PAPERS BMJ: First Published As 10.1136/Bmj.297.6641.95 on 9 July 1988

Total Page:16

File Type:pdf, Size:1020Kb

PAPERS BMJ: First Published As 10.1136/Bmj.297.6641.95 on 9 July 1988 PAPERS BMJ: first published as 10.1136/bmj.297.6641.95 on 9 July 1988. Downloaded from The case for low dose diuretics in hypertension: comparison of low and conventional doses of cyclopenthiazide Gary McVeigh, David Galloway, Dennis Johnston Abstract hypertension. The original observations of Cranston In a double blind placebo controlled randomised et al clearly indicated, however, that these drugs parallel study the antihypertensive activity and showed a flat dose-response relation in reducing arterial adverse biochemical effects of three doses of cyclo- blood pressure and that increased doses caused greater penthiazide were evaluated in patients with mild upset to the biochemical profile.7 Equivalent diuretic essential hypertension that had been recently doses of each of the drugs had similar antihypertensive diagnosed or was being treated with a single drug. effects. Much evidence suggests that the attenuation of After a four week placebo washout period 53 patients the hypotensive response to an increasing dose of with diastolic blood pressures between 90-110 mm diuretic is mediated through a reactive rise in plasma Hg were randomly assigned to 50, 125, or 500 Ftg renin activity and angiotensin II concentration to try to cyclopenthiazide or matching placebo for an eight maintain blood pressure in the face ofincreased sodium week period of treatment. Blood pressure was and water depletion.8'0 measured in thepatients' homes bythe same observer Many deleterious metabolic effects have been every two weeks. Serum urea, electrolytes, urate, associated with the use of thiazide diuretics." 12 The and creatinine concentrations and 24 hour urinary relation with hypokalaemia in particular has provoked sodium excretion were monitored every four weeks much debate since publication of the results of the and serum magnesium concentration and plasma multiple risk factor intervention trial.'3 Analysis of the renin activity at the end ofthe washout and treatment data suggested that a subgroup of patients requiring periods. After eight weeks of treatment systolic and special intervention care were at increased risk of diastolic blood pressures were significantly reduced sudden death; such patients were taking high doses of in patients taking 125 and 500 tg cyclopenthiazide diuretics and had minor baseline electrocardiographic when compared with those taking placebo. The abnormalities. These findings continue to cause con- decrement in serum potassium concentration (0.6 cern, even though they have not been substantiated'4 http://www.bmj.com/ mmol/l) and increase in serum urate concentration and are questionable because the analysis of the results (0.06 mmol/l) were greatest with the 500 [tg dose, the for the subgroup lacked statistical power.'" The results increase in serum urate concentration alone being of the previous studies suggest that the adverse effects significant. No change in serum magnesium con- may be minimised by reducing the dose of these centration or 24 hour urinary sodium excretion was drugs.I16 7 noted with any dose of cyclopenthiazide. Only the Cyclopenthiazide is the most popular thiazide 500 ig dose of cyclopenthiazide significantly in- diuretic for the treatment of essential hypertension in the United Kingdom. The aims of this community creased the mean plasma renin activity (1.8 (95% on 29 September 2021 by guest. Protected copyright. confidence interval 0*2 to 3.4)-5-4 (3.9 to 6.8) nmol based study were to define the lowest dose of drug angiotensin I/l/h); the other doses like the placebo showing significant antihypertensive activity and to had no effect. monitor the effect ofreducing the dose on the metabolic Cyclopenthiazide 125 Fg, a dose lower than is profile. In addition, in measuring 24 hour urinary currently marketed, produced a similar hypotensive excretion of sodium we tried to relate the natriuretic response to 500 tg of the drug without upsetting the effect of the various doses to their antihypertensive biochemical profile. efficacy. Introduction Patients and methods Benzothiadiazine diuretics have remained a popular Patients in whom hypertension had been newly treatment for arterial hypertension since their intro- diagnosed and those with hypertension receiving a Department ofTherapeutics duction into clinical practice in 1957.' They are a single treatment-for example, a [1 blocker, thiazide and Pharmacology, Queen's cheap, effective, well tolerated, and once daily treat- diuretic, calcium antagonist, and so on-who were University ofBelfast, Whitla ment and in combination potentiate the hypotensive willing to alter their treatment for the purposes of the Medical Building, Belfast activity of other first line agents. All the large scale trial were recruited from general practices in the BT97BL Gary McVeigh, MD, registrar clinical trials of mild hypertension have used thiazide Belfast area. With the general practitioners' permission and tutor diuretics as part of their treatment