(Irbesartan)

Antihypertensive, nephropathy in type 2 diabetes

Hypertension: P.O. (all 3) for adults (150mg q.d., may increase to 300mg q.d.), 13-16 yrs
(150mg q.d., may increase to 300mg q.d.),

and 6-12 yrs (75mg q.d., may increase to 150mg q.d.)

Nephropathy in type 2 diabetes: P.O. 300mg q.d.

Tablets 75 mg, 150 mg, 300 mg

BENICAR

(olmesartan medoxomil)

Antihypertensive

Adults: PO: Start with 20 mg once daily; after 2 wk, dosage may be increased to 40 mg/day if further
reduction in BP is needed.

Children (6 to 16 yr of age): PO: Start with 10 mg once daily for patients who weigh 20 to less than 35
kg, or 20 mg for patients who weigh 35 kg or more. After 2 wk, dosage may be increased to a max of
20 mg/day for patients who weigh 20 to less than 35 kg, or 40 mg/day for patients who weigh 35 kg or
more.

GENERAL DOSING INFORMATION:

If BP is not controlled by olmesartan alone, a diuretic or other antihypertensive agent may be
added.

For patients with depletion of intravascular volume, consider using a lower starting dose.

May be administered with or without food.

For children who cannot swallow tablets, the same dose can be given using an extemporaneous
suspension.

(combines two drugs: Norvasc/Lipitor)     (Amlodipine Besylate/Atorvastatin Calcium)  (am-LOW-duh-PEEN BEH-sih-LATE/ah-TORE-vah-STAT-in KAL-see-uhm)

Treatment of hypertension; chronic stable angina (chest pain); confirmed or suspected vasospastic angina (Prinzmetal or Variant angina).

P.O.

The max dose of amlodipine component is 10 mg once daily; the max dose of atorvastatin component is 80 mg daily.

Tablets 5 mg amlodipine per 10 mg atorvastatin
- Tablets 5 mg amlodipine per 20 mg atorvastatin
- Tablets 5 mg amlodipine per 40 mg atorvastatin
- Tablets 5 mg amlodipine per 80 mg atorvastatin
- Tablets 10 mg amlodipine per 10 mg atorvastatin
- Tablets 10 mg amlodipine per 20 mg atorvastatin
- Tablets 10 mg amlodipine per 40 mg atorvastatin
- Tablets 10 mg amlodipine per 80 mg atorvastatin

(Verapamil SR)

Oral:

Immediate-release: Treatment of vasospastic (Prinzmetal variant), chronic stable (classic effort–associated), and unstable (crescendo, preinfarction) angina; adjunctive treatment with digitalis to control ventricular rate at rest and during stress in atrial flutter or fibrillation; prophylaxis of repetitive paroxysmal supraventricular tachycardia; management of essential hypertension.

Oral:

Sustained-release: Management of essential hypertension. Management of angina pectoris (Covera HS only)

Angina Pectoris:

Adults: PO: 80 to 120 mg 3 times daily. Start with 40 or 80 mg 3 times daily. Base upward titration on therapeutic efficacy and safety evaluated approximately 8 h after dosing. Dosage may be increased daily or weekly. Covera-HS: 180 to 540 mg once daily at bedtime.

Arrhythmias:

Adults: PO: In digitalized patients, with chronic atrial fibrillation, the dose ranges from 240 to 320 mg/day divided into 3 or 4 times a day dosing. Dosage for prophylaxis of paroxysmal supraventricular tachycardia in nondigitalized patients ranges from 240 to 480 mg daily divided into 3 or 4 times a day dosing. In general, maximum effects for any given dosage will be apparent during the first 48 h of therapy.

Essential Hypertension:

Adults:

PO: 40 to 160 mg 3 times daily. Base upward titration on therapeutic efficacy, assessed at the end of the dosing interval. The antihypertensive effects are evident within the first week of therapy.

Sustained-release tablets, Calan SR: 120 to 480 mg. Daily doses of 240 mg or less are given each morning. Daily doses of 360 mg are given as 180 morning and evening or 240 mg each morning plus 120 mg each evening. Daily doses of 480 mg are administered as 240 mg every 12 h.

Covera-HS: 180 to 540 mg once daily at bedtime.

