider.

The holistic health care provider may prescribe medicines and surgical procedures to treat acute or chronic pain, or recommend exercise to boost the production of endorphins. Regardless of the condition, a holistic health care provider may also ask about your diet and lifestyle, identifying foods that contribute to inflammation and stress. If you suffer from pain, your holistic health care provider may recommend acupuncture or massage therapy, or even mindful meditation to relieve tension and stress.

What Foods Are Good If You Have Low Blood Pressure?

What is low blood pressure?

Foods rich in iron, folic acid, and vitamin B12 can be helpful, if you have low blood pressure. Foods rich in iron, folic acid, and vitamin B12 can be helpful, if you have low blood pressure.

Low blood pressure, also called hypotension, is defined as any level of blood pressure that falls below normal levels. 

Blood pressure is the pressure of your blood as it flows through your arteries. It is measured in millimeters of mercury (mm Hg). 

The lowest blood pressure considered normal is 90/60 mm Hg. The top number is called systolic pressure, which is measured when your heart beats. The second number is called diastolic pressure and is your blood pressure between heartbeats. 

Many older adults live with some amount of hypotension without knowing it. 

Main causes

A number of things can cause low blood pressure. Some people with high blood pressure, or hypertension, can accidentally create low blood pressure while treating their condition. 

Medications and diets intended to treat high blood pressure can sometimes cause low blood pressure as a side effect. 

Low blood pressure can also be caused by: 

Hypotension is often treated through changes to your diet. These will usually try to elevate your salt levels and increase your blood flow. 

Who is at risk for low blood pressure?

Low blood pressure can happen to anyone at any age. There are several factors that can predispose some people to it more than others, including: 

  • Common medications for conditions like diabetes and Parkinson’s disease can cause low blood pressure as a side effect. 
  • Diuretics that reduce the body’s salt levels can cause low blood pressure as a side effect.
  • Some older adults develop postprandial hypotension, a condition in which blood pressure suddenly drops about one or two hours after eating.  

How is low blood pressure diagnosed and treated?

People quite often don’t know they have low blood pressure until their doctor tells them during a routine checkup. Your doctor may advise you at that time to add more salt to your diet. 

If more direct intervention is needed, you could be prescribed medication or even given an intravenous (IV) line to relieve dehydration.

Foods as a treatment for low blood pressure

Lack of nutrition plays a large role in cases of low blood pressure. 

Not getting enough iron, folic acid, and vitamin B12 can prevent your body from making the right amount of blood cells. This can cause anemia and low blood pressure. 

Water

Dehydration is one of the main causes of low blood pressure. Insufficient water levels actually reduce your blood volume. This reduction then lowers your blood pressure levels. 

Doctors recommend people with low blood pressure should drink around 8 cups, about a half-gallon, of water per day. They should also limit their consumption of alcohol. 

Coffee

The caffeine in coffee is a stimulant. This means that it can raise your heart rate and blood pressure levels. Drinking coffee can be helpful in the short-term fix, but it isn’t a permanent solution. Most people develop a tolerance to caffeine over time. 

Beef liver

Beef liver is one of the best sources of vitamin B12. A 100 gram serving of liver contains an incredibly high amount of B12. 

Low levels of vitamin B12 can cause anemia and low blood pressure. 

Eggs

A single egg contains high amounts of folic acid and B12. 

Like vitamin B12, folic acid is an important aid for raising low blood pressure levels. 

Red meat

Red meat is one of the most widely available sources of iron, which is needed for raising blood pressure levels. 

Beef has one of the highest iron contents that you will find in food. 

Although some doctors recommend avoiding red meat, someone with low blood pressure may actually benefit from adding more of it to their diet. 

There are many other foods that will help increase your salt, vitamin B12, folic acid, and iron levels. These include: 

  • Beef
  • Olives
  • Cottage cheese
  • Broccoli 
  • Asparagus
  • Lentils
  • Chickpeas
  • Chicken
  • Fish

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What are the risks of low blood pressure?

While many don’t notice low blood pressure, it can cause some potentially serious problems if left untreated. Blood pressure that drops too low can cause: 

Blood pressure that continues to drop is a medical emergency. Very low blood pressure keeps your vital organs from receiving oxygen and may lead to shock. 

Signs to watch out for are rapid breathing, blue skin tone, and a rapid pulse. Call 911 if you notice any of these. 

What’s the long-term outlook for low blood pressure?

Low blood pressure is manageable with treatment and close observation. 

In addition to medication, your doctor will often recommend diet and lifestyle choices that can keep the condition under control. 

Consensi (amlodipine/celecoxib): Side Effects & Interactions


Generic drug: amlodipine and celecoxib

Brand name: Consensi

What is Consensi (amlodipine and celecoxib), and how does it work?

Consensi (amlodipine and celecoxib) is a prescription medicine used in adults who need treatment:

It is not known if Consensi is safe and effective in children.

What are the side effects of Consensi?

WARNING

RISK OF SERIOUS CARDIOVASCULAR and GASTROINTESTINAL EVENTS

Cardiovascular Thrombotic Events

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of
    serious cardiovascular (CV) thrombotic events, including myocardial
    infarction (MI), and stroke, which can be fatal. This risk may occur early
    in the treatment and may increase with duration of use.
  • Consensi is
    contraindicated in the setting of coronary artery bypass graft (CABG)
    surgery.

Gastrointestinal Bleeding, Ulceration, and Perforation

  • NSAIDs cause an increased risk of serious gastrointestinal (GI) adverse
    events including bleeding, ulceration, and perforation of the stomach or
    intestines, which can be fatal. These events can occur at any time during
    use and without warning symptoms. Elderly patients and patients with a prior
    history of peptic ulcer disease and/or GI bleeding are at greater risk for
    serious GI events.

Consensi can cause serious side effects, including:

Your healthcare provider will monitor your blood pressure and do blood tests to check you for side effects during treatment with Consensi.

Consensi may cause fertility problems in females that is reversible when treatment with Consensi is stopped. Talk to your healthcare provider if this is a concern for you.

The most common side effects of Consensi include:

Get emergency help right away if you get any of the following symptoms:

Stop taking Consensi and call your healthcare provider right away if you get any of the following symptoms:

These are not all the possible side effects of Consensi.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the dosage for Consensi?

Recommended Dosage

  • Use the lowest effective dosage of celecoxib for the shortest duration
    consistent with individual patient treatment goals. Only 200 mg of celecoxib once daily is available with
    Consensi.
  • Start Consensi in adults at (amlodipine/celecoxib) 5 mg/200 mg orally once daily or 2.5 mg/200 mg in small, fragile, or elderly patients, or patients with mild hepatic insufficiency. Use 2.5 mg/200 mg when adding
    Consensi to other antihypertensive therapy.
  • Adjust amlodipine component dosage according to blood pressure goals. In general, wait 7 to 14 days between titration steps. If more rapid titration is clinically warranted, monitor closely. The maximum dose is 10 mg/200 mg once daily.

Discontinuation

  • If analgesic therapy is no longer indicated, discontinue Consensi and initiate patient on alternative antihypertensive therapy, such as amlodipine monotherapy. If
    Consensi is stopped and replaced with an equal dose of amlodipine, monitor blood pressure carefully.

Replacement Therapy

  • For patients receiving celecoxib and amlodipine from separate capsules and tablets, respectively, substitute
    Consensi containing the same component doses. Monitor blood pressure carefully.





QUESTION

Salt and sodium are the same.
See Answer

What drugs interact with Consensi?

Celecoxib

Clinically significant drug interactions with celecoxib are shown in the following table:

Drugs That Interfere with Hemostasis

Clinical Impact:

  • Celecoxib and anticoagulants such as warfarin have a synergistic effect on bleeding. The concomitant use of celecoxib and anticoagulants have an increased risk of serious bleeding compared to the use of either drug alone.
  • Serotonin release by platelets plays an important role in hemostasis. Case-control and cohort epidemiological studies showed that concomitant use of drugs that interfere with serotonin reuptake and an NSAID may potentiate the risk of bleeding more than an NSAID alone.

Intervention:
Monitor patients with concomitant use of celecoxib with
anticoagulants (e.g., warfarin), antiplatelet drugs (e.g., aspirin),
SSRIs, and SNRIs for signs of bleeding.

