CARDIOVASCULAR DRUGS

B1. ANTI-ANGINAL DRUGS

Nifedipine
Adalat
Capsules: 10 mg
Capsules: 20 mg
Adalat CC
Tablets, extended-release: 30 mg
Tablets, extended-release: 60 mg
Tablets, extended-release: 90 mg
Nifedical XL
Tablets, extended-release: 30 mg
Tablets, extended-release: 60 mg
Procardia
Capsules: 10 mg
Capsules: 20 mg
Procardia XL
Tablets, extended-release: 30 mg
Tablets, extended-release: 60 mg
Tablets, extended-release: 90 mg
Adalat PA
Adalat PA 10
Adalat PA 20
Adalat XL

Class: Calcium channel blocker

Actions Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular
smooth muscle and myocardium. Increases CO and decreases peripheral vascular resistance. Minimal
effect on sinoatrial and AV nodal conduction. Reduces myocardial oxygen demand; relaxes and prevents
coronary artery spasm.

 Indications Treatment of vasospastic (Prinzmetal's or variant) angina, chronic stable angina,

hypertension (sustained-release tablets only).

Contraindications Sick sinus syndrome; second- or third-degree AV block, except with functioning
pacemaker.

Route/Dosage

Capsules: ADULTS: PO 10 mg tid (usual dose range, 10 to 20 mg tid); swallow whole. Some patients
(eg, coronary artery spasm) respond only to higher doses administered more frequently (eg, 20 to 30 mg
tid to qid; max 180 mg/day). In hospitalized patients, under close observation, dose may be increased in
10 mg increments throughout 4- to 6-hr periods as required to control pain and arrhythmias caused by
ischemia. A single dose rarely exceeds 30 mg. Extended-release tablets: ADULTS: PO Procardia XL
and Nifedical XL: 30 or 60 mg once daily, titrated over 7- to 14-day period (max, 120 mg/day). Adalat
CC (hypertension): Start with 30 mg/day and titrate dose over 7- to 14-day period (max, 90 mg/day).

Amlodipine

Norvasc
Class: Calcium channel blocker

Action Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular
smooth muscle.

Indications Hypertension; chronic stable angina; vasospastic (Prinzmetal's or variant) angina.

Contraindications Sick sinus syndrome; second- or third-degree atrioventricular (AV) block, except
with a functioning pacemaker.

Route/Dosage

ADULTS: PO 5 to 10 mg qd. ELDERLY: PO Initially 2.5 mg qd.

HEPATIC IMPAIRMENT PO Initially 2.5 mg qd.

Acebutolol HCl

Sectral,  Apo-Acebutolol Monitan, Novo-Acebutolol, Nu-Acebutolol, Rhotral

Class: Beta-adrenergic blocker

Action Blocks beta-receptors, primarily affecting heart (slows rate), vascular musculature (decreases
BP) and lungs (reduces function).

Indications Management of hypertension and premature ventricular contractions.

Contraindications Hypersensitivity to beta-blockers; persistently severe bradycardia; greater than first-

degree heart block; CHF, unless secondary to tachyarrhythmia treatable with beta-blockers; overt
cardiac failure; sinus bradycardia; cardiogenic shock.

Route/Dosage

Hypertension

ADULTS: PO 400 mg qd initially in single or divided doses; usual response range is 200 to 1200
mg/day. ELDERLY PATIENTS: May require lower maintenance doses. Do not exceed 800 mg qd.

Ventricular Arrhythmia
ADULTS: PO 400 mg (200 mg bid); may be titrated up to 1200 mg qd.

Atenolol

Tenormin,   APO-Atenol, Gen-Atenolol, Med-Atenolol, Novo-Atenol, Nu-Atenol, Schein Pharm

Atenolol, Taro Atenolol, Tenolin, Tenormin
Class: Beta-adrenergic blocker

Action Blocks beta receptors, primarily affecting heart (slows rate), vascular system (decreases BP) and,
to lesser extent, lungs (reduces function).

Indications Treatment of hypertension (used alone or in combination with other drugs), angina pectoris
resulting from coronary atherosclerosis, acute MI. Unlabeled use(s): Migraine prophylaxis, alcohol
withdrawal syndrome, ventricular arrhythmias, supraventricular arrhythmias or tachycardias, esophageal
varices rebleeding, anxiety.

Contraindications Hypersensitivity to beta-blockers; sinus bradycardia; greater than first-degree heart

block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure;
cardiogenic shock.

