Professional Documents
Culture Documents
Cardiovascular Drugs
Cardiovascular Drugs
CARDIOVASCULAR
DRUGS
LAWRENCE S. COHEN, M.D., LAWRENCE DECKELBAUM, M.D.,
JONATHAN ISAACSOHN, M.D., FORRESTER A. LEE, M.D.,
CRAIG A. McPHERSON, M.D., MARVIN MOSER, M.D.,
and LYNDA E. ROSENFELD, M.D.
●
METHODS OF TREATMENT
EXAMPLES OF ACE INHIBITORS “and useful medicines in too large doses are poi-
sons.” This general principle of sound pharmacology
Generic names (trade names): captopril (Capoten)
holds especially true for antiarrhythmic drugs. The
enalapril (Vasotec)
compounds used to treat heart rhythm disorders are
lisinopril (Prinivil, Zestril)
potent medications. Regardless of the type of antiar-
How suppled: captopril—tablet (12.5 mg, 25 mg,
rhythmic drug, patients should never take more than
50 mg, 100 mg)
prescribed. Conversely, because the effectiveness of
enalapril—tablet (2.5 mg, 5 mg, 10 mg, 20 mg)
these drugs depends on maintaining the optimum
lisinopril—tablet (5 mg, 10 mg, 20 mg, 40 mg)
level of medication in the blood, the patient should
Available as generic: no
be sure to take them according to the physician’s
Description: Captopril was the first of the ACE in-
instructions. (See Chapter 16.)
hibitors. They block the agent that constricts
Each of the antiarrhythmic drugs maybe used to
blood vessels by interfering with a chain of
treat many different rhythm disorders, and two pa-
chemical reactions called the renin-angiotensin
tients taking the same medication do not necessarily
system. This improves the flow of blood. ACE
have the same problem. Many patients tolerate an-
inhibitors also prevent an abnormal rise in hor-
tiarrhythmic medications quite well, but ail of these
mones associated with heart failure, such as
drugs may cause side effects, so patients should
adrenaline and aldosterone.
promptly report any new sensations, symptoms, or
Effects: They dilate the blood vessels and improve
difficulties to the doctor.
the flow of blood, thus lowering high blood Although the vast majority of patients benefit from
pressure, relieving vascular muscle spasm, and
antiarrhythmic drugs, heart arrhythmias may para-
reducing the workload of the heart.
doxically worsen in 5 to 10 percent of patients. For
Possible side effects: Common side effects are diz-
that reason and the fact that the more serious heart
ziness or weakness, loss of appetite, a rash,
rhythm abnormalities occur in sick patients, antiar-
itching, a hacking, unpredictable cough, and
rhythmic drugs are often first given in the hospital,
swelling.
so the effects on heart rhythm can be carefully
Approximate cost: for 100 tablets,
monitored. These may be measured by an electro-
captopril—12.5 mg, $45.87 to $64.83; 25 mg,
cardiogram, Helter monitor, telemetry, and/or elec-
$54.99 to $76.79; 50 mg, $75.17 to $108.49 trophysiology studies. Most of the time, however,
enalapril—5 mg, $77 to $99*
these drugs can be continued safely without
lisinopril-10 mg, $60.50 to $66*
hospitalization.
Dosage; captopril—12.5 to 37.5 mg per day
The heart’s response to a given medication may
starting dose; 75 to 150 mg per day
change over time, making regular follow-up visits es-
maintenance dose; must be taken at least
sential. Changes in treatment regimen, either to re-
twice a day
lieve side effects or to increase effectiveness, are
enalapril—2.5 mg or 5 mg to 30 mg per day
common. Because different antiarrhythmic drugs
lisinopril—5 mg to 30 mg once daily
may interact in undesirable ways, patients should
Notes:
make sure that any doctor prescribing a new medi-
● Cimetidine (Tagamet) may increase side effects
cation knows about any other antiarrhythmic drugs
and decrease captopril’s effectiveness.
that have already been prescribed.
● For people with certain kidney abnormalities,
Possible side effects: Most serious side effect is lung Generic name (trade name): disopyramide
inflammation. Also causes liver inflammation, phosphate (Norpace)
muscle degeneration and weakness, loss of bal- How supplied: capsule (100 mg, 150 mg) and
ance, and slow heart rate. Skin may become extended-release capsule (100 mg, 150 mg)
more susceptible to sunburn and may take on Available as generic: yes
a blue-gray discoloration. Paradoxically, amio- Description: It is a synthetic drug that reduces the
darone can cause both thyroid underactivity— force of the heartbeat (similar to procainamide
with symptoms of fatigue, intolerance to cold, and quinidine).
constipation, and weight gain—or hyperthy- Effects: Corrects some abnormal heart rhythms, par-
roidism—characterized by sleeplessness, heat titularly rapid heartbeats.
intolerance, sweats, weight loss, and rapid Possible side effects: Its most serious side effect is
heart rate. Other side effects are rash, weight weakening of heart contractions in hearts that
loss, nausea, constipation, dizziness, fainting, are already mildly to moderately weak. Dry
palpitations, and changes in vision. mouth is common, constipation can occur, and
Approximate cost: for 60200-mg tablets, average men can sometimes have difficulty urinating.
wholesale price, $139.39** (These three can often be reversed by giving a
Dosage: 200 mg to 600 mg per day drug called pyridostigmine [Mestinonl as well.)
Notes: Low blood sugar has also been noted, and cer-
● Because of its many side effects, amiodarone is tain forms of glaucoma may become worse.
approved only for the treatment of serious ar- Approximate cost: for 100 100-mg capsules, average
rhythmias that do not respond to other drugs. Re- wholesale price, $45.20”; for 100 100-mg ex-
searchers are seeking a less toxic form of tended-release capsules, average wholesale
amiodarone that may one day prove a highly ben- price, $54.45**
eficial antiarrhythmic agent. Dosage: 100 mg three to four times per day
● Doses of digitalis drugs or warfarin-type antico- Notes:
agulant drugs should be reduced in conjunction ● Phenytoin (Dilantin) and rifampin (Rifadin, Rifa-
with amiodarone. mate, Rimactane) may reduce the effect of diso-
pyramide.
Generic name (trade name): digoxin (Lanoxin) ● People with diabetes should use disopyramide
How supplied: tablet (0.125 mg, 0.25 mg, 0.5 mg), with caution.
capsule (0.05 mg, 0.1 mg, 0.2 mg), ● Disopyramide has drug interactions with drugs
elixir (0.05 mg per ml, 60-ml bottle), having anticholinergic effects, such as a bella-
injection (0.5 mg in 2 ml, 0.1 mg in 1 ml) donna and phenobarbital mix (Donnatal) or pro-
Available as generic: yes pantheline bromide (Pro-banthine).