regimens.2-5 patients with hypertension were identified from repeat Dennis Johnston, MD, Analysis ofthese studies confirms a small but consistent prescription books and disease indices or referred consultantphysician and senior benefit of treatment, with a reduction in the incidence directly after consultation with their family doctor. lecturer of known complications of hypertension. Letters were then circulated to each patient explaining Napp Research Centre, The antihypertensive mechanism of action of these the nature of the project. If patients were willing to Cambridge drugs is still debatable, although achieving a negative participate in the study an acknowledgement slip was David Galloway, MRCP, sodium balance with an attendant reduction in plasma returned in the stamped-addressed envelope provided. director ofclinical research and extracellular fluid volume seems to be important.6 These patients were screened in the department of Correspondence to: Dr Perhaps for this reason most clinical trials continue to therapeutics and the study protocol was explained in Johnston. use high doses of diuretic drugs to control essential detail. Possible secondary causes ofhypertension were BMJ VOLUME 297 9 JULY 1988 95 excluded by a full history and examination, which venous blood samples were taken for estimating urea, included chest radiography and electrocardiography. electrolyte, urate, and creatinine concentrations. At the Reasons for exclusion from the study included impor- end of the placebo washout and active periods of tant cardiac, hepatic, renal, cerebrovascular, or ocular treatment, samples of venous blood were taken for (grade III-IV retinopathy) disease; previous sensitivity estimating serummagnesiumconcentration and plasma to thiazide diuretics; abuse of drugs or alcohol; and a renin activity. The sample for plasma renin activity was history ofgout or diabetes mellitus. Ifat any time during withdrawn after the patient had been resting supine for BMJ: first published as 10.1136/bmj.297.6641.95 on 9 July 1988. Downloaded from the trial the diastolic blood pressure exceeded 110 mm an hour. It was collected in a tube that had been Hg the patient's original treatment was restarted and his previously cooled and was immediately centrifuged at or her general practitioner contacted. Informed verbal 4°C. Plasma renin activity was measured by the consent was obtained from suitable patients who radioimmunoassay of generated angiotensin I, with a entered into a four week single blind placebo washout generation time of90 minutes at pH 6. '9 The intra-assay and compliance period. and interassay coefficients of variation were 7 and 6%, Throughout the trial patients were seen in their own respectively. Twenty four hour urine samples were homes every two weeks by the same investigator. Blood collected every four weeks during the trial, and the pressure readings were taken at the same time of day, sodium content of the samples was estimated by flame for each patient, on every occasion. Recordings were photometry. taken from both arms initially, but subsequent Statistical methods-A 10 mm Hg drop in diastolic measurements were taken from the arm with the highest blood pressure with treatment was considered to be a diastolic pressure. A Hawksley random zero sphygmo- clinically relevant effect. To detect such a difference manometer was used to measure arterial pressure to the between groups (at the 5% alpha level and with 80% nearest 2 mm Hg. The cuffand bladder size were 14 x 90 power) with a standard deviation of 5 mm Hg, six or cm and 12 5 x 22 cm, respectively. Readings were taken more patients were required ineach group.20 An analysis once only while the patients were seated and after they of variance (Anova) was used to determine differences had rested for 10 minutes. The arm was supported at the with treatment in each variable, and Neuman-Keuls level ofthe heart during the procedure. 18 Disappearance multiple range test2' was applied to determine between of the Korotkoff sounds (phase V) was taken as a which treatments these occurred only if the overall measure of diastolic blood pressure. The arterial probability ofan effect with dose was less than 10%. The pressure reading against which the effects of treatment level of significance was chosen at the 5% level. The differences between the values at week 0 (end ofthe run TABLE I-Clinical data on patients who completed trial in period) and week 8 (end of the active period of treatment) were compared with the differences between Dose of cyclopenthiazide ()g) the corresponding values for the placebo at weeks 0 and Placebo 50 125 500 Total 8. Results are expressed as means (SD). Noofpatients 12 13 15 13 53 No of men 7 5 5 5 22 No of women 5 8 10 8 31 Mean age (range) (years) 58 (47-70) 59 (47-70) 56 (45-73) 55 (45-72) 57 (45-73) Results Mean (SD) weight (kg): Men 75 (5-8) 81 (5-8) 77 (5 8) 72 (5-2) 76 (5-8) Eighty three patients with presumed mild essential Women 71 (5-4) 66 (4 9) 70 (5 3) 66 (4-8) 68 (5 2) hypertension entered the study, and 53 fulfilled the http://www.bmj.com/ criteria for entry into the active phase of treatment of the trial.
