| Theme | Prescription of Therapeutics and Monitoring for the Dialysis Patients | |
|---|---|---|
| Title | Hypertensive treatment and TDM (therapeutic drug monitoring) of anti- hypertensive drug in hemodialyzed patients | |
| Publish Date | 1999/11 | |
| Author | Munekazu Ryuzaki | Department of Internal Medicine, Kawasaki Municipal Ida Hospital |
| [ Summary ] | Cardiovascular disease is the leading cause of death in dialyzed patients. Hypertension is the most important risk factor in the general population. But only controlling blood pressure has not brought enough improvement in prognosis for hemodialyzed patients. Therefore, we must treat patients individually, taking into account their clinical status. The First choice of treatment should be careful adjustment of dry weight. Then anti-hypertensive drugs, such as calcium antagonists, ACE inhibitors, angiotensin receptor antagonists, beta-blockers, alpha-blockers should be considered. Among these drugs, long-acting calcium antagonists like amlodipine and bile-renal excretion-type ACE inhibitors are useful in treating dialysis patients. Drugs that are excreted in the bile and lipophilic are usually metabolized by cytochrome P 450. If we use some drugs concomitantly that are metabolized by the same isoforms of P 450, we must pay attention to drug-interactions. |
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