lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral drops
Capsule
▶Nifedipine (Non-proprietary)
Nifedipine 5 mgNifedipine 5 mg capsules| 84 capsuleP£ 2. 97 –
£ 19. 99
Nifedipine 10 mgNifedipine 10 mg capsules| 84 capsuleP
£ 4. 00 – £ 21. 00
▶Adalat(Bayer Plc)
Nifedipine 5 mgAdalat 5 mg capsules| 90 capsuleP£ 5. 73 DT =
£ 5. 73
Nifedipine 10 mgAdalat 10 mg capsules| 90 capsuleP£ 7. 30 DT
=£ 7. 30
eiiiiF 108Verapamil hydrochloride
lINDICATIONS AND DOSE
Treatment of supraventricular arrhythmias
▶BY SLOW INTRAVENOUS INJECTION
▶Child 1–17 years (administered on expert
advice): 100 – 300 micrograms/kg (max. per dose 5 mg)
for 1 dose, to be given over 2 – 3 minutes (with ECG and
blood-pressure monitoring), dose can be repeated after
30 minutes if necessary
Hypertension
▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶Child 12–23 months (administered on expert advice): 20 mg
2 – 3 times a day
▶Child 2–17 years (administered on expert
advice): 40 – 120 mg 2 – 3 times a day
Prophylaxis of supraventricular arrhythmias
(administered on expert advice)
▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶Child 12–23 months: 20 mg 2 – 3 times a day
▶Child 2–17 years: 40 – 120 mg 2 – 3 times a daylCONTRA-INDICATIONSAcute porphyrias p. 603 .atrial
flutter orfibrillation associated with accessory conducting
pathways (e.g. Wolff-Parkinson-White-syndrome).
bradycardia.cardiogenic shock.history of heart failure
(even if controlled by therapy).history of significantly
impaired left ventricular function (even if controlled by
therapy).hypotension.second- and third-degree AV
block.sick sinus syndrome.sino-atrial block
lCAUTIONSFirst-degree AV block
lINTERACTIONS→Appendix 1 : calcium channel blockers
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonHypotension
▶Frequency not knownAtrioventricular block.
extrapyramidal symptoms.Stevens-Johnson syndrome.
vertigo
SPECIFIC SIDE-EFFECTS
▶Common or very common
▶With intravenous useBradycardia
▶Frequency not known
▶With intravenous useCardiac arrest.drowsiness.hepatic
impairment.hyperhidrosis.myocardial contractility
decreased.nervousness.seizure
▶With oral useAlopecia.angioedema.arthralgia.
constipation.erythromelalgia.fatigue.galactorrhoea.
gastrointestinal discomfort.heart failure.ileus.muscle
weakness.myalgia.paraesthesia.tinnitus.tremor
lPREGNANCYMay reduce uterine bloodflow with fetal
hypoxia. Manufacturer advises avoid infirst trimester
unless absolutely necessary. May inhibit labour.
lBREAST FEEDINGAmount too small to be harmful.lHEPATIC IMPAIRMENT
Dose adjustmentsOral dose may need to be reduced.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
injection, may be diluted with Glucose 5 %orSodium
Chloride 0. 9 %. Incompatible with solutions of pH greater
than 6.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Tablet
▶Verapamil hydrochloride (Non-proprietary)
Verapamil hydrochloride 40 mgVerapamil 40 mg tablets|
84 tabletP£ 2. 07 DT = £ 1. 40
Verapamil hydrochloride 80 mgVerapamil 80 mg tablets|
84 tabletP£ 2. 33 DT = £ 1. 74
Verapamil hydrochloride 120 mgVerapamil 120 mg tablets|
28 tabletP£ 2. 43 DT = £ 1. 18
Verapamil hydrochloride 160 mgVerapamil 160 mg tablets|
56 tabletP£ 28. 20 DT = £ 28. 20
Solution for injection
▶Securon(Mylan)
Verapamil hydrochloride 2.5 mg per 1 mlSecuron IV 5 mg/ 2 ml
solution for injection ampoules| 5 ampouleP£ 5. 41
Oral solution
▶Verapamil hydrochloride (Non-proprietary)
Verapamil hydrochloride 8 mg per 1 mlVerapamil 40 mg/ 5 ml oral
solution sugar free sugar-free| 150 mlP£ 39. 00 DT = £ 39. 00DIURETICS›THIAZIDES AND RELATED DIURETICS
Thiazides and related diuretics f
lCONTRA-INDICATIONSAddison’s disease.hypercalcaemia.
hyponatraemia.refractory hypokalaemia.symptomatic
hyperuricaemia
lCAUTIONSDiabetes.gout.hyperaldosteronism.
malnourishment.nephrotic syndrome.systemic lupus
erythematosus
CAUTIONS, FURTHER INFORMATION
▶Potassium lossHypokalaemia can occur with both thiazide
and loop diuretics. The risk of hypokalaemia depends on
the duration of action as well as the potency and is thus
greater with thiazides than with an equipotent dose of a
loop diuretic.
Hypokalaemia is particularly dangerous in children
being treated with cardiac glycosides. In hepatic failure
hypokalaemia caused by diuretics can precipitate
encephalopathy.
The use of potassium-sparing diuretics avoids the need
to take potassium supplements.
▶Existing conditionsThiazides and related diuretics can
exacerbate diabetes, gout, and systemic lupus
erythematosus.
lSIDE-EFFECTS
▶Common or very commonConstipation.electrolyte
imbalance.headache.postural hypotension.severe
cutaneous adverse reactions (SCARs).skin reactions
▶Rare or very rareLeucopenia.thrombocytopenia
lPREGNANCYThiazides and related diuretics should not be
used to treat gestational hypertension. They may cause
neonatal thrombocytopenia, bone marrow suppression,
jaundice, electrolyte disturbances, and hypoglycaemia;
placental perfusion may also be reduced. Stimulation of
labour, uterine inertia, and meconium staining have also
been reported.
lHEPATIC IMPAIRMENTCaution in mild to moderate
impairment. Avoid in severe liver disease. Hypokalaemia
may precipitate coma in hepatic impairment, although
hypokalaemia can be prevented by using a potassium-
sparing diuretic.110 Blood pressure conditions BNFC 2018 – 2019
Cardiovascular system2