📋 Indications & Clinical Dosage
*Essential hypertension:*
Adult: 5 mg daily. Elderly: Initially 2.5 mg daily, then increased if necessary to 5 mg daily.
*Hypertension in patient with renal impairment:*
Adult: Initially 2.5 mg once daily, then increased if necessary to 5 mg once daily.
*Adjunct in stable mild to moderate heart failure:*
Adult 70 years and over: Initially 1.25 mg once daily for 1-2 weeks, then increased to 2.5 mg oncedaily for 1-2 weeks, then increased to 5 mgonce daily for 1-2 weeks, then increased to10 mg once daily.
Children: Not recommended.
⛔ Contraindications
Acute or decompensated heart failure requiring intravenous inotropes, 2nd or 3rd degree AV block (without pacemaker), severe bradycardia, sick sinus syndrome, uncontrolled heart failure, cardiogenic shock, severe peripheral arterial disease, hypotension, metabolic acidosis, untreated pheochromocytoma, severe asthma or COPD.
⚠️ Precautions & Warnings
1st degree AV block, heart failure (avoid if un-controlled), peripheral arterial circulatory disorders (avoid if severe), Prinzmetals angina, myasthenia gravis, ischaemic heart disease, withdraw gradually, history of bronchospasm, diabetes, hyperthyroidism, renal or hepatic impairment, psoriasis, elderly, anaphylaxis risk due to increased sensitivity to al-lergens, withdraw gradually over period of 1-2 weeks.
🔄 Drug Interactions
Ca+ + antagonists, antihypertensives including centrally acting agent (e.g. clonidine), antiarrhythmics, antipsychotics. TCADs, MAOls, fluvoxamine, barbiturates, cardiac glycosides, sympathomimetics, cimetidine, hydralazine, rifampicin, insulin/oral hypoglycaemics, NSAIDs, ergot derivatives, erythromycin, anaesthetics, diuretics
⚠️ Adverse Reactions / Side Effects
Cardiovascular effects including bradycardia, postural hypotension, depression, oedema, increased AV block, cardiac arrhythmias, Raynauds phenomenon, cold extremities, sexual dysfunction, GI upset, sleep and CNS disturbances, skin reactions, fatigue, paraesthesia, peripheral neuropathy, arthralgia, myopathy, altered blood sugar haematology and lipid levels. Withdraw if unexplained dry eyes or rash. Rarely, heart failure, dyspnea, bronchospasm
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Avoid, risk cannot be ruled out.
Lactation / Breastfeeding:
Caution advised or effect undetermined,
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.