page124
Dose
. Hypertension,
initially 5 mg 2–3 times daily
or
15 mg
once daily,
increased as required at weekly intervals;
usual maintenance 15–30 mg daily;
max. 45 mg daily
. Angina,
2.5–5 mg up to 3 times daily
Pindolol
(Non-proprietary) A
Tablets
, pindolol 5 mg, net price 100-tab pack = £7.81.
Label:
8
Visken
c
(Amdipharm) A
Tablets
,
scored,
pindolol 5 mg,
net price 56-tab pack
= £5.85;
15 mg,
28-tab pack = £8.79.
Label:
8
With diuretic
Viskaldix
c
(Amdipharm) A
Tablets
,
scored,
pindolol 10 mg,
clopamide 5 mg,
net
price 28-tab pack = £6.70.
Label:
8
Dose
hypertension,
1 tablet daily in the morning,
increased if
necessary to 2 daily; max.
3 daily
SOTALOL HYDROCHLORIDE
Indications
life-threatening arrhythmias including
ventricular tachyarrhythmias;
symptomatic non-sus-
tained ventricular tachyarrhythmias;
prophylaxis of
paroxysmal atrial tachycardia or fibrillation, paroxys-
mal AV re-entrant tachycardias (both nodal and
involving accessory pathways), and paroxysmal
supraventricular tachycardia after cardiac surgery;
maintenance of sinus rhythm following cardioversion
of atrial fibrillation or flutter
Cautions
see under Propranolol Hydrochloride;
cor-
rect hypokalaemia,
hypomagnesaemia,
or other
electrolyte disturbances;
severe or prolonged diarr-
hoea;
interactions: Appendix 1 (beta-blockers),
important: verapamil interaction see also p.
133
Contra-indications
see under Propranolol Hydro-
chloride; congenital or acquired long QT syndrome;
torsade de pointes;
renal failure
Renal impairment
use half normal dose if eGFR 30–
60 mL/minute/1.73 m
2
; use one-quarter normal dose
if eGFR 10–30 mL/minute/1.73 m
2
;
avoid if eGFR
less than 10 mL/minute/1.73 m
2
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see under Propranolol Hydrochloride;
arrhythmogenic (pro-arrhythmic) effect (torsade de
pointes—increased risk in women)
Dose
. By mouth with ECG monitoring and measurement of
corrected QT interval, arrhythmias,
initially 80 mg
daily in 1–2 divided doses increased gradually at
intervals of 2–3 days to usual dose of 160–320 mg
daily in 2 divided doses;
higher doses of 480–640 mg
daily for life-threatening ventricular arrhythmias
under specialist supervision
Sotalol
(Non-proprietary) A
Tablets
,
sotalol hydrochloride 40 mg,
net price 56 =
£1.29; 80 mg, 56 = £1.91; 160 mg, 28 = £2.32. Label: 8
Beta-Cardone
c
(UCB Pharma) A
Tablets
,
scored,
sotalol hydrochloride 40 mg (green),
net price 56-tab pack = £1.29;
80 mg (pink),
56-tab
pack = £1.91;
200 mg,
28-tab pack = £2.40.
Label:
8
Sotacor
c
(Bristol-Myers Squibb) A
Tablets
,
scored,
sotalol hydrochloride 80 mg,
net
price 28-tab pack = £3.06.
Label:
8
TIMOLOL MALEATE
Indications
see under Dose; glaucoma (section 11.6)
Cautions
see under Propranolol Hydrochloride
Contra-indications
see under Propranolol Hydro-
chloride
Hepatic impairment
dose reduction may be neces-
sary
Renal impairment
manufacturer advises caution—
dose reduction may be required
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see under Propranolol Hydrochloride
Dose
. Hypertension,
initially 10 mg daily in 1–2 divided
doses; gradually increased if necessary to max. 60 mg
daily,
usual maintenance dose 10–30 mg daily (doses
above 30 mg daily given in divided doses)
. Angina,
initially 5 mg twice daily increased if neces-
sary by 10 mg daily every 3–4 days; max. 30 mg twice
daily
. Prophylaxis after myocardial infarction,
initially 5 mg
twice daily, increased after 2 days to 10 mg twice daily
if tolerated
. Migraine prophylaxis,
10–20 mg daily in 1–2 divided
doses
Betim
c
(Meda) A
Tablets
,
scored,
timolol maleate 10 mg,
net price 30-
tab pack = £2.08.
Label:
8
With diuretic
Timolol with amiloride and hydrochlorothiazide
(Non-proprietary) A
Tablets
,
scored,
timolol maleate 10 mg,
amiloride
hydrochloride 2.5 mg, hydrochlorothiazide 25 mg, net
price 28-tab pack = £29.87.
Label:
8
Dose
hypertension,
1–2 tablets daily
Prestim
c
(Meda) A
Tablets
,
scored,
timolol maleate 10 mg,
bendroflu-
methiazide 2.5 mg,
net price 30-tab pack = £3.49.
Label:
8
Dose
hypertension,
1–2 tablets daily;
max.
4 daily
2.5
Hypertension and heart
failure
Hypertension
Lowering
raised
blood
pressure
decreases
the risk of
stroke,
coronary events,
heart
failure,
and renal
impairment.
Advice on antihyper-
tensive therapy in this section takes into account
the
recommendations of
the Joint
British Societies (JBS2:
British Societies’ guidelines on prevention of cardiovas-
cular disease in clinical practice.
Heart
2005; 91 (Suppl
V):
v1–v52).
Possible causes
of
hypertension (e.g.
renal
disease,
endocrine causes),
contributory factors,
risk factors,
and the presence of any complications of hypertension,
such as left
ventricular hypertrophy,
should be estab-
lished.
Patients
should be given advice on lifestyle
104
2.5 Hypertension and heart failure
BNF 61
2
Cardiovascular system