SandboxAlonso: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 1: Line 1:
{{DrugProjectFormSinglePage
{{drug header}}
|authorTag={{Alonso}}
|genericName=Dopamine
|aOrAn=a
|drugClass=Adrenergic receptor agonist
|indicationType=treatment
|indication=hemodynamic imbalances present in the [[shock]] syndrome due to [[myocardial infarctions]], [[trauma]], endotoxic [[septicemia]], [[open heart surgery]], [[renal failure]], and chronic cardiac decompensation as in [[congestive heart failure]]
|hasBlackBoxWarning=Yes
|adverseReactions=[[chest pain]], [[hypertension]], [[palpitations]], [[tachyarrhythmia]], injection site reaction, [[piloerection]], [[nausea]], [[vomiting]], [[headache]], [[mydriasis]], [[anxiety]], [[oliguria]], [[dyspnea]]
|blackBoxWarningTitle=IMPORTANT
|blackBoxWarningBody=<i><span style="color:#FF0000;">Antidote for Peripheral Ischemia:</span></i> To prevent sloughing and necrosis in ischemic areas, the area should be infiltrated as soon as possible with 10 to 15 mL of saline solution containing 5 to 10 mg of phentolamine, an adrenergic blocking agent. A syringe with a fine hypodermic needle should be used, and the solution liberally infiltrated throughout the ischemic area. Sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours. Therefore, phentolamine should be given as soon as possible after the extravasation is noted.
|fdaLIADAdult======Condition 1=====


* Dosing Information
==Why this medication is prescribed==
Lovastatin is used together with lifestyle changes (diet, weight-loss, exercise) to reduce the amount of cholesterol (a fat-like substance) and other fatty substances in the blood. Lovastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body.


:* (Dosage)
Buildup of cholesterol and fats along the walls of the blood vessels (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to the heart, brain, and other parts of the body. Lowering blood levels of cholesterol and fats may help to decrease your chances of getting heart disease, angina (chest pain), strokes, and heart attacks. In addition to taking a cholesterol-lowering medication, making certain changes in your daily habits can also lower your cholesterol blood levels. You should eat a diet that is low in saturated fat and cholesterol (see SPECIAL DIETARY), exercise 30 minutes on most, if not all days, and lose weight if you are overweight.


=====Condition 2=====
==How should this medication be used==
Lovastatin comes as a tablet and an extended-release (long-acting) tablet to take by mouth. The regular tablet is usually taken once or twice a day with meals. The extended-release tablet is usually taken once a day in the evening at bedtime. Take lovastatin at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lovastatin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.


* Dosing Information
Swallow the extended-release tablets whole; do not split, chew, or crush them.


:* (Dosage)
Your doctor may start you on a low dose of lovastatin and gradually increase your dose, not more than once every 4 weeks.
|offLabelAdultGuideSupport======Condition 1=====


* Developed by: (Organisation)
Continue to take lovastatin even if you feel well. Do not stop taking lovastatin without talking to your doctor.


* Class of Recommendation: (Class) (Link)
==Other uses for this medicine==
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.


* Strength of Evidence: (Category A/B/C) (Link)
==Special precautions==
'''Before taking lovastatin:'''


* Dosing Information/Recommendation
*tell your doctor and pharmacist if you are allergic to lovastatin or any other medications.
*tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); anticoagulants ('blood thinners') such as warfarin (Coumadin); antifungal medications such as itraconazole (Sporanox) and ketoconazole (Nizoral); cimetidine (Tagamet); clarithromycin (Biaxin); cyclosporine (Neoral, Sandimmune); danazol (Danocrine); erythromycin (E.E.S., E-Mycin, Erythrocin); HIV protease inhibitors such as indinavir (Crixivan), ritonavir (Norvir) and saquinavir (Invirase, Fortovase); nefazodone (Serzone); other cholesterol-lowering medications such as fenofibrate (Tricor), gemfibrozil (Lopid), and niacin (nicotinic acid, Niacor, Niaspan); spironolactone (Aldactone); telithromycin (Ketek); and verapamil (Calan, Covera, Isoptin, Verelan). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
*tell your doctor if you have liver disease. Your doctor will probably tell you not to take lovastatin.
*tell your doctor if you drink large amounts of alcohol, if you have ever had liver disease or if you have or have ever had kidney disease.
*tell your doctor if you are pregnant, or plan to become pregnant. If you become pregnant while taking lovastatin, stop taking lovastatin and call your doctor immediately. Lovastatin may harm the fetus.
*Do not breastfeed while you are taking this medication.
*if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking lovastatin.
*ask your doctor about the safe use of alcoholic beverages while you are taking lovastatin. *Alcohol can increase the risk of serious side effects.


