Type of Drug:

Diuretics or “water pills.”

How the Drug Works:

Potassium-sparing diuretics increase the amount of water and sodium being excreted by the kidneys, but reduce the amount of potassium being excreted by the kidneys.

Uses:

To treat edema (fluid accumulation and swelling) due to congestive heart failure, cirrhosis of the liver, and in certain kidney conditions.

To treat high blood pressure, usually in combination with other drugs. to prevent or treat low potassium levels due to use of other medications (eg, other diuretics).

Precautions:

Spironolactone: To diagnose and treat primary hyperaldosteronism (an abnormality of electrolyte metabolism). To treat edema in children.

Triamterene: To treat edema due to secondary hyperaldosteronism (an abnormality of electrolyte metabolism).

High potassium levels (hyperkalemia): Occasionally hyperkalemia may occur when these agents are used without diuretics. Symptoms include abnormal skin sensations (burning, tingling), muscle weakness, impaired movement and irregular heartbeat.

Pregnancy: Amiloride and triamterene – Studies in pregnant women have not shown a risk to the fetus; however, no drug should be used during pregnancy unless clearly needed.

Spironolactone may cross the placenta. Use only if clearly needed and potential benefits outweigh the possible risks.

Breastfeeding: Spironolactone appears in breast milk. However, it is not known if triamterene or amiloride are excreted in breast milk. Safety for use in breastfeeding has not been established. These drugs can cause serious side effects in a nursing infant. Do not breastfeed while taking these drugs.

Children: Safety and effectiveness of triamterene and amiloride in children have not been established.

Lab Tests: Lab tests should be performed periodically for serum electrolytes, creatinine, BUN and serum potassium. Periodic blood tests should also be performed.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­the-counter or prescription medications or dietary supplements with potassium-sparing diuretics. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with potassium-sparing diuretics:

• ACE inhibitors (eg, captopril)
• Anesthetics (general)
• Antihypertensives (spironolactone and triamterene only)
• Chlorpropamide (eg, Diabinese) (triamterene only)
• Digoxin (eg, Lanoxin) (spironolactone only)
• Indomethacin (eg, Indocin)
• (spironolactone and triamterene only)
• Lithium (eg, Eskalith) (amiloride and triamterene only)
• Nonsteroidal anti inflammatory
• Agents (eg, aspirin) (amiloride and triamterene only)
• Potassium supplements (eg, Kaon)
• Salt substitutes
• Skeletal muscle relaxants (triamterene only)

Side Effects:

Every drug is capable of producing side effects. Many potassium-sparing diuretic users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include

Digestive Tract: Stomach or intestinal cramps or pain; nausea; vomiting; thirst; diarrhea; constipation; gas; appetite changes (loss of appetite). Nervous System: Weakness, fatigue; drowsiness; confusion; tingling or numbness of hands or feet; headache; dizziness; lack of coordination.

Circulatory System: Irregular pulse; chest pain. Respiratory System: Shortness of breath; cough.

Skin: Rash; hives; excessive body hair growth; yellowing of the skin or eyes; sensitivity to sunlight; unusual bleeding or bruising

Other: Deepening of the voice, breast enlargement in males (spironolactone only); menstrual abnormalities; fever; muscle weakness or cramping; inability to achieve or maintain an erection; difficult urination; dry mouth; allergic reaction

Guidelines for Use:

