Agents for Hypertensive Emergencies- Nitoprusside Sodium, Fenoldopam mesylate, Diazoxide Parentral

With beta blockers-                                                                                                                   Avoid concomittant use of fenoldopam with beta-blockers                                                           If the drugs are used together, excercise greater caution, because unexpected                hyportension could result from beta-blockers inhibition of the sympathmatic                response of fenoldopam 

Severe Hypertension ======================================================================================== Agents for Hypertensive Emergencies- Nitoprusside Sodium, Fenoldopam mesylate, Diazoxide Parentral ====================================================================================

Adults- Fenoldopam causes dose related fall in blood pressure and increase in heart rate. In controlled clinical studies, of severe hypertension in patients with end organ damage 3% of patients withdrew because of excessive fall in blood pressure Most common events reported are headache, cutaneous dilation, flushing, nausea, and hypotension Risk factors- Positive risk fasctors for CHD ( other than LDL) include- Age- men 45 age or older, womem 55 age or older oe women , who go through premature menopause, without estrogen replacement Family history of CHD , smoking, hypertension greater than 140/90 mmHg

Not known Special precautions- Intra-ocular pressure- Undertake fenoldopam administration to patients with glaucoma or intra-ocular pressure with caution Tachycardia- Fenoldopam causes dose related tachcardia particularly with infusion rates above 0.1mg/kg/min Tacycardia disappears in adults over time but remains ymptomatic substantial at higher doses Hypotension- Fenoldopam may occasionall produce symptomatic hypotension and close monitoring of blood pressure during administration is essetial Hypokalemia- Decrease in serum potassium were observed after less than 6 hours of fenoldopam infusion. Patient management should include appropiate attention to serum electrolyte Sulfite sensitivity- Contains sodium metabisulphite, a sulfite that may cause allergic-tupe reactions including analphylactic symptoms and life threatening or less severe asthmatic episods in certain seceptible people. Pregnancy- Sstudies have revealed ,maternal toxicity at highest doses but no evidence of impaired fertility or harm to the fetus. However, no adequate and well controlled studies have been made in pregnant women. Administer only if needed. Lactation- Fenoldopam is excreted in milk in rats. Not known whether the drug is excreted in human milk Excercise caution when fenoldopam is administered to breast-feeding women. Children- Anti-hypertensive effects of fenoldopam have bneen studied in children younger than 1 month of age ( at least 2kg or full term) to 12 years of age requiring blood pressure reduction

Indication: Severe Hypertension Dosage: Doses less than 0.1 mcg/kg/min have very moderate efects and appear only marginally useful. Initial lower doses (0.03 to 1mcg/kg/min tirated slowly have been associated with less reflux tachcardia than have higher initial doses (greater than or equal to 0.3mcg/kg/min ) In clinical trials dosages from 0.01 to 1.6mcg/kg/min have been studied Most of the effect of a given infusion rate is attained in 15 minutes

The product contains sulfite which can cause allergic reactons in cetain individuals Before taking this medicine tell your doctor if you glaucoma or increased pressure in the eyes, or if you taking beta-blockers

======================================================================================== Agents for Hypertensive Emergencies- Nitoprusside Sodium, Fenoldopam mesylate, Diazoxide Parentral ==================================================================================== Pharmacology- It is a rapidly acting vasodilator. It is an agonist for D1 -like receptor and binds with moderare affinity to a2 adrenoreceptors. Pharmacokinetics- Steady state concentrations are attained in about 20 minutes. Elimination is largely by conjugation without participation to P-450 enzymes. Only 4% of the administered drug is excreted unchanged Elimination half life was about 5 minutes in mild to moderate patients

Not reported

Pregnancy- Sstudies have revealed ,maternal toxicity at highest doses but no evidence of impaired fertility or harm to the fetus. However, no adequate and well controlled studies have been made in pregnant women. Administer only if needed. Lactation- Fenoldopam is excreted in milk in rats. Not known whether the drug is excreted in human milk Excercise caution when fenoldopam is administered to breast-feeding women.