This document lists several medications used for hypertension (ADR) and their common adverse drug reactions. It discusses Reserpin, Klonidin, Metildopa, Doxazosin, Propranolol, Minoksidil, Diltiazem, and ARBs like Valsartan. Common side effects for many of these drugs include fatigue, dizziness, hypotension, bradycardia, nausea, sexual dysfunction, rash, and others. A meta-analysis found that beta-blockers were associated with higher risk of cardiovascular events and strokes in older hypertensive patients compared to other antihypertensive drugs.

1. ADR

2. TUGAS
• Reserpin :
• Klonidin
• Metildopa
• Doksazozin
• propranolol
• Minoksidil
• Diltiazem
• ARB

3. Reserpin
• Vomiting, diarrhea, nausea, anorexia, dryness of mouth,
hypersecretion.
• Arrhythmias (particularly when used concurrently with digitalis or
quinidine), syncope, angina-like symptoms, bradycardia, edema.
• Dyspnea, epistaxis, nasal congestion.
• Rare parkinsonian syndrome and other extrapyramidal tract
symptoms; dizziness; headache; paradoxical anxiety; depression;
nervousness; nightmares; dull sensorium; drowsiness.
• Muscular aches.
• Pseudolactation, impotence, dysuria, gynecomastia, decreased
libido, breast engorgement.
• Weight gain.
• Deafness, optic atrophy, glaucoma, uveitis, conjunctival injection.
• Purpura, rash, pruritus.

4. Klonidin
• Fatigue, fever, headache, pallor, weakness, and withdrawal syndrome.
• Bradycardia, congestive heart failure, electrocardiographic abnormalities (i.e., sinus
node arrest, junctional bradycardia, high degree AV block and arrhythmias),
orthostatic symptoms, palpitations, Raynaud’s phenomenon, syncope, and
tachycardia. Cases of sinus bradycardia and atrioventricular block have been reported,
both with and without the use of concomitant digitalis.
• Agitation, anxiety, delirium, delusional perception, hallucinations (including visual and
auditory), insomnia, mental depression, nervousness, other behavioral changes,
paresthesia, restlessness, sleep disorder, and vivid dreams or nightmares.
• Alopecia, angioneurotic edema, hives, pruritus, rash, and urticaria.
• Abdominal pain, anorexia, constipation, hepatitis, malaise, mild transient
abnormalities in liver function tests, nausea, parotitis, pseudo-obstruction (including
colonic pseudo-obstruction), salivary gland pain, and vomiting.
• Decreased sexual activity, difficulty in micturition, erectile dysfunction, loss of libido,
nocturia, and urinary retention.
• Thrombocytopenia.
• Gynecomastia, transient elevation of blood glucose or serum creatine phosphokinase,
and weight gain.
• Leg cramps and muscle or joint pain.
• Dryness of the nasal mucosa.
• Accommodation disorder, blurred vision, burning of the eyes, decreased lacrimation,
and dryness of eyes.

5. Metildopa
• Aggravation of angina pectoris, congestive heart failure, prolonged carotid sinus
hypersensitivity, orthostatic hypotension (decrease daily dosage), edema or weight gain,
bradycardia.
• Pancreatitis, colitis, vomiting, diarrhea, sialadenitis, sore or "black" tongue, nausea,
constipation, distension, flatus, dryness of mouth.
• Hyperprolactinemia.
• Bone marrow depression, leukopenia, granulocytopenia, thrombocytopenia, hemolytic
anemia
• Liver disorders including hepatitis, jaundice, abnormal liver function tests
• Myocarditis, pericarditis, vasculitis, lupus-like syndrome, drug-related fever, eosinophilia.
• Parkinsonism, Bell's palsy, decreased mental acuity, involuntary choreoathetotic movements,
symptoms of cerebrovascular insufficiency, psychic disturbances including nightmares and
reversible mild psychoses or depression, headache, sedation, asthenia or weakness, dizziness,
light-headedness, paresthesias.
• Rise in BUN.
• Arthralgia, with or without joint swelling; myalgia.
• Nasal stuffiness.
• Toxic epidermal necrolysis, rash.
• Amenorrhea, breast enlargement, gynecomastia, lactation, impotence, decreased libido.