:* (Dosage)
==Special dietary instructions==
Avoid drinking large amounts (more than 1 quart every day) of grapefruit juice while taking lovastatin.


=====Condition 2=====
Eat a low-cholesterol, low-fat diet. This kind of diet includes cottage cheese, fat-free milk, fish (not canned in oil), vegetables, poultry, egg whites, and polyunsaturated oils and margarines (corn, safflower, canola, and soybean oils). Avoid foods with excess fat in them such as meat (especially liver and fatty meat), egg yolks, whole milk, cream, butter, shortening, lard, pastries, cakes, cookies, gravy, peanut butter, chocolate, olives, potato chips, coconut, cheese (other than cottage cheese), coconut oil, palm oil, and fried foods.


* Developed by: (Organisation)
==What to do if you forget a dose==
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.


* Class of Recommendation: (Class) (Link)
==Side Effects==
===Minor Side Effects===


* Strength of Evidence: (Category A/B/C) (Link)
Lovastatin may cause side effects. Tell your doctor if this symptom is severe or does not go away:  


* Dosing Information/Recommendation
*constipation


:* (Dosage)
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:  
|offLabelAdultNoGuideSupport======Condition 1=====


* Dosing Information
===Severe Side Effects===


:* (Dosage)
*muscle pain, tenderness, or weakness
*lack of energy
*fever
*yellowing of the skin or eyes
*pain in the upper right part of the stomach
*nausea
*extreme tiredness
*unusual bleeding or bruising
*loss of appetite
*flu-like symptoms
*rash
*hives
*itching
*difficulty breathing or swallowing
*swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
*hoarseness


=====Condition 2=====
Lovastatin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.


* Dosing Information
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/report.htm] or by phone [1-800-332-1088].


:* (Dosage)
==Storage conditions needed for this medication==
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.


=====Condition 3=====
==In case of emergency/overdose==  
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.


* Dosing Information
==Other information==
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests before and during treatment to check your body's response to lovastatin.


:* (Dosage)
Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking lovastatin.
|fdaLIADPed======Condition 1=====


* Dosing Information
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.


:* (Dosage)
==Brand names==
*Advicor®
*Altoprev®
*Mevacor®


=====Condition 2=====
[[Category:Cardiovascular Drugs]]
 
* Dosing Information
 
:* (Dosage)
|offLabelPedGuideSupport======Condition 1=====
 
* Developed by: (Organisation)
 
* Class of Recommendation: (Class) (Link)
 
* Strength of Evidence: (Category A/B/C) (Link)
 
* Dosing Information/Recommendation
 
:* (Dosage)
 
=====Condition 2=====
 
* Developed by: (Organisation)
 
* Class of Recommendation: (Class) (Link)
 
* Strength of Evidence: (Category A/B/C) (Link)
 
* Dosing Information/Recommendation
 
:* (Dosage)
|offLabelPedNoGuideSupport======Condition 1=====
 
* Dosing Information
 
:* (Dosage)
 
=====Condition 2=====
 
* Dosing Information
 
:* (Dosage)
 
=====Condition 3=====
 
* Dosing Information
 
:* (Dosage)
|contraindications=* Patients with [[pheochromocytoma]].
* Uncorrected [[tachyarrhythmias]] or [[ventricular fibrillation]].
|warnings=* Do no add dopamine to any alkaline diluent solution, since the drug is inactivated in alkaline solution.
* Patients who have been treated with [[monoamine oxidase]] ([[MAO]]) inhibitors prior to the administration of dopamine will require substantially reduced dosage. * Contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe [[asthmatic]] episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown, and probably low. Sulfite sensitivity is seen more frequently in [[asthmatic]] than in non[[asthmatic]] people.
 