Supraventricular Tachycardia, Atrial Flutter or Fibrillation:

Adults: IV: Initial dose 5 to 10 mg (0.075 to 0.15 mg/kg) IV bolus over at least 2 min. Give 10 mg (0.15 mg/kg) 30 min after the first dose if initial response is not adequate. An optimal interval for subsequent IV doses has not been determined; individualize for each patient.

Older patients: IV: Administer the dose over at least 3 min to minimize risk of untoward drug effects.

1 to 15 yr of age: IV: 0.1 to 0.3 mg/kg administered as an IV bolus over at least 2 min (max, 5 mg). Give 0.1 to 0.3 mg/kg 30 min after first dose if initial response is not adequate (max, 10 mg as a single dose). An optimal interval for subsequent IV doses has not been determined; individualize for each patient.

0 to 1 yr of age: IV: 0.1 to 0.2 mg/kg administered as an IV bolus over at least 2 min under continuous ECG monitoring. Give 0.1 mg to 0.2 mg 30 min after the first dose under continuous ECG monitoring if the initial response is not adequate. An optimal interval for subsequent IV doses has not been determined; individualize for each patient.

Parenteral: Rapid conversion of paroxysmal supraventricular tachycardia to sinus rhythm; temporary control of rapid ventricular rate in atrial flutter or fibrillation.

Calan
- Tablets 80 mg
- Tablets 120 mg

Calan SR
- Tablets, sustained-release 120 mg
- Tablets, sustained-release 180 mg
- Tablets, sustained-release 240 mg

Covera-HS
- Tablets, extended-release 180 mg
- Tablets, extended-release 240 mg

Isoptin
- Tablets 40 mg
- Tablets 80 mg
- Tablets 120 mg

Isoptin SR
- Tablets, sustained-release 120 mg
- Tablets, sustained-release 180 mg
- Tablets, sustained-release 240 mg

(Diltiazem)

Oral: Treatment of angina pectoris caused by coronary artery spasm; chronic stable angina (classic effort-associated angina); essential hypertension (extended- and sustained-release forms only).

Parenteral: Treatment of atrial fibrillation or flutter; paroxysmal supraventricular tachycardia

Angina:

Adults:

PO:

Cardizem: Start with 30 mg 4 times daily before meals and at bedtime. Gradually increase dosage at 1- to 2-day intervals until optimum response (average optimum dose range 180 to 360 mg/day).

Cardizem CD and Cartia XT: Start with 120 to 180 mg once daily. Some patients may respond to doses up to 480 mg once daily. When necessary, titrate the dose over 7 to 14 days.

Cardizem LA: Start with 180 mg once daily. Some patients may respond to doses up to 360 mg once daily. Titrate dose over 7 to 14 days.

Dilacor XR and Diltia XT: Start with 120 mg once daily. Some patients may respond to doses up to 480 mg once daily. When necessary, titrate the dose over 7 to 14 days.

Diltzac and Tiazac: Start with 120 to 180 mg once daily. Some patients may respond to doses up to 540 mg once daily. When necessary, titrate the dose over 7 to 14 days.

Atrial Fibrillation/Flutter/Paroxysmal Supraventricular Tachycardia:

Adults:

Parenteral:

Direct IV single bolus injection: Initial dose is 0.25 mg/kg as a bolus administered over 2 min (reasonable dose is 20 mg for average patient). If response is inadequate after 15 min, administer as a second 0.35 mg/kg over 2 min (reasonable dose is 25 mg for average patient). Individualize subsequent IV doses. Dose low body weight patients on a mg/kg basis. Although the duration of action may be shorter, some patients may respond to an initial dose of 0.15 mg/kg.

Continuous IV infusion: For continued reduction of heart rate (up to 24 h) in patients with atrial fibrillation or atrial flutter, IV infusion may be administered. Immediately following administration of a bolus dose of 20 mg (0.25 mg/kg) or 25 mg (0.35 mg/kg) and reduction of heart rate, begin an IV infusion. The recommended initial infusion rate is 10 mg/h; however, some patients may maintain response to an initial rate of 5 mg/h. The infusion rate may be increased in 5 mg/h increments up to 15 mg/h as needed, if further reduction in heart rate is necessary. The infusion may be maintained for up to 24 h (max, 24 h and 15 mg/h).