• Amiloride – May cause stomach upset. Take with food. Notify your doctor if any of the following occurs: Muscular weakness, irregular heartbeat, shortness of breath, rash, fatigue or muscle cramps. May cause dizziness, headache or visual disturbances. Use caution while driving or performing other tasks requiring alertness. Avoid large quantities of potassium-rich food.
• Spironolactone – May cause drowsiness, lack of coordination and mental confusion. Use caution while driving or performing other tasks requiring alertness. May cause stomach cramping, diarrhea, lethargy, thirst, headache, skin rash, menstrual abnormalities, deepening of the voice and breast enlargement (in males). Notify your doctor if these effects occur.
• Triamterene – May cause stomach upset. Take after meals. May cause weakness, headache, nausea, vomiting and dry mouth. Notify your doctor if these become severe or persistent. Notify your doctor if fever, sore throat, mouth sores, or unusual bleeding or bruising occurs. Avoid prolonged exposure to sunlight. Photosensitivity (sensitivity to sunlight) may Occur. Take protective measures (eg, sunscreens, protective clothing) against exposure to ultraviolet light or sunlight. If single daily dose is prescribed, take in morning to avoid disruption of sleep because of frequent urination.
• Do not use dietary potassium supplements, potassium-containing medications, low-salt milk or salt substitutes.
• If a dose is missed, take it as soon as possible. If shelter hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised by your doctor. If more than one dose is missed, contact your doctor or pharmacist.
• Occasionally hyperkalemia (high potassium levels) may Occur when these agents are used. Symptoms include abnormal skin sensations (burning, tingling), muscle weakness, fatigue, loss of arm and leg movement, irregular heartbeat and shock.
• Patients being treated for high blood pressure often feel tired and run­down for a few weeks after beginning therapy. Continue taking your medication even though you may not feel quite “normal.” Contact your doctor or pharmacist about any new symptoms.
• Store below 77 Degree F. Protect from light, moisture, freezing and excessive heat.

Carvedilol – Guidelines for Using Carvedilol – Uses and Benefits

Type of Drug:

Drug used to lower high blood pressure; antihypertensive; alpha/beta­adrenergic blocking agent.

How the Carvedilol Product Works:

Carvedilol lowers blood pressure by dilating blood vessels, thereby decreasing blood pressure and pulse rate.

Uses of The Carvedilol:

For the management of high blood pressure. It can be used alone or in combination with other anti hypertensive drugs such as thiazide diuretics (“water pills”).

Unlabeled Uses: Occasionally doctors may prescribe carvedilol for congestive heart failure, chest pain (angina pectoris) or idiopathic cardiomyopathy.

Precautions:

• Diabetes: These products can mask signs of hypoglycemia (low blood sugar) and alter blood sugar levels. It may be necessary for your doctor to alter your dose of diabetic medications while you are taking this medicine.

• Bronchospasm, nonallergic (eg, chronic bronchitis, emphysema): In general, patients with bronchospastic disease should not take carvedilol. However, carvedilol may be used with caution in patients who do not respond to or cannot tolerate other high blood pressure drugs. Use the lowest possible dose in these cases.

• Pregnancy: Adequate studies have not been done in pregnant women, or animal studies may have shown a risk to the fetus. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

• Breastfeeding: It is know if carvediol appears in breast milk consult your doctor before you begin breastfeeding.

• Children: Safety and effectiveness in children under 18 years of age have not been established.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over- the-counter or prescription medications while taking this medicine. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with this medicine:

• Calcium channel blockers (eg, nifedipine)
• Catecholamine-depleting agents (eg, reserpine, MAOls)
• Cimetidine (eg, Tagamet)
• Clonidine (eg, Catapres)
• Digoxin (eg, Lanoxin)
• Insulin oral hypoglycemics (eg, sulfonylureas)
• Rifampin (eg, Rifadin)

Side Effects of Carvedilol:

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend upon many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

• Digestive Tract: Stomach pain; diarrhea.

• Nervous System: Dizziness; sleeplessness; drowsiness; fatigue.

• Circulatory System: Slow heart rate; postural hypotension (dizziness or light headedness when rising from a sitting or lying position); swelling of the lower legs.

• Other: Runny nose; sore throat; difficulty breathing; back pain; infections; unusual bleeding or bruising.