Route/Dosage

Hypertension

ADULTS: PO 50 to 100 mg/day.

Angina Pectoris

May require up to 200 mg/day.

Acute MIIV 5 mg over 5 min; second IV Follow with dose 10 min later. PO 50 to 100 mg/day.

Betaxolol HCl
Betoptic, Betoptic S
Class: Beta-adrenergic blocker

Action Blocks beta receptors, primarily affecting cardiovascular system (decreases heart rate, cardiac
contractility and BP) and lungs (promotes bronchospasm). Ophthalmic use reduces intraocular pressure,
probably by reducing aqueous production.

Indications Hypertension. Ophthalmic preparation: Lowering IOP; ocular hypertension; chronic open-
angle glaucoma.

Contraindications Hypersensitivity to beta-blockers; sinus bradycardia; greater than first-degree heart

block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure;
cardiogenic shock.
Route/Dosage

Hypertension

ADULTS: PO 10 to 20 mg/day. ELDERLY: PO Reduce initial dose to 5 mg/day.

Glaucoma

Adults: Ophthalmic 1 to 2 drops bid in affected eye(s). Consider concomitant therapy if IOP is not at
satisfactory level.

Metoprolol

Lopressor
Class: Beta-adrenergic blocker

Action Blocks beta receptors, primarily affecting cardiovascular system (decreases heart rate, decreases
contractility, decreases BP) and lungs (promotes bronchospasm).

Indications Used alone or in combination with other antihypertensive agents, for management of
hypertension, long-term management of angina pectoris, myocardial infarction (immediate-release
tablets and injection).

Contraindications Greater than first-degree heart block; congestive heart failure unless secondary to
tachyarrhythmia treatable with beta-blockers; overt or moderate to severe cardiac failure; sinus
bradycardia; cardiogenic shock; hypersensitivity to beta-blockers; systolic blood pressure < 100 mm/Hg;
MI in patients with heart rate < 45 beats/min.

Route/Dosage

Hypertension

ADULTS: PO 100 mg/day in single or divided doses initially; maintenance: 100–450 mg/day.

Angina

ADULTS: PO 100 mg/day in 2 divided doses initially; maintenance: 100–400 mg/day.

Myocardial Infarction

ADULTS: IV bolus injection 5 mg slowly; may repeat every 2 min up to total of 15 mg. If tolerated,
give PO 50 mg q 6 hr beginning 15 min after last IV dose; continue for 48 hr followed by PO 100 mg
bid for 1–3 mo. If patient is intolerant of full IV dose, give PO 25–50 mg q 6 hr starting 15 min after last
IV dose.

Nadolol
Corgard,  Alti-Nadolol, Apo-Nadol, Novo-Nadolol
Class: Beta-adrenergic blocker

Action Blocks beta-receptors, which primarily affect cardiovascular system (decreases heart rate,
contractility and BP) and lungs (promotes bronchospasm).

Indications Management of hypertension and angina pectoris.

Contraindications Hypersensitivity to beta blockers; greater than first-degree heart block; CHF unless
secondary to tachyarrhythmia treatable with beta-blockers or untreated hypotension; overt cardiac
failure; sinus bradycardia; cardiogenic shock; bronchial asthma or bronchospasm, including severe
COPD.

Route/Dosage

Hypertension

ADULTS: PO Initiate with 40 mg/day; titrate in 40 to 80 mg increments to desired response.

Maintenance: 40 to 320 mg/day.

Angina

ADULTS: PO Initiate with 40 mg/day; titrate in 40 to 80 mg increments at 3 to 7 day intervals to

desired response. Maintenance: 40 to 240 mg/day. Dosage intervals may need to be altered in patients
with decreased renal function.

Pindolol

Visken,  Alti-Pindolol, APO-Pindol, Gen-Pindolol, Novo-Pindol, Nu-Pindol

Class: Beta-adrenergic blocker

Action Nonselectively blocks beta receptors, which primarily affect heart (slows rate), vascular
musculature (decreases blood pressure) and lungs (reduces function).

Indications Management of mild-to-moderate hypertension.

Contraindications Greater than first-degree heart block; CHF unless secondary to tachyarrhythmia
treatable with beta-blockers; overt cardiac failure; sinus bradycardia; cardiogenic shock; hypersensitivity
to beta-blockers; bronchial asthma or bronchospasm, including severe COPD.