====Precautions====
* '''Careful monitoring required:''' Close monitoring of the following indices-urine flow, [[cardiac output]]and [[blood pressure]] during dopamine infusion is necessary as in the case of any adrenergic agent.
* '''Avoid hypovolemia:''' Prior to treatment with dopamine, [[hypovolemia]] should be fully corrected, if possible with either whole blood or plasma as indicated. Monitoring of central venous pressure of left ventricular filling pressure may be helpful in detecting and treating [[hypovolemia]].
* '''Hypoxia, Hypercapnia, Acidosis:''' These conditions which may also reduce the effectiveness and/or increase the incidence of adverse effects of dopamine, must be identified and corrected prior to, or concurrently with administration of dopamine HCl.
* '''Ventricular Arrhythmias:''' If an increased number of ectopic beats are observed, the dose should be reduced if possible.
* '''Decreased Pulse Pressure:''' If a disproportionate rise in the [[diastolic pressure]] (i.e., a marked decrease in the [[pulse pressure]]) is observed in patients receiving dopamine, the infusion rate should be decreased and the patient observed carefully for further evidence of predominant vasoconstrictor activity, unless such an effect is desired.
* '''Hypotension:''' At lower infusion rates, if [[hypotension]] occurs, the infusion rate should be rapidly increased until adequate [[blood pressure]] is obtained. If [[hypotension]] persists, dopamine HCl should be discontinued and a more potent vasoconstrictor agent such as [[norepinephrine]] should be administered.
* '''Extravasation:''' Dopamine should be infused into a large vein whenever possible to prevent the possibility of extravasation into tissue adjacent to the infusion site. Extravasation may cause [[necrosis]] and sloughing of surrounding tissue. Large veins of the actecubital fossa are preferred to veins in the dorsum of the hand or ankle. Less suitable infusion sites should be used only if the patient’s condition requires immediate attention. The physician should switch to more suitable sites as rapidly as possible. The infusion site should be continuously monitored for free flow.
* '''Occlusive vascular disease:''' Patients with a history of occlusive vascular disease (for example, atheroscierosis, arterial embolism, and [[Raynaud's phenomenon|Raynaud’s disease]], cold injury, diabetic endarteritis, and Buergers disease) should be closely monitored for any changes in color or temperature of the skin in the extremities. If a change in skin color or temperature occurs and is thought to be the result of compromised circulation to the extremities, the benefits of continued dopamine infusion should be weighed against the risk of possible [[necrosis]]. This condition may be reversed by either decreasing or discontinuing the rate of infusion.
'''Weaning:''' When discontinuing the infusion, it may be necessary to gradually decrease the dose of dopamine HCl while expanding blood volume with IV fluids, since sudden cessation may result in marked [[hypotension]].
|clinicalTrials=======Central Nervous System======
 
: (list/description of adverse reactions)
 
======Cardiovascular======
 
: (list/description of adverse reactions)
 
======Respiratory======
 
: (list/description of adverse reactions)
 
======Gastrointestinal======
 
: (list/description of adverse reactions)
 
======Hypersensitive Reactions======
 
: (list/description of adverse reactions)
 
======Miscellaneous======
 
: (list/description of adverse reactions)
 
=====Condition 2=====
 
======Central Nervous System======
 
: (list/description of adverse reactions)
 
======Cardiovascular======
 
: (list/description of adverse reactions)
 
======Respiratory======
 
: (list/description of adverse reactions)
 
======Gastrointestinal======
 
: (list/description of adverse reactions)
 