Aspirin

Clinical Impact:
Controlled clinical studies showed that the concomitant use of
NSAIDs and analgesic doses of aspirin does not produce any greater
therapeutic effect than the use of NSAIDs alone. In a clinical
study, the concomitant use of an NSAID and aspirin was associated
with a significantly increased incidence of GI adverse reactions as
compared to use of the NSAID alone. In two studies in healthy volunteers, and in patients with osteoarthritis and established heart disease respectively, celecoxib (200-400 mg daily) has demonstrated a lack of interference with the cardioprotective antiplatelet effect of aspirin (100-325 mg).

Intervention:
Concomitant use of celecoxib and analgesic doses of aspirin is
not generally recommended because of the increased risk of bleeding. Celecoxib is not a substitute for low dose aspirin for CV protection.

ACE Inhibitors, Angiotensin Receptor Blockers, and Beta-Blockers

Clinical Impact:

  • NSAIDs may diminish the antihypertensive effect of ACE inhibitors, ARBs, orbeta-blockers (including propranolol).
  • In patients who are elderly, volume-depleted (including those on diuretic therapy), or have renal impairment, co-administration of an NSAID with ACE inhibitors or ARBs may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible.

Intervention:

  • During concomitant use of celecoxib and ACE-inhibitors, ARBs, or beta-blockers, monitor blood pressure to ensure that the desired blood pressure is obtained.
  • During concomitant use of celecoxib and ACE-inhibitors or
    ARBs in patients who are elderly, volume-depleted, or have
    impaired renal function, monitor for signs of worsening renal
    function.
  • When these drugs are administered concomitantly, patients should be adequately hydrated. Assess renal function at the beginning of the concomitant treatment and periodically thereafter.

Diuretics

Clinical Impact:
Clinical studies, as well as post-marketing observations, showed that NSAIDs reduced the natriuretic effect of loop diuretics (e.g., furosemide) and thiazide diuretics in some patients. This effect has been attributed to the NSAID inhibition of renal prostaglandin synthesis.

Intervention:
During concomitant use of celecoxib with diuretics, observe
patients for signs of worsening renal function, in addition to
assuring diuretic efficacy including antihypertensive effects.

Digoxin

Clinical Impact:
The concomitant use of celecoxib with digoxin has been reported to increase the serum concentration and prolong the half-life of digoxin.

Intervention:
During concomitant use of celecoxib and digoxin, monitor serum digoxin levels.

Lithium

Clinical Impact:
NSAIDs have produced elevations in plasma lithium levels and reductions in renal lithium clearance. The mean minimum lithium concentration increased 15%, and the renal clearance decreased by approximately 20%. This effect has been attributed to NSAID inhibition of renal prostaglandin synthesis.

Intervention:
During concomitant use of celecoxib and lithium, monitor patients for signs of lithium toxicity.

Methotrexate

Clinical Impact:
Concomitant use of NSAIDs and methotrexate may increase the risk for methotrexate toxicity (e.g., neutropenia, thrombocytopenia, renal dysfunction). Celecoxib has no effect on methotrexate pharmacokinetics.

Intervention:
During concomitant use of celecoxib and methotrexate, monitor patients for methotrexate toxicity.

Cyclosporine

Clinical Impact:
Concomitant use of celecoxib and cyclosporine may increase cyclosporine's nephrotoxicity.

Intervention:
During concomitant use of celecoxib and cyclosporine, monitor patients for signs of worsening renal function.

NSAIDs and Salicylates

Clinical Impact:
Concomitant use of celecoxib with other NSAIDs or salicylates
(e.g., diflunisal, salsalate) increases the risk of GI toxicity,
with little or no increase in efficacy.

Intervention:
The concomitant use of celecoxib with other NSAIDs or salicylates is not recommended.

Pemetrexed

Clinical Impact:
Concomitant use of celecoxib and pemetrexed may increase the risk of pemetrexed-associated myelosuppression, renal, and GI toxicity (see the pemetrexed prescribing information).

Intervention:
During concomitant use of celecoxib and pemetrexed, in patients with renal impairment whose creatinine clearance ranges from 45 to 79 mL/min, monitor for myelosuppression, renal and GI toxicity. NSAIDs with short elimination half-lives (e.g., diclofenac, indomethacin) should be avoided for a period of two days before, the day of, and two days following administration of pemetrexed. In the absence of data regarding potential interaction between pemetrexed and NSAIDs with longer half-lives (e.g., meloxicam, nabumetone), patients taking these NSAIDs should interrupt dosing for at least five days before, the day of, and two days following pemetrexed administration.

CYP2C9 Inhibitors or Inducers

Clinical Impact:
Celecoxib metabolism is predominantly mediated via CYP2C9 in the liver. Coadministration of celecoxib with drugs that are known to inhibit CYP2C9 (e.g. fluconazole) may enhance the exposure and toxicity of celecoxib whereas co-administration with CYP2C9 inducers (e.g. rifampin) may lead to compromised efficacy of celecoxib.

Intervention:
Evaluate each patient’s medical history when consideration is
given to prescribing celecoxib. A dosage adjustment may be warranted
when celecoxib is administered with CYP2C9 inhibitors or inducers.

CYP2D6 Substrates

Clinical Impact:
In vitro studies indicate that celecoxib, although not a substrate, is an inhibitor of CYP2D6. Therefore, there is a potential for an in vivo drug interaction with drugs that are metabolized by CYP2D6 (e.g. atomoxetine), and celecoxib may enhance the exposure and toxicity of these drugs.

Intervention:
Evaluate each patient’s medical history when consideration is
given to prescribing celecoxib. A dosage adjustment may be warranted
when celecoxib is administered with CYP2D6 substrates.

Corticosteroids

Clinical Impact:
Concomitant use of corticosteroids with celecoxib may increase the risk of GI ulceration or bleeding.

Intervention:
Monitor patients with concomitant use of celecoxib with
corticosteroids for signs of bleeding.

Amlodipine

Impact Of Other Drugs On Amlodipine

CYP3A Inhibitors

  • Co-administration with CYP3A inhibitors (moderate and strong) results in
    increased systemic exposure to amlodipine and may require dose reduction.
    Monitor for symptoms of hypotension and edema when amlodipine is
    co-administered with CYP3A inhibitors to determine the need for dose
    adjustment.

CYP3A Inducers

  • No information is available on the quantitative effects of CYP3A inducers on amlodipine. Blood pressure should be closely monitored when amlodipine is co-administered with CYP3A inducers.
Impact Of Amlodipine On Other Drugs

Simvastatin

  • Co-administration of simvastatin with amlodipine increases the systemic
    exposure of simvastatin. Limit the dose of simvastatin in patients on
    amlodipine to 20 mg daily.

Immunosuppressants

  • Amlodipine may increase the systemic exposure of cyclosporine or
    tacrolimus when co-administered. Frequent monitoring of trough blood levels
    of cyclosporine and tacrolimus is recommended and adjust the dose when
    appropriate.

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Is Consensi safe to use while pregnant or breastfeeding?

  • Use of NSAIDs, including Consensi, can cause premature closure of the fetal ductus arteriosus and fetal renal dysfunction leading to oligohydramnios and, in some cases, neonatal renal impairment.
  • Because of these risks, limit dose and duration of Consensi use between about 20 and 30 weeks of gestation and avoid
    Consensi use at about 30 weeks of gestation and later in pregnancy.
  • The available published literature report the individual components of
    Consensi (celecoxib, amlodipine) are present in human breast milk at low levels.
  • No adverse effects of amlodipine were observed in the breastfed infants.
  • There is no available information on the effects of celecoxib or amlodipine on milk production.

Beta-Blockers vs. Calcium Channel Blockers: Blood Pressure Drug Class Differences

What is the Difference Between Beta Blockers and Calcium Channel Blockers?

What Are Beta Blockers and Calcium Channel Blockers?

Beta blockers, also called beta adrenergic blocking agents, block the neurotransmitters norepinephrine and epinephrine (adrenaline) from binding to beta receptors on nerves, which can reduce the heart rate and reduce blood pressure by dilating blood vessels. Beta blockers are used to treat high blood pressure, heart failure, angina (chest pain), abnormal heart rhythms, tremors, pheochromocytoma, hypertrophic subaortic stenosis, migraine headache prevention, hyperthyroidism, akathisia (restlessness or inability to sit still), panic disorder, anxiety, eye pressure caused by glaucoma, and aggressive behavior. Beta blockers can also prevent further heart attacks and death after a heart attack.