Description: It is a digitalis drug extracted from the
leaves of the foxglove plant. Generic names (trade names): flecainide
Effects: Relieves heart failure and corrects some ab- (Tambocor)
normal heart rhythms. propafenone (Rhythmol)
Possible side effects: Side effects are tiredness, nau- How supplied: flecainide-tablet (50 mg, 100 mg,
sea, loss of appetite, confusion, vision disturb- 150 mg)
ances, and palpitations, propafenone—tablet (150 mg, 300 mg)
Approximate cost: for 100 tablets, 0.125 mg, $5.59 to Available as generic: no
$8.63; 0.25 mg, $5.99 to $10.19 Description: These are highly potent drugs used only
Dosage: 0.125 mg to 0.25 mg per day for adults; re- for serious ventricular arrhythmias that fail to
duced dosage for children based on weight and respond to other medications and never in pa-
age tients with a history of heart attack or conges-
Notes: tive heart failure.
● Check with doctor before combining with any Effects: Suppresses vigorous potentially dangerous
other medication. There are numerous drug in- ventricular arrhythmias.
teractions. Possible side effects: May worsen some arrhythmias,
● People taking digoxin should be monitored be- weaken cardiac pumping, slow heart rate, or
cause an effective digoxin dose may be near the increase blood sugar. May cause fever, rash,
toxic dose. liver inflammation, confusion, loss of concen-
289
METHODS OF TREATMENT
tration, dizziness, a metallic taste in the mouth, loss of concentration, dizziness, tremors, and
or changes in vision. changes in vision may occur.
Approximate cost: for lOO capsules or tablets, Approximate cost: for 100150-mg capsules, average
flecainide-50 mg, average wholesale price, wholesale price, $57.95**
$48.66** Dosage: 150 to 300 mg three to four times per day
propafenone—150 mg, average wholesale price, Notes:
$59.16***; 300 mg, average wholesale price, ● Adverse effects can be reduced by taking the drug
$107.34*** with meals.
Dosage: flecainide-100 mg to 200 mg twice a day ● Drug interactions are minimal.
Generic name (trade name): mexiletine (Mexitil) Generic name (trade names): quinidine gluconate
How supplied: capsule (150 mg, 200 mg, 250 mg) (Duraquin, Quinaglute Dura-Tabs, Quinalan
Available as generic: no Sustained-Release)
Description: It is a local anesthetic and antiar- quinidine sulfate (Quinidex Extentabs)
rhythmic that came into use in the 1980s. Re- How supplied: quinidine gluconate—tablet
lated to the drug lidocaine. (sustained-release 324 mg, 330 mg)
Effects: Suppresses ventricular arrhythmias. quinidine sulfate–tablet (200 mg, 300 mg),
Possible side effects: Fever, rash, lower blood platelet extended-release tablet (300 mg), capsule
count, liver inflammation, nausea, confusion, (325 mg)
Available as generic: yes inhibit the ability of the blood to clot—preventing
Description: Used since 1918, this is one of the oldest clots from forming in blood vessels and from getting
antiarrhythmics. It is derived from the bark of bigger. Under a number of different circumstances,
the South American cinchona tree. it becomes necessary to stop clotting. Anticoagulants,
Effects: It controls many different abnormal heart antiplatelet agents, and thrombolytics each have spe-
rhythms, especially those that are fast or irreg- cific indications and uses.
ular. Any patient who has had a heart valve replaced
Possible side effects: Diarrhea is the most common with a mechanical valve (see Chapter 13) requires
side effect. In rare cases, may cause a drop in lifelong oral anticoagulants in order to prevent clots
blood platelets, causing bruises or bleeding. from forming on the valve. Patients who develop
Other possible effects are fever, rash, dizziness, atrial fibrillation (see Chapter 16) may require anti-
and ringing in the ears. coagulants; clot formation in the left atrium is a po-
Approximate cost: quinidine sulfate—100200-mg tential hazard of this rhythmic disturbance. Oral
tablets, generic, $10.67 to $16.43 anticoagulants are prescribed for patients who de-
Dosage: 200 mg to 400 mg three to four times per velop thrombophlebitis, an inflammation of the veins
day in the legs or pelvis. (See Chapter 17.) One of the
Notes: dangers of this condition is the development of blood
• Digoxin dosage should be cut in half if taken with clots that may travel to the lungs and cause pulmo-
quinidine. nary emboli. Lastly, some patients who have a serious
● Quinidine may increase bleeding if taken in con- heart attack involving the front surface of the heart
junction with warfarin (Coumadin). are prescribed an anticoagulant to prevent clots from
● Phenobarbital and rifampin reduce the effect of forming on the inner lining of the scar.
quinidine. Heparin is an anticoagulant that is administered
intravenously when rapid anticoagulation is neces-
Generic name (trade name): tocainide (Tonocard) sary. All patients undergoing open-heart surgery are
How supplied: tablet (400 mg, 600 mg) treated with heparin while their blood is being oxy-
Available as generic: no genated by the heart-lung machine. At the end of the
Description: It came into use in the 1980s and is operation, medication is given to reverse the effects
related to lidocaine. of heparin. (See Chapter 11.)
Effects: It suppresses ventricular arrhythmias. When a person first develops thrombophlebitis,
Possible side effects: Most significant common side heparin is often used because its action is almost im-
effects are weight loss, nausea, and tremors. mediate. It also is used in people who have had a
Other less common effects are fever, rash, de- heart attack and have been treated with thrombolytic
pressed white blood cell count, liver inflam- therapy. Keeping the affected artery open often re-
mation, confusion, loss of concentration, quires vigorous anticoagulation.
dizziness, and disturbances in vision. About 0.1 Aspirin is not an anticoagulant but has a profound
to 0.2 percent of patients suffer lung inflam- effect on a component of the blood called platelets—
mation, a potentially serious side effect. blood cells that stick together and cause clots to form.
Approximate cost: for 100 400-mg tablets, average Platelets are important in blood clotting and are in
wholesale price, $75.20** large part responsible for allowing us to stop bleed-
Dosage: 200 mg to 600 mg three times per day ing when we cut ourselves. Platelets are also in part
Notes: responsible for the formation of a clot in a coronary
• Collectively, tocainide’s more serious side effects artery-a phenomenon that initiates many heart at-
have discouraged its use as a frontline drug. tacks. Because of aspirin’s ability to inhibit the clot-
ting action of platelets, it is designated as an
antiplatelet and is frequently prescribed in patients
who have recovered from a heart attack, in order to
ANTICOAGULANTS, ANTIPLATELETS prevent clots from forming in the veins used for cor-
AND THROMBOLYTICS onary bypass surgery.