======Hypersensitive Reactions======
 
: (list/description of adverse reactions)
 
======Miscellaneous======
 
: (list/description of adverse reactions)
|postmarketing=(Description)
|drugInteractions=* Cyclopropane or halogenated hydrocarbon anesthetics increase cardiac autonomic irritability and may sensitize the [[myocardium]] to the action of certain intravenously administered [[catecholamines]], such as dopamine. The interaction appears to be related both to pressor activity and to the beta adrenergic stimulating properties of these [[catecholamines]], and may produce [[ventricular arrhythmias]].  Therefore, '''extreme caution''' should be exercised when administering dopamine HCl to patients receiving cyclopropane or halogenated hydrocarbon anesthetics. Results of studies in animals indicate that dopamine induced ventricular arrhythmias during anesthesia can be reversed by propranolol.
* Because dopamine is metabolized by [[monoamine oxidase]] ([[MAO]]), inhibition of this enzyme prolongs and potentiates the effect of dopamine. Patients who have been treated with MAO inhibitors within two to three weeks prior to the administration of dopamine should receive initial doses of dopamine HCl not greater than one-tenth (1/10) of the usual dose.
* Concurrent administration of low-dose dopamine HCl and [[diuretic]] agents may produce an additive or potentiating effect on urine flow.
* [[Tricyclic antidepressants]] may potentiate the cardiovascular effects of adrenergic agents.
* Cardiac effects of dopamine are antagonized by [[beta-blockers]], such as [[propranolol]] and [[metoprolol]]. The peripheral vasoconstriction caused by high doses of dopamine HCl is antagonized by [[alpha-blockers]]. Dopamine-induced renal and mesenteric vasodilation is not antagonized by either alpha- or beta-adrenergic blocking agents.
* Butyrophenones (such as [[haloperidol]]) and [[phenothiazines]] can suppress the dopaminergic renal and mesenteric vasodilation induced with low-dose dopamine infusion.
* The concomitant use of [[vasopressors]], vasoconstricting agents (such as [[ergonovine]]) and some oxytocic drugs may result in severe [[hypertension]].
* Administration of [[phenytoin]] to patients receiving dopamine HCl has been reported to lead to [[hypotension]] and [[bradycardia]]. It is suggested that in patients receiving dopamine HCl, alternatives to [[phenytoin]] should be considered if anticonvulsant therapy is needed.
|FDAPregCat=C
|useInPregnancyFDA=[[Teratogenicity]] studies in rats and rabbits at dopamine hydrochloride dosages up to 6 mg/kg/day intravenously during organogenesis produced no detectable [[teratogenic]] or embryotoxic effects, although maternal toxicity consisting of mortalities, decrease body weight gain, and pharmacotoxic signs were observed in rats. In a published study, dopamine hydrochloride administered at 10 mg/kg subcutaneously for 30 days, markedly prolonged metestrus and increased mean pituitary and ovary weights in female rats. Similar administration to pregnant rats throughout gestation or for 5 days starting on gestation day 10 or 15 resulted in decreased body weight gains, increased mortalities and slight increases in cataract formation among the offspring. There are no adequate and well-controlled studies in pregnant women, and it is not known if dopamine hydrochloride crosses the placental barrier. Dopamine hydrochloride should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
|useInLaborDelivery=In obstetrics, if vasopressor drugs are used to correct [[hypotension]] or are added to a local anesthetic solution the interaction with some oxytocic drugs may cause severe [[hypertension]].
|useInNursing=It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when dopamine is administered to a nursing mother.
|useInPed=Safety and effectiveness in children have not been established. Dopamine HCl has been used in a limited number of pediatric patients, but such use has been inadequate to fully define proper dosage and limitations for use. Peripheral [[gangrene]] has been reported in neonates and children.
|administration=Intravenous
|monitoring=Close monitoring of the following indices-urine flow, [[cardiac output]] and [[blood pressure]] during dopamine infusion is necessary as in the case of any adrenergic agent.
|IVCompat======Cardiovascular System=====
* [[Ventricular arrhythmia]] (at very high doses)
* Ectopic beats
* [[Tachycardia]]
* [[Angina]]l pain
* [[Palpitation]]
* Cardiac conduction abnormalities
* Widened QRS complex
* [[Bradycardia]]
* [[Hypotension]]
* [[Hypertension]]
* [[Vasoconstriction]]
 