Calcium channel blockers (CCBs) dilate the arteries, reducing pressure within and making it easier for the heart to pump blood, and, as a result, the heart needs less oxygen. By reducing the heart's need for oxygen, calcium channel blockers relieve or prevent angina (chest pain). Calcium channel blockers also are used for treating high blood pressure, certain types of abnormally rapid heart rhythms, pulmonary hypertension, Raynaud's syndrome, cardiomyopathy, subarachnoid hemorrhage, and to prevent migraine headaches.

What Are the Side Effects of Beta Blockers vs. Calcium Channel Blockers?

Beta Blockers

Beta blockers may cause:

Other important side effects include:

As an extension of their beneficial effect, they slow heart rate and reduce blood pressure, but they may cause adverse effects such as heart failure or heart block in patients with heart problems.

Beta blockers should not be withdrawn suddenly because sudden withdrawal may worsen angina (chest pain) and cause heart attacks, serious abnormal heart rhythms, or sudden death.

Central nervous system effects of beta blockers include:

Beta blockers that block β2 receptors may cause shortness of breath in asthmatics.

As with other drugs used for treating high blood pressure, sexual dysfunction may occur.

Beta blockers may cause low or high blood glucose and mask the symptoms of low blood glucose (hypoglycemia) in people with diabetes.

Other serious side effects of beta-blockers include:

  • Toxic epidermal necrolysis
  • Raynaud's phenomenon
  • Lupus erythematosus
  • Bronchospasm
  • Serious allergic reactions
  • Erythema multiform
  • Steven Johnson Syndrome

Calcium Channel Blockers

The most common side effects of calcium channel blockers are:

Liver dysfunction and over growth of the gums also occurs.

When diltiazem (Cardizem) or verapamil (Calan, Isoptin) are given to individuals with heart failure, symptoms of heart failure may worsen because these drugs reduce the ability of the heart to pump blood.

Like other blood pressure medications, calcium channel blockers are associated with sexual dysfunction.

What Drugs Interact with Beta Blockers and Calcium Channel Blockers?

Beta Blockers

  • Combining propranolol (Inderal) or pindolol (Visken) with thioridazine (Mellaril) or chlorpromazine (Thorazine) may result in low blood pressure (hypotension) and abnormal heart rhythms because the drugs interfere with each other's elimination and result in increased levels of the drugs.
  • Dangerous elevations in blood pressure may occur when clonidine (Catapres) is combined with a beta blocker, or when clonidine or beta blocker is discontinued after their concurrent use. Blood pressure should be closely monitored after initiation or discontinuation of clonidine or a beta blocker when they have been used together.
  • Phenobarbital and similar agents may increase the breakdown and reduce blood levels of propanolol (Inderal) or metoprolol (Lopressor, Toprol XL). This may reduce effectiveness of the beta blocker.
  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) (for example, ibuprofen) may counteract the blood pressure reducing effects of beta blockers by reducing the effects of prostaglandins, which play a role in control of blood pressure.
  • Beta blockers may prolong hypoglycemia (low blood sugar) and mask symptoms of hypoglycemia in diabetics who are taking insulin or other diabetic medications.

Calcium Channel Blockers

Most of the interactions of calcium channel blockers occur with verapamil (Calan, Isoptin) or diltiazem (Cardizem). The interaction occurs because verapamil and diltiazem decrease the elimination of a number of drugs by the liver. Through this mechanism, verapamil and diltiazem may reduce the elimination and increase the blood levels of carbamazepine (Tegretol), simvastatin (Zocor), atorvastatin (Lipitor), and lovastatin (Mevacor). This can lead to toxicity from these drugs.

Grapefruit juice (approximately 200 ml) may elevate blood concentrations of felodipine (Plendil), verapamil (Calan, Isoptin), nisoldipine (Sular), nifedipine (Adalat, Procardia), nicardipine (Cardene), and possibly amlodipine (Norvasc). Grapefruit juice should not be consumed within 2 hours before or 4 hours after administration of affected calcium channel blockers.

What Are the Different Types of Beta Blockers and Calcium Channel Blockers?

Beta Blockers

  • acebutolol (Sectral)
  • atenolol (Tenormin)
  • betaxolol (Kerlone)
  • betaxolol (Betoptic S)
  • bisoprolol fumarate (Zebeta)
  • carteolol (Cartrol, discontinued)
  • carvedilol (Coreg)
  • esmolol (Brevibloc)
  • labetalol (Trandate [Normodyne – discontinued])
  • metoprolol (Lopressor, Toprol XL)
  • nadolol (Corgard)
  • nebivolol (Bystolic)
  • penbutolol (Levatol)
  • pindolol (Visken, discontinued)
  • propranolol (Hemangeol, Inderal LA, Inderal XL, InnoPran XL)
  • sotalol (Betapace, Sorine)
  • timolol (Blocadren, discontinued)
  • timolol ophthalmic solution (Timoptic, Betimol, Istalol)

Calcium Channel Blockers

The calcium channel blockers that have been approved for use in the US include:

  • amlodipine (Norvasc)
  • amlodipine and atorvastatin (Caduet)
  • amlodipine and benazepril (Lotrel)
  • amlodipine and valsartan (Exforge)
  • amlodipine and telmisartan (Twynsta)
  • amlodipine and olmesartan (Azor)
  • amlodipine and olmesartan and hydroclorothiazide (Tribenzor)
  • amlodipine and aliskiren and hydroclorothiazide
  • amlodipine and perindopril (Prestalia)
  • clevidipine (Cleviprex)
  • diltiazem (Cardizem)
  • felodipine (Cardene, Cardene SR)
  • isradipine
  • nicardipine
  • nimodipine
  • nisoldipine (Sular)
  • verapamil (Calan)

Azor (amlodipine & olmesartan medoxomil) for Hypertension

What is Azor (amlodipine and olmesartan medoxomil), and how does it work?

Azor is indicated for the treatment of hypertension, alone or with other antihypertensive agents, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including the class to which this drug principally belongs.

Azor provided as a tablet for oral administration, is a combination of the calcium channel blocker (CCB) amlodipine besylate and the angiotensin II receptor blocker (ARB) olmesartan medoxomil.

Azor may also be used as initial therapy in patients who are likely to need multiple antihypertensive agents to achieve their blood pressure goals.

What are the side effects of Azor?

WARNING

Female patients of childbearing age should be told about the consequences of exposure to Azor during pregnancy. Discuss treatment options with women planning to become pregnant. Patients should be asked to report pregnancies to their physicians as soon as possible.

Azor

The data described below reflect exposure to Azor in more than 1600 patients including more than 1000 exposed for at least 6 months and more than 700 exposed for 1 year. Azor was studied in one placebo-controlled factorial trial. The population had a mean age of 54 years and included approximately 55% males. Seventy-one percent were Caucasian and 25% were Black. Patients received doses ranging from 5/20 mg to 10/40 mg orally once daily.

The overall incidence of adverse reactions on therapy with Azor was similar to that seen with corresponding doses of the individual components of Azor, and to placebo. The reported adverse reactions were generally mild and seldom led to discontinuation of treatment (2.6% for Azor and 6.8% for placebo).

Edema

Edema is a known, dose-dependent adverse effect of amlodipine but not of olmesartan medoxomil.

The placebo-subtracted incidence of edema during the 8-week, randomized, double-blind treatment period was highest with amlodipine 10 mg monotherapy. The incidence was significantly reduced when 20 mg or 40 mg of olmesartan medoxomil was added to the 10 mg amlodipine dose.

Placebo-Subtracted Incidence of Edema During the Double-Blind Treatment Period

 
Olmesartan Medoxomil

Placebo
20 mg
40 mg

Amlodipine
Placebo
-*
-2.4%
6.2%

5 mg
0.7%
5.7%
6.2%

10 mg
24.5%
13.3%
11.2%

*12.3% = actual placebo incidence

Across all treatment groups, the frequency of edema was generally higher in women than men, as has been observed in previous studies of amlodipine.

