A-CARD ( TABLET )

• Angina and myocardial infarction
• Arrhythmias
• Hypertension
• Migraine prophylaxis

Source : IAP Pediatric Drug Formulary
0.5-2 mg/kg once daily. Renal failure: No dose adjustment is required in ptients with a creatinine clearance >35ml/minute/1.73sqm. If creatinine clearance 10-35ml/minute/1.73sqm give 50% dose, <10ml/minute/1.73msqm give 30-50% dose and adjust according to response. In hemodialysis and CAPD give 30-50% of dose and adjust according to response. Adjust according to pulse and BP. May give 2 times daily upto maximum of 100mg/24 hr.

Source : NFI National Formulary of India
Oral

• Adult- 50 mg once daily, increased if neces-sary to 50 mg twice daily or 100 mg once dai-ly. Angina: 50 mg daily administered alone orwith a diuretic, dose can be increased to 100mg (over 100 mg has no added advantage).May also be administered in combinationwith a mlodipine besylate 2.5 or 5 mg.
• Child- 1 to 1.3 mg/kg body weight once dailyor divided every 12 h.

Intravenous injection

2.5 mg at a rate of 1 mg/min, repeat at 5 mininterval to a max. 10 mg.

• Asthma or history of obstructive airways disease (unless no alternative, then with extreme caution and under specialist supervision); uncontrolled heart failure,
• Prinzmetal angina, marked bradycardia, hypotension, sick sinus syndrome, second-and third-degree atrioventricular block, cardiogenic shock
• Metabolic acidosis
• Severe peripheral arterial disease
• Pheochromocytoma (unless used with alpha-blocker).

• Avoid abrupt withdrawal especially in angina
• May precipitate or worsen heart failure
• Acute myocardial infarction, pregnancy, thyrotoxicosis, pheochromocytoma
• Lactation
• First-degree atrioventricular block
• Liver function deteriorates in portal hypertension
• Reduce dose in renal impairment
• Diabetes mellitus (small decrease in glucose tolerance, masking of symptoms of hypoglycaemia)
• History of hypersensitivity (increased reaction to allergens, also reduced response to epinephrine (adrenaline)
• Myasthenia gravis
• Interactions

• Gastrointestinal disturbances (nausea, vomiting, diarrhoea, constipation, abdominal cramp)
• Fatigue
• Cold hands and feet; 
• Exacerbation of intermittent claudication and Raynaud phenomenon; bronchospasm; 
• Bradycardia, heart failure, conduction disorders, hypotension; sleep disturbances, including nightmares; depression, confusion; 
• Hypoglycaemia or hyperglycaemia; 
• Exacerbation of psoriasis; rare reports of rashes and dry eyes (oculomucocutaneous syndrome-reversible on withdrawal).