Centrally acting antihypertensives

Rilmenidine. RiLmenidine is a central a2 adrenoceptor agonist and has been shown to be a potent centrally acting antihypertensive agent without the prominent side effect of sedation. 

These centrally acting antihypertensives have been widely used in clinical practice in the nineteen-seventies and -eighties. Their haemodynamic profile and antihypertensive efficacy are without any doubt favourable. However, their profile of side-effects... 

Sica DA. Centrally acting antihypertensive agents an np-date. J Clin Hypertens (Greenwich) 2007 9(5) 399-405. 

Clonidine, a central acting antihypertension agent (q 2 adrenergic agonist) is classically cited as an antimigraine drug although it is less effective than beta-blockers. 

Depression P-Blockers, centrally acting antihypertensives, alcohol, benzodiazepines, corticosteroids Precipitation or exacerbation of depression... 

Methyldopa [Aldomet) [Antihypertensive/Centrally Acting Antiadrenergic] Uses HTN Action Centrally acting antihypertensive Dose Adults. 250-500 mg PO bid-dd (max 2-3 g/d) or 250 mg-1 g IV q6-8h Peds. 10 mg/kg/24 h PO in 2-3 + doses (max 40 mg/kg/24 h - q6-l2h) or 5-10 mg/kg/dose IV q6-8h to total dose of 20—40 mg/kg/24 h i in renal insuff/elderly Caution [B (PO), C (IV), +] Contra Liver Dz MAOIs Disp Tabs, inj SE Discolors urine inidal transient sedadon/drowsiness frequent, edema, hemolydc anemia, hepadc disorders Interactions T Effects W/ anesthetics, diuredcs, levodopa, Li, methotrimeprazine, thioxanthenes, vasodilators, verapamil T effects OF haloperidol, Li, tolbutamide 1 effects W7amphetamines, Fe, phenothiazine, TCAs 1 effects OF ephedrine EMS Use diuredcs, verapamil, and sympathomimedcs w/ caudon may T risk hypotension, arrhythmias and pressors effects OD May cause profound hypotension, drowsiness, and impaired myocardial conduction activated charcoal may be effective... 

Direct vasodilators frequently produce baroreflex-induced tachycardia, but rarely orthostatic hypotension. They are usually prescribed with a beta blocker or a centrally acting antihypertensive to minimize the reflex increase in heart rate and cardiac output. It should be noted that another member of the directly acting class of antihypertensives is minoxidil. This potent, long-acting drug has gained considerable notoriety for its use as a topical hair-restorer. Oral use can result in hirsutism (unwanted hair growth over the face as well as other parts of the body). 

CENTRALLY ACTING ANTIHYPERTENSIVES ALCOHOL Clonidine and moxonidine may exacerbate the sedative effects of alcohol, particularly during initiation of therapy Uncertain Warn patients of this effect and advise them to avoid driving or operating machinery if they suffer from sedation... 

ADRENERGIC NEURONE BLOCKERS-GUANETHIDINE CENTRALLY ACTING ANTIHYPERTENSIVES-METHYLDOPA MAOIs Risk of adrenergic syndrome (see above). Reports of an enhanced hypotensive effect and hallucinations with methyldopa, which may cause depression Due to inhibition of MAOI, which breaks down sympathomimetics Avoid concurrent use. Onset may be 6-24 hours after ingestion... 

CENTRALLY ACTING ANTIHYPERTENSIVES ACE INHIBITORS Some evidence that when switching from donidine to captopril, there may be a delayed onset of action of captopril Sudden cessation of donidine causes rebound t BP, and this may be the reason for the delay in onset of captopril Monitor BP at least weekly until stable... 

CENTRALLY ACTING ANTIHYPERTENSIVES ANTIPARKINSON S DRUGS -AMANTADINE 1 efficacy of amantadine with methyldopa Antagonism of antiparkinsonian effect these drugs have extrapyramidal side-effects Use with caution avoid in patients aged under 20 years... 

ADRENERGIC NEURONE BLOCKERS, ALPHA-BLOCKERS, CENTRALLY ACTING ANTIHYPERTENSIVES, VASODILATOR ANTIHYPERTENSIVES ASPIRIN 1 hypotensive effect not noted with low-dose aspirin Aspirin may cause sodium retention and vasoconstriction at possibly both renal and endothelial sites Monitor BP at least weekly until stable when high-dose aspirin is prescribed... 

CENTRALLY ACTING ANTIHYPERTENSIVES HALOPERIDOL Case reports of sedation or confusion on initiating co-administration of haloperidol and methyldopa Uncertain possible additive effect Watch for excess sedation when starting therapy... 

ACE INHIBITORS, ANGIOTENSIN II RECEPTOR ANTAGONISTS, CENTRALLY ACTING ANTIHYPERTENSIVES, VASODILATOR ANTIHYPERTENSIVES BETA-BLOCKERS t hypotensive effect Additive hypotensive effect may be used therapeutically Monitor BP at least weekly until stable. Warn patients to report symptoms of hypotension (light-headedness, dizziness on standing, etc.)... 

VERAPAMIL CENTRALLY ACTING ANTIHYPERTENSIVES Reports of two cases of complete heart block when donidine was given to a patient on verapamil Additive effect both drugs are known to rarely cause AV dysfunction Monitor ECG closely when coadministering... 

SNRIs ANTI HYPERTENSIVES AND HEART FAILURE DRUGS -CENTRALLY ACTING ANTIHYPERTENSIVES-methyldopa Methyldopa may 1 effect of antidepressants Methyldopa can cause depression Methyldopa should be avoided in patients with depression... 

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