Recommended publications
  • Health Reports for Mutual Recognition of Medical Prescriptions: State of Play
    The information and views set out in this report are those of the author(s) and do not necessarily reflect the official opinion of the European Union. Neither the European Union institutions and bodies nor any person acting on their behalf may be held responsible for the use which may be made of the information contained therein. Executive Agency for Health and Consumers Health Reports for Mutual Recognition of Medical Prescriptions: State of Play 24 January 2012 Final Report Health Reports for Mutual Recognition of Medical Prescriptions: State of Play Acknowledgements Matrix Insight Ltd would like to thank everyone who has contributed to this research. We are especially grateful to the following institutions for their support throughout the study: the Pharmaceutical Group of the European Union (PGEU) including their national member associations in Denmark, France, Germany, Greece, the Netherlands, Poland and the United Kingdom; the European Medical Association (EMANET); the Observatoire Social Européen (OSE); and The Netherlands Institute for Health Service Research (NIVEL). For questions about the report, please contact Dr Gabriele Birnberg ([email protected] ). Matrix Insight | 24 January 2012 2 Health Reports for Mutual Recognition of Medical Prescriptions: State of Play Executive Summary This study has been carried out in the context of Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross- border healthcare (CBHC). The CBHC Directive stipulates that the European Commission shall adopt measures to facilitate the recognition of prescriptions issued in another Member State (Article 11). At the time of submission of this report, the European Commission was preparing an impact assessment with regards to these measures, designed to help implement Article 11.
    [Show full text]
  • Comprehensive Screening of Diuretics in Human Urine Using Liquid Chromatography Tandem Mass Spectrometry
    id5246609 pdfMachine by Broadgun Software - a great PDF writer! - a great PDF creator! - http://www.pdfmachine.com http://www.broadgun.com AAnnaallyyttiiccaaISllS N : 0974-7419 Volume 13 Issue 7 CCHHEEAnMM IndIIiSaSnT TJoRuRrnYaYl Full Paper ACAIJ, 13(7) 2013 [270-283] Comprehensive screening of diuretics in human urine using liquid chromatography tandem mass spectrometry Shobha Ahi1, Alka Beotra1*, G.B.K.S.Prasad2 1National Dope Testing Laboratory, Ministry of Youth Affairs and Sports, CGO Complex, Lodhi Road, New Delhi,-110003, (INDIA) 2SOS in Biochemistry, Jiwaji University, Gwalior, (INDIA) E-mail : [email protected] ABSTRACT KEYWORDS Diuretics are drugs that increase the rate of urine flow and sodium excretion Doping, diuretics; to adjust the volume and composition of body fluids. There are several LC-MS/MS; WADA; major categories of this drug class and the compounds vary greatly in Drugs of abuse. structure, physicochemical properties, effects on urinary composition and renal haemodynamics, and site mechanism of action. Diuretics are often abused by athletes to excrete water for rapid weight loss and to mask the presence of other banned substances. Because of their abuse by athletes, ’s (WADA) diuretics have been included in the World Anti-Doping Agency list of prohibited substances. The diuretics are routinely screened by anti- doping laboratories as the use of diuretics is banned both in-competition and out-of-competition. This work provides an improved, fast and selective –tandem mass spectrometric (LC/MS/MS) method liquid chromatography for the screening of 22 diuretics and probenecid in human urine. The samples preparation was performed by liquid-liquid extraction. The limit of detection (LOD) for all substances was between 10-20 ng/ml or better.
