Names and pronunciation
(dox-ay′zoe-sin) Cardura, Cardura XL
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Drug reference
(dox-ay′zoe-sin) Cardura, Cardura XL
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Func. class.: Peripheral α1-adrenergic receptor blocker
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Chem. class.: Quinazoline
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Do not confuse: Cardura/Coumadin/Cardene/Ridaura
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ACTION: Dilates peripheral blood vessels, lowers peripheral resistance; reduction in B/P results from periph- eral α1-adrenergic receptors being blocked
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USES: Hypertension, urinary outflow obstruction, symptoms of benign pros- tatic hyperplasia
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CONTRAINDICATIONS: Hyper- sensitivity to quinazolines Precautions: Pregnancy, breastfeeding, children, hepatic disease, geriatric patients
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SIDE EFFECTS CNS: Dizziness, headache, drowsiness, anxiety, depression, vertigo, weakness, fatigue CV: Palpitations, orthostatic hypoten- sion, tachycardia, edema, dysrhythmias, chest pain EENT: Epistaxis, tinnitus, dry mouth, red sclera, pharyngitis, rhinitis, blurred vision GI: Nausea, vomiting, diarrhea, constipa- tion, abdominal pain, hepatitis GU: Priapism, impotence, decreased libido RESP: Dyspnea
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INTERACTIONS Increase: hypotensive effects—alcohol, other antihypertensives, nitrates, PDE-5 inhibitors, CYP3A4 inhibitors, monitor B/P Decrease: hypotensive effects—NSAIDs, estrogens, sympathomimetics Drug/Herb Decrease: Ma huang Drug/Lab Decrease: WBCs, neutrophils
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TREATMENT OF OVERDOSE: Administer volume expanders or vaso- pressors; discontinue product; place patient in supine position HIGH ALERT
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DOSAGE AND ROUTES BPH • Adult: PO 1 mg/day at bedtime; in- crease in stepwise manner to 2, 4, 8 mg/ day as needed at 1-2 wk intervals, max 8 mg; extended-release tablet (Cardura XL) 4 mg daily with breakfast, adjust dose q3-4wk, up to 8 mg daily Hypertension • Adult: PO 1 mg/day at bedtime, in- creasing gradually up to 16 mg/day if required; usual range 4-16 mg/day • Geriatric: PO 0.5 mg nightly, gradually increase
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Available forms: Tablets 1, 2, 4, 8 mg; extended-release tablets 4, 8 mg
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Administer: • Store in tight container at room tem- perature • Tablets: may be broken, crushed, or chewed; if chewed, will be bitter; do not break, crush, chew XL tablets • Immediate-release tablet: without re- gard to meals; extended-release tablets: give with breakfast; when switching from immediate release to extended release, the final evening dose of immediate re- lease should not be taken
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Assess: • Hypertension: B/P (lying, standing), pulse 2-6 hr after each dose, with each in- crease; postural effects may occur, crack- les, dyspnea, orthopnea with increased B/P; increased pulse; jugular venous dis- tention during beginning treatment • BPH: urinary pattern changes (hesi- tancy, dribbling, incomplete bladder emptying, dysuria, urgency, nocturia, ur- gency incontinence, intermittency) be- fore and during treatment • I&O, weight daily; edema in feet, legs daily • Pregnancy/breastfeeding: no well- controlled studies; use only if clearly needed; use caution in breastfeeding (immediate release), avoid use with ex- tended release
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Evaluate: • Therapeutic response: decreased B/P; D decreased symptoms of BPH
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That fainting occasionally occurs after first dose; not to drive, operate machinery for 4 hr after first dose, after dosage increase; to take first dose at bedtime; may take 1-2 wk to respond with BPH • To rise slowly from sitting position • To comply with hypertension regimen: low-sodium diet, exercise, weight reduc- tion, stress management; not to smoke • How to take B/P, to check at least once/wk • For male to notify prescriber of erec- tion >4 hr or priapism • To notify all health care providers of all Rx and OTC medications and herbal supplements; not to add any products unless approved by pre- scriber • To avoid hazardous activities until re- sponse is known; dizziness or drowsiness may occur • To continue to take product even if feeling better; to take at same time each day, not to double doses
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PHARMACOKINETICS PO: Onset 2 hr, peak 2-3 hr, duration up to 24 hr, half-life 22 hr, metabolized in liver, excreted via bile/feces (<63%) and in urine (9%), extensively protein bound (98%)
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• Geriatric: PO 0.5 mg nightly, gradually increase
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