=====Respiratory System=====
* [[Dyspnea]]
 
=====Gastrointestinal System=====
* [[Nausea]]
* [[Vomiting]]
 
=====Metabolic/Nutritional System=====
* [[Azotemia]]
 
=====Central Nervous System=====
* [[Headache]]
* [[Anxiety]]
 
=====Dermatological System=====
* [[Piloerection]]
 
=====Other=====
* [[Gangrene]] of the extremities has occurred when moderate to high doses were administered for prolonged periods or in patients with occlusive vascular disease receiving low doses of dopamine HCl.
* A few cases of peripheral [[cyanosis]] have been reported.
|overdose=In case of accidental overdosage, as evidenced by excessive [[blood pressure]] elevation, reduce rate of administration or temporarily discontinue dopamine until patient’s condition stabilizes. Since the duration of action of dopamine is quite short, no additional remedial measures are usually necessary. If these measures fail to stabilize the patient’s condition, use of the short-acting [[alpha-blocker]], [[phentolamine]], should be considered.
|drugBox={{Drugbox2
| Watchedfields = changed
| drug_name = Dopamine
| verifiedrevid = 595793408
| image =DopamineStructure.png
| width=200px
| alt =
| width2=180px
| alt2 =
| IUPAC_name=4-(2-Aminoethyl)benzene-1,2-diol
| synonyms=2-(3,4-Dihydroxyphenyl)ethylamine;  3,4-Dihydroxyphenethylamine;  3-hydroxytyramine; DA; Intropin; Revivan; Oxytyramine
 
<!--Clinical data-->
| tradename =
| Drugs.com =
| pregnancy_US =
| legal_AU =
| legal_CA =
| legal_UK =
| legal_US =
| licence_US = Dopamine
| legal_status = Rx-only
| dependency_liability =
| routes_of_administration= [[Intravenous]] Injection
 
<!--Pharmacokinetic data-->
| bioavailability =
| protein_bound =
| metabolism = [[aldehyde dehydrogenase|ALDH]], [[Dopamine beta hydroxylase|DBH]], [[Monoamine oxidase A|MAO-A]], [[Monoamine oxidase B|MAO-B]], [[catechol-O-methyl transferase|COMT]]
| elimination_half-life =
| excretion = Renal
 
<!--Identifiers-->
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = VTD58H1Z2X
| InChI = 1/C8H11NO2/c9-4-3-6-1-2-7(10)8(11)5-6/h1-2,5,10-11H,3-4,9H2
| InChIKey = VYFYYTLLBUKUHU-UHFFFAOYAA
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C8H11NO2/c9-4-3-6-1-2-7(10)8(11)5-6/h1-2,5,10-11H,3-4,9H2
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = VYFYYTLLBUKUHU-UHFFFAOYSA-N
| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number =51-61-6
| CASNo_Ref = {{cascite|correct|CAS}}
| CAS_supplemental ={{CAS|62-31-7}} (hydrochloride)
| PubChem=681
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 59
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 661
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D07870
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB00988
| IUPHAR_ligand = 940
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 18243
| SMILES = c1cc(c(cc1CCN)O)O
| ATC_prefix = C01
| ATC_suffix = CA04
 
<!--Chemical data-->
| C=8 | H=11 | N=1 | O=2
| molecular_weight = 153.18 g/mol
| density = 1.26
| boiling_point =
| boiling_notes = decomposes
| melting_point = 128
| melting_notes =
| solubility = <!--60.0 g/100 ml-->
}}
|mechAction=Dopamine is a natural catecholamine formed by the decarboxylation of 3,4-dihydroxyphenylalanine (DOPA). It is a precursor to norepinephrine in noradrenergic nerves and is also a neurotransmitter in certain areas of the central nervous system, especially in the nigrostriatal tract, and in a few peripheral sympathetic nerves.
 
