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severe arrhythmias;
congenital or acquired heart-
valve defects;
within 3 months of cerebrovascular
events; pulmonary veno-occlusive disease; conditions
which increase risk of bleeding
Hepatic impairment
elimination reduced—initially
2.5 micrograms no more frequently than every 3
hours (max.
6 times daily),
adjusted according to
response (consult product literature)
Pregnancy
manufacturer advises avoid (toxicity in
animal
studies); effective contraception must be used
during treatment
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
vasodilatation,
hypotension,
syncope,
cough, headache,
throat or jaw pain;
nausea,
vomi-
ting, diarrhoea, chest pain, dyspnoea, bronchospasm,
and wheezing also reported
Dose
. By inhalation of nebulised solution,
initial dose
2.5 micrograms increased to 5 micrograms for second
dose, if tolerated maintain at 5 micrograms 6–9 times
daily according to response; reduce to 2.5 micrograms
6–9 times daily if higher dose not tolerated;
CHILD
8–
18 years see
BNF for Children
Ventavis
c
(Bayer Schering) A
Nebuliser solution
,
iloprost (as trometamol)
10 micrograms/mL, net price 30 1-mL (10 micr-
ogram) unit-dose vials = £400.19,
168 1-mL =
£2241.08. For use with
Prodose
c
D or
Venta-Neb
c
D nebuliser
MINOXIDIL
Indications
severe hypertension,
in addition to a
diuretic and a beta-blocker
Cautions
see notes above; angina;
after myocardial
infarction (until stabilised);
lower doses in dialysis
patients; acute porphyria (section 9.8.2); interactions:
Appendix 1 (vasodilator antihypertensives)
Contra-indications
phaeochromocytoma
Renal impairment
use with caution in significant
impairment
Pregnancy
avoid—possible toxicity including reduced
placental perfusion;
neonatal hirsutism reported
Breast-feeding
present in milk but not known to be
harmful
Side-effects
sodium and water retention; weight gain,
peripheral oedema, tachycardia, hypertrichosis;
reversible rise in creatinine and blood urea nitrogen;
occasionally,
gastro-intestinal disturbances,
breast
tenderness, rashes
Dose
. Initially 5 mg (
ELDERLY
,
2.5 mg) daily,
in 1–2 divided
doses, increased in steps of 5–10 mg at intervals of at
least 3 days; max. 100 mg daily (seldom necessary to
exceed 50 mg daily)
Loniten
c
(Pharmacia) A
Tablets
,
scored,
minoxidil 2.5 mg,
net price 60-tab
pack = £8.88;
5 mg,
60-tab pack = £15.83; 10 mg, 60-
tab pack = £30.68
SILDENAFIL
Indications
pulmonary arterial hypertension;
erectile
dysfunction (section 7.4.5)
Cautions
hypotension (avoid if systolic blood pressure
below 90 mmHg); intravascular volume depletion; left
ventricular outflow obstruction;
cardiovascular dis-
ease;
autonomic dysfunction;
pulmonary veno-
occlusive disease; anatomical deformation of the
penis,
predisposition to priapism;
bleeding disorders
or active peptic ulceration;
consider gradual with-
drawal; interactions: Appendix 1 (sildenafil)
Contra-indications
recent history of stroke or myo-
cardial infarction,
history of non-arteritic anterior
ischaemic optic neuropathy; hereditary degenerative
retinal disorders;
avoid concomitant use of nitrates
Hepatic impairment
for
pulmonary hypertension
,
if
usual dose not tolerated,
reduce
oral
dose to 20 mg
twice daily, or reduce
intravenous
dose to 10 mg twice
daily; manufacturer advises avoid in severe impair-
ment
Renal impairment
for
pulmonary hypertension
,
if
usual dose not tolerated,
reduce
oral
dose to 20 mg
twice daily, or reduce
intravenous
dose to 10 mg twice
daily
Pregnancy
manufacturer advises use only if potential
benefit outweighs risk—no evidence of harm in
ani-
mal
studies
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
gastro-intestinal disturbances,
dry
mouth;
flushing,
oedema;
bronchitis,
cough;
head-
ache,
migraine,
night sweats,
paraesthesia,
insomnia,
anxiety,
tremor,
vertigo; fever,
influenza-like symp-
toms;
anaemia;
back and limb pain, myalgia;
visual
disturbances,
retinal haemorrhage,
photophobia,
painful red eyes; nasal congestion, epistaxis; cellulitis,
alopecia;
less commonly
gynaecomastia,
priapism;
also reported
rash, retinal vascular occlusion and non-
arteritic anterior ischaemic optic neuropathy (dis-
continue if sudden visual impairment),
and sudden
hearing loss (advise patient to seek medical help)
Dose
. By mouth,
20 mg 3 times daily;
CHILD
under 18 years
see
BNF for Children
. By intravenous injection,
when oral route not appro-
priate,
10 mg three times daily
Revatio
c
(Pfizer) T A
Tablets
, f/c, sildenafil (as citrate), 20 mg, net price 90-
tab pack = £373.50
Injection
,
sildenafil (as citrate),
800 micrograms/mL,
net price 50-mL vial = £45.28
Viagra
c
(Pfizer) A D
Section 7.4.5 (erectile dysfunction)
SITAXENTAN SODIUM
Indications
pulmonary arterial hypertension (but see
notes above)
Cautions
test liver function before treatment and
monitor monthly during treatment (discontinue
treatment if liver enzymes significantly raised); mea-
sure haemoglobin concentration before treatment,
after 1–3 months, then every 3 months; interactions:
Appendix 1 (sitaxentan)
Hepatic impairment
avoid
Pregnancy
avoid unless essential—toxicity in
animal
studies; manufacturer advises effective contraception
during treatment
BNF 61
2.5.1 Vasodilator antihypertensive drugs
109
2
Cardiovascular system