HealthCare

Metolazone is a diuretic with actions and uses similar to those of the thiazide diuretics even though it does not contain a thiazide ring system. Metalazone is available under brand names  Zaroxolyn and Mykrox. It is mainly  used to treat congestive heart failure and high blood pressure.

Metolazone is used in the treatment edema,  including that associated with heart failure and for hypertension. For edema usual dose is 5 to 10mg, in some cases doses of 20mg or more but nor more than 80mg to be given in 24 hrs.For  Hypertension:- 2.5 to 5 mg daily either alone or with other anti hypertensives.

Metolazone aggravates  hypersensitivity to other thiazides and sulfonamide derivatives. It is contraindicated in  anuria, hepatic coma, severe renal and hepatic dysfunction, refractory hypokalaemia, hyponatraemia, hypercalcaemia, symptomatic hyperuricaemia and Addison's disease.

Metolazone  Drug Interactions: In drugs like Furosemide, ACE inhibitors and  glibendamide. Preacaustiosn should be taken while using Metolazone in cases of  Diabetes mellitus; gout; electrolyte,disturbances; lupus erythematosus; hepatic and renal impairment;

Side effects on using Metolazone (zaroxolyn ) include dizziness, headache, or heart arrhythmias (palpitations).The  Serious, though rare, side effects include aplastic anemia, pancreatitis, agranulocytosis, and angioedema. Metolazone, like other thiazide diuretics, may unmask latent diabetes mellitus or exacerbate gout, especially by interacting with medicines used to treat gout.

Carvedilol –brand name Coreg and Coreg CR is an arylethanolamine nonspecific fl-adrenoreceptor antagonist with beta blocking activity. It is a beta blocker group of drugs having anti hypertension effect partly by reducing total peripheral resistance and vasodilatation. It blocks adreno receptors and inhibits J-adreno receptor-mediated compensatory mechanisms.

Carvedilol is widely used for the treatment of hypertension and congestive heart failure.
Dosage for hypertension is initially 6.25 mg twice daily. If tolerated well after 7-14 days, increase to 12.5mg twice daily if needed. If needed again increase the dose up to 25 mg twice daily, after 7-14 days. Maximum total daily dose is 50mg.

In case of congestive heart failure start the dosage with 3.125 mg twice daily for 2 weeks. If tolerated raise to 6.25mg twice daily and then double the dose every 2 weeks to the level tolerated by patients. Maximum dose is 25mg and 50mg for patients weighing less than 85 kgs and more than 85 kgs respectively.

Contraindications of Carvedilol include hypersensitivity; Patients with NYHA class IV decompensated cardiac failure requiring IV inotropic therapy, bronchial asthma, second or third-degree AV block, Sick Sinus syndrome, cardiogenic shock or severe bradycardia, severe hepatic impairment and lactation.

Special Precautions: Before starting the Carvedilol treatment, laboratory confirmation of liver injury is very much essential. Abrupt withdrawal of 3-blockers may result in exacerbation of the symptoms of hyperthyroidism. During the initiation of therapy, avoid driving or operating machinery. Safety of Carvedilol is not established during pregnancy. as well as in Children. Side effects of Carvedilol include increased sweating, fatigue, oedema, bradycardia, hypotension (including postural), hyperglycaemia, hypercholesterolemia, bronchitis, insomnia, impotency, skin reactions, tinnitus, anaemia and even sudden death.

Drug interactions of Carvedilol: Rifampicin decrease while cimetidine increase the AUC & Cmax of carvedilol. Increase in Steady-state AUC and trough concentration of digoxin. Catecholamine-depleting agents & beta-receptors blockers results in hypotension or severe bradycardia.

DIGOXIN is a CARDIAC  GLYCOSIDES type of drug. It has direct effects on myocardial contractility and electrophysiological conduction properties i.e. 1. Negative chronotropic effect (Reduces heart rate & A.V. conduction). 2. Positive inotropic effect i.e. there is a dose dependent increase in force of contraction of myocardium. The above two effects thereby make it an ideal drug for treatment of cardiac failure of diverse aetiologies without increasing the oxygen demand of the failing myocardium. There is also a mild direct vasoconstrictor action thereby increasing peripheral resistance mildly. Diuresis is seen promptly in C.H.F. patients owing to improved renal perfusion which was previously compromised but at times an addition of diuretic may be considered to improve the patients hypoxic and hypervolemic condition rapidly if need arises.

DIGOXIN is used in Congestive heart failure, cardiac tachyarrhythmias (Paroxysmal supraventricular tachycardia, atrial flutter & fibrillation). Dosage : Initially 0.25-1.5 mg daily. Maint; 0.25-0.5 mg daily. For Children : initially 10-20 meg/kg body wt. 6 hrly. Maint 10-20 meg/kg body wt. in single or divided doses daily. 

Contra-lndicatlons of DIGOXIN : Hypokalemia, ventricular tachycardia, partial A.V.    block, acute myocarditis. Wolf-Parkinson-White Syndrome. Special Precautions has to be taken in Elderly, renal or severe hepatic disease, myocardial infarction and  thyrotoxi-cosis patients.

Common Side-effects that can be expected with DIGOXIN are Anorexia, nausea, vomiting, ab¬dominal pain, fatigue, headache, mental confusion, restlessness.

PROPRANOLOL is a BETA  BLOCKERS group of medicines for heart ailments. It decreases heart rate, force of contraction & cardiac output. On prolonged administration BP gradually falls in hypertensives but not in normotensives.

PROPRANOLOL is used in Hypertension, angina pectoris, cardiac arrhythmias, post M.I. tachycardia,migraine and anxiety. the common  Dosage is 10 mg B.D. to 160 mg Q.I.D (average 40-160 mg/day)

Contra-lndicatlons of PROPRANOLOL are Obstructive COPD like asthma. Partial or complete heart block, C.H.F. Acute M.I. Cardiogenic shock and those taking Digitalis & verapamil therapy.

Special Precautions have to be taken while taking PROPRANOLOL in Impaired renal & hepatic functions, pregnancy, cardiac failure. Myocardial insufficiency and  reduced cardiac reserve. Side-effects include Tiredness, lack of drive, G.I. upsets, nightmares, forgetfulness, rare cases of  hallucinations, muscle fatigue.

PROPRANOLOL can interact with other drugs and can cause Hypertension & bradycardia with adrenaline, reduced heart rate & output with anaesthetic agents. Also Severe bradycardia may occur with digitalis and calcium channel blockers. PROPRANOLOL causes elevated blood levels with cimetidine .

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