The most recent and exciting class of drugs that
are useful for people with heart attacks are the throm-
These drugs are sometimes referred to as “blood bolytic drugs. These agents are given intravenously
thinners,” but this term is not truly accurate. They as soon as possible with the goal of dissolving the
METHODS OF TREATMENT
offending clot within a coronary artery. A patient Dosage: 75 mg to 400 mg per day
having a heart attack can be helped considerably if Note:
the clot can be dissolved before it causes permanent, ● Dipyridamole may increase the effect of other an-
debilitating damage. The three most commonly used ticoagulants.
thrombolytics are t-PA, streptokinase, and APSAC.
They are generally used only in hospitals or in emer- Generic name (trade names): warfarin (Coumadin,
gency situations. Panwarfin)
How supplied: tablet (1 mg, 2 mg, 2.5 mg, 5 mg,
EXAMPLES OF ANTICOAGULANTS, 7.5 mg, 10 mg)
ANTIPLATELETS, AND THROMBOLYTICS Available as generic: yes
Description: Warfarin is the prototype oral antico-
Generic name (trade names): acetylsalicylic acid or agulant. It and some drugs related to it have
aspirin (Alka-Seltzer, Anacin, Ascriptin, been used for nearly 50 years.
Bayer, Bufferin, Easprin, Ecotrin, St. Josephs, Effects; Prevents blood clots, especially in the leg and
Zorprin) pelvic veins where blood flow is at its slowest.
How supplied: tablet (81 mg, 325 mg, 650 mg), Also used in people with atria] fibrillation or
capsule (325 mg, 650 mg), rectal suppository after a heart valve replacement.
(325 mg, 650 mg) Possible side effects: Excessive bleeding is the most
Available as generic: yes common adverse effect. Nausea or vomiting,
Description: It is a nonnarcotic analgesic and anti- loss of appetite, abdominal pain or diarrhea,
platelet used since 1899. rash or bruising, and hair loss are also possib!e.
Effects: Helps prevent blood clots. Also treats pain, Approximate cost: For 100 5-mg tablets, $48.29 to
fever, arthritis, colds, menstrual cramps, head- $61.13 (generic, $28.33 to $37.37)
aches, and joint and muscular aches. Dosage: 15 mg on the first day of treatment, 10 mg
Possible side eflects: Indigestion is the most common on the second, and 2.5 mg to 7.5 mg per day
side effect. thereafter
Approximate cost: Varies greatly. Generic may cost Note:
only pennies per pill. Shop around for best ● Interacts with a variety of drugs. Check with your
over-the-counter drug values. physician and pharmacist.
Dosage: to inhibit clotting, 81 mg to 325 mg per
day
Notes:
● Aspirin can cause Reye’s syndrome, a rare brain
ment, thus reducing the possibility of angina caused opposed to both heart and lungs) beta blockers
by oxygen deprivation. that were first introduced in 1985, 1981, and
Beta blockers may be prescribed as the initial 1978 respectively. Nadolol was introduced in
drugs to lower blood pressure, or they maybe given 1980. Pindolol is one of the newer beta blockers.
along with a diuretic or other antihypertensive drug. Propranolol was introduced in 1968 and was the
In general, beta blockers are more effective in first beta blocker to be available in the United
younger patients. Because they relieve angina, they States.
may be the drug of choice for people who have this Effects: They treat hypertension, angina, some ab-
problem along with high blood pressure. Beta block- normal heart rhythms, palpitations, and
ers also damp heart rate increases caused by stress, tremors caused by overactivity of the thyroid
exercise, or anxiety. Stage performers occasionally gland, and anxiety such as stage fright. May
take them to combat the heart palpitations, voice protect the heart from further damage after a
cracking, or fine tremors of the hands that may be heart attack. May help prevent migraine head-
associated with stage fright. aches.
For reasons that are not fully understood, African- Possible side effects: Lethargy and cold hands and
Americans do not seem to respond as well as whites feet because of reduced circulation may occur.
to beta blockers, although there are exceptions. Be- Also may cause nausea, nightmares or vivid
cause beta blockers may actually constrict peripheral dreams, and impotence. May also precipitate
blood vessels, they generally are not recommended asthmatic attack.
for people with circulatory problems in their hands Approximate cost: For 100 tablets or capsules,
or legs. They also are not prescribed for people with acebutolol—200 mg, average wholesale price,
asthma. Their use tends to result in a spasm of the $58.2***; 400 mg, average wholesale price,
bronchial tubes in the lungs of susceptible persons. $77.40’”
Most patients tolerate beta blockers well, espe- atenolol—50 mg, $66.59 to $92.99; 100 mg,
cially if they are administered in low doses along with $107.37 to $147.99
a diuretic or other antihypertensive drug. The effects metoprolol—50 mg, $35.97 to $53.37; 100 mg,
of beta blockers are particularly complemented by $61.57 to $83.99
nitrate therapy for angina. nadolol—40 mg, $73.99 to $103.33
pindolol—5 mg, average wholesale price,
EXAMPLES OF BETA BLOCKERS $54.48***; 10 mg, average wholesale price,
Generic names (trade names): acebutolol (Sectral) $69.60***
atenolol (Tenormin) propranolol—20 mg, $27.77 to $45.93 (generic,
metoprolol (Lopressor) $10.47 to $17.43); 40 mg, $38.27 to $56.57
nadolol (Corgard) (generic, $12.69 to $23.27); 80 mg long-acting,
pindolol (Visken) $70.60 to $93.73 (generic, $41.23 to $57.87)
propranolol (Inderal) Dosage; acebutolol—200 mg to 600 mg per day
How supplied: acebutolol—capsule (200 mg, atenolol—25 mg to 100 mg per day
400 mg) metoprolol—50 mg to 150 mg per day
atenolol—tablet (50 mg, 100 mg), injection nadolol—40 mg to 160 mg per day
(0.5 mg/ml, 10-ml ampule) pindolol—10 mg to 40 mg per day
metoprolol—tablet (50 mg, 100 mg), injection propranolol—40 mg to 240 mg per day
(1 mg/ml, 5-ml ampule) Notes:
nadolol—tablet (20 mg, 40 mg, 80 mg, 120 mg, ● None of the beta blockers should be used by asth-
160 mg) matics or people with chronic lung disease.
pindolol–tablet (5 mg, 10 mg) ● Beta blockers should be used with caution in in-
propranolol—tablet (10 mg, 20 mg, 40 mg, 60 sulin-dependent diabetics and people with periph-
mg, 80 mg, 90 mg), sustained-release capsule eral vascular disease.