Adverse reactions seen at lower rates during the double-blind period also occurred in the patients treated with Azor at about the same or greater incidence as in patients receiving placebo. These included hypotension, orthostatic hypotension, rash, pruritus, palpitation, urinary frequency, and nocturia.

The adverse event profile obtained from 44 weeks of open-label combination therapy with amlodipine plus olmesartan medoxomil was similar to that observed during the 8-week, double-blind, placebo-controlled period.

Initial Therapy

Analyzing the data described above specifically for initial therapy, it was observed that higher doses of Azor caused slightly more hypotension and orthostatic symptoms, but not at the recommended starting dose of Azor 5/20 mg. No increase in the incidence of syncope or near syncope was observed. The incidences of discontinuation because of any treatment emergent adverse events in the double blind phase are summarized in the table below.

Discontinuation for any Treatment Emergent Adverse Event1

 
Olmesartan Medoxomil

Placebo
10 mg
20 mg
40 mg

Amlodipine
Placebo
4.9%
4.3%
5.6%
3.1%

5 mg
3.7%
0.0%
1.2%
3.7%

10 mg
5.5%
6.8%
2.5%
5.6%

1 Hypertension is counted as treatment failure and not as treatment emergent adverse event.
N=160-163 subjects per treatment group.

Amlodipine

Amlodipine has been evaluated for safety in more than 11,000 patients in U.S. and foreign clinical trials. Most adverse reactions reported during therapy with amlodipine were of mild or moderate severity. In controlled clinical trials directly comparing amlodipine (N=1730) in doses up to 10 mg to placebo (N=1250), discontinuation of amlodipine due to adverse reactions was required in only about 1.5% of amlodipinetreated patients and about 1% of placebo-treated patients. The most common side effects were headache and edema. The incidence (%) of dose-related side effects was as follows:

Adverse Event
Placebo
N=520
2.5 mg
N=275
5.0 mg
N=296
10.0 mg
N=268

Edema
0.6
1.8
3.0
10.8

Dizziness
1.5
1.1
3.4
3.4

Flushing
0.0
0.7
1.4
2.6

Palpitation
0.6
0.7
1.4
4.5

For several adverse experiences that appear to be drug- and dose-related, there was a greater incidence in women than men associated with amlodipine treatment as shown in the following table:

Adverse Event
Placebo
Amlodipine

 
Male=%
(N=914)
Female=%
(N=336)
Male=%
(N=1218)
Female=%
(N=512)

Edema
1.4
5.1
5.6
14.6

Flushing
0.3
0.9
1.5
4.5

Palpitation
0.9
0.9
1.4
3.3

Somnolence
0.8
0.3
1.3
1.6

Olmesartan Medoxomil

Olmesartan medoxomil has been evaluated for safety in more than 3825 patients/subjects, including more than 3275 patients treated for hypertension in controlled trials. This experience included about 900 patients treated for at least 6 months and more than 525 treated for at least 1 year. Treatment with olmesartan medoxomil was well tolerated, with an incidence of adverse events similar to that seen with placebo. Events were generally mild, transient, and without relationship to the dose of olmesartan medoxomil.

The overall frequency of adverse events was not dose-related. Analysis of gender, age, and race groups demonstrated no differences between olmesartan medoxomil- and placebo-treated patients. The rate of withdrawals due to adverse events in all trials of hypertensive patients was 2.4% (i.e., 79/3278) of patients treated with olmesartan medoxomil and 2.7% (i.e., 32/1179) of control patients. In placebo-controlled trials, the only adverse event that occurred in more than 1% of patients treated with olmesartan medoxomil and at a higher incidence in olmesartan medoxomil treated patients vs. placebo was dizziness (3% vs 1%).

What is the dosage for Azor?

The side effects of olmesartan medoxomil are generally rare and apparently independent of dose. Those of amlodipine are generally dose-dependent (mostly edema).

  • Maximum antihypertensive effects are attained within 2 weeks after a change in dose.
  • Azor may be taken with or without food.
  • Azor may be administered with other antihypertensive agents.
  • Dosage may be increased after 2 weeks. The maximum recommended dose of Azor is 10/40 mg.

Replacement Therapy

Azor may be substituted for its individually titrated components.

When substituting for individual components, the dose of one or both of the components can be increased if blood pressure control has not been satisfactory.

Add-On Therapy

Azor may be used to provide additional blood pressure lowering for patients not adequately controlled with amlodipine (or another dihydropyridine calcium channel blocker) alone or with olmesartan medoxomil (or another angiotensin receptor blocker) alone.

Initial Therapy

The usual starting dose of Azor is 5/20 mg once daily. The dosage can be increased after 1 to 2 weeks of therapy to a maximum dose of one 10/40 mg tablet once daily as needed to control blood pressure.

Initial therapy with Azor is not recommended in patients ≥75 years old or with hepatic impairment.

Dosage Forms And Strengths

Azor tablets are formulated for oral administration in the following strength combinations:

 
5/20
5/40
10/20
10/40

Amlodipine equivalent (mg)
5
5
10
10

Olmesartan medoxomil (mg)
20
40
20
40




QUESTION

Salt and sodium are the same.
See Answer

What drugs interact with Azor?

Drug Interactions With Azor

The pharmacokinetics of amlodipine and olmesartan medoxomil are not altered when the drugs are co-administered.

No drug interaction studies have been conducted with Azor and other drugs, although studies have been conducted with the individual amlodipine and olmesartan medoxomil components of Azor, as described below, and no significant drug interactions have been observed.

Drug Interactions With Amlodipine

In vitro data indicate that amlodipine has no effect on the human plasma protein binding of digoxin, phenytoin, warfarin, and indomethacin.

Effect Of Other Agents On Amlodipine
  • Cimetidine: Co-administration of amlodipine with cimetidine did not alter the pharmacokinetics of amlodipine.
  • Grapefruit juice: Co-administration of 240 mL of grapefruit juice with a single oral dose of amlodipine 10 mg in 20 healthy volunteers had no significant effect on the pharmacokinetics of amlodipine.
  • Maalox® (antacid): Co-administration of the antacid Maalox® with a single dose of amlodipine had no significant effect on the pharmacokinetics of amlodipine.
  • Sildenafil: A single 100 mg dose of sildenafil in subjects with essential hypertension had no effect on the pharmacokinetic parameters of amlodipine. When amlodipine and sildenafil were used in combination, each agent independently exerted its own blood pressure lowering effect.
  • Effect Of Amlodipine On Other Agents
  • Atorvastatin: Co-administration of multiple 10 mg doses of amlodipine with 80 mg
    of atorvastatin resulted in no significant change in the steady state pharmacokinetic
    parameters of atorvastatin.
  • Digoxin: Co-administration of amlodipine with digoxin did not change serum
    digoxin levels or digoxin renal clearance in normal volunteers.
  • Ethanol (alcohol): Single and multiple 10 mg doses of amlodipine had no
    significant effect on the pharmacokinetics of ethanol.
  • Warfarin: Co-administration of amlodipine with warfarin did not change the
    warfarin prothrombin response time.
  • Simvastatin: Co-administration of multiple doses of 10 mg of amlodipine with 80
    mg simvastatin resulted in a 77% increase in exposure to simvastatin compared to
    simvastatin alone. Limit the dose of simvastatin in patients on amlodipine to 20 mg
    daily.

In clinical trials, amlodipine has been safely administered with thiazide diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, long-acting nitrates, sublingual nitroglycerin, digoxin, warfarin, non-steroidal anti-inflammatory drugs, antibiotics, and oral hypoglycemic drugs.

Drug Interactions With Olmesartan Medoxomil

Non-Steroidal Anti-Inflammatory Agents including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors)

In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, co-administration of NSAIDs, including selective COX-2 inhibitors, with angiotensin II receptor antagonists, including olmesartan medoxomil, may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically in patients receiving olmesartan medoxomil and NSAID therapy.

