Common side effects include
- Dermatological: rash, pruritus, anaphylaxis, Stevens-Johnson Syndrome
- Gastrointestinal: nausea, vomiting, diarrhea, abdominal pain
- Cardiovascular: hypotension, postural hypotension, dizziness
- Neurological: headache
- General: Fatigue
Common contraindications are:
- Known allergy to drug X
- For all antihypertensives – hypotension
Here is are the major contraindications and side effects of the CVD drugs
Antihypertensives
- Beta-Blockers (Carvedilol, Atenolol, Metoprolol, Sotalol):
- Contraindications
- Severe asthma and COPD
- Severe allergies where Epipen is used
- Diabetes (increase insulin resistance, mask hypos, dyslipidaemia)
- Heart block
- Bradycardia
- Non-Dihydropyridine Calcium Channel Blockers (Verapamil, Diltiazem)
- Side Effects
- Bronchospasm (particularly non selective)
- Bradycardia, Fatigue and Dizziness are common
- Cold Hands and Feet
- Sleep Disturbances
- Depression
- Sexual Dysfunction ie errectile dysfunction in men
- Contraindications
- Dihydropyridine Calcium Channel Blockers (Amlodipine, Nifedipine):
- Contraindications
- Severe Aortic Stenosis
- Unstable Angina or immediately post AMI
- Side Effects
- Swelling of the ankles and feet
- Flushing and Dizziness
- Reflex tachycardia
- Gingival Hyperplasia
- Contraindications
- Non-dihydropyridine Calcium Channel Blockers (Verapamil, Diltiazem):
- Contraindications
- Heart block
- Bradycardia
- Heart failure
- Sick Sinus Syndrome
- Use with Beta Blockers
- Side Effects
- Constipation (especially with verapamil)
- Swelling of ankles and feet
- Elevated Liver Enzymes
- Gingival Hyperplasia
- Contraindications
- ACE Inhibitors (Ramipril):
- Contraindications
- History of angioedema
- Renal artery stenosis
- Hyperkalaemia
- Pregnancy
- Side Effects
- Dry cough
- Hyperkalemia (high potassium levels)
- Renal impairment
- Angioedema
- Contraindications
- Angiotensin II Receptor Blockers (ARBs) (Irbesartan, Valsartan):
- Contraindications
- Renal artery stenosis
- Hyperkalaemia
- Pregnancy
- Side Effects
- Lower risk of cough compared to ACE inhibitors
- Hyperkalemia
- Renal impairment
- Contraindications
- Thiazide Diuretics (Hydrochlorothiazide, Indapamide)
- Contraindications
- eGFR < 30
- Hypercalcaemia
- Gout
- Side Effects
- Decreased Na, K and Mg
- Increased Ca
- Hyperuricaemia
- Hyperglyaemia
- Dyslipidaemia
- Contraindications
- Alpha-Blockers (Prazosin):
- Nasal congestion
- Postural hypotension
- Reflex tachycardia
- Palpitation
- Drowsiness
- Direct Vasodilators (Hydralazine, Minoxidil):
- Nasal congestion
- Reflex tachycardia
- Oedema
- Flushing
- Hypertrichosis (Minoxidil)
- Cardiac Glycosides (Digoxin):
- Nausea and vomiting (toxic levels)
- Visual disturbances (blurred vision, yellow-green halos)
- Confusion
- Anorexia
- Arrhythmias
- Nitrates (Isosorbide):
- Headache ++
- Reflex tachycardia
- Flushing
- Centrally Acting Antihypertensives (Clonidine, Methyldopa):
- Rebound hypertension if stopped abruptly (especially with Clonidine)
- Bradycardia
- Drowsiness and sedation
- Dry mouth
- Constipation
- Depression
- If Channel Blocker (Funny Channel Blocker) (Ivabradine):
- Bradycardia
- Visual disturbances (phosphenes, bright lights)
- Hypertension
- Atrial fibrillation
- Neprilysin Inhibitor (Sacubitril, often combined with valsartan):
- Cough
- Hyperkalemia
- Renal impairment
- Angioedema (rare but serious)