On this podcast episode, I discuss niacin pharmacology, adverse effects, drug interactions, and much more.
Niacin has historically been used to manage lipids but has fallen out of favor due to adverse effects, and newer, more effective therapies being developed.
Niacin can elevate uric acid. Be sure to use this medication cautiously in patients with gout.
Flushing is one of the most common adverse effects of niacin. High doses, immediate-release formulations, and the use of alcohol can increase the risk.
On this episode, I discuss isosorbide mononitrate pharmacology, adverse effects, and important drug interactions.
Isosorbide mononitrate is a vasodilator that works by relaxing and widening the blood vessels (primarily veins) through nitric oxide action. This reduces the preload and oxygen demand on the heart.
The primary use for isosorbide mononitrate is angina prevention. It is important to remember that it is NOT meant for acute relief of chest pain.
Headache is a major adverse effect of isosorbide mononitrate and can be very bothersome for patients. Vasodilation is primarily responsible for this adverse effect.
PDE-5 inhibitors are notorious for causing drug interactions with any nitrate medication. I discuss management strategies in this podcast episode.
On this episode of the Real Life Pharmacology Podcast, I discuss amlodipine pharmacology, adverse effects, and important drug interactions.
I break down why edema occurs with amlodipine on this episode of the Real Life Pharmacology podcast.
While beta-blockers are typically the first-line agent for the prevention of chronic angina symptoms, CCBs like amlodipine can be used as an alternative.
There are some potential CYP3A4 interactions with amlodipine. I discuss the severity of these interactions and how to monitor patients.
Bempedoic acid, also known as Nexletol, is a once-daily medication used in lipid management. I discuss its pharmacology, side effects, and much more on this podcast episode.
Bempedoic is a once-daily medication that doesn’t need to be titrated. Standard dosing is 180mg once daily which can be taken with or without food.
What are the most common side effects of bempedoic acid? One of the most notable adverse effects is hyperuricemia. This is usually seen within the first 4 weeks of being on the medication but could happen throughout the treatment.
Tendon problems can happen as well, especially in patients who are greater than 60 years old, on fluoroquinolones, have renal failure, or are taking corticosteroids.
If Bempedoic acid is taken along with Simvastatin, it is recommended to avoid doses greater than 20mg. This is partly because Bempedoic Acid 180mg along with 40mg of Simvastatin was found to increase Simvastatin AUC by 2-fold. The mechanism of this interaction has yet to be reported. Pravastatin doses greater than 40mg are to be avoided as well due to an increased risk of myopathy. Atorvastatin and Rosuvastatin didn’t have any maximum dose considerations.
On this episode, I discuss prazosin pharmacology, adverse effects, drug interactions and much more.
Prazosin is an alpha-blocker but lacks selectivity. A reduction in blood pressure is expected, but it is notorious for causing orthostatic hypotension.
Prazosin may be used off-label for nightmares, when this is the case, you will likely only see this drug dosed at bedtime.
Alpha agonist medications (such as pseudoephedrine and ADHD stimulants) may counteract the effects of prazosin.
On this episode, I discuss indapamide pharmacology, adverse effects, drug interactions, and pharmacokinetics.
I discuss how indapamide differs from other thiazide diuretics. Particularly, I discuss indapamide compared to hydrochlorothiazide.
Frequent urination, hypokalemia, and dehydration are all possible risks with indapamide.
Pay attention to medications that can increase the risk for acute renal failure when added to indapamide. NSAIDs, ACEIs, ARBs, and other diuretics can increase this risk.
Ranolazine is primarily used for chronic angina management. I discuss pharmacology, drug interactions, adverse effects, and more in this podcast episode.
Ranolazine is well known to have drug interactions. CYP3A4 is of major importance but there are other subtle drug interactions that are important.
QTc prolongation has been reported with ranolazine so it is important to recognize risk factors and other medications that may contribute to this concern.
Enzyme inducers like carbamazepine, phenytoin, and St. John’s wort are all associated with reducing the concentrations of ranolazine.
On this podcast episode, I discuss valsartan pharmacology, adverse effects, drug interactions, and much more.
Valsartan is a fairly common ARB. I mostly see losartan and valsartan used as the most common ARBs in hypertension management.
Valsartan has a longer half-life than losartan which is why we can often get away with once daily dosing compared to losartan which sometimes requires twice daily.
Hyperkalemia is a major concern with ARBs like valsartan. Trimethoprim and spironolactone are two medications that can increase this risk.