  • The antihypertensive effect of angiotensin II receptor antagonists, including olmesartan medoxomil may be attenuated by NSAIDs including selective COX-2 inhibitors.
  • No significant drug interactions were reported in studies in which olmesartan medoxomil was co-administered with digoxin or warfarin in healthy volunteers.
  • The bioavailability of olmesartan medoxomil was not significantly altered by the coadministration of antacids [Al(OH)3/Mg(OH)2].
  • Olmesartan medoxomil is not metabolized by the cytochrome P450 system and has no effects on P450 enzymes; thus, interactions with drugs that inhibit, induce, or are metabolized by those enzymes are not expected.
Dual Blockade of the Renin-Angiotensin System (RAS)

Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy. Most patients receiving the combination of two RAS inhibitors do not obtain any additional benefit compared to monotherapy. In general, avoid combined use of RAS inhibitors. Closely monitor blood pressure, renal function and electrolytes in patients on Azor and other agents that affect the RAS.

  • Do not co-administer aliskiren with Azor in patients with diabetes. Avoid use of aliskiren with Azor in patients with renal impairment (GFR <60 ml/min).
Use with Colesevelam Hydrochloride

Concurrent administration of bile acid sequestering agent colesevelam hydrochloride reduces the systemic exposure and peak plasma concentration of olmesartan. Administration of olmesartan at least 4 hours prior to colesevelam hydrochloride decreased the drug interaction effect. Consider administering olmesartan at least 4 hours before the colesevelam hydrochloride dose.

Lithium

Increases in serum lithium concentrations and lithium toxicity have been reported during concomitant administration of lithium with angiotensin II receptor antagonists, including AZOR. Monitor serum lithium levels during concomitant use.

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Is Azor safe to use while pregnant or breastfeeding?

When pregnancy is detected, discontinue Azor as soon as possible.

Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death. Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations. Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death.

It is not known whether the amlodipine or olmesartan medoxomil components of Azor are excreted in human milk, but olmesartan is secreted at low concentration 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.

Tribenzor (olmesartan medoxomil, amlodipine, hydrochlorothiazide)

What is Tribenzor, and how does it work?

Tribenzor (olmesartan medoxomil, amlodipine, hydrochlorothiazide) Tablets is a combination of an angiotensin receptor blocker, a calcium channel blocker, and a diuretic used to treat high blood pressure.

What are the side effects of Tribenzor?

WARNING

FETAL TOXICITY

  • When pregnancy is detected, discontinue Tribenzor as soon as possible.
  • Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

Common side effects of Tribenzor include:

Tell your doctor if you have serious side effects of Tribenzor including:

  • fainting,
  • severe tiredness,
  • big toe/joint pain,
  • swelling hands/ankles/feet,
  • symptoms of a high potassium blood level (such as muscle weakness, slow/irregular heartbeat),
  • unusual change in the amount of urine (not including the normal increase in urine when you first start this drug), and
  • severe or persistent diarrhea.

What is the dosage for Tribenzor?

Dose once daily. Dosage may be increased in 2 week intervals, as needed. The maximum recommended dose of Tribenzor is 40/10/25 mg.

Dose selection should be individualized based on previous therapy.

Dosage Forms And Strengths

Tribenzor tablets are available in the following strength combinations:

20/5/12.540/5/12.540/5/2540/10/12.540/10/25Olmesartan medoxomil (mg)2040404040Amlodipine equivalent (mg)5551010Hydrochlorothiazide (mg)12.512.52512.525




QUESTION

Salt and sodium are the same.
See Answer

What drugs interact with Tribenzor?

Drug Interactions With Olmesartan Medoxomil

Non-Steroidal Anti-Inflammatory Agents Including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors)
  • In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, co-administration of NSAIDs, including selective COX-2 inhibitors, with angiotensin II receptor antagonists, including olmesartan medoxomil, may result in deterioration of renal function, including possible acute renal failure.
  • These effects are usually reversible. Monitor renal function periodically in patients receiving olmesartan medoxomil and NSAID therapy.
  • The antihypertensive effect of angiotensin II receptor antagonists, including olmesartan medoxomil may be attenuated by NSAIDs including selective COX-2 inhibitors.
Dual Blockade Of The Renin-Angiotensin System (RAS)
  • Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy.
  • Most patients receiving the combination of two RAS inhibitors do not obtain any additional benefit compared to monotherapy.
  • In general, avoid combined use of RAS inhibitors.
  • Closely monitor blood pressure, renal function and electrolytes in patients on Tribenzor and other agents that affect the RAS.
  • Do not co-administer aliskiren with Tribenzor in patients with diabetes [See
    CONTRAINDICATIONS]. Avoid use of aliskiren with Tribenzor in patients with renal impairment (GFR <60 ml/min).
Use With Colesevelam Hydrochloride
  • Concurrent administration of bile acid sequestering agent colesevelam
    hydrochloride reduces the systemic exposure and peak plasma concentration of
    olmesartan.
  • Administration of olmesartan at least 4 hours prior to colesevelam
    hydrochloride decreased the drug interaction effect.
  • Consider administering olmesartan at least 4 hours before the
    colesevelam hydrochloride dose.
Lithium
  • Increases in serum lithium concentrations and lithium toxicity have been reported with concomitant use of olmesartan or thiazide diuretics.
  • Monitor lithium levels in patients receiving Tribenzor and lithium.

Drug Interactions With Amlodipine

Simvastatin
  • Co-administration of simvastatin with amlodipine increases the systemic
    exposure of simvastatin. Limit the dose of simvastatin in patients on
    amlodipine to 20 mg daily.
Immunosuppressants
  • Amlodipine may increase the systemic exposure of cyclosporine or
    tacrolimus when co-administered. Frequent monitoring of trough blood levels
    of cyclosporine and tacrolimus is recommended and adjust the dose when
    appropriate.
CYP3A Inhibitors
  • Co-administration of amlodipine with CYP3A inhibitors (moderate and strong) results in increased systemic exposure to amlodipine and may require dose reduction.
  • Monitor for symptoms of hypotension and edema when amlodipine is co-administered with CYP3A inhibitors to determine the need for dose adjustment.
CYP3A Inducers
  • No information is available on the quantitative effects of CYP3A inducers on amlodipine.
  • Blood pressure should be closely monitored when amlodipine is co-administered with CYP3A inducers.

Drug Interactions With Hydrochlorothiazide

  • When administered concurrently the following drugs may interact with thiazide diuretics:
  • Antidiabetic Drugs (oral agents and insulin): Dosage adjustment of the antidiabetic drug may be required.
  • Cholestyramine and Colestipol Resins: Absorption of hydrochlorothiazide is impaired in the presence of anionic exchange resins. Single dose of either cholestyramine or colestipol resins bind the hydrochlorothiazide and reduce its absorption from the gastrointestinal tract by up to 85% and 43%, respectively.
  • Corticosteroids, ACTH: Intensified electrolyte depletion, particularly hypokalemia.
  • Non-steroidal Anti-inflammatory Drugs: In some patients the administration of a non-steroidal anti-inflammatory agent can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing and thiazide diuretics. Therefore, when hydrochlorothiazide tablets and non-steroidal anti-inflammatory agents are used concomitantly, the patients should be observed closely to determine if the desired effect of the diuretic is obtained.

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Is Tribenzor safe to use while pregnant or breastfeeding?

  • Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death.
  • Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations.
  • Potential neonatal adverse effects include
    • skull hypoplasia,
    • anuria,
    • hypotension,
    • renal failure, and
    • death.
  • When pregnancy is detected, discontinue Tribenzor as soon as possible.
  • These adverse outcomes are usually associated with use of these drugs in the second and third trimester of pregnancy.
  • Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in the first trimester have not distinguished drugs affecting the renin-angiotensin system from other antihypertensive agents.
  • Appropriate management of maternal hypertension during pregnancy is important to optimize outcomes for both mother and fetus.
  • In the unusual case that there is no appropriate alternative to therapy with drugs affecting the renin-angiotensin system for a particular patient, apprise the mother of the potential risk to the fetus.
  • Perform serial ultrasound examinations to assess the intra-amniotic environment. If oligohydramnios is observed, discontinue Tribenzor, unless it is considered lifesaving for the mother.
  • Fetal testing may be appropriate, based on the week of pregnancy.
  • Patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained irreversible injury. Closely observe infants with histories of in utero exposure to Tribenzor for hypotension, oliguria, and hyperkalemia.
  • It is not known whether amlodipine or olmesartan are excreted in human milk, but thiazides appear in human milk and olmesartan is secreted at low concentration 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.

Tekturna HCT (hydrochlorothiazide/aliskiren) Blood Pressure Drug


Generic drug: hydrochlorothiazide and aliskiren

Brand name: Tekturna HCT

What is Tekturna HCT, and how does it work?

