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{{DevelopmentPhase}}
''Heather Melrose, Jonas de Jong''
 
__TOC__


Cardiovascular disease including heart disease, arrhythmias and hypertension, is the leading cause of morbidity and mortality in the Western world. There are numerous devastating conditions affecting the heart and/or the vasculature, leading to high demand for cardiovascular drugs. This chapter focuses on some key therapeutic targets within the cardiovascular system and the drugs used to combat cardiovascular disease.
Cardiovascular disease including heart disease, arrhythmias and hypertension, is the leading cause of morbidity and mortality in the Western world. There are numerous devastating conditions affecting the heart and/or the vasculature, leading to high demand for cardiovascular drugs. This chapter focuses on some key therapeutic targets within the cardiovascular system and the drugs used to combat cardiovascular disease.


==Renin-Angiotensin-Aldosterone System==
==Renin-Angiotensin-Aldosterone System==
[[Image:Renin-angiotensin-aldosterone_system.png|thumb|right|500px|RAAS schematic]]
The renin-angiotensin-aldosterone system (RAAS) is an important hormone-based pathway within the body that regulates fluid balance and thus systemic blood pressure. The system is activated by decreases in blood volume or pressure detected in two ways: a drop in blood pressure detected by baroreceptors (pressure sensors) located in the carotid sinus or a drop in flow rate through the kidneys, detected by the juxtaglomerular apparatus. The body responds to these stimuli to effect a restoration in blood pressure via the actions of three hormones; renin, angiotensin and aldosterone. Following the detected drop in blood pressure, the enzyme renin is released from specialised cells within the kidney. The substrate of renin is the inactive precursor of angiotensin I, angiotensinogen. Angiotensin I is then enzymatically converted by angiotensin converting enzyme (ACE) into angiotensin II, a hormone with various actions throughout the body that ultimately increase blood pressure, restoring fluid balance within the body.  
The renin-angiotensin-aldosterone system (RAAS) is an important hormone-based pathway within the body that regulates fluid balance and thus systemic blood pressure. The system is activated by decreases in blood volume or pressure detected in two ways: a drop in blood pressure detected by baroreceptors (pressure sensors) located in the carotid sinus or a drop in flow rate through the kidneys, detected by the juxtaglomerular apparatus. The body responds to these stimuli to effect a restoration in blood pressure via the actions of three hormones; renin, angiotensin and aldosterone. Following the detected drop in blood pressure, the enzyme renin is released from specialised cells within the kidney. The substrate of renin is the inactive precursor of angiotensin I, angiotensinogen. Angiotensin I is then enzymatically converted by angiotensin converting enzyme (ACE) into angiotensin II, a hormone with various actions throughout the body that ultimately increase blood pressure, restoring fluid balance within the body.  


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==Neural Control of the Cardiovascular System==
==Neural Control of the Cardiovascular System==
[[File:Sympathic_parasympathic.svg|thumb|400px|Interaction between the sympathic and parasympathic nervous system and the heart]]
===Sympathetic (Adrenergic) Nervous System===
===Sympathetic (Adrenergic) Nervous System===
The adrenergic nervous system is a vital component of many processes throughout the body, including the cardiovascular system. Circulating catecholamines (e.g. adrenaline and noradrenaline) bind to and activate adrenergic receptors on cell membranes. Adrenergic receptors are a class of G-protein coupled receptors that elicit a variety of tissue-specific effects and exist in several subtypes.  
The adrenergic nervous system is a vital component of many processes throughout the body, including the cardiovascular system. Circulating catecholamines (e.g. adrenaline and noradrenaline) bind to and activate adrenergic receptors on cell membranes. Adrenergic receptors are a class of G-protein coupled receptors that elicit a variety of tissue-specific effects and exist in several subtypes.  
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==Platelet/Clotting System==
==Platelet/Clotting System==
[[File:Platelet_receptors.svg|thumb|400px|Platelet activation and inhibition operates through surface receptors on platelets. Feedback loops enhance platelet activation (e.g. ADP released by platelets increases platelet activation, through the ADP receptor)]]
Platelets (also known as thrombocytes) are small cells lacking nuclei that are responsible for haemostasis, or blood clotting. Damage or injury leading to blood loss and exposure of extracellular collagen fibres is detected, activating platelets. Once activated, platelets become adhesive, sticking to both the damaged vessel wall and each other, forming a clump of cells, or ‘clot’, helping to dam the vessel leak. They then begin to secrete cytokines that encourage invasion of fibroblasts present in the surrounding tissue which form a more permanent patch, either by creating healthy tissue, or depositing extracellular matrix to form a scar.  
Platelets (also known as thrombocytes) are small cells lacking nuclei that are responsible for haemostasis, or blood clotting. Damage or injury leading to blood loss and exposure of extracellular collagen fibres is detected, activating platelets. Once activated, platelets become adhesive, sticking to both the damaged vessel wall and each other, forming a clump of cells, or ‘clot’, helping to dam the vessel leak. They then begin to secrete cytokines that encourage invasion of fibroblasts present in the surrounding tissue which form a more permanent patch, either by creating healthy tissue, or depositing extracellular matrix to form a scar.  


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!Formula
!Formula
|-
|-
|Dose
!Dose
|Amount of active drug given to patient
|Amount of active drug given to patient
|mg (D)
|align="center"|mg (D)
|Drug Specific (From clinical studies)
|Drug Specific (From clinical studies)
|-
|-
|Concentration
!Concentration
|Amount of drug in a given plasma volume
|Amount of drug in a given plasma volume
|µg/ml (C)
|align="center"|µg/ml (C)
|= D / Vd
|align="center"|= D / Vd
|-
|-
|EC50
!EC<sub>50</sub>
|The concentration of drug needed to elicit a response halfway between zero and maximal responses.
|The concentration of drug needed to elicit a response halfway between zero and maximal responses.
|µg/ml (EC50)
|align="center"|µg/ml (EC<sub>50</sub>)
|   y=bottom+ (Top-Bottom)/(1+ [x/EC50] Hill Coefficient)
|align="center"|y = bottom + (Top-Bottom)/(1+ [x/EC50] Hill Coefficient)
|-
|-
|Volume of Distribution
!Volume of Distribution
|The theoretical volume the drug would occupy if distributed uniformly throughout the tissues to elicit the current plasma concentration.
|The theoretical volume the drug would occupy if distributed uniformly throughout the tissues to elicit the current plasma concentration.
|L (Vd)
|align="center"|L (Vd)
|D / C
|align="center"|D / C
|-
|-
|Elimination Constant (Rate)
!Elimination Constant (Rate)
|The rate at which the drug is removed from the body.
|The rate at which the drug is removed from the body.
|h-1 (Ke)
|align="center"|h-1 (Ke)
|ln(2) / t1/2  or  CL / Vd
|align="center"|ln(2) / t1/2  or  CL / Vd
|-
|-
|Bioavailability
!Bioavailability
|How much of the administered dose is available for actual use by the body.
|How much of the administered dose is available for actual use by the body.
|no units as expressing a fraction (f)
|no units as expressing a fraction (f)
|100 ×  (AUC (po)×D (iv))/(AUC (iv)×D (po))
|align="center"|100 ×  (AUC (po)×D (iv))/(AUC (iv)×D (po))