Dopamine produces positive chronotropic and inotropic effects on the myocardium, resulting in increased heart rate and cardiac contractility. This is accomplished directly by exerting an agonist action on beta-adrenoceptors and indirectly by causing release of norepinephrine from storage sites in sympathetic nerve endings.
|structure=Dopamine hydrochloride injection is a clear, practically colorless, aqueous, additive solution for intravenous infusion after dilution. Each mL contains either 40 mg, 80 mg, or 160 mg dopamine HCl, USP (equivalent to 32.3 mg, 64.6 mg and 129.2 mg dopamine base respectively) in Water for Injection, USP, containing 9 mg sodium metabisulfite as an antioxidant. The pH range (2.5 to 5.0) may be adjusted with citric acid and/or sodium citrate. The solution is sterile and nonpyrogenic. Dopamine HCl, a naturally occurring catecholamine, is an inotropic vasopressor agent. Its chemical name is 3,4 dihydroxyphenethylamine hydrochloride and its chemical structure is:
 
[[File:DopamineStructure.png|600px|thumbnail|left|This image of the FDA label is provided by the National Library of Medicine.]]
{{clr}}
 
Dopamine HCl is sensitive to alkalis, iron salts and oxidizing agents. dopamine must be diluted in an appropriate, sterile parenteral solution before intravenous administration.
|PD=The predominant effects of dopamine are dose-related, although actual response of an individual patient will largely depend on the clinical status of the patient at the time the drug is administered. At low rates of infusion (0.5-2 mcg/kg/min) dopamine causes vasodilation that is presumed to be due to a specific agonist action on dopamine receptors (distinct from alpha and beta adrenoceptors) in the renal, mesenteric, coronary, and intracerebral vascular beds. At these dopamine receptors, [[haloperidol]] is an antagonist. The vasodilation in these vascular beds is accompanied by increased glomerular filtration rate, renal blood flow, sodium excretion, and urine flow. [[Hypotension]] sometimes occurs. An increase in urinary output produced by dopamine is usually not associated with a decrease in osmolarity of the urine.
 
At intermediate rates of infusion (2-10 mcg/kg/min) dopamine acts to stimulate the beta1- adrenoceptors, resulting in improved [[myocardial contractility]], increased SA rate and enhanced impulse conduction in the heart. There is little, if any, stimulation of the beta2-adrenoceptors (peripheral vasodilation). Dopamine causes less increase in myocardial oxygen consumption than [[isoproterenol]], and its use is not usually associated with a [[tachyarrhythmia]]. Clinical studies indicate that it usually increases [[systolic pressure]] and [[pulse pressure]] with either no effect or a slight increase in [[diastolic pressure]]. Blood flow to the peripheral vascular beds may decrease while mesenteric flow increases due to increased cardiac output. At low and intermediate doses, total peripheral resistance (which would be raised by alpha activity) is usually unchanged.
 
