Drug/drug: oral contraceptives
Herbal/food: grapefruit juice inhibits the metabolism of statins, allowing them to reach toxic levels. Patients may benefit from CoQ10 supplements
atorvastatin
Drug/drug: May increase the effects of anticoagulants by decreasing the levels of vitamin K in the body
cholestyramine
Black box warning: May lead to profound diuresis with water and electrolyte depletion
Drug/drug: Combination with digoxin must be carefully monitored
Herbal/food: High sodium intake can reduce the effectiveness of diuretics
furosemide
Drug/drug: When given concurrently, other antihypertensives have additive or synergistic effects with this drug
hydrochlorothiazide
Black box warning: This drug has been found to cause tumors in animals or clinical studies, it should only be used for specified indications
Contraindication: Contraindicated during pregnancy and lactation
Drug/drug: Aspirin and other salicylates cause in
spironolactone
Drug/drug: Have additive effects on blood pressure. Alcohol potentiates the vasodilating action and could lead to syncope
Herbal/food: Grapefruit juice may enhance the absorption
nifedipine
Black box warning: Fetal injury and death may occur
Contraindications: Should not be administered during pregnancy or lactation
enalapril
Contraindications: Should not be given to patients with pre-existing hypotension or with high intracranial pressure or head trauma
Drug/Drug: Concurrent use with Viagra, Levitra, or Cialis may cause life-threatening hypotension and cardiovascular collapse
nitroglycerin
Black Box Warning: Abrupt discontinuation should be avoided
Contraindications: Should not be used in patients with severe bradycardia, AV heart block, cardiogenic shock, or decompensated heart failure
Treatment for OD: atropine or isoproterenol
atenolol
Contraindications: Patients with AV heart block, sick sinus syndrome, severe hypotension, bleeding aneurysm, or those undergoing intracranial surgery; should be used with caution in patients with renal or hepatic impairment
Drug/Drug: Not with digoxin or
diltiazem
Contraindications: In patients with active bleeding, history of stroke, or who have had recent surgical procedures
reteplase
Contraindications: In patients with hyperkalemia and in those who have previously experienced angioedema caused by ACE inhibitor therapy. It should not be used during pregnancy
Drug-Drug: Indomethacin and other NSAIDs may interact with this drug, causing
lisinopril
Herbal/Food: Ginseng
Treatment for OD: Can be fatal; involves IV infusion of Digiband
digoxin
Black Box Warning: Abrupt withdrawal is not advised in patients with angina or heart disease; dosage should gradually be reduced over 1 to 2 weeks and the drug should be reinstituted if angina symptoms develop during this period
Contraindications: Should
metoprolol
Black Box Warning: Following extravasation, the affected area should be infiltrated immediately with 5mg to 10mg of phentolamine
Contraindications: Should not be administered to patients who are experiencing hypotension due to blood volume deficits
norepinephrine
Black Box Warning: A lupus like syndrome may occur in 30% to 50% of patients who are taking the drug for more than a year
Contraindications: In patients with complete AV block, severe heart failure, blood dycrasias, and myasthenia gravis
Lab Tests: Can pr
procainamide
Contraindications: In patients with COPD or asthma
Drug/Drug: Should not be given within 2 weeks of an MAOI; Use of ethanol or antacids containing aluminum hydroxide gel will slow the absorption of this drug and reduce its therapeutic effects
propranolol
Black Box Warning: Causes a pneumonia-like syndrome
Drug/Drug: Can increase serum digoxin levels as much as 70%
Lab Tests: May increase values for tests over ANA, ALT, AST, ALP, & thyroid stimulating hormone (TSH)
Herbal/Food: Use with echinacea may cause
amiodarone
Herbal/Food: Grapefruit juice may increase levels; Hawthorne may have additive hypotensive effects
verapamil