Download Antihypertensive Drugs Today by G. L. Wollam, R. W. Gifford Jr., R. C. Tarazi (auth.), R. N. PDF

By G. L. Wollam, R. W. Gifford Jr., R. C. Tarazi (auth.), R. N. Brogden (eds.)

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1975). Guanethidine should be used with extreme caution in patients with advanced renal insufficiency as gradual accumulation can occur resulting in severe orthostatic hypotension (Gifford, 1973). , 1964). , 197 J). , 197 J). Large doses of guanethidine are required to overcome this antagonism and if the tricyclic agents are suddenly withdrawn without a concomitant decrease in the guanethidine dosage, severe hypotension may result. , 1965). , 1976), probably by inhibition of the uptake mechanism.

1969; Rutledge and Weiner, 1967). The noradrenaline pump by which catecholamines gain access to the sympathetic nerve terminal is not inhibited by reserpine (Shore, 1972). Reserpine rapidly crosses the blood-brain barrier and depletes brain tissue of serotonin and dopamine as well as noradrenaline (Vogt, 1959). This latter action probably accounts for the sedation and depression which is frequently associated with reserpine. However, central sympathetic outflow is not significantly altered by reserpine (Iggo and Vogt, 1960) and the effect on the central nervous system is thought to be less important than its peripheral effect in regard to its antihypertensive potency (Nickerson and Collier, 1975), although this remains controversial.

It has also been used successfully in combination with sympathetic inhibiting drugs and may be used as an alternative to hydrallazine in step 3 of table IV. Prazosin is also effective in the management of patients with renal insufficiency and is often effective in relatively low doses (Bolzano, 1974; Curtis and Bateman, 1975). OrthOstatic hypotension not uncommonly occurs at the onset of treatment but this usually disappears with continued therapy (Bolzano, 1974). Reports of syncopal episodes occurring within 30 to 90 minutes following the initial dose of prazosin have led to the introduction of the term 'first-dose effect'.

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