RxIndia
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Reserve aliskiren for patients intolerant to ACE inhibitors (e.g., persistent dry cough) or ARBs, as cardiovascular outcome data are less robust Nev...
1. Dry cough: Occurs in up to 10% of patients and is not doserelated — if persistent and troublesome, switch to an ARB (e.g., losartan, telmisartan). ...
1. Dual channel blockade advantage: Cilnidipine inhibits both Ltype (vascular) and Ntype (neuronal) calcium channels, resulting in less reflex tachyca...
Never stop abruptly: Rebound hypertension can be lifethreatening — always taper over 3–7 days; risk increases with higher doses and longer duration of...
1. ALLHAT warning: Avoid doxazosin as firstline monotherapy for hypertension — ALLHAT trial demonstrated increased heart failure risk compared to chlo...
1. Prodrug requiring hepatic activation — enalapril is converted to active enalaprilat by liver esterases; in severe hepatic impairment, consider lisi...
1. Extendedrelease formulation only: Felodipine is available only as prolongedrelease tablets in India — must be swallowed whole. Breaking or crushing...
1. Obsolete agent: Guanethidine is of historical and academic interest only; not used in current Indian clinical practice due to withdrawal from marke...
1. Never use as monotherapy — reflex tachycardia and fluid retention limit efficacy; always combine with betablocker + diuretic 2. Preferred in pregn...
1. Metabolic advantage: Indapamide has a more favourable metabolic profile than hydrochlorothiazide — less impact on glucose tolerance, lipid profile,...
1. Limited availability issue: Isradipine is rarely stocked in Indian pharmacies; confirm availability before prescribing. Amlodipine (once daily, wid...
Supine position mandatory for IV: Always administer IV labetalol with patient supine — severe postural hypotension can occur within minutes if patient...
1. Empty stomach administration is critical: Bioavailability drops by up to 70% when taken with highfat meals. Counsel patients to take 15–30 minutes ...
Pregnancy drug of choice: Methyldopa has the longest safety record in pregnancy; preferred for chronic/maintenance hypertension control — NOT for acut...
1. Key advantage over thiazides in CKD — Metolazone remains effective even when eGFR falls below 30 mL/min/1.73 m², unlike conventional thiazides; mak...
NEVER use immediaterelease for chronic hypertension: Associated with reflex tachycardia and increased cardiovascular mortality in chronic use — reserv...
1. Oncedaily convenience — perindopril has a long halflife allowing true oncedaily dosing with consistent 24hour BP control; preferred when compliance...
1. Sequence of blockade is critical — Always establish adequate alphablockade with phenoxybenzamine for at least 2–3 days BEFORE adding betablocker; r...
1. Unique ISA property: Pindolol causes less resting bradycardia and fatigue compared to betablockers without intrinsic sympathomimetic activity — may...
1. Firstdose precaution: Always initiate prazosin at bedtime with the patient lying down; advise the patient to rise slowly from bed the next morning....
1. Firstdose precaution: Always initiate at 1.25–2.5 mg in elderly, diuretictreated, or volumedepleted patients to avoid significant firstdose hypoten...
1. Always start at bedtime: Firstdose hypotension is a class effect — never skip the 1 mg starting dose regardless of final target. 2. Retitrate afte...