At higher rates of infusion (10-20 mcg/kg/min) there is some effect on alpha-adrenoceptors, with consequent vasoconstrictor effects and a rise in [[blood pressure]]. The vasoconstrictor effects are first seen in the skeletal muscle vascular beds, but with increasing doses they are also evident in the renal and mesenteric vessels. At very high rates of infusion (above 20 mcg/kg/min), stimulation of alpha-adrenoceptors predominates and vasoconstriction may compromise the circulation of the limbs and override the dopaminergic effects of dopamine, reversing renal dilation and natriuresis.
|PK=Dopamine’s onset of action occurs within five minutes of intravenous administration, and with dopamine’s plasma half-life of about two minutes, the duration of action is less than ten minutes. If [[monoamine oxidase]] ([[MAO]]) inhibitors are present, however, the duration may increase to one hour. The drug is widely distributed in the body but does not cross the [[blood-brain barrier]] to a significant extent. [[Dopamine]] is metabolized in the [[liver]], [[kidney]], and plasma by [[MAO]] and catechol-O-methyltransferase to the inactive compounds homovanillic acid (HVA) and 3,4-dihydroxyphenylacetic acid. About 25% of the dose is taken up into specialized neurosecretory vesicles (the adrenergic nerve terminals), where it is hydroxylated to form norepinephrine. It has been reported that about 80% of the drug is excreted in the urine within 24 hours, primarily as HVA and its sulfate and glucuronide conjugates and as 3,4-dihydroxyphenylacetic acid. A very small portion is excreted unchanged.
|nonClinToxic=Long-term animal studies have not been performed to evaluate carcinogenic potential of dopamine hydrochloride.
 
Dopamine hydrochloride at doses approaching maximal solubility shows no clear genotoxic potential in the Ames test. Although there was a reproducible dose-dependent increase in the number of revertant colonies with strains TA100 and TA98, both with and without metabolic activation, the small increase was considered inconclusive evidence of mutagenicity. In the L5178Y TK+/− mouse lymphoma assay, dopamine hydrochloride at the highest concentrations used of 750 mcg/mL without metabolic activation, and 3000 mcg/mL with activation, was toxic and associated with increases in mutant frequencies when compared to untreated and solvent controls; at the lower concentrations no increases over controls were noted.
 
No clear evidence of clastogenic potential was reported in the in vivo mouse or male rat [[bone marrow]] micronucleus test when the animals were treated intravenously with up to 224 mg/kg and 30 mg/kg of dopamine hydrochloride, respectively.
|clinicalStudies======Poor Perfusion of Vital Organs=====
 
Clinical studies have shown that when dopamine is administered before urine flow has diminished to levels approximating 0.3 mL/minute, prognosis is more favorable.  Nevertheless, in a number of [[oliguric]] or [[anuric]] patients, administration of dopamine resulted in an increase in urine flow which in some cases reached normal levels. Dopamine may also increase urine flow in patients whose output is within normal limits and thus may be of value in reducing the degree of preexisting fluid accumulation. It should be noted that at doses above those optimal for the individual patient urine flow may decrease, necessitating reduction of dosage. Concurrent administration of dopamine and [[diuretic]] agents may produce an additive or potentiating effect.
|howSupplied=* Packages of 25 vials: 200 mg/5 mL Vial (40 mg/mL) (NDC 0517-1805-25) (color-coded WHITE)
* Packages of 25 vials: 400 mg/5 mL Vial (80 mg/mL) (NDC 0517-1905-25)(color-coded GREEN)
* Packages of 25 vials: 800 mg/5 mL Vial (160 mg/mL) (NDC 0517-1305-25) (color-coded YELLOW)
 
|storage=* Store at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F).
* Avoid contact with alkalis (including sodium bicarbonate), oxidizing agents or iron salts.
|fdaPatientInfo=There is limited information regarding Patient Counseling Information of aminocaproic acid in the drug label.
|alcohol=Alcohol-SandboxAlonso interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
|brandNames=* Intropin
|lookAlike=* Dopamine - [[Dobutamine]]
|nlmPatientInfo=(Link to patient information page)
|drugShortage=Drug Shortage
}}
{{LabelImage
|fileName=DopaminePackage1.png
}}
{{LabelImage
|fileName=DopaminePackage2.png
}}

Revision as of 17:21, 21 July 2014

Template:Drug header

Why this medication is prescribed

Lovastatin is used together with lifestyle changes (diet, weight-loss, exercise) to reduce the amount of cholesterol (a fat-like substance) and other fatty substances in the blood. Lovastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body.