Route/Dosage

ADULTS: PO 5 mg bid. May be increased by 10 mg q 3 to 4 wk until desired response; maximum dose

is 60 mg/day.
Propranolol HCl

Betachron E-R, Inderal, Inderal LA, Propranolol Intensol,  APO-Propranolol, Detensol, Detensol,
Dom-Propranolol, Novo-Pranol, Nu-Propranolol, PMS-Propranolol
Class: Beta-adrenergic blocker

Action Blocks beta receptors, primarily affecting the cardiovascular system (decreased heartrate,
decreased cardiac contractility and decreased BP) and lungs (promotes bronchospasm).

Indications Treatment of hypertension; angina pectoris; hypertrophic subaortic stenosis; MI;

pheochromocytoma; migraine prophylaxis; essential tremor; some ventricular and supraventricular
arrhythmias. Unlabeled use(s): Treatment of alcohol withdrawal syndrome; esophageal varices
rebleeding; anxiety; thyrotoxicosis symptoms.

Contraindications Hypersensitivity to beta-blockers; greater than first-degree heart block; CHF unless
secondary to tachyarrhythmia or untreated hypertension treatable with beta-blockers; overt cardiac
failure; sinus bradycardia; cardiogenic shock; untreated bronchial asthma or bronchospasm, including
severe COPD.

Route/Dosage

Hypertension

ADULTS: PO Initial dose: 40 mg bid initially or 80 mg sustained-release medication/day; titrate to

response. Maintenance: 120 to 240 mg/day in 2 to 3 divided doses or 120 to 160 mg/day sustained-
release medication. Do not exceed 640 mg/day. CHILDREN: PO 0.5 mg/kg bid; titrate q 3 to 5 days to
maximum dose of 1 mg/kg bid.

Angina

ADULTS: PO 80 to 320 mg/day in 2 to 4 divided doses or 160 mg/day of sustained-release medication.

Arrhythmias

ADULTS: PO 10 to 30 mg 3 to 4 times/day before meals and at bedtime.

Hypertrophic Aortic Stenosis

ADULTS: PO 20 to 40 mg 3 to 4 times/day before meals and at bedtime or 80 to 160 mg sustained-

release medication 1 time/day.

MI

ADULTS: PO 180 to 240 mg/day in 3 to 4 divided doses up to 240 mg/day.

Pheochromocytoma
ADULTS: PO 60 mg/day for 3 days prior to surgery, given with alpha-blocker.

Migraine

ADULTS: PO 80 mg in divided doses daily or once daily (sustained release); titrate to response
(maximum dose: 240 mg/day); discontinue after 6 wk if no response.

Arrhythmias (Life Threatening)

ADULTS: IV 1 to 3 mg at rate of 1 mg/min; may repeat after 2 min; give subsequent doses q 4 hr.

Essential Tremor

ADULTS: PO 40 mg bid initially; titrate to response. Maintenance: 120–320 mg/day in 2 to 3 divided

doses.

Nitroglycerin
Deponit, Minitran, Nitrek, Nitro-Bid, Nitro-Bid IV, Nitro-Dur, Nitro-Time, Nitrodisc, Nitrogard,

Nitroglyn, Nitrol, Nitrolingual, Nitrong, NitroQuick, Nitrostat, Transderm-Nitro, Tridil,  Nitrong

SR
Class: Antianginal

Action Relaxation of smooth muscle of venous and arterial vasculature.

Indications Treatment of acute angina (SL, translingual, IV, transmucosal); prophylaxis of angina (SL,
transmucosal, translingual, sustained release, transdermal, topical); control of blood pressure in
perioperative or intraoperative hypertension (IV); CHF associated with MI (IV). unlabeled use(s):
Reduce cardiac workload in patients with MI and in refractory CHF (SL, topical, oral, IV); adjunctive
treatment of Raynaud's disease (topical); treatment of hypertensive crisis (IV).

Contraindications Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma; orthostatic

hypotension; early MI; pericarditis or pericardial tamponade; head trauma or cerebral hemorrhage;
allergy to adhesives (transdermal); hypotension or uncorrected hypovolemia (IV); increased intracranial
pressure or decreased cerebral perfusion (IV).

Route/Dosage

Perioperative Hypertension

ADULTS IV 5 mcg/min using nonperipheral vein catheter (PVCP) IV administration set initially; titrate
to response.