(60 mg, 80 mg, 120 mg, 160 mg)
Available as generic: acebutolol, atenolol, metopro- Altogether, there are about 10 beta blockers cur-
101, nadolol, pindolol—no rently on the market in the United States, including
propranolol—yes betaxolol (Kerlone), carteolol (Cartrol), penbutolol
Description: Acebutolol, atenolol, and metoprolol are (Levatol), and timolol maleate (Blocadren). For more
cardioselective (acting mainly on the heart as complete information on these less commonly pre-
METHODS OF TREATMENT
.
scribed or newly released medications, consult your Description: Nicardipine is one of the more recently
physician or pharmacist. introduced calcium channel blockers. Nifedi-
pine is a calcium channel blocker and antian-
ginal and antihypertensive drug introduced in
1982.
Effects: They help relieve anginal pain and prevent
CALCIUM CHANNEL BLOCKERS attacks, reduce blood pressure, and help im-
prove circulation in the limbs.
Calcium plays a central role in the electrical stimu- Possible side effects: May cause redness of face and
lation of cardiac cells and in the mechanical contrac- neck, headache, palpitations, dizziness, nausea,
tion of smooth muscle cells in the wails of arteries. low blood pressure, ankle swelling, and rash.
Calcium channel blockers are relatively new synthetic Approximate cost: for 100 tablets,
drugs that work by blocking the passage of calcium nicardipine—20 mg, $44 to $49.50’
into the muscle cells that control the size of blood nifedipine—10 mg, $40.27 to $57.13; 20 mg,
vessels. All muscles need calcium in order to con- $79.97 to $111.37; 30 mg XL, $92.99 to
strict; by preventing the muscles of the arteries from $118.23; 60 mg XL, $164.63 to $215.89
constricting, blood vessels open up (dilate), allowing Dosage: nicardipine—60 mg to 120 mg per day
blood to flow through them more easily. Blood pres- nifedipine—30 mg to 120 mg per day
sure is reduced.
Calcium channel blockers are effective in initial Generic name (trade name): nimodipine (Nimotop)
treatment of high blood pressure in about 30 to 40 How suppiied: capsule (30 mg)
Available as generic: no
percent of patients with hypertension. They maybe
Description: It is a calcium channel blocker, available
added to a diuretic or other antihypertensive medi-
cation. They are generally well tolerated (even by peo- since 1989, that is used to treat people who have
ple with asthma), but they are more costly than had a burst blood vessel in the head (known as
subarachnoid hemorrhage or ruptured aneu-
diuretics or beta blockers. Thus, many doctors still
recommend that other drugs be tried first. rysm). (See Chapter 18.)
Effects: It may help relax constricted blood vessels
EXAMPLES OF CALCIUM CHANNEL BLOCKERS (known as vasospasm), a condition that can lead
to a recurrence of stroke.
Generic name (trade name): diltiazem (Cardizem) Possible side effects: Dizziness or lightheadedness,
How supplied: tablet (30 mg, 60 mg, 90 mg, 120 mg), headache, nausea, fast heart rate, skin rash, or
sustained-release capsule (60 mg, 90 mg, swelling of the lower extremities may occur.
120 mg) Approximate cost: for 100 30-mg capsules, average
Available as generic: no wholesale price, $480.19***
Description: It is a calcium channel blocker and an- Dosage: 60 mg, every four hours for 21
tianginal drug, introduced in 1984. consecutive days
Effects: Reduces the frequency of angina attacks and
lowers blood pressure. Generic name (trade names): verapamil (Calan,
Possible side effects: Headache, nausea, tiredness, Isoptin, Verelan)
ankle swelling, dizziness, and rash can occur. How supplied: tablet (40 mg, 80 mg, 120 mg),
Approximate cost: for 100 tablets, 30 mg, $31.99 to sustained-release tablet (180 mg, 240 mg),
$43.69; 60 mg, $49.63 to $65.43; 90 mg, $67.57 capsule (120 mg, 240 mg), sustained-release
to $88.63 caplet (180 mg, 240 mg), injection (5-mg/ml
Dosage: 60 mg to 240 mg per day and 10-mg/ml ampules, 5-mg/2ml and 10-mg/
4ml vials)
Generic names (trade names): nicardipine Available as generic: yes
(Cardene) Description: It is a calcium channel blocker, antian-
nifedipine (Procardia, Procardia XL) ginal drug, and antiarrhythmic drug introduced
How supplied: nicardipine–capsule (20 mg, 30 mg) in 1981.
nifedipine—capsule (10 mg, 20 mg), extended- Effects: Suppresses some arrhythmias, helps prevent
release tablet (30 mg, 60 mg, 90 mg) anginal attacks, and reduces high blood pres-
Available as generic: no sure.
CARDIOVASCULAR DRUGS
fats only after several months of dietary modification drugs do not reduce triglycerides and, in fact,
alone have failed to do the job adequately. may raise them in some people.
How high a level of blood cholesterol warrants Possible side effects: Constipation, bloating, heart-
drug therapy? This is a decision made by the physi- burn, nausea, vomiting, headaches, and inter-
cian, based on a person’s individual health profile— ference with absorption of other drugs may
including age, overall health status, cardiovascular occur. Many people are unable to tolerate
risk factors, history of heart disease, and many other dosages high enough to produce the desired
factors. effect.
Remember, cholesterol-lowering medication is con- Approximate cost: cholestyramine powder—$63.74
sidered an adjunct to dietary modification, not a re- per carton of 60 packets**; $27.92 per can (378
placement for it. If a person on drug therapy for high gin)”
blood cholesterol continues to eat a high-fat, high- colestipol-$27.99 per box of 30 packets**;
cholesterol diet, the effects of the medication maybe $62.29 per bottle (500 gm)**
undermined or undone. Once drug therapy for ele- Dosage: 2 to 4 packets or scoops twice daily; most
vated blood cholesterol is begun, the therapy may effective when taken with meals
have to be continued indefinitely. This is why the de- Notes:
cision to begin cholesterol-lowering drug therapy ● May interfere with absorption of several drugs,
calls for careful consideration. including thiazide diuretics, digoxin, warfarin,
Drugs that lower cholesterol do so in various ways beta blockers, thyroid medications, and antibiot-
and have differing effects on the various components ics. Patients taking any of these drugs maybe ad-
of total blood cholesterol (including HDL and LDL vised to take them one hour before or several
cholesterol and triglycerides). An individual’s “lipid hours after a dose of bile acid sequestrant.
profile: or the levels of various fats in the blood- ● To decrease the possibility of constipation, in-
stream, helps determine which drug or drugs to pre- crease intake of fluids and dietary fiber. If consti-
scribe. (Sometimes physicians use the ratio of total pation still occurs, ask the physician about taking
to HDL cholesterol, or of LDL to HDL, in assessing a psyllium-based stool softener or other laxative.
risk and determining a course of treatment.) Other ● With a long record of safety and effectiveness,
factors in drug selection include cost, side effects, these drugs are listed among the first choices for
convenience, safety, effectiveness, and impact on car- cholesterol-lowering therapy. Inconveniences in-
diovascular risk as shown in clinical trials. clude the gritty powder form of the medication
and the common side effects of constipation and
EXAMPLES OF CHOLESTEROL-LOWERING other gastrointestinal disorders.