    [Show full text]
  • DIURETICS Diuretics Are Drugs That Promote the Output of Urine Excreted by the Kidneys
    DIURETICS Diuretics are drugs that promote the output of urine excreted by the Kidneys. The primary action of most diuretics is the direct inhibition of Na+ transport at one or more of the four major anatomical sites along the nephron, where Na+ reabsorption takes place. The increased excretion of water and electrolytes by the kidneys is dependent on three different processes viz., glomerular filtration, tubular reabsorption (active and passive) and tubular secretion. Diuretics are very effective in the treatment of Cardiac oedema, specifically the one related with congestive heart failure. They are employed extensively in various types of disorders, for example, nephritic syndrome, diabetes insipidus, nutritional oedema, cirrhosis of the liver, hypertension, oedema of pregnancy and also to lower intraocular and cerebrospinal fluid pressure. Therapeutic Uses of Diuretics i) Congestive Heart Failure: The choice of the diuretic would depend on the severity of the disorder. In an emergency like acute pulmonary oedema, intravenous Furosemide or Sodium ethacrynate may be given. In less severe cases. Hydrochlorothiazide or Chlorthalidone may be used. Potassium-sparing diuretics like Spironolactone or Triamterene may be added to thiazide therapy. ii) Essential hypertension: The thiazides usually sever as primary antihypertensive agents. They may be used as sole agents in patients with mild hypertension or combined with other antihypertensives in more severe cases. iii) Hepatic cirrhosis: Potassium-sparing diuretics like Spironolactone may be employed. If Spironolactone alone fails, then a thiazide diuretic can be added cautiously. Furosemide or Ethacrymnic acid may have to be used if the oedema is regractory, together with spironolactone to lessen potassium loss. Serum potassium levels should be monitored periodically.
    [Show full text]
  • Extracts from PRAC Recommendations on Signals Adopted at the 9-12 March 2020 PRAC
    6 April 20201 EMA/PRAC/111218/2020 Corr2,3 Pharmacovigilance Risk Assessment Committee (PRAC) New product information wording – Extracts from PRAC recommendations on signals Adopted at the 9-12 March 2020 PRAC The product information wording in this document is extracted from the document entitled ‘PRAC recommendations on signals’ which contains the whole text of the PRAC recommendations for product information update, as well as some general guidance on the handling of signals. It can be found here (in English only). New text to be added to the product information is underlined. Current text to be deleted is struck through. 1. Immune check point inhibitors: atezolizumab; cemiplimab; durvalumab – Tuberculosis (EPITT no 19464) IMFINZI (durvalumab) Summary of product characteristics 4.4. Special warnings and precautions for use Immune-mediated pneumonitis [..] Patients with sSuspected pneumonitis should be evaluated confirmed with radiographic imaging and other infectious and disease-related aetiologies excluded, and managed as recommended in section 4.2. LIBTAYO (cemiplimab) Summary of product characteristics 1 Expected publication date. The actual publication date can be checked on the webpage dedicated to PRAC recommendations on safety signals. 2 A footnote was deleted on 8 April 2020 for the signal on thiazide and thiazide-like diuretics (see page 3). 3 A minor edit was implemented in the product information of the signal on thiazide and thiazide-like diuretics on 5 June 2020 (see page 4). Official address Domenico Scarlattilaan 6 ● 1083 HS Amsterdam ● The Netherlands Address for visits and deliveries Refer to www.ema.europa.eu/how-to-find-us Send us a question Go to www.ema.europa.eu/contact Telephone +31 (0)88 781 6000 An agency of the European Union © European Medicines Agency, 2020.