Hypertension:

Adults:

PO:

Extended-release capsules:

Start with 60 to 120 mg twice daily or 180 to 240 mg once daily. Max antihypertensive effect usually occurs by 14 days of chronic therapy (optimum dose range 240 to 360 mg once daily, but some patients respond to lower doses or higher doses up to 480 mg once daily).

Cardizem CD and Cartia XT: 180 to 240 mg once daily; however, some patients may respond to lower doses. Maximum effect is usually achieved by 14 days of chronic therapy. Usual range is 240 to 360 mg once daily. Some patients may respond to doses up to 480 mg once daily.

Cardizem LA: Start with 180 to 240 mg once daily; however, some patients may respond to lower doses. Max effect is usually achieved by 14 days of chronic therapy. Dose range studied in clinical trials was 120 to 540 mg once daily (max, 540 mg daily).

Dilacor XR and Diltia XT: 180 to 240 mg once daily (usual dose range, 180 to 480 mg once daily). Individual patients, particularly those 60 yr of age and older, may respond to lower doses of 120 mg once daily. Some patients may require doses up to 540 mg once daily.

Diltzac and Tiazac: Start with 120 to 240 mg once daily. Max effect is usually achieved by 14 days of chronic therapy. Usual dose range is 120 to 540 mg once daily.

Cardizem LA
- Tablets, extended-release 120 mg
- Tablets, extended-release 180 mg
- Tablets, extended-release 240 mg
- Tablets, extended-release 300 mg
- Tablets, extended-release 360 mg
- Tablets, extended-release 420 mg

Cartia XT
- Capsules, extended-release 120 mg
- Capsules, extended-release 180 mg
- Capsules, extended-release 240 mg
- Capsules, extended-release 300 mg

Dilacor XR
- Capsules, extended-release 120 mg
- Capsules, extended-release 180 mg
- Capsules, extended-release 240 mg

Tiazac
- Capsules, extended-release 120 mg
- Capsules, extended-release 180 mg
- Capsules, extended-release 240 mg
- Capsules, extended-release 300 mg
- Capsules, extended-release 360 mg
- Capsules, extended-release 420 mg

(Clonidine)

Management of hypertension. Used in combination with opiates for epidural use for relief of cancer pain

Hypertension:

Adults:

Initial dose:

PO: Initially, 0.1 mg twice daily (immediate-release) or 0.1 mg at bedtime (modified-release); increase by increments of 0.1 mg/day at weekly intervals until desired response is achieved (max, 2.4 mg/day of immediate-release or 0.6 mg/day of modified-release).

Transdermal: 0.1 mg patch weekly initially; titrate to determine best response. Dosages greater than two 0.3 mg patches does not improve efficacy.

Children 12 yr of age and older: PO: Initially, 0.1 mg twice daily (immediate-release); increase by increments of 0.1 mg/day at weekly intervals until desired response is achieved (max, 2.4 mg/day of immediate-release).

Pain Relief:

Adults: Epidural infusion: 30 mcg/h as starting dose. Dosage may be titrated up or down depending on pain relief and occurrence of adverse reactions. Experience with dosage rates greater than 40 mcg/h is limited.

Renal function impairment:

PO: Adjust dose according to the degree of renal impairment and uptitrate slowly.

GENERAL DOSING INFORMATION:

Tablet

• May be used alone or with other antihypertensives.
• Dosages above 0.1 mg per day should be divided and taken in the morning and at bedtime. The larger portion of the daily dose should be taken at bedtime.
• Modified-release clonidine is not to be used interchangeably with the immediate-release formulation.
• Reduce the dose gradually over 2 to 4 days to avoid withdrawal symptomatology.
• If therapy is to be discontinued in patients receiving a beta-blocker and clonidine concurrently, the beta-blocker should be withdrawn several days before the gradual discontinuation of clonidine.

Epidural

• Dilute the 500 mcg/mL product in sodium chloride 0.9% injection to a final concentration of 100 mcg/mL.
• Must not be used with a preservative.
• When discontinuing therapy with epidural clonidine, gradually reduce the dose over 2 to 4 days to avoid withdrawal symptoms. If therapy is to be discontinued in patients receiving a beta-blocker and clonidine concurrently, discontinue the beta-blocker several days before the gradual discontinuation of epidural clonidine.