AUC = Area under curve  po = oral administration  iv = intravenous administration
AUC = Area under curve  po = oral administration  iv = intravenous administration
|-
|-
|Cmax or Cmin
!Cmax or Cmin
|The maximum (Cmax) /  minimum (Cmin) plasma drug concentration reached following drug administration
|The maximum (Cmax) /  minimum (Cmin) plasma drug concentration reached following drug administration
|µg/ml (Cmax or Cmin)
|align="center"|µg/ml (Cmax or Cmin)
|Identified via direct measurement of plasma C
|Identified via direct measurement of plasma C
|-
|-
|tmax
!tmax
|The time it takes for a drug to reach Cmax following administration
|The time it takes for a drug to reach Cmax following administration
|h (tmax)
|align="center"|h (tmax)
|Identified via direct measurement of plasma C over time
|Identified via direct measurement of plasma C over time
|-
|-
|Half-life
!Half-life
|The time it takes for a drug to reach half its original concentration
|The time it takes for a drug to reach half its original concentration
|h (t1/2)
|align="center"|h (t1/2)
|ln(2) / Ke
|align="center"|ln(2) / Ke
|-
|-
|Drug Clearance
!Drug Clearance
|The volume of plasma cleared of the drug over a set time
|The volume of plasma cleared of the drug over a set time
|l/h (CL)
|align="center"|l/h (CL)
|Vd x Ke  or  D / Area under curve
|align="center"|Vd x Ke  or  D / Area under curve
|}
|}


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|-
|-
!Drug
!Drug
!Drugs that ?drug action
!Drugs that <big>↑</big> drug action
!Drugs that ? drug action
!Drugs that <big>↓</big> drug action
|-
|-
!Digoxin
!Digoxin
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|-
|-
|+Cardiovascular Drugs
|+Cardiovascular Drugs
|-
|-
!Drug Category
!Drug Type
!Drug Type
!Examples (generic name)
!Examples (generic name)
!Indications
!Indications
!Typical Dosage
!Typical Dosage
!Guidelines/Class of Indication
!Guidelines / Class of Indication
!Side Effects (Prevalence %)
!Side Effects (Prevalence %)
|-
|-
|Anti-hypertensives
|colspan="6" bgcolor="#E6E6FA"|:'''Anti-hypertensives'''
|
|-
|
|rowspan="2"|Diuretics
|rowspan="2"|Furosemide
|Oedema
|Oedema
|Furosemide: 20-40mg once daily
|Furosemide: 20-40mg once daily
|
|
|
|rowspan="2" valign="top"|Mild gastro-intestinal disturbances, pancreatitis, hepatic encephalopathy, postural hypotension, temporary increase in serum-cholesterol and triglyceride concentration, hyperglycaemia, acute urinary retention, electrolyte disturbances, metabolic alkalosis, blood disorders, hyperuricaemia, visual disturbances, tinnitus and deafness, and hypersensitivity reactions (including rash, photosensitivity, and pruritus).
|-
|-
|
|Diuretics
|Furosemide
|Resistant Hypertension
|Resistant Hypertension
|Furosemide: 40-80mg once daily
|Furosemide: 40-80mg once daily
|
|Hypertension in symptomatic (NYHA class II-IV) HF and LVD: Class IC <cite>Esc1</cite>
|Mild gastro-intestinal disturbances, pancreatitis, hepatic encephalopathy, postural hypotension, temporary increase in serum-cholesterol and triglyceride concentration, hyperglycaemia, acute urinary retention, electrolyte disturbances, metabolic alkalosis, blood disorders, hyperuricaemia, visual disturbances, tinnitus and deafness, and hypersensitivity reactions (including rash, photosensitivity, and pruritus).<cite>Esc1</cite>
|-
|-
|
|rowspan="4"|ACE Inhibitors
|ACE Inhibitors
|rowspan="4"|Captopril, Monopril
|Captopril
Monopril
|Hypertension
|Hypertension
|Captopril: 12.5mg twice daily
|Captopril: 12.5mg twice daily
|
|Hypertension: Class IA <cite>Esc2</cite>
|Hypotension (2.4%), renal impairment, persistent dry cough, angioedema, rash pancreatitis, upper respiratory-tract symptoms (2-10%), gastro-intestinal symptoms (1-2%), altered liver function tests, cholestatic jaundice, hepatitis, fulminant hepatic necrosis and failure, hyperkalaemia (2%), hypoglycaemia, blood disorders including thrombocytopenia, leucopenia, neutropenia, headache (3%), dizziness (2-12%), fatigue, malaise, taste disturbance, paraesthesia, bronchospasm, fever, serositis, vasculitis, myalgia (3%), arthralgia, positive antinuclear antibody, raised erythrocyte sedimentation rate, eosinophilia, leucocytosis, and photosensitivity.<cite>Esc2</cite><cite>Esc3</cite><cite>Esc4</cite>
 
Hypertension in symptomatic (NYHA class II-IV) HF and LVD: Class IA <cite>Esc1</cite>
 
Hypertension in diabetics: Class IA <cite>Esc3</cite>
|rowspan="4" valign="top"|Hypotension (2.4%), renal impairment, persistent dry cough, angioedema, rash pancreatitis, upper respiratory-tract symptoms (2-10%), gastro-intestinal symptoms (1-2%), altered liver function tests, cholestatic jaundice, hepatitis, fulminant hepatic necrosis and failure, hyperkalaemia (2%), hypoglycaemia, blood disorders including thrombocytopenia, leucopenia, neutropenia, headache (3%), dizziness (2-12%), fatigue, malaise, taste disturbance, paraesthesia, bronchospasm, fever, serositis, vasculitis, myalgia (3%), arthralgia, positive antinuclear antibody, raised erythrocyte sedimentation rate, eosinophilia, leucocytosis, and photosensitivity.
|-
|-
|
|
|
|Heart Failure
|Heart Failure
|Captopril: 12.5mg 3 times daily<cite>Esc5</cite><cite>Esc6</cite><cite>Esc7</cite>
|Captopril: 12.5mg 3 times daily
|
|Post STEMI: Class IA <cite>Esc4</cite>
|
 
