📋 Indications & Clinical Dosage
*Raynauds syndrome:*
Adult: Initially 5 mg 3 times a day, then adjusted according to response to 20 mg 3 times a day.
*Hiccup in palliative care:*
Adult: 10 mg 3 times a day.
*Hypertension, Angina prophylaxis:*
Adult: 10 mg Retard Tab twice daily, adjusted according to response to 40 mg twice daily.
Children: Not recommended.
⛔ Contraindications
Cardiogenic shock, unstable angina, severe aortic stenosis, within a month of Mt. Hepatic impairment, history of GI obstruction, Crohns disease, Kock pouch.
⚠️ Precautions & Warnings
Poor cardiac reserve, heart failure, hepatic im-pairment, severe hypotension, diabetes, dialysis, elderly.
🔄 Drug Interactions
Anti hypertensives, cimetidine, quinidine, digoxin, rifampicin, phenytoin, diltiazem, cisapride, erythromycin, azole antifungals, fluoxetIne, indinavir, ritonavir, tacrolimus, quinupristin/dalfopristin, nefazodone, grapefruit juice.
⚠️ Adverse Reactions / Side Effects
Headache, flushes, oedema, dizziness, tachycardia, hypotension, GI upset, lethargy, paraesthesia, skin reactions, myalgia, tremor, visual disturbances, in-creased urinary frequency, gingival hyperplasia, gynaecomastia. Rare: Hypersensitivity, jaundice, impotence, mood changes. MI, ischaemic pain (discontinue).
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Contraindicated in pregnancy.
Lactation / Breastfeeding:
Not recommended.
📚 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.