Tekturna HCT (hydrochlorothiazide and aliskiren) contains 2 prescription medicines in 1 tablet that work together to lower blood pressure. It contains:

  • aliskiren (Tekturna), a direct renin inhibitor (DRI)
  • hydrochlorothiazide (HCTZ), a diuretic (water pill)

Aliskiren (Tekturna) reduces the effect of renin, and the harmful process that narrows blood vessels. Aliskiren also helps blood vessels relax and widen so blood pressure is lower. Hydrochlorothiazide reduces the amount of salt and water in your body so your blood pressure is lower.

Tekturna HCT may be used to lower high blood pressure in adults

Tekturna HCT has not been studied in children under 18 years of age.

What are the side effects of Tekturna HCT?

WARNING

FETAL TOXICITY

  • When pregnancy is detected, discontinue Tekturna HCT as soon as possible.
  • Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

Tekturna HCT may cause serious side effects:

  • Harm to an unborn baby, causing injury or death. 
  • Severe Allergic Reactions and Angioedema (hypersensitivity). Aliskiren, one of the medicines in Tekturna HCT, can cause
    • difficulty breathing or swallowing,
    • tightness of the chest,
    • hives,
    • general rash,
    • swelling,
    • itching,
    • dizziness,
    • vomiting, or
    • abdominal pain (signs of a severe allergic reaction called anaphylactic reaction).
    • Aliskiren can also cause
      • swelling of the face,
      • lips,
      • tongue,
      • throat,
      • arms and legs, or
      • the whole body (signs of angioedema).
    • Stop taking Tekturna HCT and get medical help right away. Tell your doctor if you get any one or more of these symptoms. Angioedema can happen at any time while you are taking Tekturna HCT.
  • Low blood pressure (hypotension). Your blood pressure may get too low if you also take water pills, are on a low-salt diet, get dialysis treatments, have heart problems, or get sick with vomiting or diarrhea. Drinking alcohol and taking certain medicines (barbiturates or narcotics) can cause low blood pressure to get worse. Lie down if you feel faint or dizzy, and call your doctor right away.
  • Renal Impairment or Failure. Aliskiren, one of the medicines in Tekturna HCT, may cause renal disorder with symptoms such as severely decreased urine output or decreased urine output (signs of renal impairment or failure).
  • Tekturna HCT may affect your potassium levels. Your doctor will do blood tests to check your potassium levels.
  • Allergic reactions: Hydrochlorothiazide, one of the medicines in Tekturna HCT, can cause allergic reactions.
  • Active or Worsened Systemic Lupus Erythematosus (SLE). If you have SLE, tell your doctor right away if you get any new or worse symptoms.
    Possible signs of SLE are facial rash, joint pain, muscle disorder, fever.
  • Eye problems. One of the medicines in Tekturna HCT can cause eye problems that may lead to vision loss. Symptoms of eye problems can happen within hours to weeks of starting Tekturna HCT. Tell your doctor right away if you have:

Common side effects of Tekturna HCT include:

Less common side effects include

  • skin rash,
  • severe skin reactions (signs may include severe blistering of the lips, eyes or mouth, rash with fever and skin peeling),
  • liver disorder (signs may include nausea, loss of appetite, dark-colored urine, or yellowing of skin and eyes) and
  • low level of sodium in the blood.

Protect your skin from the sun and undergo regular skin cancer screening, as one of the medicines in Tekturna HCT may cause non-melanoma skin cancer.

Tell your doctor if you have any side effect that bothers you or that does not go away. These are not all of the possible side effects of Tekturna HCT. For a complete list of side effects, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.




QUESTION

Salt and sodium are the same.
See Answer

What is the dosage for Tekturna HCT?

Dose Selection

  • The recommended once-daily doses of Tekturna HCT in order of increasing mean effect are 150/12.5 mg, 150/25 mg or 300/12.5 mg, and 300/25 mg.

Dose Titration

  • The antihypertensive effect of Tekturna HCT is largely manifested within 1 week, with maximal effects generally seen at around 4 weeks.
  • If blood pressure remains uncontrolled after 2 to 4 weeks of therapy, the dose may be titrated up to a maximum of aliskiren 300 mg/HCTZ 25 mg.

Add-On Therapy

  • A patient whose blood pressure is not adequately controlled with aliskiren alone or hydrochlorothiazide alone may be switched to combination therapy with Tekturna HCT.
  • The usual recommended starting dose is 150/12.5 mg once daily as needed to control blood pressure.
  • The dose may be titrated up to a maximum of aliskiren 300 mg/hydrochlorothiazide 25 mg once daily.

Replacement Therapy

  • Tekturna HCT may be substituted for the individually titrated components.

Initial Therapy

  • The usual recommended starting dose is 150/12.5 mg once daily as needed to control blood pressure. The dose may be titrated up to a maximum of aliskiren 300 mg/HCTZ 25 mg once daily.
  • Tekturna HCT is not recommended for use as initial therapy in patients
    with intravascular volume depletion.

Relationship To Meals

  • Patients should establish a routine pattern for taking Tekturna HCT with
    regard to meals. High-fat meals decrease absorption substantially.

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What drugs interact with Tekturna HCT?

No drug interaction studies have been conducted with Tekturna HCT and other drugs, although studies with the individual aliskiren and HCTZ components are described below.

Aliskiren

Cyclosporine
Itraconazole
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors)
  • In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs, including selective COX-2 inhibitors with agents that affect the RAAS, including aliskiren, may result in deterioration of renal function, including possible acute renal failure.
  • These effects are usually reversible. Monitor renal function periodically in patients receiving aliskiren and NSAID therapy.
  • The antihypertensive effect of aliskiren may be attenuated by NSAIDs.
Dual Blockade Of The Renin-Angiotensin-Aldosterone System (RAAS)
  • The concomitant use of aliskiren with other agents acting on the RAAS
    such as ACEIs or ARBs is associated with an increased risk of hypotension,
    hyperkalemia, and changes in renal function (including acute renal failure)
    compared to monotherapy.
  • Most patients receiving the combination of two drugs that inhibit the
    renin-angiotensin system do not obtain any additional benefit compared to
    monotherapy.
  • In general, avoid combined use of aliskiren with ACE inhibitors or ARBs,
    particularly in patients with CrCl less than 60 mL/min.
  • Monitor blood pressure, renal function, and electrolytes in patients on
    aliskiren and other agents that affect the RAAS.
  • The concomitant use of aliskiren with an ARB or an ACEI in diabetic
    patients is contraindicated.
Furosemide
  • Oral coadministration of aliskiren and furosemide reduced exposure to furosemide. Monitor diuretic effects when furosemide is coadministered with aliskiren.

Hydrochlorothiazide (HCTZ)

  • When administered concurrently, the following drugs may interact with thiazide diuretics.
Antidiabetic Drugs (Oral Agents And Insulin)
  • Dosage adjustment of the antidiabetic drug may be required.
Lithium
  • Diuretic agents increase the risk of lithium toxicity. Increases in serum lithium concentrations and lithium toxicity have been reported during concomitant administration of lithium with angiotensin II receptor antagonists.
  • Monitoring of serum lithium levels is recommended during concomitant use.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) And COX-2 Selective Agents
  • When Tekturna HCT and NSAIDs are used concomitantly, the patient should be observed closely to determine if the desired effect of the diuretic is obtained.
Ion-Exchange Resins
  • Staggering the dosage of HCTZ and ion exchange resins (e.g.,
    cholestyramine, colestipol) such that HCTZ is administered at least 4 hours
    before or 4 to 6 hours after the administration of resins would potentially
    minimize the interaction.

Is Tekturna HCT safe to use while pregnant or breastfeeding?

  • Inform female patients of childbearing age about the consequences of exposure to Tekturna HCT during pregnancy.
  • Discuss treatment options with women planning to become pregnant.
  • Advise patients to report pregnancies to their physicians as soon as possible.
  • Advise nursing women that breastfeeding is not recommended during treatment with Tekturna HCT.

Prestalia (perindopril arginine and amlodipine)

What is Prestalia, and how does it work?

Prestalia is a prescription medicine that contains
perindopril arginine, an angiotensin converting enzyme inhibitor (ACE
inhibitor), and amlodipine, a calcium channel blocker.