Diabetic patients: Class IC <cite>Esc2</cite>
 
Symptomatic (NYHA class II-IV) HF: Class IA; Acute heart failure with ACS: Class IA <cite>Esc1</cite>
|-
|-
|
|
|
|Prophylaxis Following MI
|Prophylaxis Following MI
|Captopril: 6.25mg once daily
|Captopril: 6.25mg once daily
|
|
|
|-
|-
|
|
|
|Diabetic nephropathy
|Diabetic nephropathy
|Captopril: 75-100mg once daily
|Captopril: 75-100mg once daily
|
|
|
|-
|-
|
|rowspan="3"|Angiotensin Receptor Blockers
|Angiotensin Receptor Blockers
|rowspan="3"|Losartan, Candesartan
|Losartan. Candesartan
|Hypertension
|Hypertension
|Losartan: 50mg once daily
|Losartan: 50mg once daily
|
|Hypertension: Class IA <cite>Esc2</cite>
|Gastro-intestinal disturbances (<3%), dizziness (14%), angina, palpitation, oedema, dyspnoea, headache (14%), malaise, urticaria, pruritus, rash;<cite>Esc5</cite><cite>Esc8</cite><cite>Esc9</cite>
 
Hypertension in diabetics: Class IA  <cite>Esc3</cite>
|rowspan="3" valign="top"|Gastro-intestinal disturbances (<3%), dizziness (14%), angina, palpitation, oedema, dyspnoea, headache (14%), malaise, urticaria, pruritus, rash;
|-
|-
|
|
|
|Left ventricular hypertrophy
|Left ventricular hypertrophy
|Losartan: 12.5-150mg daily
|Losartan: 12.5-150mg daily
|ESC Guidelines (European Heart Journal (2012) 33, 2569–2619
|LVH:  Class IB <cite>Esc4</cite>
doi:10.1093/eurheartj/ehs215):
|-
LVH:  Class IB
|
|-
|
|
|
|Diabetic nephropathy
|Diabetic nephropathy
|Losartan: 50mg daily
|Losartan: 50mg daily
|
|
|
|-
|-
|rowspan="3"|Alpha Blockers
|rowspan="3"|Prazosin, Doxazosin
|Hypertension
|Prazosin: 1-10mg 2-3 times daily
|
|
|Alpha Blockers
|rowspan="3" valign="top"|Drowsiness, hypotension (notably postural hypotension) (10-70% initially), syncope (1%), asthenia, dizziness, depression, headache (8-18%), dry mouth, gastro-intestinal disturbances, oedema, blurred vision (<5%), intra-operative floppy iris syndrome, rhinitis (<4%), erectile disorders (including priapism), tachycardia and palpitations (7-14%), gastrointestinal side-symptoms (4-5%), hypersensitivity reactions including rash, pruritus and angioedema.
|Prazosin, Doxazosin
|Hypertension
|Prazosin: 1-10mg 2-3 times daily
|
|Drowsiness, hypotension (notably postural hypotension) (10-70% initially), syncope (1%), asthenia, dizziness, depression, headache (8-18%), dry mouth, gastro-intestinal disturbances, oedema, blurred vision (<5%), intra-operative floppy iris syndrome, rhinitis (<4%), erectile disorders (including priapism), tachycardia and palpitations (7-14%), gastrointestinal side-symptoms (4-5%), hypersensitivity reactions including rash, pruritus and angioedema.
|-
|-
|
|
|
|Congestive Heart Failure
|Congestive Heart Failure
|Prazosin: 4-20mg daily
|Prazosin: 4-20mg daily
|
|
|
|-
|-
|
|
|
|Raynaud’s Syndrome
|Raynaud’s Syndrome
|Prazosin: 1-2mg daily
|Prazosin: 1-2mg daily
|
|
|
|-
|-
|rowspan="4"|Beta Blockers
|
|rowspan="4"|Atenolol, Propranolol
|Beta Blockers
|Atenolol, Propranolol
|Hypertension
|Hypertension
|Atenolol: 25-50mg daily
|Atenolol: 25-50mg daily
|
|
|Gastro-intestinal disturbances (2-4%); bradycardia, heart failure, hypotension, conduction disorders, peripheral vasoconstriction, bronchospasm, dyspnoea; headache, fatigue, sleep disturbances (2-5%), paraesthesia, dizziness (2-5%), vertigo, psychoses; sexual dysfunction; purpura, thrombocytopenia; visual disturbances; exacerbation of psoriasis, alopecia; rarely rashes and dry eyes  
|rowspan="4" valign="top"|Gastro-intestinal disturbances (2-4%); bradycardia, heart failure, hypotension, conduction disorders, peripheral vasoconstriction, bronchospasm, dyspnoea; headache, fatigue, sleep disturbances (2-5%), paraesthesia, dizziness (2-5%), vertigo, psychoses; sexual dysfunction; purpura, thrombocytopenia; visual disturbances; exacerbation of psoriasis, alopecia; rarely rashes and dry eyes.
|-
|-
|
|
|
|Angina
|Angina
|Atenolol: 100mg once/twice daily
|Atenolol: 100mg once/twice daily
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261)
|ACS: Class IIaB <cite>Esc2</cite>
ACS: Class IIaB


ESC Guidelines (European Heart Journal
Angina in symptomatic (NYHA class II-IV) HF and LVD: Class IA <cite>Esc1</cite>
doi:10.1093/eurheartj/ehs104):
Angina in symptomatic (NYHA class II-IV) HF and LVD: Class IA
|
|-
|-
|
|
|
|Arrhythmias
|Arrhythmias
|Atenolol: 50-100mg daily
|Atenolol: 50-100mg daily
|ESC Guidelines (European Heart Journal (2012) 33, 2569–2619
|Atrial fibrillation: Class IA; Polymorphic VT: Class IB <cite>Esc4</cite>
doi:10.1093/eurheartj/ehs215):
 
Atrial fibrillation: Class IA
Polymorphic VT: Class IB


ESC Guidelines (European Heart Journal
Symptomatic (NYHA class II-IV) HF, LVD and AF: Class IA; Management of VA in HF: Class IA <cite>Esc1</cite>
doi:10.1093/eurheartj/ehs104):
Symptomatic (NYHA class II-IV) HF, LVD and AF: Class IA
Management of VA in HF: Class IA


