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| __NOTOC__
| | #REDIRECT [[Doxazosin#Warnings]] |
| {{Doxazosin}}
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| {{CMG}}; {{AE}} {{AK}}
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| ==WARNINGS==
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| [[Syncope ]]and “First-dose” Effect: Doxazosin, like other[[ alpha blocker|alpha-adrenergic blocking]] agents, can cause marked [[hypotension]], especially in the upright position, with [[syncope ]]and other postural symptoms such as [[dizziness]]. Marked orthostatic effects are most common with the first dose but can also occur when there is a dosage increase, or if therapy is interrupted for more than a few days. To decrease the likelihood of excessive hypotension and [[syncope]], it is essential that treatment be initiated with the 1 mg dose. The 2, 4, and 8 mg tablets are not for initial therapy. Dosage should then be adjusted slowly (see [[Doxazosin dosage and administration|DOSAGE AND ADMINISTRATION]]), with evaluations and increases in dose every two weeks to the recommended dose. Additional antihypertensive agents should be added with caution.
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| Patients being titrated with doxazosin should be cautioned to avoid situations where injury could result should syncope occur, during both the day and night.
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| In an early investigational study of the safety and tolerance of increasing daily doses of doxazosin in normotensives beginning at 1 mg/day, only 2 of 6 subjects could tolerate more than 2 mg/day without experiencing symptomatic [[postural hypotension]]. In another study of 24 healthy normotensive male subjects receiving initial doses of 2 mg/day of doxazosin, seven (29%) of the subjects experienced symptomatic postural hypotension between 0.5 and 6 hours after the first dose, necessitating termination of the study. In this study, 2 of the normotensive subjects experienced syncope. Subsequent trials in hypertensive patients always began doxazosin dosing at 1 mg/day, resulting in a 4% incidence of postural side effects at 1 mg/day with no cases of syncope.
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| In multiple-dose clinical trials in hypertension involving over 1500 hypertensive patients with dose titration every one to two weeks, syncope was reported in 0.7% of patients. None of these events occurred at the starting dose of 1 mg, and 1.2% (8/664) occurred at 16 mg/day.
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| In placebo-controlled clinical trials in BPH, 3 out of 665 patients (0.5%) taking doxazosin reported syncope. Two of the patients were taking 1 mg doxazosin, while one patient was taking 2 mg doxazosin when syncope occurred. In the open-label, long-term extension follow-up of approximately 450 BPH patients, there were 3 reports of syncope (0.7%). One patient was taking 2 mg, one patient was taking 8 mg, and one patient was taking 12 mg when syncope occurred. In a clinical pharmacology study, one subject receiving 2 mg experienced syncope.
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| If syncope occurs, the patient should be placed in a recumbent position and treated supportively as necessary.
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| ===Priapism===
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| Rarely (probably less frequently than once in every several thousand patients), alpha1 antagonists, including doxazosin, have been associated with [[priapism ]](painful penile erection, sustained for hours and unrelieved by sexual intercourse or masturbation). Because this condition can lead to permanent impotence if not promptly treated, patients must be advised about the seriousness of the condition (see [[Doxazosin precautions|PRECAUTIONS, Information for Patients]]).<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = DOXAZOSIN TABLET [APOTEX CORP.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=4fa5c2f7-cda9-56cd-622f-b3d05dc7c94b | publisher = | date = | accessdate = 7 March 2014 }}</ref>
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| ==References==
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| {{Reflist|2}}
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| [[Category:Cardiovascular Drugs]]
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| [[Category:Drugs]]
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