    [Show full text]
  • Ehealth DSI [Ehdsi V2.2.2-OR] Ehealth DSI – Master Value Set
    MTC eHealth DSI [eHDSI v2.2.2-OR] eHealth DSI – Master Value Set Catalogue Responsible : eHDSI Solution Provider PublishDate : Wed Nov 08 16:16:10 CET 2017 © eHealth DSI eHDSI Solution Provider v2.2.2-OR Wed Nov 08 16:16:10 CET 2017 Page 1 of 490 MTC Table of Contents epSOSActiveIngredient 4 epSOSAdministrativeGender 148 epSOSAdverseEventType 149 epSOSAllergenNoDrugs 150 epSOSBloodGroup 155 epSOSBloodPressure 156 epSOSCodeNoMedication 157 epSOSCodeProb 158 epSOSConfidentiality 159 epSOSCountry 160 epSOSDisplayLabel 167 epSOSDocumentCode 170 epSOSDoseForm 171 epSOSHealthcareProfessionalRoles 184 epSOSIllnessesandDisorders 186 epSOSLanguage 448 epSOSMedicalDevices 458 epSOSNullFavor 461 epSOSPackage 462 © eHealth DSI eHDSI Solution Provider v2.2.2-OR Wed Nov 08 16:16:10 CET 2017 Page 2 of 490 MTC epSOSPersonalRelationship 464 epSOSPregnancyInformation 466 epSOSProcedures 467 epSOSReactionAllergy 470 epSOSResolutionOutcome 472 epSOSRoleClass 473 epSOSRouteofAdministration 474 epSOSSections 477 epSOSSeverity 478 epSOSSocialHistory 479 epSOSStatusCode 480 epSOSSubstitutionCode 481 epSOSTelecomAddress 482 epSOSTimingEvent 483 epSOSUnits 484 epSOSUnknownInformation 487 epSOSVaccine 488 © eHealth DSI eHDSI Solution Provider v2.2.2-OR Wed Nov 08 16:16:10 CET 2017 Page 3 of 490 MTC epSOSActiveIngredient epSOSActiveIngredient Value Set ID 1.3.6.1.4.1.12559.11.10.1.3.1.42.24 TRANSLATIONS Code System ID Code System Version Concept Code Description (FSN) 2.16.840.1.113883.6.73 2017-01 A ALIMENTARY TRACT AND METABOLISM 2.16.840.1.113883.6.73 2017-01
    [Show full text]
  • SOME ASPECTS of DIURETIC ACTIVITY of CYCLOPENTHIAZIDE and EFFECT of SPIRONOLAC [ONE on THEM, COMPARED with MERSALYL By
    SOME ASPECTS OF DIURETIC ACTIVITY OF CYCLOPENTHIAZIDE AND EFFECT OF SPIRONOLAC [ONE ON THEM, COMPARED WITH MERSALYL By D. J. ifEHTAl, N. G. SUCHAK" S. S. MANDREKAR\ R. C. KHOKHANI2, M. J. SHAH2 AND U. K. SHETH' From the Seth G. S. Medical College and K. E. M. Hospital, Bombay (Received August 30, 1962) Cydopenthiazide, a new thiazide oral diuretic was compared by itself and in combination with spironolactone to intramuscular mersalyl in patients with edema using a rapid quantitative method for determining the efficacy of diuretic drugs. Diuretic efficacy of the thiazide drug, alone or in combination with the ste-iod was about 2/3rd that of mersalyl. Cyclopenthiazide affected adversely Na/K excretion ratio while addition of spironolactone brought it more or less in line with mersalyl. Cyclopenthiazide is a comparatively newer drug belonging to the thiazide group of diuretics. We have been interested in evaluating one aspect of thiazide diuretics, namely, their efficacy when compared in maximally effective doses to that of an organic mercurial given by intramuscular injection. It was decided to gather similar information about this drug. The scope of the trial was extended so as to include the effect of addition of aldosterone antagonist spironolactone to cyclopenthiazide with the hope that it might increase the diuretic efficacy of and prevent the expected high excretion of potassium in urine with thiaizde diuretic or at least do the latter. The trial was carried out in 21 in-door patients admitted (in K.E M Hospital, Bombay) for edema due to varied pathological conditions. METHODS The method used was a slight modification of the one used by Gold et al., 1960,(961).