Angina
ADULTS SL 0.15 to 0.6 mg dissolved under tongue or in buccal pouch at first sign of acute angina
attack; repeat q 5 min (do not exceed 3 tablets in 15 min). Translingual 1 to 2 sprays onto or under
tongue at first onset of attack. Transmucosal 1 mg every 3 to 5 hr during waking hours; tablet placed
between lip or cheek and gum. PO 2.5 or 2.6 mg (sustained-release form) tid to qid initially; titrate to
response. Transdermal 0.2 to 0.4 mg/hr patch initially applied once daily; titrate dose to response.
Topical 1 to 2 inches q 8 hr up to 4 to 5 inches spread over 3 x 4 inch area and cover with plastic wrap
to prevent staining of clothes or application q 4 hr prn. Allow a nitrate-free period of 10 to 12 hr/day.

Refractory Angina, CHF Secondary to Acute MI

Adults IV 5 mcg/min initially; titrate according to hemodynamic readings (BP, heart rate, pulmonary
capillary wedge pressure).

Isosorbide Mononitrate

ISMO, Imdur, Monoket, Isotrate ER

Class: Antianginal

Action Relaxation of smooth muscle of venous and arterial vasculature.

Indications Prevention of angina pectoris.

Contraindications Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma; orthostatic

hypotension; head trauma or cerebral hemorrhage.

Route/Dosage

ADULTS: PO 20 mg bid, given 7 hr apart. Extended release tablets are given as 30 (½ of 60 mg tablet)
or 60 mg once daily. After several days dosage may be increased to 120 mg (given as two 60 mg tablets)
once daily. Rarely, 240 mg may be required.

Isosorbide Dinitrate

Dilatrate-SR, Isordil, Isordil Tembids, Isodril Titradose, Sorbitrate,  APO-ISDN, Cedocard-SR

Class: Antianginal

Action Relaxation of smooth muscle of venous and arterial vasculature.

Indications Treatment and prevention of angina pectoris.

Contraindications Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma; orthostatic

hypotension; head trauma or cerebral hemorrhage.

Route/Dosage

Angina Pectoris
ADULTS: SL (sublingual tablets) 2.5 to 5 mg; PO (chewable tablets) 5 mg; PO (oral tablets) 5 to 40 mg
q 6 hr; PO (sustained release tablets) 40 to 80 mg q 8 to 12 hr.

Acute Prophylaxis

ADULTS: PO (sublingual or chewable tablets) 5 to 10 mg q 2 to 3 hr.

ADRENERGIC
Dobutamine

Dobutrex
Class: Vasopressor

Action Stimulates beta1-receptors in heart, causing more complete and forceful contractions (inotropy)
without significantly increasing heart rate or BP.

Indications Treatment of cardiac decompensation caused by organic heart disease or cardiac surgical
procedures. Unlabeled use(s): Congenital heart disease in children undergoing diagnostic cardiac
catheterization.

Contraindications Idiopathic hypertrophic subaortic stenosis.

Route/Dosage

ADULTS: IV infusion 2.5 to 10 mcg/kg/min; titrate to desired response; increase in heart rate > 10%
may develop in rate > 20 mcg/kg/min; rates up to 40 mcg/kg/min are rarely used. Duration of therapy up
to 72 hr without decrease in clinical effectiveness may be used.

Dopamine HCl

Intropin,  Revimine
Class: Vasopressor

Action Stimulates beta1 receptors in heart, causing more complete and forceful contractions (inotropy).
Also acts on alpha receptors (dose dependent) and has dopaminergic effects.

Route/Dosage

ADULTS: IV Initial dose: 2 to 5 mcg/kg/min with incremental changes of 5 to 10 mcg/kg/min at 10 to

15 min intervals until adequate response is noted. Most patients are maintained at < 20 mcg/kg/min. If
dosage exceeds 50 mcg/kg/min, assess renal function frequently.

Epinephrine
Adrenalin Chloride
Solution: 0.1%, 1 mg/mL as HCl
Ana-Kit
AsthmaNefrin
Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base)
Epifrin
Solution: 0.5%, 1%, 2%
Epinal
Solution: 0.5%, 1%
Epipen
Solution: 1 mg/mL as HCl
Epipen Jr.
Solution: 1 mg/mL as HCl
Glaucon
Solution: 1%, 2%
MicroNefrin
Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base)
Nephron
Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base)
Primatene Mist
Aerosol: 0.2 mg epinephrine per spray
S-2
Solution for inhalation: 2.25% racepinephrine HCl (1.125% epinephrine base)
Sus-Phrine
Suspension for injection: 5 mg/mL
Bronkaid Mistometer
Epi E•Z Pen Jr
Class: Vasopressor

Actions Stimulates both alpha-and beta-receptors (alpha-receptors at high doses; beta1 - and beta2
-receptors at moderate doses) within sympathetic nervous system. Relaxes smooth muscle of bronchi
and iris and is antagonist of histamine.

