CMS Manual System - Louisiana Department of Health and Hospitals

Medication Issues and Concerns
duration of use
disopyramide Adverse Consequences
All antihypertensives Dosage/Monitoring
Alpha blockers, e.g.,
alfuzosin
doxazosin
prazosin
tamsulosin
terazosin
Angiotensin converting
enzyme (ACE) inhibitors,
e.g.,
benazepril
captopril
enalapril
fosinopril
lisinopril
ramipril
Disopyramide has potent negative inotropic effects
(decreased force of heart contraction), which may
induce heart failure in older individuals, and is
also strongly anticholinergic
Doses of individual antihypertensives may require
modification in order to achieve desired effects
while minimizing adverse consequences,
especially when multiple antihypertensives are
prescribed simultaneously
When discontinuing some antihypertensives (e.g.,
clonidine, beta blockers), gradual tapering may be
required to avoid adverse consequences caused by
abrupt cessation
Interactions/Adverse Consequences
May cause dizziness, postural hypotension,
fatigue, and an increased risk for falls
Many other medications may interact with
antihypertensives to potentiate their effect (e.g.,
levodopa, nitrates)
Adverse Consequences
Doxazosin, prazosin, and terazosin can cause
significant hypotension and syncope during the
first few doses. Therefore, these medications
should be initiated at bedtime with a slow titration
of dose
Prazosin can cause more CNS side effects and
generally should be avoided in older individuals
Monitoring
Monitoring of serum potassium is necessary
especially in individuals receiving ACE inhibitors
with potassium, or potassium sparing diuretics
Adverse Consequences
May cause angioedema (signs and symptoms of
immediate hypersensitivity), chronic persistent
nonproductive cough, or may worsen renal failure