Guidelines for Use:

• Use exactly as prescribed.
• Take with food to reduce lightheadedness when rising or standing.
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised to do so by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Do not stop taking this medicine or change the dose without checking with your doctor; this could cause serious adverse effects.
• May cause drowsiness, dizziness, lightheadedness or fainting (especially when rising or standing). If these symptoms should occur, sit or lie down and contact your doctor. Use caution when driving or performing other tasks requiring alertness, coordination or physical dexterity.
• Patients being treated for high blood pressure often feel tired and run down for a few weeks after beginning therapy. It takes time for the body to adjust to lowered blood pressure. The full effect may take 7 to 14 days. Continue taking your medication even though you may not feel quick “normal.” Check with your doctor or pharmacist during this time regarding any new symptoms that occur to assure that these new feelings are a normal consequence of changes in blood pressure.
• If itching, dark urine, appetite loss, yellowing of skin or eyes, pain in the upper right side or flu-like symptoms occur, contact your doctor immediately.
• Dose adjustments may be required after checking blood pressure. Be sure to keep appointments.
• Contact lens wearers may notice decreased tearing (dry eyes).
• Store at room temperature (59° to 86° F) away from moisture and light.

Nonprescription Uses and Benefits of Nonprescription – Side Effects of Nonprescription

Type of Drug:

Over-the-counter (otc) diuretics or “water pills.”

How the Nonprescription Products Works:

Ammonium chloride alone has limited value in promoting urine flow. Its use in combination with caffeine is effective since the diuretic actions are additive. Doses up to 3 g/day may be given in divided doses 3 to 4 times daily for up to 6 days. Large doses (4 to 12 g/day) may cause nausea and vomiting, headache, hyperventilation, drowsiness and confusion.

Caffeine increases urination. It may lessen the mental and physical fatigue associated with water retention. Caffeine is effective for relief of premenstrual and menstrual symptoms in doses of 100 to 200 mg every 3 to 4 hours. For more information on caffeine, see monograph.

Uses of The Nonprescription:

Nonprescription diuretics may lessen menstrual discomfort. When taken 4 to 6 days before onset of a period, they may help relieve symptoms related to water retention, including: Excess water weight, bloating, painful breasts, cramps and tension.

Guidelines for Use:

• Ammonium chloride – Do not use if you have function .
• Caffeine – May cause sleeplessness when taken time. Consider this when drinking coffee, taking products containing caffeine. Doses above stomach upset.

Epoprostenol Drug – How does Epoprostenol Works?

Type of Drug:

Peripheral vasodilator.

How the Epoprostenol Product Works:

Epoprostenol relaxes pulmonary and arterial blood vessels, allowing them to dilate (widen). This allows more blood to flow through the vessels and improves heart function in patients with pulmonary hypertension.

Uses of The Epoprostenol:

For the long-term treatment of primary pulmonary hypertension in NYHA Class III and Class IV patients who do not adequately respond to conventional therapy.

Precautions:

Do not use in the following situations:

allergy to the drug or any of its ingredients congestive heart failure due to severe left ventricular systolic dysfunction (chronic use) pulmonary edema during dose initiation.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits out­weigh the possible risks to the fetus.

Breastfeeding: It is not known if this drug appears in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness have not been established.

Elderly: In general, dose selection should be cautious, reflecting the greater frequency of decreased liver, kidney, or heart function and of concomitant disease or other drug therapy.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­ the-counter or prescription medications or dietary supplements while taking this drug. Drug doses may need to be modified or a different drug prescribed. The following drugs and drug classes interact with this drug:

• Antihypertensive agents (eg, ACE inhibitors)
• Antiplatelet agents (eg, anticogulants)
• Diuretics (eg, hydrochlorothiazide)
• Vasodilators (eg, nitrates)

Side Effects of the Epoprostenol:

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Circulatory System: Low blood pressure; chest pain; abnormal heart rhythm; changes in heartbeat; heart failure; fainting; pounding in the chest (palpitations).

Nervous System: Headache; anxiety; nervousness; agitation; dizziness; tremor; confusion; convulsions; depression; sleeplessness; stroke.

Skin: Flushing; sweating; abnormal skin sensations; itching; rash; pallor; bluish skin.