Prestalia is used to treat high blood pressure
(hypertension):

  • when one medicine to lower your high blood pressure is
    not enough
  • as the first medicine to lower your high blood pressure
    if your doctor decides you are likely to need more than one medicine

It is not known if Prestalia is safe and effective in
children.

What are the side effects of Prestalia?

WARNING

FETAL TOXICITY

  • When pregnancy is detected, discontinue Prestalia as soon as
    possible.
  • Drugs that act directly on the renin-angiotens in system can cause
    injury and death to the developing fetus

Prestalia can cause serious side effects, including:

  • Serious allergic reactions that can be life
    threatening.     Stop taking Prestalia and get emergency medical help right
    away if you get any of these symptoms of a serious allergic reaction:

    • swelling of your face, lips, tongue, throat, arms, hands,
      legs, or feet
    • trouble swallowing
    • trouble breathing
    • stomach (abdomen) pain with or without nausea or vomiting

People who are black and take Prestalia have a greater
risk of having a serious allergic reaction than people who are not black and
take Prestalia.

If you feel faint or dizzy, lie down and call your
doctor right away.

  • Increased amount of potassium in the blood. Your
    doctor will check your potassium blood level during your treatment with
    Prestalia.
  • Cough.
  • Kidney problems. Some people with certain
    conditions may develop kidney problems and may need to stop treatment with
    Prestalia. Call your doctor if you get swelling in your feet, ankles, or hands,
    or unexplained weight gain.

The most common side effects of Prestalia include:

Tell your doctor if you have any side effect that bothers
you or that does not go away.

These are not all the possible side effects of Prestalia.
For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects.
You may report side effects to FDA at 1-800- FDA-1088.

What is the dosage for Prestalia?

General Considerations

  • The recommended starting dose of Prestalia is 3.5/2.5 mg
    once daily.
  • Adjust dosage according to blood pressure goals. In general, wait 7 to
    14 days between titration steps.
  • The maximum recommended dose is 14/10 mg once daily.
  • Prestalia may be used as initial therapy if a patient is
    likely to need multiple drugs to achieve blood pressure goals.
  • Consider use in patients unable to achieve adequate antihypertensive
    effect with amlodipine monotherapy because of dose-limiting peripheral edema
    caused by amlodipine.
  • Administered as monotherapy, perindopril erbumine is an effective
    treatment for hypertension in oncedaily doses ranging from 4 mg to 16 mg
    daily.
  • Amlodipine is effective in once-daily doses of 5 mg and 10 mg.
  • Adverse reactions related to perindopril are generally uncommon and
    independent of dose, while those related to amlodipine are a mixture of
    dose-dependent phenomena (primarily peripheral edema) and dose-independent
    phenomena, the former much more common than the latter.

Dosage Adjustment In Renal Impairment

  • Prestalia is not recommended in patients with creatinine clearances <30
    mL/min.
  • For patients with creatinine clearance between 30 and 80 mL/min (mild or
    moderate renal impairment), do not exceed 7/5 mg.

Monitoring In Elderly Patients (Over 65 Years Of Age)

  • Monitor blood pressure for up to two weeks following titrations at
    dosages above 7/5 mg in patients over 65 years of age.





QUESTION

Salt and sodium are the same.
See Answer

What drugs interact with Prestalia?

Prestalia

  • The pharmacokinetics of perindopril and amlodipine are
    not altered when the drugs are co-administered.
  • No drug interaction studies have been conducted with
    Prestalia, although studies have been conducted with perindopril and
    amlodipine.
mTOR Inhibitors
  • Patients taking concomitant mTOR inhibitor (e.g. temsirolimus) therapy
    may be at increased risk for angioedema.
Neprilysin Inhibitor
  • Patients taking concomitant neprilysin inhibitors may be at increased
    risk for angioedema.

Perindopril

Diuretics
  • Patients on diuretics, especially those in whom diuretic
    therapy was recently instituted, may occasionally experience an excessive
    reduction of blood pressure after initiation of therapy with Prestalia.
  • Provide
    close medical supervision with the first dose of Prestalia, for at least two hours
    and until blood pressure has stabilized for another hour.
  • Perindopril can
    attenuate potassium loss caused by thiazide diuretics.
Potassium Supplements And Potassium-Sparing Diuretics
Lithium
  • Increased serum lithium levels and symptoms of lithium
    toxicity have been reported in patients receiving ACE inhibitors during therapy
    with lithium.
  • When co-administering Prestalia and lithium, frequent monitoring
    of serum lithium levels is recommended.
  • Use of a diuretic may further increase
    the risk of lithium toxicity.
Gold
  • Nitritoid reactions (symptoms include facial flushing,
    nausea, vomiting, and hypotension) have been reported rarely in patients on
    therapy with injectable gold (sodium aurothiomalate) and concomitant ACE
    inhibitor therapy.
Non-Steroidal Anti-Inflammatory Agents (NSAIDS) Including
Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors)
  • In patients who are elderly, volume-depleted (including
    those on diuretic therapy), or with compromised renal function,
    co-administration of NSAIDS, including selective COX-2 inhibitors, with ACE
    inhibitors, including perindopril, may result in deterioration of renal
    function, including possible acute renal failure. These effects are usually
    reversible.
  • Monitor renal function periodically in patients receiving
    perindopril and NSAID therapy.
  • The antihypertensive effects of ACE inhibitors, including
    perindopril, may be attenuated by NSAIDS, including selective COX-2 inhibitors.
Dual Blockade Of The Renin-Angiotensin System (RAS)
  • Dual blockade of the RAS with angiotensin receptor
    blockers, ACE inhibitors, or aliskiren is associated with increased risks of
    hypotension, hyperkalemia, and changes in renal function (including acute renal
    failure) compared to monotherapy.
  • In most patients no benefit has been
    associated with using two RAS inhibitors concomitantly.
  • In general, avoid
    combined use of RAS inhibitors. Closely monitor blood pressure, renal function,
    and electrolytes in patients on Prestalia and other agents that affect the RAS.
  • Do not co-administer aliskiren with Prestalia in patients
    with diabetes. Avoid use of aliskiren with Prestalia in patients with renal
    impairment (GFR <60 mL/min).
Amlodipine

Simvastatin

  • Co-administration of multiple doses of 10 mg of
    amlodipine with 80 mg simvastatin resulted in a 77% increase in exposure to
    simvastatin compared to simvastatin administered alone.
  • Limit the dose of
    simvastatin in patients on amlodipine to 20 mg daily.

Cyclosporine

  • A prospective study in renal transplant patients showed
    an average 40% increase in trough cyclosporin levels during concomitant
    treatment with amlodipine. Frequent monitoring of trough blood levels of
    cyclosporine is recommended.

CYP3A Inhibitors

  • Co-administration of the moderate CYP3A inhibitor
    diltiazem increases the exposure to amlodipine by 60%.
  • Co-administered
    erythromycin, also a moderate CYP3A inhibitor, does not impact the exposure to
    amlodipine.
  • Strong CYP3A inhibitors (e.g., itraconazole) may increase the plasma
    concentrations of the CYP3A substrate amlodipine to a greater extent.
  • Monitor
    for symptoms of hypotension and edema when amlodipine is co-administered with
    moderate or strong CYP3A inhibitors to determine the need for dose adjustment.

CYP3A Inducers

  • No information is available on the quantitative effects
    of CYP3A inducers on amlodipine.
  • Blood pressure should be monitored when
    amlodipine is co-administered with CYP3A inducers.

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Is Prestalia safe to use while pregnant or breastfeeding?

  • Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death.
  • Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations.
  • Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death.
  • When pregnancy is detected, discontinue Prestalia as soon as possible.
  • These adverse outcomes are usually associated with use of these drugs in the second and third trimester of pregnancy.
  • Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in the first trimester have not distinguished drugs affecting the renin-angiotensin system from other antihypertensive agents.
  • Appropriate management of maternal hypertension during pregnancy is important to optimize outcomes for both mother and fetus.
  • It is not known whether perindopril or amlodipine is excreted in human milk, but radioactivity was detected in the milk of lactating rats following administration of 14C-perindopril.
  • Because of the potential for adverse effects on the nursing infant, decide whether to discontinue nursing or discontinue Prestalia.