ACC/AHA/ESC Guidelines (Blomström-Lundqvist and Scheinman et al. 2003):
SVT: Class IIbC; Wide QRS-complex tachycardia of unknown origin: Class IIIC; Sinus tachycardia: Class IC; Poorly tolerated AVNRT with haemodynamic intolerance: Class IIaC; Recurrent symptomatic AVNRT: Class IC; Documented PSVT with only dual AV-nodal pathways or single echo beats demonstrated during electrophysiological study and no other identified cause of arrhythmia: Class IC; Infrequent, well tolerated AVNRT: Class IB; Focal junction tachycardia: Class IIaC; Nonparoxysmal junctional tachycardia: Class IIaC; WPW Syndrome: Class IIaC; AVRT, poorly tolerated: Class IIbC; Since or infrequent AVRT episode(s): Class IIaB; Acute treatment of Focal Atrial Tachycardia: Class IIaC; Prophylactic therapy for AT: Class IC; AF (Poorly tolerated): Class IIaC; AF (Stable flutter): Class IC; Prophylaxis of SVT during pregnancy: Class IIaB <cite>Acc5</cite>
SVT: Class IIbC
Wide QRS-complex tachycardia of unknown origin: Class IIIC
Sinus tachycardia: Class IC
Poorly tolerated AVNRT with haemodynamic intolerance: Class IIaC
Recurrent symptomatic AVNRT: Class IC
Documented PSVT with only dual AV-nodal pathways or single echo beats demonstrated during electrophysiological study and no other identified cause of arrhythmia: Class IC
Infrequent, well tolerated AVNRT: Class IB
Focal junction tachycardia: Class IIaC
Nonparoxysmal junctional tachycardia: Class IIaC
WPW Syndrome: Class IIaC
AVRT, poorly tolerated: Class IIbC
Since or infrequent AVRT episode(s): Class IIaB
Acute treatment of Focal Atrial Tachycardia: Class IIaC
Prophylactic therapy for AT: Class IC
AF (Poorly tolerated): Class IIaC
AF (Stable flutter): Class IC
Prophylaxis of SVT during pregnancy: Class IIaB
|
|-
|-
|
|
|
|Migraine
|Migraine
|Atenolol: 50-200mg daily
|Atenolol: 50-200mg daily
|
|
|
|-
|-
|
|rowspan="3"|Calcium Channel Blockers
|Calcium Channel Blockers
|rowspan="3"|Nifedipine, Verapamil, Diltiazem
|Nifedipine, Verapamil, Diltiazem
|Hypertension
|Hypertension
|Nifedipine: 20-30mg once daily
|Nifedipine: 20-30mg once daily
|ESC Guidelines (European Heart Journal
|Hypertension in symptomatic (NYHA class II-IV) HF and LVD: Class IA <cite>Esc1</cite>
doi:10.1093/eurheartj/ehs104):
|rowspan="3" valign="top"|Gastro-intestinal disturbance (2-11%); hypotension (1-5%), oedema (7-29%), vasodilatation, palpitation; headache (7-35%), dizziness (3-27%), lethargy (4-6%), asthenia (10-12%); less commonly tachycardia (<1-7%), syncope (<1%), chills, nasal congestion, dyspnoea (<3%), anxiety, sleep disturbance (<2%), vertigo (<3%), migraine, paraesthesia, tremor (1-8%), polyuria, dysuria, nocturia, erectile dysfunction (<2%), epistaxis, myalgia, joint swelling, visual disturbance (<2%), sweating (<2%), hypersensitivity reactions (<1%); rarely anorexia, gum hyperplasia, mood disturbances, hyperglycaemia, male infertility, purpura (<1%), and photosensitivity reactions (<1%); also reported dysphagia, intestinal obstruction, intestinal ulcer, bezoar formation, gynaecomastia, agranulocytosis, and anaphylaxis;
Hypertension in symptomatic (NYHA class II-IV) HF and LVD: Class IA
|gastro-intestinal disturbance (2-11%); hypotension (1-5%), oedema (7-29%), vasodilatation, palpitation; headache (7-35%), dizziness (3-27%), lethargy (4-6%), asthenia (10-12%); less commonly tachycardia (<1-7%), syncope (<1%), chills, nasal congestion, dyspnoea (<3%), anxiety, sleep disturbance (<2%), vertigo (<3%), migraine, paraesthesia, tremor (1-8%), polyuria, dysuria, nocturia, erectile dysfunction (<2%), epistaxis, myalgia, joint swelling, visual disturbance (<2%), sweating (<2%), hypersensitivity reactions (<1%); rarely anorexia, gum hyperplasia, mood disturbances, hyperglycaemia, male infertility, purpura (<1%), and photosensitivity reactions (<1%); also reported dysphagia, intestinal obstruction, intestinal ulcer, bezoar formation, gynaecomastia, agranulocytosis, and anaphylaxis;
|-
|-
|
|
|
|Raynaud’s Syndrome
|Raynaud’s Syndrome
|Nifedipine: 5-20mg 3 times daily
|Nifedipine: 5-20mg 3 times daily
|
|
|
|-
|-
|
|
|
|Angina (prophylaxis)
|Angina (prophylaxis)
|Nifedipine: 5-20mg 3 times daily
|Nifedipine: 5-20mg 3 times daily
|ESC Guidelines (European Heart Journal
|Angina in symptomatic (NYHA class II-IV) HF and LVD: Class IIaA <cite>Esc1</cite>
doi:10.1093/eurheartj/ehs104):
Angina in symptomatic (NYHA class II-IV) HF and LVD: Class IIaA
|
|-
|-
|Anti-Arrhythmics
|colspan="6" bgcolor="#E6E6FA"|'''Anti-Arrhythmics'''
|-
|Class I (sodium channel blockers)
|Class I (sodium channel blockers)
|Flecainide, Lidocaine, Procainamide
|Flecainide, Lidocaine, Procainamide
|Ventricular Arrhythmias
|Ventricular Arrhythmias
|Flecainide: 50-100mg twice daily
|Flecainide: 50-100mg twice daily
|ESC Guidelines(European Heart Journal (2012) 33, 2569–2619
|Sustained VT and VF: Class IIbC <cite>Esc4</cite>
doi:10.1093/eurheartj/ehs215):
Sustained VT and VF: Class IIbC