AGENTS
Generic name (trade name): gemfibrozil (Lopid)
Generic names (trade names): cholestyramine How suppiied: capsule (600 mg)
(Questran, Questran Light) Available as generic: no
colestipol (Colestid) Description: This drug, which belongs to a class of
How supplied: cholestyramine-powder (carton of agents known as fibric acids, works by breaking
60 9-gin packets or can of 378 gm) down a component of blood cholesterol called
colestipol—granules (box of 30 5-gm packets; very-low-density lipoprotein (VLDL).
bottle of 500 gin) Effects: Gemfibrozil is prescribed to lower elevated
Available as generic: no levels of blood triglycerides and to increase
Description: These drugs, called bile acid seques- HDL. However, the drug may also cause a mod-
trants, work in the intestine to bind bile acids, erate reduction in LDL cholesterol. Thus, it may
which are then excreted. This stimulates the be indicated for individuals who have very low
liver to remove more LDL cholesterol from the levels of HDL cholesterol in addition to high
blood in order to manufacture more bile acids. total or LDL cholesterol levels.
The medications are in powder form and must Possible side effects: Muscle aches or weakness, ab-
be taken mixed with water or some other liquid dominal pain or discomfort, diarrhea, and nau-
such as orange juice. They are available in pack- sea may occur.
ets or in bulk, with a scoop equal to one packet. Approximate cost: for 100 600-mg capsules, $88.23
Effects: Total cholesterol may be reduced 15 to 20 to $122.17
percent on an average regimen. However, these Dosage: 600 mg twice daily (most effective when
CARDIOVASCULAR DRUGS
taken 30 minutes before morning or evening 750 mg), timed-release preparation (125 mg,
meals) 250 mg, 500 mg)
Notes: Available as generic: yes
● Gemfibrozil may increase the effect of warfarin Description: Nicotinic acid, a B vitamin, works in the
and other anticoagulant drugs; if you take an an- liver in a manner that is still unclear.
ticoagulant drug, your physician may need to Effects: It lowers triglycerides and LDL cholesterol;
readjust the dosage. raises HDL cholesterol.
• Offers convenience and relative lack of side ef- Possible side effects: Itching, rash, or flushing of the
fects; however, increases chance of developing skin, gastrointestinal distress, dizziness, light-
gallstones or liver dysfunction. headedness, and rapid heartbeat may occur.
● Another drug in this class, fenofibrate (Lipidil), Approximate cost: for 100 500-mg tabs, $43.52** (Ge-
may soon be available in the United States. nerics may be a fraction of the cost of brand
names. Shop around for best over-the-counter
drug values.)
Generic name (trade name): lovastatin (Mevacor) Dosage: 500 mg to 1,000 mg or more, three times a
How supplied: tablet (20 mg, 40 mg) day (usually taken with meals). Dosage usually
Available as generic: no starts low (for example, 100 mg three times a
Description: The drug restricts the liver’s production day) and increases slowly over several weeks to
of cholesterol by inhibiting the action of an en- minimize side effects.
zyme called HMG-COA reductase. As the liver Notes:
synthesizes less cholesterol, it absorbs more ● It can be purchased without a prescription, but
LDL (“bad) cholesterol from the bloodstream. should not be taken as a cholesterol-lowering
Effects: May lower LDL cholesterol by 30 to 40 medication unless prescribed by a physician. At
percent. At higher doses, it may moderately the high doses necessary to lower cholesterol, nia-
decrease triglycerides and increase HDL cho- cin is as powerful as any prescription drug, and
lesterol as well. should be monitored accordingly for effects and
Possible side effects: Headache, rash, muscle ache or side effects.
weakness, dizziness, lightheadedness, cataracts, ● It is safe and effective, but often causes side effects,
and liver function abnormalities may occur. particularly flushing and itching at the outset of
Approximate cost: for 100 20-mg tablets, $167.63 to therapy. This can be minimized by taking aspirin
$215.27 once a day; ask your physician. At high doses, liver
Dosage: 20 mg to 80 mg function abnormalities may occur; periodic testing
Notes: of liver enzymes, blood sugar, and uric acid may
● Lovastatin causes relatively few side effects in be necessary.
most people. However, as a newer drug, it has a ● Skipping doses may increase side effects when the
shorter track record of safety than some other drug is next taken. If you stop taking the drug for
agents. more than two days, ask your physician about re-
● It is possible that lovastatin may cause liver dys- starting at a lower dose.
function or cataracts. For this reason, liver func- ● Sustained-release form occasionally has caused
tion tests every six to eight months and annual eye severe liver damage, even at low doses (500 mg).
examinations may be recommended for people
taking the drug. Generic name (trade name): probucol (Lorelco)
● Other drugs in the category of HMG-COA re- How supplied: tablet (250 mg, 500 mg)
ductase inhibitors that may become available in the Available as generic: no
future include simvastatin (Zocor), pravastatin Description: Probucol works in the bloodstream
(Pravachol), and fluvastatin (LoChol), pending to alter the makeup of LDL cholesterol, caus-
FDA approval for prescription use. ing it to be removed more quickly from the
blood.
Generic names (trade names): nicotinic acid, niacin Effects: It lowers total and LDL cholesterol, but it also
(Nia-Bid, Niacels, Niacor, Niaplus, Nicolar, may lower beneficial HDL cholesterol. May in-
Nicobid, Slo-Niacin) hibit the oxidation of LDL cholesterol and thus
How supplied: tablet (100 mg, 250 mg, 500 mg), help keep it from being deposited in artery
sustained-release capsule (250 mg, 500 mg, walls.
297
METHODS OF TREATMENT
Possible side effects: Indigestion, diarrhea, head- When patients with heart failure start taking dig-
ache, rash, and insomnia may occur. italis, their symptoms improve significantly, partic-
Approximate cost: for 120 250-mg tablets, $65.82**; ularly the breathlessness that results from congestion
for 100 500-mg tablets, $94.86** of fluids in the lungs. Digitalis drugs also reduce
Dosage: 500 mg twice daily swelling in the legs, alleviate fatigue as blood and
oxygen are delivered more effectively to body organs,
and increase the person’s overall capacity to perform
daily activities and exercise.