    [Show full text]
  • Diuretics and Other Therapies for Hospitalized Heart
    i n d i a n h e a r t j o u r n a l 6 8 ( 2 0 1 6 ) s 6 1 – s 6 8 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/ihj Review Article Decongestion: Diuretics and other therapies for hospitalized heart failure a,b, c Ali Vazir *, Martin R. Cowie a Consultant in Cardiology and Critical Care (HDU), Royal Brompton Hospital, United Kingdom b Honorary Clinical Senior Lecturer, National Heart and Lung Institute, Imperial College London, United Kingdom c Professor of Cardiology, Imperial College London (Royal Brompton Hospital), United Kingdom a r t i c l e i n f o a b s t r a c t Article history: Acute heart failure (AHF) is a potentially life-threatening clinical syndrome, usually requir- Received 28 September 2015 ing hospital admission. Often the syndrome is characterized by congestion, and is associat- Accepted 30 October 2015 ed with long hospital admissions and high risk of readmission and further healthcare Available online 24 November 2015 expenditure. Despite a limited evidence-base, diuretics remain the first-line treatment for congestion. Loop diuretics are typically the first-line diuretic strategy with some evidence Keywords: that initial treatment with continuous infusion or boluses of high-dose loop diuretic is Decongestion superior to an initial lower dose strategy. In patients who have impaired responsiveness to Diuretics diuretics, the addition of an oral thiazide or thiazide-like diuretic to induce sequential nephron blockade can be beneficial. The use of intravenous low-dose dopamine is no longer Acute heart failure Ultrafiltration supported in heart failure patients with preserved systolic blood pressure and its use to assist diuresis in patients with low systolic blood pressures requires further study.
    [Show full text]
  • Evidence Review G: Step 4 Treatment
    National Institute for Health and Care Excellence Final Hypertension in adults: diagnosis and management [G] Evidence review for step 4 treatment NICE guideline NG136 Intervention evidence review underpinning recommendations 1.4.44 to 1.4.50 in the guideline August 2019 Final This evidence review was developed by the National Guideline Centre Hypertension in adults: Final Contents Disclaimer The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and, where appropriate, their carer or guardian. Local commissioners and providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties. NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive.
    [Show full text]
  • Hyperuricemia Induced by Some Antihypertensives and Uricosuric Drugs in Oxonate-Treated Rats
    HYPERURICEMIA INDUCED BY SOME ANTIHYPERTENSIVES AND URICOSURIC DRUGS IN OXONATE-TREATED RATS Yukio YONETANI, Mitsuo ISHII and Kazumi IWAKI Shionogi Research Laboratories, Shionogi & Co., Ltd. Fukushima-ku, Osaka 553, Japan Accepted June 20, 1980 Abstract-Effects of antihypertensive and uricosuric drugs were studied on the plasma and urinary levels of uric acid in oxonate-treated rats. We made use of animals with a catheterized aorta to successively collect blood samples and this procedure simplified the evaluation of progressive changes of plasma uric acid, under successive loading with potassium oxonate. The plasma uric acid level of the oxonate-treated rats was increased even with a single administration of diuretic chlorothiazides, furosemide, diazoxide and also uricosuric drugs such as tienilic acid and probenecid. On the other hand, a wellmaintained plasma uric acid level was also produced by exogenously administered uric acid in rats which had been given allopurinol and potassium oxonate. Diazoxide, tienilic acid and probenecid increased the plasma uric acid, while diuretic chlorothiazides did not. Furosemide tended to decrease the plasma uric acid level at the early stage of administration to rats treated with allopurinol, oxonate and uric acid, but increased these levels several hours later when the effect was studied by uric acid loading test with rats treated with allopurinol and oxonate. These effects also appeared as changes in the urine-excreted uric acid. Thus, the oxonate-treated rats demonstrated an acutely induced hyperuricemia not only with certain antihypertensives, but also with uricosuric drugs. The utility of these procedures for evaluating the hyperuricemic and uricosuric effects of drugs is discussed.