Transdermal

• Each transdermal system has 2 parts: (1) patch containing active drug, and (2) adhesive overlay. Apply patch to hairless area of intact skin on upper arm or torso as directed. Then apply adhesive overlay to ensure good adhesion of patch.
• Do not alter or trim patch.
• Change patch every 7 days.
• Alternate sites of patch application to prevent skin irritation.
• Before discarding old patch, fold adhesive edges together.

Catapres
- Tablets 0.1 mg
- Tablets 0.2 mg
- Tablets 0.3 mg

Catapres-TTS-1
- Transdermal system 2.5 mg

Catapres-TTS-2
- Transdermal system 5 mg

Catapres-TTS-3
- Transdermal system 7.5 mg

(Carvedilol)

Management of essential hypertension; treatment of mild to severe heart failure of ischemic or cardiomyopathic origin; reduction of CV mortality in clinically stable patients who have survived the acute phase of MI and have a left ventricular ejection fraction of 40% or less.

Essential Hypertension:

Adults:

Tablets: PO: Start with 6.25 mg twice daily. If tolerated (based on standing BP about 1 h after dosing), maintain the dosage for 7 to 14 days, then increase to 12.5 mg twice daily. If tolerated, maintain the dosage for 7 to 14 days, then increase to 25 mg twice daily if tolerated and needed (max, 50 mg/day).

Extended-release (ER) capsules: PO: Start with 20 mg once daily. If tolerated (based on standing BP about 1 h after dosing), maintain the dosage for 7 to 14 days, then increase to 40 mg once daily if needed. If tolerated, maintain the dosage for 7 to 14 days, then increase to 80 mg once daily if needed, maintaining the patient at lower doses if higher doses not tolerated (max, 80 mg once daily).

CHF:

Adults:

Tablets: PO: Start with 3.125 mg twice daily for 14 days. If tolerated, dosage may be increased to 6.25 mg twice daily; dosing may be doubled every 2 wk to the highest amount tolerated by patient (max, 25 mg twice daily for patients less than 85 kg [187 lbs]; 50 mg twice daily for patients more than 85 kg).

ER capsules: PO: Start with 10 mg once daily for 14 days. If tolerated, dosage may be increased to 20, 40, and 80 mg once daily over successive intervals of at least 14 days, maintaining the patient at lower doses if higher doses not tolerated.

Left Ventricular Dysfunction (LVD) Following MI:

Adults:

Tablets: PO: Start treatment once patient is stable and fluid retention is minimized. The recommended starting dosage is 6.25 mg twice daily and increased to 12.5 mg twice daily after 3 to 10 days, based on tolerability. The dosage may be increased again to the target dosage of 25 mg twice daily. A lower starting dosage may be used (3.125 mg twice daily) and/or, the rate of up-titration may be slowed if clinically indicated (eg, because of low BP or heart rate, or fluid retention). Patients may be maintained at lower dose if higher doses are not tolerated. The recommended dosing regimen need not be altered in patients receiving treatment with an IV or oral beta-blocker during the acute phase of the MI.

ER capsules: PO: Start with 20 mg once daily and increase after 3 to 10 days if tolerated to 40 mg once daily, then again to the target dosage of 80 mg once daily, maintaining the patient at lower doses if higher doses not tolerated.

Coreg
- Tablets 3.125 mg
- Tablets 6.25 mg
- Tablets 12.5 mg
- Tablets 25 mg

Coreg CR
- Capsules, extended-release 10 mg
- Capsules, extended-release 20 mg
- Capsules, extended-release 40 mg
- Capsules, extended-release 80 mg

(Losartan)

Treatment of hypertension; nephropathy in type 2 diabetic patients; reduce risk of stroke in patients with hypertension and left ventricular hypertrophy.

Hypertension:

Adults:

Initial dose: PO: 50 mg/day; 25 mg/day if volume depleted or history of hepatic impairment.

Maintenance dose: PO: 25 to 100 mg/day.

Children 6 yr of age and older:

Initial dose: PO: 0.7 mg/kg (max, 50 mg) once daily.

Maintenance dose: PO: 0.7 to 1.4 mg/kg/day (max, 100 mg).

Nephropathy in Type 2 Diabetes:

Adults:

Initial dose: PO: 50 mg/day; the dose may be increased to 100 mg/day based on BP response.

Hypertension in Patients with Left Ventricular Hypertrophy:

Adults: PO: 50 mg/day; add hydrochlorothiazide 12.5 mg/day and/or increase the dose of losartan to 100 mg/day followed by an increase in hydrochlorothiazide to 25 mg/day based on BP response.