DIGITALIS DRUGS Digitalis may be given on a short-term basis in
acute heart failure or over a long period of time to
treat chronic heart failure. Physicians usually pre-
Like many drugs, digitalis was originally derived scribe digitalis together with diuretics, which further
from a plant, in this case the foxglove. Digitalis has promote removal of fluids from body tissues. Newer
the primary effect of strengthening the force of con- classes of drugs, particularly ACE inhibitors, are now
tractions in weakened hearts, but it is not a cardiac also combined with digitalis and diuretics in the treat-
vitamin that can make a strong heart stronger. It is ment of heart failure.
also used in the control of atrial fibrillation. The most The availability of other heart failure medications
commonly used digitalis products are digoxin and allows physicians to prescribe digitalis drugs at doses
digitoxin. that are less likely to produce serious side effects.
Physicians and folk healers have used digitalis However, digitalis remains the standard against
preparations for more than 200 years to treat various which the effectiveness of new heart failure therapies
ailments. The major benefits of foxglove extracts in is measured.
patients with heart disease were believed to be a re- Digitalis drugs can be used to treat disturbances
sult of their ability to control abnormally fast heart of the heartbeat, particularly the abnormally rapid
rhythms. At the turn of the 20th century, however, it contractions of the atria referred to as atrial or su-
was recognized that digitalis improves the function praventricuiar arrhythmias (especially atrial fibrilla-
of the failing heart independently of its effects on the tion). The drugs restore the normal heartbeat either
heart rhythm. by interrupting the abnormal rhythm or by slowing
The drug penetrates all body tissues and reaches down the rapid beats to a rate at which effective and
a high concentration in the muscle of the heart. Its coordinated heart contractions are possible.
molecules bind with cell receptors that regulate the
concentration of sodium and potassium in the spaces
between tissue cells and in the bloodstream. These EXAMPLES OF DIGITALIS PREPARATIONS
two minerals determine the level of calcium—a po- Generic name (trade names): digoxin (Lanoxicaps,
tent stimulator of heart contractions-within muscle Lanoxin)
cells. Digitalis preparations act by increasing the How supplied: tablet (0.125 mg, 0.25 mg, 0.5 mg),
amount of calcium supplied to the heart muscle and capsule (0.05 mg, 0.1 mg, 0.2 mg), elixir (0.05
thus enhancing its contractions. mg per ml, 60-ml bottle), injection (0.5 mg in 2
Digitalis drugs also affect electrical activity in car- ml, 0.1 mg in 1 ml)
diac tissues. They control the rate at which electric Available as generic: yes
impulses are released and the speed of their conduc- Description: It is a digitalis drug extracted from the
tion through the chamber wails. leaves of the foxglove plant. It slows the heart
These two actions determine the two major uses rate so that each beat is more effective in pump-
of digitalis drugs in heart disease—treatment of heart ing blood.
failure and control of abnormal heart rhythms. Effects: It treats heart failure and corrects some ab-
Digitalis preparations are a major class of drugs normal heart rhythms.
used in the treatment of heart failure. By increasing Possible side effects: Some side effects include tired-
the force of heart contractions, they increase the ness, nausea, loss of appetite, and disturbances
amount of blood pumped with each beat. The im- in vision.
proved pumping capacity offsets the mechanisms Approximate cost: for 100 tablets, 0.125 mg, $5.59 to
that lead to the enlargement of the failing heart. A $8.63; 0.25 mg, $5.99 to $10.19
more efficient heart pumps more effectively, reducing Dosage: 0.125 mg to 0.25 mg per day for adults; re-
the tendency for fluid retention and tissue congestion. duced dosage for children based on weight and
CARDIOVASCULAR DRUGS
age; up to 3 times a day to start and then once prevent the excessive loss of potassium that some-
daily times occurs with the thiazides. They are most often
Notes: given in conjunction with a thiazide or loop diuretic.
● Check with doctor before combining with any Diuretics are highly effective, generally well tol-
other medication. There are numerous drug in- erated, and less expensive than most other antihy -
teractions. pertensive medications. They were the medications
● People taking digoxin must be carefully moni- used in all of the long-term hypertension treatment
tored, because an effective digoxin dose may be studies that demonstrated a marked decrease in
near the toxic dose. strokes and heart failure.
menstrual tension, and it lowers blood pres- Description: It is a short-acting loop diuretic that has
sure. been in use for more than 20 years.
Possible side effects: See chlorthalidone. Effects: See chlorthalidone.
Approximate cost: for 100 tablets, generic, 50 mg, Possible side effects: See chlorthalidone.
$3.67 to $7.59 Approximate cost: for 100 tablets, 20 mg, $9.87 to
Dosage: 25 mg to 50 mg per day $17.69 (generic, $6.17 to $11.53); 40 mg, $13.89
Notes: to $22.37 (generic, $6.53 to $12.27)
• See chlorthalidone. Dosage: 20 mg to 40 mg per day divided into two
doses
Notes:
Generic name (trade names): metolazone (Diulo,
• Larger doses maybe required for people with kid-
Mykrox, Zaroxolyn)
ney disease.
How supplied: tablet (0.5 mg, 2.5 mg, 5 mg, 10 mg)
● See chlorthalidone.
Available as generic: yes
Description: It is a thiazide diuretic. See
chlorthalidone. EXAMPLES OF POTASSIUM-SPARING
Effects: See chlorthalidone. DIURETICS
Possible side effects: See chlorthalidone. Generic name (trade name): amiloride (Midamor)
Approximate cost: for 100 0.5-mg tablets, $35.20’ How supplied: tablet (5 mg)
Dosage: 2.5 mg to 10 mg per day Available as generic: yes
Notes: Description: It is a potassium-sparing diuretic that
●Metolazone is longer-acting than most thiazide is rarely used alone.
diuretics. Effects: Combined with thiazide or loop diuretics, it
• See chlorthalidone. treats high blood pressure and fluid retention
resulting from heart failure or liver disease.
EXAMPLES OF LOOP DIURETICS Possible side effects: If excessive potassium is re-
tained, muscle weakness and numbness may re-
Generic name (trade name): bumetanide (Bumex) sult. The drug also can cause upset stomach,
How supplied: tablet (0.5 mg, 1 mg, 2 mg), injection lethargy, or rash.