Digestive Tract: Nausea; vomiting; stomach pain; indigestion; diarrhea; appetite loss; constipation; fluid in the abdomen.

Other: Muscle, back, jaw, or bone pain; difficulty breathing; local infection; pain at the injection site; chills; fever; flu-like symptoms; shock; deficiency of oxygen to body tissues (hypoxia); bleeding; swelling (edema); low blood calcium levels; weight changes; increased cough; nosebleed; abnormal vision; weakness; abnormal blood counts

Guidelines for Use:

• This drug is administered by continuous intravenous (IV; into a vein) infusion via a central venous catheter using an ambulatory infusion pump. Therapy requires commitment to drug reconstitution (mixing), administration, and care of the catheter for a prolonged period, possibly years. Brief interruptions in therapy may result in rapid deterioration.
• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose, unless instructed by your doctor.
• Abrupt withdrawal of the drug may result in symptoms associated with pulmonary hypertension, including difficulty breathing, dizziness, and weakness.
• Store unopened vials at 59° to 77° F. Protect from light.
• Refrigerate reconstituted solution at 36° to 46°F for not more than 40 hours; discard any solution that has been refrigerated for more than 48 hours. Do not freeze; discard any solution that has been frozen. Protect from light.
• A single reservoir of reconstituted solution can be administered at room temperature for a duration of 8 hours or it can be used with a cold pouch and administered for 24 hours or less with the use of 2 frozen 6 oz gel packs. Insulate solution from temperatures higher than 70°F. and lower than 32° F. Do not expose to direct sunlight.

Ezetimibe Drug – How does Ezetimibe Works?

Type of Drug:

Antihyperlipidemic; cholesterol-lowering drug.

How the Ezetimibe Product Works:

Ezetimibe lowers blood cholesterol levels by blocking the absorption of cholesterol from the small intestine.

Uses of The Ezetimibe :

As adjunctive therapy to lifestyle changes for the reduction of elevated total cholesterol, LDL (“bad”) cholesterol, and apolipoprotein B in patients with high cholesterol. May be used in combination with other cholesterol ­lowering drugs.

Precautions:

Use with caution in the following situations: Current HMG-CoA reductase inhibitor (eg, lovastatin) use.

Pregnancy: There are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and potential benefits out­weigh the possible risks to the fetus.

Breastfeeding: It is not known if ezetimibe appears in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness in children younger than 10 years of age have not been established.

Lab Tests: Lab tests will be required during treatment. Tests include cholesterol levels and liver function tests.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­the-counter or prescription medications or dietary supplements with this drug. Drug doses may need to be modified or a different drug prescribed. The following drugs and drug classes interact with this drug:

• Bile acid sequestrants (eg, cholestyramine)
• Cyclosporine (eg, Neoral)
• Fenofibrate (eg, Tricor)
• Gemfibrozil (eg, Lopid)
• HMG-CoA reductase inhibitors (eg, lovastatin)

Side Effects:

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend on many factors, including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Stomach pain; diarrhea.

Respiratory System: Sore throat; sinus infection; cough; upper respiratory tract infection.

Other: Fatigue; chest, back, muscle, and joint pain; dizziness; headache.

Guidelines for Use:

• Dosage is individualized. Use exactly as prescribed.
• Do not stop taking or change the dose, unless instructed by your doctor.
• May be taken without regard to food,
• Take 2 or more hours before or 4 or more hours after a bile acid sequestrant (eg, cholestyramine).
• Continue to follow a cholesterol-lowering diet while taking ezetimibe. Ask your doctor if you need diet information.
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless instructed by your doctor. If more than one dose is missed, or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Inform your doctor if you are pregnant, become pregnant, are planning to become pregnant, or are breastfeeding.
• Notify your doctor if you experience persistent stomach pain or tired­ness or unexplained muscle pain, tenderness, or weakness.
• Lab tests will be required to monitor therapy. Be sure to keep appointments.
• Store at 59° to 86°F. Protect from moisture.