May increase the number and duration of angina attacks in patients with Prinzmetal's angina due to unopposed alpha-receptor mediated coronary artery vasoconstriction. Caution must be exercised in patients whose cardiac reserve is poor. Although contraindicated in uncontrolled heart failure, may be used in patients whose signs of heart failure have been controlled. The patient may be protected against vagal reactions by intravenous administration of atropine. If treatment is continued, an anaesthetic with little negative inotropic activity should be selected to minimise the risk of myocardial depression. The risk-benefit assessment of stopping beta-blockade should be made for each patient. Continuation of beta-blockade reduces the risk of arrhythmias during induction and intubation, however the risk of hypotension may be increased as well. When a patient is scheduled for surgery, and a decision is made to discontinue beta-blocker therapy, this should be done at least 24 hours prior to the procedure. Furthermore there is a risk on myocardial infarction and sudden death. Patients should be followed during withdrawal, especially those with ischaemic heart disease. The dosage should be withdrawn gradually over a period of 7-14 days, to facilitate a reduction in beta-blocker dosage. Patients on haemodialysis should be given 50 mg orally after each dialysis this should be done under hospital supervision as marked falls in blood pressure can occur. No significant accumulation of Noten occurs in patients who have a creatinine clearance greater than 35 ml/min/1.73 m 2 (normal range is 100-150 ml/min/1.73 m 2).įor patients with a creatinine clearance of 15-35 ml/min/1.73 m 2 (equivalent to serum creatinine of 300-600 micromol/litre), the oral dose should be 50 mg daily and the intravenous dose should be 10 mg once every two days.įor patients with a creatinine clearance of less than 15 ml/min/1.73 m 2 (equivalent to serum creatinine of greater than 600 micromol/litre), the oral dose should be 25 mg daily or 50 mg on alternate days and the intravenous dose should be 10 mg once every four days. Since Noten is excreted via the kidneys, the dosage should be adjusted in cases of severe impairment of renal function. There is no paediatric experience with Noten and for this reason it is not recommended for use in children. If bradycardia and/or hypotension requiring treatment, or any other untoward effects occur, Noten should be discontinued.ĭosage requirements may be reduced, especially in patients with impaired renal function. This should be followed by a further 50 mg orally 12 hours after the intravenous dose, and then 12 hours later by 100 mg orally, once daily. Having controlled the dysrhythmias with intravenous Noten a suitable maintenance dosage is 50 mg - 100 mg daily, given as single dose.įor patients suitable for treatment with intravenous beta-blockade and presenting within 12 hours of the onset of chest pain, Noten 5-10 mg should be given by slow intravenous injection (1 mg/minute) followed by Noten 50 mg orally about 15 minutes later, provided no untoward effects have occurred from the intravenous dose. It is unlikely that additional benefit will be gained by increasing the dose. Most patients with angina pectoris will respond to 100 mg given orally once daily or 50 mg given twice daily. For example, co-administration of Noten tablets with a diuretic provides a highly effective and convenient antihypertensive therapy. A further reduction in blood pressure may be achieved by combining Noten tablets with other antihypertensive agents. The effect will be fully established after one to two weeks. Some patients, however, will respond to 50 mg given as a single daily dose. Most patients respond to 100 mg daily given orally as a single dose. The dose must always be adjusted to individual requirements of the patients, with the lowest possible starting dosage.
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