Cozaar
- Tablets 25 mg
- Tablets 50 mg
- Tablets 100 mg

Dionvan

(Valsartan)

Treatment of hypertension; treatment of heart failure; reduction of CV mortality in clinically stable patients with left ventricular failure or dysfunction after MI.

Hypertension:

Adults: PO: Initial dosage: 80 or 160 mg once daily. Maintenance dosage: 80 to 320 mg once daily.

Children 6 to 16 yr of age: PO: Initial dosage: 1.3 mg/kg (up to 40 mg) once daily. Adjust dose based on BP response. Dosages higher than 2.7 mg/kg (up to 160 mg) once daily have not been studied in children.

Heart Failure:

Adults: PO: Initial dosage: 40 mg twice daily; titration to 80 and 160 mg twice daily should be done to the highest dose, as tolerated by the patient (max dose, 320 mg/day).

Post-myocardial infarction:

Adults: PO: Initiate 12 h after MI at 20 mg twice daily. Titrate within 7 days to 40 mg twice daily with additional titrations to a target maintenance dosage of 160 mg twice daily, as tolerated by the patient.

Diovan
- Tablets 40 mg
- Tablets 80 mg
- Tablets 160 mg
- Tablets 320 mg

(Propranolol)

Oral: Angina pectoris caused by coronary atherosclerosis (excluding InnoPran XL); cardiac arrhythmias (excluding ER); essential tremor (excluding ER); hypertension; hypertrophic subaortic stenosis (excluding InnoPran XL); migraine prophylaxis (excluding InnoPran XL); MI (excluding ER); pheochromocytoma (excluding ER).

IV: Cardiac arrhythmias.

Angina Pectoris Caused by Coronary Artherosclerosis:

Adults: PO: 80 to 320 mg/day in 2 to 4 divided doses or 80 mg/day of sustained-release medication (max, 320 mg/day).

Arrythmias:

Adults: PO: 10 to 30 mg (immediate-release) 3 to 4 times daily before meals and at bedtime.

Adults: IV: 1 to 3 mg at rate of 1 mg/min; may repeat after 2 min; give subsequent doses every 4 h.

Essential Tremor:

Adults: PO: The initial dosage is 40 mg of immediate-release twice daily; titrate to response. Max dosage is 320 mg/day in divided doses.

Hypertension:

Adults: PO: The initial dosage is 40 mg twice daily initially (or 80 mg/day of ER); titrate to response. The usual maintenance dosage is 120 to 240 mg/day in 2 to 3 divided doses or 120 to 160 mg/day of ER. For InnoPran XL, initial dosage is 80 mg once daily at bedtime (approximately 10 pm); titrate 120 mg/day. Do not exceed 640 mg/day.

Children: PO: 0.5 mg/kg twice daily; titrate every 3 to 5 days to max dose of 16 mg/kg/day.

Hypertrophic Subaortic Stenosis:

Adults: PO: 20 to 40 mg 3 to 4 times daily before meals and at bedtime or 80 to 160 mg of sustained-release once daily.

Migraine Prevention:

Adults: PO: 80 mg in divided doses daily or once daily (sustained-release); titrate to response (max dosage, 240 mg/day); discontinue after 6 wk if no response.

MI:

Adults: PO: 40 mg (immediate-release) 3 times per day as initial dose; after 1 mo, titrate to 60 mg to 80 mg 3 times daily as tolerated. Maintenance dosage is 180 to 240 mg/day in divided doses.

Pheochromocytoma:

Adults: PO: 60 mg/day in divided doses for 3 days prior to surgery, given with alpha-blocker. 30 mg/day in divided doses, given with alpha-blocker for management of inoperable tumor.

Inderal
- Injection 1 mg/mL

Inderal LA
- Capsules, ER 60 mg
- Capsules, ER 80 mg
- Capsules, ER 120 mg
- Capsules, ER 160 mg

InnoPran XL
- Capsules, ER 80 mg
- Capsules, ER 120 mg

Propranolol Hydrochloride
- Tablets 10 mg
- Tablets 20 mg
- Tablets 40 mg
- Tablets 60 mg
- Tablets 80 mg

Propranolol
- Solution, oral 4 mg/mL
- Solution, oral 8 mg/mL