(0.25 mg/ml 2-ml ampules or 0.25 mg/ml 2-,4-, Approximate cost: for 100 5-mg tablets, average
and 10-ml vials) wholesale price, $37.76***
Available as generic: no Dosage: 5 mg to 10 mg per day
Description: It is a short-acting loop diuretic. Note:
Effects: It reduces fluid retention resulting from heart ● It should not be taken in conjunction with lithium.
failure, liver disease, or kidney disorders, and
it lowers elevated blood pressure. In emergen-
Generic name (trade name): spironolactone
cies, it relieves fluid retention in the lungs.
(Aldactone)
Possible side effects: See chlorthalidone.
How supplied: tablet (25 mg, 50 mg, 100 mg)
Approximate cost: for 100 l-mg tablets, $31.27 to
Available as generic: yes
$43.39 Description: It is a potassium-sparing diuretic intro-
Dosage: 0.5 mg to 2.5 mg per day divided into two
duced in 1959, and it is rarely used alone.
doses
Effects: Combined with thiazide or loop diuretics, it
Notes:
treats elevated blood pressure and fluid reten-
• Larger doses maybe required for people with kid-
tion resulting from heart failure, liver disease,
ney disease. or a kidney disorder (nephrotic syndrome).
• See chlorthalidone.
Possible side effects: If too much potassium is re-
tained, muscle weakness and numbness may re-
Generic name (trade name): furosemide (Lasix) sult. Nausea and vomiting are fairly common.
How supplied: tablet (20 mg, 40 mg, 80 mg), oral Side effects may also include diarrhea, lethargy,
solution (10 mg/ml, 60-ml or 120-ml bottle), in- irregular menstruation, breast enlargement in
jection (10 mg/ml, 4-ml or 10-ml prefilled sy- men, impotence, or rash.
ringes, ampules, or vials) Approximate cost: for 100 tablets, 25 mg, $10.03 to
Available as generic: yes $17.13
CARDIOVASCULAR DRUGS
Available as generic: yes wholesale price, 0.1 mg, $5.19***; 0.25 mg,
Description: It is a nitrate vasodilator and antianginal $8.81***
drug introduced in the late 1970s; it is a longer- Dosage: 0.1 mg to 0.5 mg per day
acting form of nitroglycerin. Notes:
Effects: It relieves and prevents angina. ● Reserpine is a component of several combination
Possible side effects: Headaches, flushing, or dizzi- drugs. See the section entitled “Combination
ness may occur. Less frequently, fainting may Drugs.”
occur. ● The rauwolfia plant has been used in India and
Approximate cost: for 100 tablets, generic, 5 mg, other Asian countries for many years as a sedative.
$3.89 to $9.29; 10 mg, $4.73 to $10.77; 20 mg, ● Reserpine is also used for some psychiatric dis-
$6.19 to $13.17 orders.
Dosage: for relief of angina, 5 mg to 10 mg per dose; ● The drug should not be used by people with a
for prevention of angina, 40 mg to 160 mg daily history of mental depression.
Notes: ● The use of reserpine in conjunction with digitalis
● Alcohol and other antidepressants may further drugs or quinidine may cause abnormal heart
lower blood pressure. rhythms.
● Unlike nitroglycerin, isosorbide dinitrate can be
stored for long periods of time without losing its
effectiveness.
OTHER VASODILATORS
PERIPHERAL ADRENERGIC As their name indicates, these drugs lower blood
ANTAGONISTS pressure by opening up or dilating arteries, thereby
facilitating blood flow through them. Vasodilators are
rarely used as initial therapy and are usually pre-
These drugs, which are among the older antihyper- scribed along with other drugs such as a beta blocker
tensive agents, lower biood pressure by inhibiting the and a diuretic. Some produce a very rapid reduction
release of adrenaline or by blocking its effect on the in blood pressure, especially when administered by
nerve endings. Dilation of blood vessels results. They injection. Thus, they may be useful in treating a
have a sedating effect at high dosages. This remains hypertensive crisis. For chronic use, several office
a major drawback to the continuing use of the drug visits may be needed to fine-tune the dosage. Side
to treat high blood pressure. This is the least expen- effects may be annoying, and lowering of blood pres-
sive of all the antihypertensive medications, and, in sure may be less when these drugs are used as initial
combination with a diuretic, is effective in lowering treatment.
blood pressure.
EXAMPLES OF MISCELLANEOUS
EXAMPLE OF PERIPHERAL ADRENERGIC VASODILATORS
ANTAGONISTS
Generic name (trade name): hydralazine
Generic name (trade name); reserpine (Serpasil) (Apresoline)
How supplied: tablet (0.1 mg, 0.25 mg) How supplied: tablet (10 mg, 25 mg, 50 mg, 100 mg),
Available as generic: yes injection (20 mg/ml-ml ampule)
Description: This is the oldest drug in this category. Available as generic: yes
It is derived from the rauwolfia plant. Description: It is an antihypertensive and vasodilator
Effects: It lowers moderately high blood pressure. It introduced in the 1950s.
is rarely used by itself; usually used with a di- Effects: It lowers moderately to severely high blood
uretic. pressure.
Possible side effects: Drowsiness, diarrhea, nausea, Possible side effects: Side effects include nausea and
dry mouth, dizziness, headache, depression, vomiting, headaches, dizziness, and irregular
muscular aches, temporary impotence, weight heart beat. Less frequently, loss of appetite,
gain, and rash may occur. rash, flushing, or joint pains will occur. Pro-
Approximate cost: for 100 tablets, average longed use of hydralazine can cause drug-in-
CARDIOVASCULAR DRUGS
duced lupus, especially in people who regimen including two or three drugs in dosages that
metabolize the drug slowly (a tendency that can are available in a single medication, the physician
be determined with a blood test). Symptoms of may prescribe the combination drug to save the per-
lupus, an autoimmune syndrome, are fever, son time and effort in his or her daily routine. It
joint pains, low blood counts, and inflammation should be stressed, however, that combination drugs
of the linings of the lungs or heart (felt as chest are usually not prescribed for initial drug therapy.
pain on deep inhalation). Some examples of combination drugs now avail-
Approximate cost: for 100 tablets, 25 mg, $4.03 to able are listed below. Further information is available
$7.43; 50 mg, $5.73 to $10.23 by finding each component in other sections of this
Dosage: 50 mg to 100 mg daily, generally up to a chapter.
maximum of 200 mg daily
EXAMPLES OF COMBINATION DRUGS
Generic name (trade name): minoxidil (Loniten)
How supplied: tablet (2.5 mg, 10 mg) Generic name (trade name): amiloride/
Available in generic: yes hydrochlorothiazide (Moduretic)
Description: This antihypertensive and vasodilator is How supplied: tablet (5 mg/50 mg)
never used by itself; it is usually used with a Description: It is a potassium-sparing diuretic/
diuretic and other drugs. thiazide diuretic.