Indications Treatment and prophylaxis of cardiac arrest and attacks of transitory atrioventricular heart
block; treatment of Adams-Stokes syndrome; treatment of hay fever; relief of bronchial asthma;
treatment of syncope caused by heart block or carotid sinus hypersensitivity; symptomatic relief of
serum sickness, urticaria and angioedema; relaxation of uterine musculature; anaphylaxis; allergic
reactions (eg, bronchospasm, urticaria, pruritus, angioneurotic edema, or swelling of the lips, eyelids,
tongue, and nasal mucosa) because of anaphylactic shock caused by stinging insects (primarily of the
order Hymenoptera, which includes bees, wasps, hornets, yellow jackets, bumble bees, and fire ants);
severe allergic or anaphylactoid reactions caused by allergy injections; exposures to pollens, dusts
molds, foods, drugs, and exercise or unknown substances (so-called idopathic anaphylaxis); severe, life-
threatening asthma attacks characterized by wheezing, dysypena, and inability to breathe.
Nasal Solution: Treatment of nasal congestion; relief of eustachian tube congestion. Inhalation:
Temporary relief from acute paroxysms of bronchial asthma and other states; treatment of postintubation
and infectious croup. Ophthalmic Solution: Treatment of open-angle glaucoma.

Contraindications Hypersensitivity to epinephrine; narrow-angle glaucoma; concomitant use during

general anesthesia with halogenated hydrocarbons or cyclopropane; cerebral arteriosclerosis or organic
brain damage; use with anesthesia for fingers and toes; use during labor; phenothiazine-induced
circulatory collapse; MAOI therapy; nonanaphylactic shock during general anesthesia with halogenated
hydrocarbons or cyclopropane; organic heart disease.

Route/Dosage

Cardiac Arrest

ADULTS: IV/Endotracheal/Intracardiac 0.5 to 1 mg (5 to 10 mL of 1:10,000 solution) q 5 min prn.

Myocardial injection usually given in left ventricular chamber by trained personnel at dose of 0.3 to 0.5
mg.

Other IV Uses

ADULTS: IV 1 mg in 250 mL of D5W (4 mcg/mL) for infusion at 1 to 4 mcg/min (15 to 60 mL/hr).

Intraspinal Use

ADULTS: Intraspinal 0.2 to 0.4 mL of 1:1000 solution added to anesthetic spinal fluid mixture.
Epinephrine 1:100,000 to 1:200,000 is usual concentration employed with local anesthetics.

Open-Angle Glaucoma

ADULTS: Ophthalmic 1 gtt in affected eye(s) 2 time/day.

Nasal Congestion

ADULTS AND CHILDREN  6 yr: Nasal Apply as drops, spray, or with sterile swab as required.

Asthma

ADULTS AND CHILDREN  4 yr (Asthma Nefrin  12 yr): Inhalation Hand pump nebulizer: Place
0.5 mL ( 8 to 10 drops) of racemic epinephrine into nebulizer reservoir. Squeeze bulb 1 to 3 times in
partially opened mouth. If relief does not occur within 2 to 3 min, administer 2 to 3 additional
inhalations. Do not administer > q 3 hr. Aerosol-nebulizer: Add 0.5 mL ( 10 drops) racemic
epinephrine to 3 mL of diluent or 0.2 to 0.4 mL ( 4 to 8 drops) of MicroNefrin to 4.6 to 4.8 mL water.
Administer for 15 min q 3 to 4 hr. ADULTS SC/IM Solution (1:1000): 0.2 to 1 mL (0.2 to 1 mg); repeat
q 4 hr. SC Suspension (1:200): 0.1 to 0.3 mL (0.5 to 1.5 mg). IV Solution (1:10,000): 0.1 to 0.25 mg (1
to 2.5 mL) injected slowly. INFANTS AND CHILDREN: SC Solution (1:1000): 0.01 mL/kg or 0.3
mL/m2 (0.01 mg/kg or 0.3 mg/m2); repeat q 20 min to 4 hr. Do not exceed 0.5 mL (0.5 mg) in single
dose. Suspension (1:200): 0.005 mL/kg (0.025 mg/kg). Maximum single dose for children  30 kg is
0.15 mL (0.75 mg). IV Solution (1:10,000): 0.01mg/kg to 0.05 mg repeated at 20 to 30 min intervals.