FIRST LINE SECOND LINE LAST LINE

Non-
Thiazide Dihydropyridine Beta- Alpha Centrally
ACE ARB Dihydropyridine
Diuretics CCB Blockers Blockers Acting Agents
CCB

metoprolol
Most commonly used losartan amlodipine verapamil ER doxazosin clonidine patch
HCTZ lisinopril succinate
in its class (Cozaar) (Norvasc) (Calan SR) (Cardura) (Catapres-TTS)
(Toprol XL)
DOSING

1, 2, 4, 8 qhs. 0.1, 0.2, 0.3 per 24

Dosages (mg) & 25, 50, 100, 200 Give at night to
12.5, 25 qd 10, 20, 40 qd 20, 50, 100 qd 5, 10 qd 120, 180, 240 qd hours (changed q
Frequency qd reduce week)
orthostasis

0.6 mg per 24
Maximum dose / day 25 mg 40 mg 100 mg 10 mg 480 mg 400 mg 16 mg hours

Cost per month $4 $4 $15 $20 $4 $4 $4 $106

I N D I C AT I O N S
S E C O N DA RY

Less effective in Less effective in Less effective in

Race — — — — —
black patients black patients black patients

CHF, MI, angina, ADHD, opiate

Other indications Angina, Reynaud’s, migraine, atrial withdrawl, hot
(note some may be Peripheral CHF, MI, diabetes CHF, MI, diabetes migraine, atrial
Angina, Reynaud’s fibrillation, stage BPH flashes, anxiety,
off-label uses) edema renal protection renal protection fibrillation, SVT anxiety, essential adjunct cancer pain
prophylaxis tremors treatment

Contraindicated in Contraindicated in Avoid if taking Recent MI. Caution

Asthma,
pregnancy. pregnancy. with ED meds. in elderly because
Contraindications Renal failure, Edema (may worsen), Bradycardia, AV block, bradycardia, AV
Caution in renal Caution in renal May increase of CNS effects,
and cautions gout severe aortic stenosis acute MI, CHF block, diabetes,
failure, angioedema, failure, risk of CHF. bradycardia, and
Raynaud’s
RAS angioedema, RAS Caution elderly orthostasis
CAUTIONS

Renal Cough, renal orthostatic Rebound

Renal insufficiency, Bradycardia,
insufficiency, insufficiency, Bradycardia, hypotension hypertension,
Adverse Reactions hyperkalemia, Edema constipation,
hypokalemia, hyperkalemia, fatigue (dose at night), bradycardia,
angioedema edema
gout angioedema CHF sedation, fatigue

Caution if
Frequently used Ok to use with beta- Caution if used with used with non-
Use with other BP Do not use with Do not use with
together with blockers since it does Beta-blockers—may dihydropyridine — —
medications ARB ACE
ACE and ARB not cause bradycardia cause AV block. CCB—may
cause AV block
EBM

Outcomes data for

CV disease ?
Electrolytes and Electrolytes and
renal function at renal function at Monitor for Monitor for Do not stop
LABS

No labs needed. Follow pulse

Followup Labs or Electrolytes and baseline and repeat baseline and bradycardia, pedal dizziness and abruptly—severe
Monitor for worsening carefully. Do not
issues renal function. 1-4 weeks repeat 1-4 weeks edema, and orthostasis rebound
pedal edema stop abruptly
afterwards. Then afterwards. Then constipation carefully hypertension
check periodically. check periodically.