page144
With diuretic
Note
For patients with hypertension not adequately controlled
by telmisartan alone. For prescribing information on thiazides,
see section 2.2.1
Micardis Plus
c
(Boehringer Ingelheim) A
Tablets 40/12.5
,
red/white,
telmisartan 40 mg,
hydrochlorothiazide 12.5 mg,
net price 28-tab pack =
£12.50
Tablets 80/12.5
,
red/white,
telmisartan 80 mg,
hydrochlorothiazide 12.5 mg,
net price 28-tab pack =
£17.00
Tablets 80/25
,
yellow/white,
telmisartan 80 mg,
hydrochlorothiazide 25 mg,
net price 28-tab pack =
£17.00
VALSARTAN
Indications
hypertension;
heart failure when ACE
inhibitors cannot be used,
or in conjunction with an
ACE inhibitor when a beta-blocker cannot be used
(see also section 2.5.5); myocardial infarction with left
ventricular failure or left ventricular systolic dysfunc-
tion (adjunct—see section 2.5.5 and section 2.10.1)
Cautions
see notes above
Contra-indications
biliary cirrhosis,
cholestasis
Hepatic impairment
max. dose 80 mg daily in mild to
moderate impairment;
avoid if severe
Renal impairment
use with caution if eGFR less than
10 mL/minute/1.73 m
2
—no information available
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
renal impairment;
less
commonly
gastro-intestinal disturbance,
syncope,
fatigue,
cough, headache,
acute renal failure;
neutro-
penia,
thrombocytopenia,
myalgia,
and hypersensi-
tivity reactions (including rash,
pruritus,
vasculitis,
and serum sickness) also reported
Dose
. Hypertension,
usually 80 mg once daily (initially
40 mg once daily in intravascular volume depletion); if
necessary increased at intervals of 4 weeks up to max.
320 mg daily
. Heart failure,
initially 40 mg twice daily increased at
intervals of at least 2 weeks up to max. 160 mg twice
daily
. Myocardial infarction,
initially 20 mg twice daily
increased over several weeks to 160 mg twice daily if
tolerated
Diovan
c
(Novartis) T A
Capsules
,
valsartan 40 mg (grey),
net price 28-cap
pack = £13.97;
80 mg (grey/pink),
28-cap pack =
£13.97;
160 mg (dark grey/pink),
28-cap pack =
£18.41
Tablets
,
f/c,
valsartan 40 mg (yellow,
scored),
net
price 7-tab pack = £3.49;
320 mg (dark grey-violet),
28-tab pack = £20.23
With diuretic
Note
For hypertension not adequately controlled by valsartan
alone.
For prescribing information on thiazides, see section
2.2.1
Co-Diovan
c
(Novartis) A
Tablets 80/12.5
,
orange, f/c,
valsartan 80 mg,
hydrochlorothiazide 12.5 mg,
net price 28-tab pack =
£13.97
Tablets 160/12.5
,
red,
f/c,
valsartan 160 mg,
hydrochlorothiazide 12.5 mg,
net price 28-tab pack =
£18.41
Tablets 160/25
,
brown-orange,
f/c,
valsartan
160 mg,
hydrochlorothiazide 25 mg,
net price 28-tab
pack = £18.41
2.5.5.3
Renin inhibitors
Renin inhibitors inhibit
renin directly;
renin converts
angiotensinogen to angiotensin I.
Aliskiren is licensed
for
the treatment
of
hypertension,
either
alone or
in
combination with other antihypertensives. The
Scottish
Medicines
Consortium
(p.
4)
has
advised
(January
2010)
that
aliskiren (
Rasilez
c
)
is
not
recommended
for use within NHS Scotland.
ALISKIREN
Indications
essential hypertension
Cautions
patients taking concomitant diuretics,
on a
low-sodium diet, or who are dehydrated (first doses
may cause hypotension—initiate with care); renal
artery stenosis;
patients at risk of renal impairment;
monitor plasma-potassium concentration and renal
function in diabetes mellitus and heart failure;
inter-
actions: Appendix 1 (aliskiren)
Renal impairment
caution in renal artery stenosis or
if eGFR less than 30 mL/minute/1.73 m
2
—no infor-
mation available; monitor plasma-potassium concen-
tration
Pregnancy
manufacturer advises avoid—no informa-
tion available;
other drugs acting on the renin-angio-
tensin system have been associated with fetal mal-
formations and neonatal death
Breast-feeding
present in milk in
animal
studies—
manufacturer advises avoid
Side-effects
diarrhoea;
less commonly
rash;
rarely
angioedema;
acute renal failure (reversible on dis-
continuation of treatment),
anaemia,
and hyperkal-
aemia also reported
Dose
.
ADULT
over 18 years, 150 mg once daily,
increased if
necessary to 300 mg once daily
Rasilez
c
(Novartis) T A
Tablets
,
f/c,
aliskiren (as hemifumarate) 150 mg
(pink),
net price 28-tab pack = £19.80;
300 mg (red),
net price 28-tab pack = £23.80.
Label:
21
2.6
Nitrates, calcium-channel
blockers, and other
antianginal drugs
2.6.1 Nitrates
2.6.2 Calcium-channel blockers
2.6.3 Other antianginal drugs
2.6.4 Peripheral vasodilators and related
drugs
Nitrates,
calcium-channel
blockers,
and
potassium-
channel
activators
have
vasodilating
effects.
Vaso-
dilators can act in heart failure by arteriolar dilatation
which reduces both peripheral
vascular resistance and
124
2.6 Nitrates, calcium-channel blockers, and other antianginal drugs
BNF 61
2
Cardiovascular system