Metolazone vs. Thiazide Diuretics: Side Effects, Dosage, Drug Interactions

What are the differences between metolazone and thiazide diuretics?

What are metolazone and thiazide diuretics?

Metolazone is a diuretic ("water pill") used to treat high blood pressure and fluid accumulation. It works by blocking salt and fluid retention by the kidneys, thereby increasing urinary output of salt and water (diuresis). Although it is not a true thiazide, metolazone is chemically related to the thiazide class of diuretics which includes chlorthalidone (Hygroton) and hydrochlorothiazide, and works in a similar manner. Zaroxolyn is the original formulation of metolazone, and Diulo is similar. The absorption of these two drugs is relatively incomplete. Mykrox has more complete absorption and so less Mykrox needs to be given to have the same effects as a larger dose of Zaroxolyn or Diulo.

Thiazide diuretics (water pills) are used to treat high blood pressure (hypertension), congestive heart failure, and the accumulation of fluid and swelling (edema) of the body caused by conditions such as heart failure, chronic kidney failure, cirrhosis, corticosteroid medications, and nephrotic syndrome. Thiazides work by reducing the ability of the kidneys to reabsorb salt and water from the urine and into the body, thereby increasing the production and output of urine (diuresis). Examples of thiazide diuretics include chlorthalidone (Thalitone), hydrochlorothiazide (Microzide), and methyclothiazide.

What are the side effects of metolazone and thiazide diuretics?

Metolazone

Metolazone generally is well tolerated. Common side effects of metolazone are:

  • Hypokalemia (low blood potassium)
  • Hyponatremia (low blood sodium)
  • Hypomagnesemia (low blood magnesium)
  • Hypercalcemia (high blood calcium)

About 1 out of every 10 patients reports dizziness, lightheadedness, and headache. Fatigue has been reported in 1 out of every 25 patients. About 1 out of every 50 patients reports:

Thiazide diuretics, which are chemically related to metolazone, are known to increase the amount of uric acid in the blood. Precipitation of gout (which is associated with high uric acid) is rare. Metolazone can increase blood sugar in people with diabetes.

Thiazide diuretics

Side effects of thiazide diuretics are dose related and include:

  • Dizziness and lightheadedness
  • Blurred vision
  • Loss of appetite
  • Itching
  • Stomach upset
  • Headache
  • Weakness

Other side effects and adverse reactions include an increased sensitivity to sunlight, therefore avoid prolonged sun exposure.

Owing to their ability to increase the production of urine, these drugs may lower levels in the body of potassium and magnesium, which also are present in urine.

Thiazide diuretics may increase uric acid levels in blood.

Like other antihypertensive medications, thiazides cause sexual dysfunction.

What is the dosage of metolazone vs. thiazide diuretics?

Metolazone

The recommended dose is 2.5 to 5 mg for treating hypertension and 2.5 to 20 mg for treating edema.

Thiazide diuretics

Thiazide diuretics may come in oral tablet form. For example, Thalitone (chlorthalidone) is a common thiazide diuretic.

The optimal dose of Thalitone varies greatly from patient to patient. For high blood pressure, the recommended dose range is 25 to 100 mg daily. Most patients receive 12.5 to 25 mg daily.

Edema is treated with 50 to 100 mg daily or 100 mg every other day and the maximum dose is 200 mg daily.

Heart failure is treated with 12.5 to 100 mg daily.




QUESTION

Salt and sodium are the same.
See Answer

What drugs interact with metolazone and thiazide diuretics?

Metolazone

Metolazone can reduce blood potassium and magnesium levels. This is especially true in patients who also are taking "loop" diuretics such as furosemide (Lasix), bumetanide (Bumex), and torsemide (Demadex). Low potassium and magnesium levels can lead to heart rhythm abnormalities, especially in patients taking digoxin (Lanoxin).

Metolazone reduces excretion of lithium (Lithobid, Eskalith) by the kidneys and can lead to lithium toxicity in patients receiving lithium.

Steroids (for example, hydrocortisone) and nonsteroidal anti-inflammatory agents (NSAIDs) such as ibuprofen (Motrin), naproxen (Naprosyn), and nabumetone (Relafen) can reduce the effectiveness of metolazone by interfering with the excretion of salt and water.

Thiazide diuretics

Thiazide diuretics can lower potassium and magnesium blood levels since they are both eliminated in urine. Low levels of potassium and magnesium in the blood can result in abnormal heart rhythms, particularly in those who are also taking digoxin (Lanoxin) in addition to a thiazide. Thiazide diuretics can increase the risk of lithium (Eskalith, Lithobid) toxicity by reducing the kidney's ability to eliminate lithium in the urine.

Drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin), naproxen (Naprosyn), and nabumetone (Relafen) can reduce the effectiveness of thiazide diuretics in lowering blood pressure because they may reduce the ability of the kidneys to make urine, particularly in patients who have reduced kidney function.

People who have diabetes may have increased blood sugar levels when taking thiazide diuretics.

It is not recommended to use thiazide diuretics with dofetilide (Tikosyn), a drug used for treating abnormal heart rhythms, as this may increase the blood levels of dofetilide (Tikosyn) and cause abnormal heart rhythms. Thiazide diuretics can reduce how the body responds to norepinephrine and render norepinephrine less effective.

Are metolazone and thiazide diuretics safe to use while pregnant or breastfeeding?

Metolazone

Metolazone should not be used during pregnancy unless absolutely necessary.

Metolazone is excreted in breast-milk. Intense diuresis using metolazone may reduce the production of milk. Otherwise metolazone is considered safe to use during nursing if required by the mother.

Thiazide diuretics

Thiazide diuretics including Thalitone (chlorthalidone) cross the placenta and can cause jaundice in the fetus or newborn. Therefore, thiazide diuretics such as Thalitone should not be used during pregnancy unless absolutely necessary.

Large doses of thiazide diuretics may suppress milk production, but the American Academy of Pediatrics considers thiazides to be compatible with breastfeeding.

nisoldipine (Sular): Drug Facts, Side Effects and Dosage

What is nisoldipine, and how does it work (mechanism of action)?

Nisoldipine is an oral calcium channel blocker (CCB) of the dihydropyridine (DHP) class that is used to treat high blood pressure. Other calcium channel blockers in the DHP class include nifedipine (Procardia, Adalat), amlodipine (Norvasc), felodipine (Plendil), nicardipine (Cardene), and isradipine (Dynacirc). Calcium channel blockers prevent calcium from entering certain types of muscle cells. Since the muscle cells need calcium to contract, CCBs prevent the cells from contracting, that is, they cause the muscle cells to relax. Nisoldipine selectively relaxes the muscles of small arteries causing the arteries to dilate but has little or no effect on muscles of veins or the heart. Dilation of arteries reduces blood pressure. Nisoldipine was approved by the FDA in February of 1995.

What brand names are available for nisoldipine?

Sular

Is nisoldipine available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for nisoldipine?

Yes

What are the uses for nisoldipine?

Nisoldipine is used for the treatment of high blood pressure (hypertension).

What are the side effects of nisoldipine?

The most common side effects of nisoldipine are:

What is the dosage for nisoldipine?

The recommended dose is 17 to 34 mg or 20 to 40 mg daily depending on the formulation that is used. Doses may be increased at one week intervals. Tablets should be swallowed whole and taken on an empty stomach. Individuals with poor liver function require lower doses of nisoldipine.




QUESTION

Salt and sodium are the same.
See Answer

Which drugs or supplements interact with nisoldipine?

Cimetidine (Tagamet) or any drug that reduces the activity of liver enzymes that break down nisoldipine can increase blood levels of nisoldipine, possibly causing more side effects. Examples of drugs that may reduce break down of nisoldipine include ketoconazole, itraconazole (Sporanox), and erythromycin.

Is nisoldipine safe to take if I’m pregnant or breastfeeding?

The effects of nisoldipine in pregnancy are unknown.

It is unknown if nisoldipine appears in breast milk.

What else should I know about nisoldipine?

What preparations of nisoldipine are available?

Tablets (Extended Release): 8.5, 17, 20, 25.5, 30, 34, and 40 mg.

How should I keep nisoldipine stored?

Tablets should be stored below 30 C (86 F) and should be protected from light and moisture.