Buildup of cholesterol and fats along the walls of the blood vessels (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to the heart, brain, and other parts of the body. Lowering blood levels of cholesterol and fats may help to decrease your chances of getting heart disease, angina (chest pain), strokes, and heart attacks. In addition to taking a cholesterol-lowering medication, making certain changes in your daily habits can also lower your cholesterol blood levels. You should eat a diet that is low in saturated fat and cholesterol (see SPECIAL DIETARY), exercise 30 minutes on most, if not all days, and lose weight if you are overweight.

How should this medication be used

Lovastatin comes as a tablet and an extended-release (long-acting) tablet to take by mouth. The regular tablet is usually taken once or twice a day with meals. The extended-release tablet is usually taken once a day in the evening at bedtime. Take lovastatin at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lovastatin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the extended-release tablets whole; do not split, chew, or crush them.

Your doctor may start you on a low dose of lovastatin and gradually increase your dose, not more than once every 4 weeks.

Continue to take lovastatin even if you feel well. Do not stop taking lovastatin without talking to your doctor.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Special precautions

Before taking lovastatin:

  • tell your doctor and pharmacist if you are allergic to lovastatin or any other medications.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); anticoagulants ('blood thinners') such as warfarin (Coumadin); antifungal medications such as itraconazole (Sporanox) and ketoconazole (Nizoral); cimetidine (Tagamet); clarithromycin (Biaxin); cyclosporine (Neoral, Sandimmune); danazol (Danocrine); erythromycin (E.E.S., E-Mycin, Erythrocin); HIV protease inhibitors such as indinavir (Crixivan), ritonavir (Norvir) and saquinavir (Invirase, Fortovase); nefazodone (Serzone); other cholesterol-lowering medications such as fenofibrate (Tricor), gemfibrozil (Lopid), and niacin (nicotinic acid, Niacor, Niaspan); spironolactone (Aldactone); telithromycin (Ketek); and verapamil (Calan, Covera, Isoptin, Verelan). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have liver disease. Your doctor will probably tell you not to take lovastatin.
  • tell your doctor if you drink large amounts of alcohol, if you have ever had liver disease or if you have or have ever had kidney disease.
  • tell your doctor if you are pregnant, or plan to become pregnant. If you become pregnant while taking lovastatin, stop taking lovastatin and call your doctor immediately. Lovastatin may harm the fetus.
  • Do not breastfeed while you are taking this medication.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking lovastatin.
  • ask your doctor about the safe use of alcoholic beverages while you are taking lovastatin. *Alcohol can increase the risk of serious side effects.

Special dietary instructions

Avoid drinking large amounts (more than 1 quart every day) of grapefruit juice while taking lovastatin.

Eat a low-cholesterol, low-fat diet. This kind of diet includes cottage cheese, fat-free milk, fish (not canned in oil), vegetables, poultry, egg whites, and polyunsaturated oils and margarines (corn, safflower, canola, and soybean oils). Avoid foods with excess fat in them such as meat (especially liver and fatty meat), egg yolks, whole milk, cream, butter, shortening, lard, pastries, cakes, cookies, gravy, peanut butter, chocolate, olives, potato chips, coconut, cheese (other than cottage cheese), coconut oil, palm oil, and fried foods.

What to do if you forget a dose

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Side Effects

Minor Side Effects

Lovastatin may cause side effects. Tell your doctor if this symptom is severe or does not go away:

  • constipation

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

Severe Side Effects

  • muscle pain, tenderness, or weakness
  • lack of energy
  • fever
  • yellowing of the skin or eyes
  • pain in the upper right part of the stomach
  • nausea
  • extreme tiredness
  • unusual bleeding or bruising
  • loss of appetite
  • flu-like symptoms
  • rash
  • hives
  • itching
  • difficulty breathing or swallowing
  • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • hoarseness

Lovastatin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/report.htm] or by phone [1-800-332-1088].

Storage conditions needed for this medication

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Other information

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests before and during treatment to check your body's response to lovastatin.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking lovastatin.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Brand names

  • Advicor®
  • Altoprev®
  • Mevacor®
Retrieved from "https://www.wikidoc.org/index.php?title=SandboxAlonso&oldid=996901"