Effects: In combination, it controls dangerously high Approximate cost: for 100 tablets, $38.50*
blood pressure and pressure that is rising very
rapidly. Generic name (trade name): atenolo/chlorthalidone
Possible side effects: It increases hair growth, es- (Tenoretic)
pecially on the face, back, etc.; other common How supplied: tablet (100 mg/25 mg, 50 mg/25 mg)
side effects are fluid retention and shortness of Description: It is a beta blocker/thiazide diuretic.
breath. R can cause tiredness, dizziness or light- Approximate cost: for 100 tablets, 50 mg/25 mg,
headedness, nausea, headache, or rash. $81.73 to $112.29
Approximate cost: for 100 10-mg tablets, $71.50 to
$82.50* Generic name (trade name): captopril/
Dosage: 5 mg to 20 mg per day hydrochlorothiazide (Capozide)
Notes: How supplied: tablet (25 mg/15 mg, 25 mg/25 mg,
● It is always prescribed with a diuretic and often 50 mg/15 mg, 50 mg/25 mg)
with a beta blocker. Description: It is an ACE inhibitor/thiazide diuretic.
Ž Because of its side effect of increasing hair Approximate cost: for 100 tablets, 25 mg/15 mg,
growth, it is now available in a solution to treat $63.80 to $66*
baldness (Rogaine).
Generic name (trade name): clonidine/
chlorthalidone (Combipres)
How supplied: tablet (0.1 mg/15 mg, 0.2 mg/15 mg,
COMBINATION DRUGS 0.3 mg/15 mg)
Description: It is a centrally acting drug/thiazide
diuretic.
When a person begins drug treatment for heart ail- Approximate cost: for 100 tablets, 0.1 mg/15 mg,
ments, his or her physician must first determine the $27.50 to $49.50’
correct dose of the particular drug or drugs that are
most effective. Cardiovascular drugs often work best Generic name (trade names): chlorthalidone/
in combination, so the physician may prescribe sev- reserpine (Demi-Regroton, Regroton)
eral different combinations and different doses be- How supplied: tablet (25 mg/0.125 mg,
fore achieving optimal results. 50 mg/O.25 mg)
In some cases, drugs that are commonly pre- Description: It is a thiazide diuretic peripheral
scribed together are available in a single pill, which adrenergic agonist.
may, in some cases, be less expensive than its sepa- Approximate cost: for 100 tablets, average
rate components. Convenience is a major advantage wholesale price, 25 mg/0.125 mg, $92.59***;
to combination therapy: If a person is on a long-term 50 mg/0.25 mg, $105.5O***
303
METHODS OF TREATMENT
Generic name (trade name]: enalapril/ Generic name (trade name): methyldopa/
hydrochlorothiazide (Vaseretic) hydrochlorothiazide (Aldoril)
How supplied: tablet (10 mg/25 mg) How supplied: tablet (250 mg/15 mg, 250 mg/25 mg,
Description: It is an ACE inhibitor/thiazide diuretic. 500 mg/30 mg, 500 mg/50 mg)
Approximate cost: for 100 tablets, $88 to $93.50 Description: It is a centrally acting drug/thiazide
diuretic.
Generic name (trade name): hydralazine/ Approximate cost: for 100 tablets, generic,
hydrochlorothiazide (Apresazide) 250 mg/25 mg, $16.83 to $29.47
How supplied: capsule (25 mg/25 mg, 50 mg/50
mg, 100 mg/50 mg) Generic name (trade names,): propranolol/
Description: It is a miscellaneous vasodilator/ hydrochlorothiazide (Inderide, Inderide LA)
thiazide diuretic. How supplied: tablet (40 mg/25 mg, 80 mg/25 mg),
Approximate cost: for 100 capsules, average long-acting capsule (80 mg/50 mg, 120 mgl
wholesale price, 25 mg125 mg, $32.83***; 50 mg, 160 mg/50 mg)
50 mg/50 mg, $49.06’”; 100 mg/50 mg, Description: It is a beta blocker/thiazide diuretic.
$59.77*** Approximate cost: for 100 tablets, 40 mg/25 mg,
$33*; for 100 long-acting capsules, 80 mg/50
Generic name (trade name): hydrochlorothiazide/ mg, $55 to $60.50*
reserpine (Hydropres)
How supplied: tablet (25 mg/0.125 mg, Generic name (trade name): reserpine/hydralazinel
50 mg/0.125 mg) hydrochlorothiazide (Ser-Ap-Es)
Description: It is a thiazide diuretic/peripheral How supplied: tablet (0.1 mg/25 mg/15 mg)
adrenergic antagonist. Description: It is a peripheral adrenergic antagonist
Approximate cost: for 100 tablets, average vasodilator/thiazide diuretic.
wholesale price, 25 mg/0.125 mg, $22.83***; Approximate cost: for 100 tablets, generic, $7.57 to
50 mg/O.125 mg, $35.61*** !$12.63
Generic name (trade names): labetolol/ Generic name (trade name): spironolactone/
hydrochlorothiazide (Normozide, Trandate hydrochlorothiazide (Aldactazide)
HCT) How supplied: tablet (25 mg/25 mg; 50 mg/50 mg)
How supplied: tablet (100 mg/25 mg, Description: It is a potassium-sparing diuretic/
200 mg/25 mg, 300 mg/25 mg) thiazide diuretic.
Description: It is an alpha- and beta-blocking drug/ Approximate cost: for 100 tablets, generic,
thiazide diuretic. 25 mg/25 mg, $10.03 to $17.13
Approximate cost: for 100 tablets, average
wholesale price, 100 mg/25 mg, $33.21***; 200 Generic name (trade name): triamterene/
mg/25 mg, $48.72***; 300 mg125 mg, $64.83*** hydrochlorothiazide (Dyazide, Maxzide)
How supplied: tablet (37.5 mg/25 mg, 50 mg/25 mg,
Generic name (trade name): lisinopril/ 75 mg/50 mg)
hydrochlorothiazide (Zestoretic) Description: It is a potassium-sparing diuretic/
How supplied: tablet (20 mg/12.5 mg, 20 mg/25 mg) thiazide diuretic.
Description: It is an ACE inhibitor/thiazide diuretic. Approximate cost: for 100 tablets,
Approximate cost: for 100 tablets, average Dyazide-$24.37 to $35.49
wholesale price, 20 mg/12.5 mg, $87.24***; Maxzide-$54.47 to $80.73
20 mg/25 mg, $88.32*** generic–75 mg/50 mg, $17.73 to $28.07