    [Show full text]
  • Change Notification No 9
    Northern Ireland BLOOD TRANSFUSION SERVICE Date of publication: 24th April 2006 Implementation: To be determined by each Service Change Notification UK National Blood Services No. 9 - 2006 Appendix 5 – Treatment for High Blood Pressure Applies to Tissue Donor Selection Guidelines – Bone Marrow and PBSC and also appears as Appendix 6 – Treatment for High Blood Pressure Applies to Donor Selection Guidelines - Whole Blood and Components The entry in both the guidelines is the same: Treatment for High Blood Pressure Donors who have been diagnosed with high blood pressure may donate provided that: 1. They have not suffered any adverse effects of raised blood pressure (BP) such as heart disease (angina, heart attack or heart failure), stroke, transient ischaemic attack (TIA or mini-stroke), or peripheral vascular disease (intermittent claudication, gangrene). 2. They are taking only a Beta(ß)-blocker and/or diuretic as their treatment for the raised BP. The list below shows the proper and trade names of allowed drugs. It is important to note that this list is not exclusive and that these drugs may be used to treat other conditions such as heart failure and abnormal heart rhythms (arrhythmia); both of which would mean the donor must not donate. Other medication should be assessed independently. 3. Treatment is stable. This requires: That the donor is well and not having any problems with feeling faint, fainting or giddiness. They have been on the same dose of medication for at least a month. They are not undergoing tests to find out the underlying
    [Show full text]
  • And Ethacrynic Acid
    27 November 1965 Gastric Ulceration-Horwich and Galloway BRmsm 1277 The ulcer crater disappeared completely in 81% of the cases Dr. S. Gottfried for his assistance; to Biorex Laboratories Ltd. for Br Med J: first published as 10.1136/bmj.2.5473.1277 on 27 November 1965. Downloaded from after six weeks and in 92 % after 12 weeks of carbenoxolone. supplies of trial tablets and carbenoxolone sodium; to Mr. F. M. Sullivan, of Guy's Hospital Medical School, for his assistance with The dose used in the trial was 100 mg. thrice daily for the the statistical analysis; and to Mr. E. Thomas, Chief Pharmacist, first week and 50 mg. thrice daily for the second and subsequent Whiston Hospital, who distributed the trial tablets. weeks. Treatment should be continued until the ulcer has been shown radiologically to have healed. After complete healing a maintenance dose should be prescribed to prevent recurrence. REFERENCES Attention is also drawn to the drug's side-effects, which Br0chner-Mortensen, K. Krarup, N. B., Meulengracht, E., Videbwk, A. occurred in 35 % of patients, and of which salt-and-water (1955). Brt. med. i., 1, 818. retention is the most important. The side-effects led to the Doll, R., Hill, I. D., Hutton, C., and Underwood, D. J. (1962). Lancet, 2, 793. introduction of a five- or six-day regime in which carbenoxolone Jones, F. A., and Pygott, F. (1958). Ibid., 1, 657. was omitted on one or both days at the week-end in those at - Price, A. V., Pygott, F., and Sanderson, P. H.
    [Show full text]
  • Section B Changed Classes/Guidelines Final Version Date of Issue
    EPHMRA ANATOMICAL CLASSIFICATION GUIDELINES 2021 Section B Changed Classes/Guidelines Final Version Date of issue: 19th December 2020 1 A2B ANTIULCERANTS r2020 Combinations of specific antiulcerants with other substances, such as anti- infectives against Helicobacter pylori, antispasmodics, gastroprokinetics, that are for ulcers, gastro-oesophageal reflux disease or similar conditions are classified according to the antiulcerant substance. For example, proton pump inhibitors in combination with these anti-infectives are classified in A2B2. Combinations of antiulcerants with non-steroidal anti-inflammatories where the antiulcerant is present for gastric protection are classified in M1A1. A2B1 H2 antagonists R2002 Includes, for example, cimetidine, famotidine, nizatidine, ranitidine, roxatidine. Combinations of low dose H2 antagonists with antacids are classified with antacids in A2A6. A2B2 Proton pump inhibitors r2021 Includes esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole. Combinations of proton pump inhibitors with gastroprokinetics for ulcers, gastro- oesophageal disease or similar conditions are classified here. Includes potassium- competitive acid blockers (P-CABs) such as revaprazan, tegoprazan, vonoprazan, etc. A2B3 Prostaglandin antiulcerants Includes misoprostol, enprostil. A2B4 Bismuth antiulcerants Includes combinations with antacids. A2B9 All other antiulcerants r2020 Includes all other products containing substances with antiulcerant action where the type of substance is not specified in classes A2B1 to
    [Show full text]