ACC/AHA/ESC Guidelines (Blomström-Lundqvist and Scheinman et al. 2003):
Pre-excited SVT/AF: Class IB; Wide QRS-complex tachycardia of unknown origin: Lidocaine (Class IIbB) / Procainamide (Class IB); Wide QRS-complex tachycardia of unknown origin with LVD: Class IB; Focal junction tachycardia: Class IIaC; WPW Syndrome: IIaC; AVRT, poorly tolerated: IIaC; Single or infrequent AVRT episode(s): Class IIbC; Acute treatment of Focal Atrial Tachycardia: Class IIaC; Prophylactic therapy for AT: Class IIaC; AF (Stable flutter): Class IIbA; Prophylaxis of SVT during pregnancy: Class IIbB <cite>Acc5</cite>
Pre-excited SVT/AF: Class IB
|Oedema, pro-arrhythmic effects (1-13%); dyspnoea; nervous-system side-effects including dizziness, asthenia, fatigue, fever; visual disturbances (13-28%); rarely pneumonitis, hallucinations, depression, confusion, amnesia, dyskinesia, convulsions, peripheral neuropathy; also reported gastro-intestinal disturbances (1-4%), anorexia, hepatic dysfunction, flushing, syncope, drowsiness, tremor, vertigo, headache, anxiety, insomnia, ataxia, paraesthesia, anaemia, leucopenia, thrombocytopenia, corneal deposits, tinnitus, increased antinuclear antibodies, hypersensitivity reactions (including rash, urticaria, and photosensitivity), increased sweating.
Wide QRS-complex tachycardia of unknown origin: Lidocaine (Class IIbB) / Procainamide (Class IB)
Wide QRS-complex tachycardia of unknown origin with LVD: Class IB
Focal junction tachycardia: Class IIaC
WPW Syndrome: IIaC
AVRT, poorly tolerated: IIaC
Single or infrequent AVRT episode(s): Class IIbC
Acute treatment of Focal Atrial Tachycardia: Class IIaC
Prophylactic therapy for AT: Class IIaC
AF (Stable flutter): Class IIbA
Prophylaxis of SVT during pregnancy: Class IIbB
|Oedema, pro-arrhythmic effects (1-13%); dyspnoea; nervous-system side-effects including dizziness, asthenia, fatigue, fever; visual disturbances (13-28%); rarely pneumonitis, hallucinations, depression, confusion, amnesia, dyskinesia, convulsions, peripheral neuropathy; also reported gastro-intestinal disturbances (1-4%), anorexia, hepatic dysfunction, flushing, syncope, drowsiness, tremor, vertigo, headache, anxiety, insomnia, ataxia, paraesthesia, anaemia, leucopenia, thrombocytopenia, corneal deposits, tinnitus, increased antinuclear antibodies, hypersensitivity reactions (including rash, urticaria, and photosensitivity), increased sweating
|-
|-
|
|Class II (Beta blockers)
|Class II (Beta blockers)
|(See above)
|(See above)
|(See above)
|(See above)
|(See above)
|(See above)
|
|
|(See above)
|(See above)
|-
|-
|
|Class III (Potassium channel blockers)
|Class III (Potassium channel blockers)
|Amiodarone,
|Amiodarone, Sotalol
Sotalol
|Ventricular, Arrhythmias
|Ventricular  
Arrhythmias
|Amiodarone: 200mg 2-3 times daily
|Amiodarone: 200mg 2-3 times daily
|ESC Guidelines(European Heart Journal (2012) 33, 2569–2619
|Sustained VT and VF: Class IIaC; Polymorphic VT: Class IC <cite>Esc4</cite>
doi:10.1093/eurheartj/ehs215):
Sustained VT and VF: Class IIaC
Polymorphic VT: Class IC


ESC Guidelines (European Heart Journal
Management of VA in HF: Class IA; Prevention of VA in HF: Class IIbB <cite>Esc1</cite>
doi:10.1093/eurheartj/ehs104):
Management of VA in HF: Class IA
Prevention of VA in HF: Class IIbB


ACC/AHA/ESC Guidelines (Blomström-Lundqvist and Scheinman et al. 2003):
SVT: Class IIBC; Wide QRS-complex tachycardia of unknown origin: Class IB; Wide QRS-complex tachycardia of unknown origin with LVD: Class IB; Recurrent AVNRT unresponsive to beta blocker or calcium-channel blocker and patient not desiring RF ablation: Class IIbC; Focal junction tachycardia: Class IIaC; WPW Syndrome: IIaC; AVRT, poorly tolerated: Class IIaC; Since or infrequent AVRT episode(s): Class IIbB; Acute treatment of Focal Atrial Tachycardia: Class IIaC; Prophylactic therapy for AT: Class IIaC; AF (Poorly tolerated): Class IIbC; AF (Stable flutter): Class IIbC; Prophylaxis of SVT during pregnancy: Class IIIC <cite>Acc5</cite>
SVT: Class IIBC
Wide QRS-complex tachycardia of unknown origin: Class IB
Wide QRS-complex tachycardia of unknown origin with LVD: Class IB
Recurrent AVNRT unresponsive to beta blocker or calcium-channel blocker and patient not desiring RF ablation: Class IIbC
Focal junction tachycardia: Class IIaC
WPW Syndrome: IIaC
AVRT, poorly tolerated: Class IIaC
Since or infrequent AVRT episode(s): Class IIbB
Acute treatment of Focal Atrial Tachycardia: Class IIaC
Prophylactic therapy for AT: Class IIaC
AF (Poorly tolerated): Class IIbC
AF (Stable flutter): Class IIbC
Prophylaxis of SVT during pregnancy: Class IIIC
|Gastro-intestinal disturbances (2-20%)), taste disturbances, hepatic disturbances (up to 50%); bradycardia; pulmonary toxicity (1-17%); tremor (9-59%), sleep disorders; hypothyroidism (5-10%), hyperthyroidism (5-10%); reversible corneal microdeposits (up to 98%); phototoxicity, persistent slate-grey skin discoloration (1-7%), injection-site reactions; less commonly onset or worsening of arrhythmia, conduction disturbances, peripheral neuropathy (1-105) and myopathy; very rarely sinus arrest, bronchospasm, ataxia (2-37%), benign intracranial hypertension, headache, vertigo, epididymo-orchitis, impotence, haemolytic or aplastic anaemia, thrombocytopenia, rash, hypersensitivity including photosensitivity (2-20%), anaphylaxis on rapid injection, hypotension (10-30%), respiratory distress syndrome, sweating, and hot flushes
|Gastro-intestinal disturbances (2-20%)), taste disturbances, hepatic disturbances (up to 50%); bradycardia; pulmonary toxicity (1-17%); tremor (9-59%), sleep disorders; hypothyroidism (5-10%), hyperthyroidism (5-10%); reversible corneal microdeposits (up to 98%); phototoxicity, persistent slate-grey skin discoloration (1-7%), injection-site reactions; less commonly onset or worsening of arrhythmia, conduction disturbances, peripheral neuropathy (1-105) and myopathy; very rarely sinus arrest, bronchospasm, ataxia (2-37%), benign intracranial hypertension, headache, vertigo, epididymo-orchitis, impotence, haemolytic or aplastic anaemia, thrombocytopenia, rash, hypersensitivity including photosensitivity (2-20%), anaphylaxis on rapid injection, hypotension (10-30%), respiratory distress syndrome, sweating, and hot flushes
|-
|-
|
|Class IV (Calcium channel blockers)
|Class IV (Calcium channel blockers)
|(See above)
|(See above)
Line 592: Line 480:
|(See above)
|(See above)
|-
|-
|
|rowspan="2"|
|
|rowspan="2"|Digoxin
|Digoxin
|Supra-ventricular Arrhythmias
|Supra-ventricular Arrhythmias
|Acute: 0.75-1.5mg over 24 hours
|Acute: 0.75-1.5mg over 24 hours; Maintenance: 125-150µg daily
Maintenance: 125-150µg daily
|SVT: Class IIbC; WPW Syndrome: Class IIIC; AVRT, poorly tolerated: Class IIIC; Since or infrequent AVRT episode(s): Class IIIC; Prophylaxis of SVT during pregnancy: Class IC <cite>Acc5</cite>
|ACC/AHA/ESC Guidelines (Blomström-Lundqvist and Scheinman et al. 2003):
|rowspan="3" valign="top"|Gastro-intestinal disturbances (vomiting, diarrhoea, anorexia, abdominal pain) (25%); arrhythmias (up to 50%), AV conduction disturbances (50%); nervous system disturbances (dizziness, apathy, confusion, headache, fatigue, weakness) (25%); blurred or yellow vision; rash, eosinophilia, depression, anorexia, intestinal ischaemia and necrosis, psychosis, gynaecomastia on long-term use, and thrombocytopenia.
SVT: Class IIbC
WPW Syndrome: Class IIIC
AVRT, poorly tolerated: Class IIIC
Since or infrequent AVRT episode(s): Class IIIC
Prophylaxis of SVT during pregnancy: Class IC
|Gastro-intestinal disturbances (vomiting, diarrhoea, anorexia, abdominal pain) (25%); arrhythmias (up to 50%), AV conduction disturbances (50%); nervous system disturbances (dizziness, apathy, confusion, headache, fatigue, weakness) (25%); blurred or yellow vision; rash, eosinophilia, depression, anorexia, intestinal ischaemia and necrosis, psychosis, gynaecomastia on long-term use, and thrombocytopenia
|-
|-
|
|
|
|Heart Failure
|Heart Failure
|62.5-125 µg daily
|62.5-125 µg daily
|ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Symptomatic (NYHA class II-IV) HF: Class IIbB
|Symptomatic (NYHA class II-IV) HF: Class IIbB
ESC Guidelines Symptomatic (NYHA class II-IV) HF, LVD and AF: Class IB; Acute HF with AF and VT: Class IC
 