6. Table 4 ADVERSE REACTIONS DURING
PLACEBO-CONTROLLED STUDIES
HYPERTENSION
Doxazosin
(N=339)
PLACEBO
(N=336)
CARDIOVASC
ULAR SYSTEM
Dizziness 19% 9%
Vertigo 2% 1%
Postural
Hypotension
0.3% 0%
Edema 4% 3%
Palpitation 2% 3%
Arrhythmia 1% 0%
Hypotension 1% 0%
Tachycardia 0.3% 1%
Peripheral
Ischemia
0.3% 0%
SKIN &
APPENDAGES
Rash 1% 1%
Pruritus 1% 1%

7. Propranolol
• Bradycardia; congestive heart failure; intensification of AV block; hypotension; paresthesia of
hands; thrombocytopenic purpura; arterial insufficiency, usually of the Raynaud type.
• Light-headedness; mental depression manifested by insomnia, lassitude, weakness, fatigue;
catatonia; visual disturbances; hallucinations; vivid dreams; an acute reversible syndrome
characterized by disorientation for time and place, short-term memory loss, emotional lability,
slightly clouded sensorium, and decreased performance on neuropsychometrics. For immediate
release formulations, fatigue, lethargy, and vivid dreams appear dose related.
• Nausea, vomiting, epigastric distress, abdominal cramping, diarrhea, constipation, mesenteric
arterial thrombosis, ischemic colitis.
• Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions; pharyngitis and
agranulocytosis; erythematous rash; fever combined with aching and sore throat; laryngospasm;
respiratory distress.
• Bronchospasm.
• Agranulocytosis, nonthrombocytopenic purpura, and thrombocytopenic purpura.
• Systemic lupus erythematosus (SLE).
• Stevens-Johnson Syndrome, toxic epidermal necrolysis, dry eyes, exfoliative dermatitis, erythema
multiforme, urticaria, alopecia, SLE-like reactions, and psoriasisiform rashes. Oculomucocutaneous
syndrome involving the skin, serous membranes, and conjunctivae reported for a beta-blocker
(practolol) have not been associated with Propranolol.
• Male impotence; Peyronie's disease.

8. Minoksidil
• 1. Salt and Water Retention - Temporary edema
developed in 7% of patients who were not edematous
at the start of therapy.
• 2. Pericarditis, Pericardial
• 3. Dermatologic -Hypertrichosis-Elongation, thickening,
and enhanced pigmentation of fine body hair are seen
in about 80% of patients taking Minoxidil tablets. This
develops within 3 to 6 weeks after starting therapy. It is
usually first noticed on the temples, between the
eyebrows, between the hairline and the eyebrows, or
in the side-burn area of the upper lateral cheek, later
extending to the back, arms, legs, and scalp

9. Diltiazem
• Allergic - Rashes have been reported, including rare
reports of bullous eruptions, toxic epidermal
necrolysis, and Stevens-Johnson Syndrome.
• 4. Hematologic -Thrombocytopenia and leukopenia
(WBC<3000/mm3) have rarely been reported.
• 5. Gastrointestinal -Nausea and/or vomiting has been
reported. In clinical trials the incidence of nausea and
vomiting associated with the underlying disease has
shown a decrease from pretrial levels.
• 6. Miscellaneous -Breast tenderness - This developed in
less than 1% of patients.
• 7. Altered Laboratory Findings :ECG, ALP

10. • Angina, arrhythmia, AV block (second- or third-degree),
bundle branch block, congestive heart failure, ECG
abnormalities, hypotension, palpitations, syncope,
tachycardia, ventricular extrasystoles
• Abnormal dreams, amnesia, depression, gait
abnormality, hallucinations, insomnia, nervousness,
paresthesia, personality change, somnolence, tinnitus,
tremor
• Anorexia, constipation, diarrhea, dry mouth, dysgeusia,
dyspepsia, mild elevations of SGOT, SGPT, LDH, and
alkaline phosphatase, thirst, vomiting, weight increase
• Petechiae, photosensitivity, pruritus, urticaria

11. Valsartan (n = 3,282) Placebo (n = 2,740)
Dizziness 17% 9%
Hypotension 7% 2%
Diarrhea 5% 4%
Arthralgia 3% 2%
Fatigue 3% 2%
Back Pain 3% 2%
Dizziness, postural 2% 1%
Hyperkalemia 2% 1%
Hypotension, postural 2% 1%

12. • Nifedipin vs amlodipin (Amlodipin is long
acting)
• Nifedipin (oral) vs nicardipin (i.v)

13. The Kahn and McAlister meta-analysis1 pooled data from 21
randomized hypertension trials (including 6 placebo-controlled
trials) that evaluated the efficacy of beta-blockers as first-line
therapy for hypertension in preventing major cardiovascular
outcomes (death, nonfatal MI, or nonfatal stroke).
The results were analyzed by age group: trials enrolling patients
with a mean age of 60 years or older at baseline vs trials
enrolling patients with a mean age of under 60 years.
Conclusion. They concluded that in trials comparing other
antihypertensive medications with beta-blockers, all agents
showed similar efficacy in younger patients, while in older
patients, beta-blockers were associated with a higher risk of
both composite events and strokes
Beta bloker utk lansia