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Loop Diuretics
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Entresto Sacubitril with Valsartan
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Ivabradine
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Angiotensin Converting Enzyme Inhibitors
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ℹ️ About
Always check the BNF link here 📖 for up-to-date information.
⚙️ Mode of Action
- Nitric oxide (NO) donor → increases cGMP in vascular smooth muscle → vasodilation (predominantly venous) → reduced preload and myocardial oxygen demand.
💊 Indications & Dose
- Stable angina / left ventricular failure (LVF): Isosorbide mononitrate 20–40 mg orally, up to TDS (three times daily).
- To avoid tachyphylaxis, ensure a nitrate-free interval overnight.
⚠️ Interactions
- Concurrent use with PDE-5 inhibitors (e.g. sildenafil, tadalafil) may cause severe, potentially fatal hypotension 💥.
- Caution with other antihypertensives → additive BP lowering.
🔎 Cautions
- See BNF - use carefully in patients with hypovolaemia, aortic/mitral stenosis, raised intracranial pressure, or severe anaemia.
🚫 Contraindications
- See BNF - marked hypotension, acute circulatory failure, cardiogenic shock (unless adequate BP maintained), concurrent PDE-5 inhibitor use.
❗ Side Effects
- Headache (very common, due to cerebral vasodilation) 🤕
- Reflex tachycardia 💓
- Hypotension, dizziness, flushing 📉
- Tolerance with continuous use >24 h (hence need for nitrate-free period).
📚 References