|
Symptomatic (NYHA class II-IV) HF, LVD and AF: Class IB; Acute HF with AF and VT: Class IC <cite>Esc1</cite>
|-
|-
|Anti-platelet Drugs
|colspan="6" bgcolor="#E6E6FA"|'''Anti-platelet Drugs'''
|
|-
|Aspirin
|rowspan="7"|
|rowspan="2"|Aspirin
|Prevention of thrombotic cerebro- or cardio-vascular disease
|Prevention of thrombotic cerebro- or cardio-vascular disease
|75mg once/day
|75mg once/day
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): Prevention in AF: Class IC; Prevention in diabetic patients: IIaB
|Prevention in AF: Class IC; Prevention in diabetic patients: IIaB <cite>Esc2</cite>


ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA
Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA <cite>Esc1</cite>


ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Prevention in hypertensive patients with CV events: Class IA; Prevention in hypertensive patients without CV history but with reduced renal function/high risk: Class IIbA
Prevention in hypertensive patients with CV events: Class IA; Prevention in hypertensive patients without CV history but with reduced renal function/high risk: Class IIbA <cite>Esc3</cite>


ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Post-MI: Class Ia
Post-MI: Class Ia <cite>Esc3</cite>
|Bronchospasm (10-30% in asthmatics); gastro-intestinal irritation (up to 83%), gastro-intestinal haemorrhage (occasionally major), also other haemorrhage (e.g. intracranial (0.5%), subconjunctival), chest pain (8.3%), oedema (4.5%), hypertension (4.3%).
|rowspan="2" valign="top"|Bronchospasm (10-30% in asthmatics); gastro-intestinal irritation (up to 83%), gastro-intestinal haemorrhage (occasionally major), also other haemorrhage (e.g. intracranial (0.5%), subconjunctival), chest pain (8.3%), oedema (4.5%), hypertension (4.3%).
|-
|-
|
|
|
|Pain / pyrexia
|Pain / pyrexia
|300-600mg every 4-6 hours as necessary
|300-600mg every 4-6 hours as necessary
|
|
|
|-
|-
|
|rowspan="3"|Clopidogrel
|
|Clopidogrel
|Prevention of thrombotic events (esp. when warfarin not tolerated)
|Prevention of thrombotic events (esp. when warfarin not tolerated)
|75mg once/day
|75mg once/day
|ESC and EASD Guidelines (European Heart Journal doi:10.1093/eurheart/ehl261): Prevention in diabetic patients: IIaB; Primary and secondary prevention of stroke: Class IB
|Prevention in diabetic patients: IIaB; Primary and secondary prevention of stroke: Class IB <cite>Esc2</cite>


ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA; Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA
Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA <cite>Esc1</cite>


ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Acute phase of coronary artery syndrome: Class IB; Non-cardioembolic cerebral ischaemic events: Class IA
Acute phase of coronary artery syndrome: Class IB; Non-cardioembolic cerebral ischaemic events: Class IA <cite>Esc3</cite>
|Dyspepsia (5.2%), abdominal pain (5.6%), diarrhoea (4.5%); bleeding disorders including gastro-intestinal (2.0%) and intracranial (0.4%), nausea (3.4%), vomiting, gastritis, flatulence, constipation, gastric and duodenal ulcers, headache (7.6%), epistaxis (2.9%), dizziness (6.2%), paraesthesia, leucopenia, decreased platelets (very rarely severe thrombocytopenia), eosinophilia, rash (4.2%), pruritus (3.3%), vertigo, colitis, pancreatitis, hepatitis (<1%), acute liver failure, hypertension (4.3%), chest pain (8.3%), oedema (4.1%), vasculitis, confusion, hallucinations, taste disturbance, cough (3.9%), fatigue (4.8%) stomatitis, bronchospasm, interstitial pneumonitis, pyrexia (2.2%), blood disorders including thrombocytopenic purpura (5.3%), agranulocytosis, neutropenia (0.04%) and pancytopenia and hypersensitivity-like reactions (<0.1%)including fever, glomerulonephritis, arthralgia, Stevens-Johnson syndrome, toxic epidermal necrolysis, lichen planus
|rowspan="3" valign="top"|Dyspepsia (5.2%), abdominal pain (5.6%), diarrhoea (4.5%); bleeding disorders including gastro-intestinal (2.0%) and intracranial (0.4%), nausea (3.4%), vomiting, gastritis, flatulence, constipation, gastric and duodenal ulcers, headache (7.6%), epistaxis (2.9%), dizziness (6.2%), paraesthesia, leucopenia, decreased platelets (very rarely severe thrombocytopenia), eosinophilia, rash (4.2%), pruritus (3.3%), vertigo, colitis, pancreatitis, hepatitis (<1%), acute liver failure, hypertension (4.3%), chest pain (8.3%), oedema (4.1%), vasculitis, confusion, hallucinations, taste disturbance, cough (3.9%), fatigue (4.8%) stomatitis, bronchospasm, interstitial pneumonitis, pyrexia (2.2%), blood disorders including thrombocytopenic purpura (5.3%), agranulocytosis, neutropenia (0.04%) and pancytopenia and hypersensitivity-like reactions (<0.1%)including fever, glomerulonephritis, arthralgia, Stevens-Johnson syndrome, toxic epidermal necrolysis, lichen planus.
|-
|-
|
|
|
|Acute myocardial infarction
|Acute myocardial infarction
|300mg daily initially then 75mg once/day
|300mg daily initially then 75mg once/day
|ESC Guidelines(European Heart Journal (2012) 33, 2569-2619 doi:10.1093/eurheartj/ehs215): Post STEMI: Class IA
|Post STEMI: Class IA <cite>Esc4</cite>
|
|-
|-
|
|
|
|Acute coronary syndrome
|Acute coronary syndrome
|300mg daily initially then 75mg once/day
|300mg daily initially then 75mg once/day
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): ACS: Class IIaC
|ACS: Class IIaC <cite>Esc2</cite>
|
|-
|-
|
|
|Prasugrel
|Prasugrel
|Prevention of thrombotic events.
|Prevention of thrombotic events.
|60mg bolus then 5-10mg once daily
|60mg bolus then 5-10mg once daily
|ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA
|Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA <cite>Esc1</cite>


ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Acute phase of coronary artery syndrome: Class IB
Acute phase of coronary artery syndrome: Class IB <cite>Esc3</cite>
|Haemorrhage (11.3%) (including gastro-intestinal (1.5%) and intracranial), haematoma, haematuria, hypertension (7.5%), hypotension (3.9%), headache (5.5%), back pain (5.0%), dyspnoea (4.9%), nausea (4.6%), dizziness (4.1%), cough (3.9%), fatigue (3.7%), chest pain (3.1%), arrhythmias including atrial fibrillation (2.9%) and bradycardia (2.9%), rash (2.8%), pyrexia (2.7%), oedema (2.7%), diarrhoea (2.3%), hypercholesterolaemia/hyperlipidaemia (7.5%), anaemia, rash,hypersensitivity reactions including angioedema (0.06%), thrombocytopenia (0.06%), thrombotic thrombocytopenic purpura
|Haemorrhage (11.3%) (including gastro-intestinal (1.5%) and intracranial), haematoma, haematuria, hypertension (7.5%), hypotension (3.9%), headache (5.5%), back pain (5.0%), dyspnoea (4.9%), nausea (4.6%), dizziness (4.1%), cough (3.9%), fatigue (3.7%), chest pain (3.1%), arrhythmias including atrial fibrillation (2.9%) and bradycardia (2.9%), rash (2.8%), pyrexia (2.7%), oedema (2.7%), diarrhoea (2.3%), hypercholesterolaemia/hyperlipidaemia (7.5%), anaemia, rash,hypersensitivity reactions including angioedema (0.06%), thrombocytopenia (0.06%), thrombotic thrombocytopenic purpura.
|-
|-
|
|
|Ticragelor
|Ticragelor
|Prevention of thrombotic events.
|Prevention of thrombotic events.
|180mg bolus then 90mg twice daily
|180mg bolus then 90mg twice daily
|ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA
|Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA <cite>Esc1</cite>


ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Acute phase of coronary artery syndrome: Class IB
Acute phase of coronary artery syndrome: Class IB <cite>Esc3</cite>
|Dyspnoea (13.8%), haemorrhage, bruising; nausea (4.3%), vomiting, diarrhoea (3.7%), hypertension (3.8%), hypotension (3.2%), back pain (3.6%), abdominal pain, dyspepsia, gastritis, dizziness (4.5%), chest pain (3.7%), headache (6.5%), cough (4.9%), rash, pruritus, fatigue (3.2%),  constipation, arrhythmias including atrial fibrillation (4.2%), paraesthesia, confusion, hyperuricaemia, raised serum creatinine (7.4%), vertigo
|Dyspnoea (13.8%), haemorrhage, bruising; nausea (4.3%), vomiting, diarrhoea (3.7%), hypertension (3.8%), hypotension (3.2%), back pain (3.6%), abdominal pain, dyspepsia, gastritis, dizziness (4.5%), chest pain (3.7%), headache (6.5%), cough (4.9%), rash, pruritus, fatigue (3.2%),  constipation, arrhythmias including atrial fibrillation (4.2%), paraesthesia, confusion, hyperuricaemia, raised serum creatinine (7.4%), vertigo.
|-
|colspan="6" bgcolor="#E6E6FA"|'''Vitamin K Antagonists'''
|-
|-
|Vitamin K Antagonists
|
|
|Warfarin
|Warfarin
Line 691: Line 553:
|5-10mg initially then tailored to individual (usually 3-9mg once daily at the same time)
|5-10mg initially then tailored to individual (usually 3-9mg once daily at the same time)
|
|
|Haemorrhage, nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, rash, ‘purple toes’, skin necrosis (increased risk in patients with protein C or protein S deficiency)
|valign="top"|Haemorrhage, nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, rash, ‘purple toes’, skin necrosis (increased risk in patients with protein C or protein S deficiency)
|-
|-
|
|
|
|Acenocoumarol
|Acenocoumarol
|Prevention of thrombotic/ embolic events (esp. after prosthetic valve insertion)
|Prevention of thrombotic/ embolic events (esp. after prosthetic valve insertion)
|4mg initially, followed by 1-8mg daily
|4mg initially, followed by 1-8mg daily
|
|
|Haemorrhage, nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, rash, ‘purple toes’, skin necrosis (increased risk in patients with protein C or protein S deficiency)
|valign="top"|Haemorrhage, nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, rash, ‘purple toes’, skin necrosis (increased risk in patients with protein C or protein S deficiency)
|-
|-
|Lipid-Lowering Drugs
|colspan="6" bgcolor="#E6E6FA"|'''Lipid-Lowering Drugs'''
|Statins
|-
|Simvastatin, Atorvastatin
|rowspan="3"|Statins
|rowspan="3"|Simvastatin, Atorvastatin
|Primary hyper-cholesterolaemia, combined hyperlipidaemia
|Primary hyper-cholesterolaemia, combined hyperlipidaemia
|Simvastatin: 10-20mg once daily
|Simvastatin: 10-20mg once daily
|ESC and EASD Guidelines (European Heart Journal doi:10.1093/eurheart/ehl261); Dyslipidaemia: Class IA; Low HDL-C: Class IIbB; Elderly patients with CVD: IB; Elderly patients with no CVD but CV risk factors: IIbB; Type I diabetes: IC; Patients with CKD: IIaC; Transplant patients: Class IIaB; PAD: Class IA; HIV patients: IIaC
|Dyslipidaemia: Class IA; Low HDL-C: Class IIbB; Elderly patients with CVD: IB; Elderly patients with no CVD but CV risk factors: IIbB; Type I diabetes: IC; Patients with CKD: IIaC; Transplant patients: Class IIaB; PAD: Class IA; HIV patients: IIaC <cite>Esc2</cite>


ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Hypertension in diabetics: Class IA; ACS: Class IA
Hypertension in diabetics: Class IA; ACS: Class IA <cite>Esc3</cite>
|Oedema (2.7%), abdominal pain (5.9%), nausea (5.4%), atrial fibrillation (5.7%), constipation (2.2%), gastritis (4.9%), diabetes mellitus (4.2%), myalgia (3.7%), headache (2.5%), insomnia (4.0%), vertigo (4.5%), bronchitis (6.6%), sinusitis (2.3%), eczema (4.5%), urinary tract infection (3.2%)
|rowspan="3" valign="top"|Oedema (2.7%), abdominal pain (5.9%), nausea (5.4%), atrial fibrillation (5.7%), constipation (2.2%), gastritis (4.9%), diabetes mellitus (4.2%), myalgia (3.7%), headache (2.5%), insomnia (4.0%), vertigo (4.5%), bronchitis (6.6%), sinusitis (2.3%), eczema (4.5%), urinary tract infection (3.2%)
|-
|-
|
|
|
|Familial hyper-cholesterolaemia
|Familial hyper-cholesterolaemia
|Simvastatin: 40mg once daily
|Simvastatin: 40mg once daily
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): HeFH: Class IC
|HeFH: Class IC <cite>Esc2</cite>
|
|-
|-
|
|
|
|Prevention of cardiovascular events
|Prevention of cardiovascular events
|20-40mg once daily<cite>Esc3</cite>
|20-40mg once daily
|
|Class IA <cite>Esc2</cite>
|
|-
|-
|rowspan="2"|Fibrates
|
|Fibrates
|Gemfibrozil
|Gemfibrozil
|Hyperlipidaemias of types IIa, IIb, III, IV and V
|Hyperlipidaemias of types IIa, IIb, III, IV and V  
|Gemfibrozil: 0.9-1.2mg daily
|Gemfibrozil: 0.9-1.2mg daily
|
|Low HDL-C: Class IIbB; Transplant patients (with HTG, low HDL-C): Class IIbC <cite>Esc6</cite>
|Gastro-intestinal disturbances including dyspepsia (19.6%), nausea (4%), abdominal pain (9.8%), diarrhoea (7.2%), vomiting (1.2%); headache (1.2%), fatigue (3.8%), vertigo (1.5%), eczema, rash (1.7%), atrial fibrillation (0.7%), pancreatitis, appendicitis, disturbances in liver function including hepatitis and cholestatic jaundice, dizziness, paraesthesia, sexual dysfunction, thrombocytopenia, anaemia, leucopenia, eosinophilia, bone-marrow suppression, myalgia, myopathy, myasthenia, myositis accompanied by increase in creatine kinase, blurred vision, exfoliative dermatitis, alopecia, and photosensitivity<cite>Esc2</cite>
|Gastro-intestinal disturbances including dyspepsia (19.6%), nausea (4%), abdominal pain (9.8%), diarrhoea (7.2%), vomiting (1.2%); headache (1.2%), fatigue (3.8%), vertigo (1.5%), eczema, rash (1.7%), atrial fibrillation (0.7%), pancreatitis, appendicitis, disturbances in liver function including hepatitis and cholestatic jaundice, dizziness, paraesthesia, sexual dysfunction, thrombocytopenia, anaemia, leucopenia, eosinophilia, bone-marrow suppression, myalgia, myopathy, myasthenia, myositis accompanied by increase in creatine kinase, blurred vision, exfoliative dermatitis, alopecia, and photosensitivity
|-
|-
|
|
|Ezetimibe
|Ezetimibe
|Primary and familial hyper-cholesterolaemia
|Primary and familial hyper-cholesterolaemia
|10mg once daily
|10mg once daily
|
|Transplant patients (with high LDL-C): Class IIbC <cite>Esc6</cite>
|Gastro-intestinal disturbance including diarrhoea (4.1%) and abdominal pain (3.0%); headache, fatigue (2.4%); myalgia, arthralgia (3.0%), sinusitis (3.6%), pharyngitis (2.3%), viral infection (2.2%), coughing (2.3%), hypersensitivity reactions including rash, angioedema, and anaphylaxis, hepatitis,pancreatitis, cholelithiasis, cholecystitis, thrombocytopenia, raised creatine kinase, myopathy, and rhabdomyolysis<cite>Esc1</cite>
|Gastro-intestinal disturbance including diarrhoea (4.1%) and abdominal pain (3.0%); headache, fatigue (2.4%); myalgia, arthralgia (3.0%), sinusitis (3.6%), pharyngitis (2.3%), viral infection (2.2%), coughing (2.3%), hypersensitivity reactions including rash, angioedema, and anaphylaxis, hepatitis,pancreatitis, cholelithiasis, cholecystitis, thrombocytopenia, raised creatine kinase, myopathy, and rhabdomyolysis
|}
|}


==References==
==References==
<biblio>
<biblio>
#Esc1 ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Hypertension in symptomatic (NYHA class II-IV) HF and LVD: Class IC
#Esc1 pmid=22611136
#Esc2 ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): Hypertension: Class IA
#Esc2 pmid=17220161
#Esc3 ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Hypertension in symptomatic (NYHA class II-IV) HF and LVD: Class IA
#Esc3 pmid=22555213
#Esc4 ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092):Hypertension in diabetics: Class IA
#Esc4 pmid=22922416
#Esc5 ESC Guidelines (European Heart Journal (2012) 33, 2569–2619 doi:10.1093/eurheartj/ehs215): Post STEMI: Class IA
#Acc5 pmid=14557344
#Esc6 ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): Diabetic patients: Class IC
#Esc6 pmid=21712404
#Esc7 ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Symptomatic (NYHA class II-IV) HF: Class IA; Acute heart failure with ACS: Class IA
#Esc8 ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): Hypertension: Class IA
#Esc9 ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Hypertension in diabetics: Class IA
 
 
 
 
#Esc3 ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): HeFH: Class IC
#Esc2 ESC and EAS Guidelines (European Heart Journal (2011) 32, 1769–1818 doi:10.1093/eurheartj/ehr158): Low HDL-C: Class IIbB; Transplant patients (with HTG, low HDL-C): Class IIbC
#Esc1 ESC and EAS Guidelines (European Heart Journal (2011) 32, 1769–1818 doi:10.1093/eurheartj/ehr158): Transplant patients (with high LDL-C): Class IIbC
 
</biblio>
</biblio>
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