Adrenergic Drugs
Adrenergic Drugs
(Sympathomimetics)
1. Pressor agents
- Noradrenaline (Norepinephrine)
- Ephedrine
- Dopamine
- Phenylephrine
- Methoxamine
- Mephentermine
2. Cardiac stimulants
- Adrenaline
- Isoprenaline
- Dobutamine
3. Bronchodilators
- Isoprenaline
- Salbutamol (Albuterol)
- Terbutaline
- Salmeterol
- Formoterol
- Bambuterol
4. Nasal decongestants
- Xylometazoline
- Oxymetazoline
- Naphazoline
- Phenylephrine
- Phenylpropanolamine
- Pseudoephedrine
5. CNS stimulants
- Amphetamine
- Dexamphetamine
- Methamphetamine
- Methylphenidate
6. Anorectics
- Amphetamine
- Fenfluramine
- Dexafenfluramine
- Sibutramine
7. Uterine relaxants
- Ritodrine
- Isoxsuprine
- Salbutamol
- Terbutaline
α adrenergic blocking agents
1. Non equilibrium type
a. β haloalkylamine
- Phenoxybenzamine
2. Equilibrium type (Competative antagonists)
a. Non selective
i) Ergot alkaloids
- Ergotamine
- Ergotoxine
ii) Hydrogenated ergot alkaloids
- Dihydroergotamine (DHE)
- Dihydroergotoxine (Codergocrine)
iii) Imidazoline
- Phentolamine
iv) Miscellaneous
- Chlorpromazine
b. α-1 Selective
- Prazosin
- Terazosin
- Doxazosin
- Alfuzosin
- Tamsulosin
c. α-2 Selective
- Yohimbine
β Adrenergic Blockers
1. Non selective (β1 + β2)
a. Without ISA* (* Intrinsic sympathomimetic activity)
- Propranolol
- Sotaolol
- Timolol
b. With ISA*
- Pindolol
c. With α blocking property
- Labetalol
- Carvedilol
2. Cardio selective (β1)
- Metoprolol
- Atenolol
- Acebutolol
- Bisoprolol
- Esmolol
- Betaxolol
- Celiprolol
- Nebivolol
Preparations (Adrenergic drugs)
1. Adrenaline (Epinephrine): 0.2–0.5 mg s.c./i.m.; ADRENALINE 1 mg/ml inj;
ADRENA 4 mg (of adrenaline bitartrate=2 mg adrenaline base) per ml inj.
2. Noradrenaline (Norepinephrine, Levarterenol): 2–4 µg/min i.v. infusion;
ADRENOR, NORAD, NORDRIN 2 mg (base)/2 ml amp.
3. Isoprenaline (Isoproterenol): 20 mg s.l., 1–2 mg i.m., 5–10 µg/min i.v. infusion;
NEOEPININE 20 mg sublingual tab, ISOPRIN, ISOSOL 4 mg/2 ml inj.
4. Dopamine: 0.2–1.0 mg/min i.v. infusion; DOPAMINE, INTROPIN, DOPACARD 200 mg/5 ml amp.
5. Dobutamine: 2.5–10 µg/kg/min i.v. infusion;
CARDIJECT 50 mg/4 ml and 250 mg/20 ml inj, DOBUTREX, DOBUSTAT 250 mg inj.
6. Ephedrine: 15–60 mg oral, 15–30 mg i.m./i.v.; 0.5–0.75% topically in nose.
EPHEDRINE HCL 15, 30 mg tabs, SUFIDRIN 50 mg in 1 ml inj, ENDRINE 0.75% nasal drops.
7. Phenylephrine: 5–10 mg oral, 2–5 mg i.m., 0.1–0.5 mg slow i.v. inj, 30–60 µg/min i.v. infusion, 0.25% topically in nose, 5–10% topically in eye; in DECOLD PLUS 5 mg with paracetamol 400 mg + chlorpheniramine 2 mg + caffeine 15 mg tab; SINAREST 10 mg with chlorpheniramine 2 mg, paracetamol 500 mg, caffeine 30 mg tab; FRENIN 10 mg in 1 ml inj, in FENOX 0.25% with naphazoline 0.025% nasal drops, DROSYN 10% eye drops, in DROSYN-T, TROPAC-P 5% with tropicamide 0.8% eye drops.
8. Methoxamine: 10–20 mg i.m., 3–5 mg slow i.v. inj; VASOXINE 20 mg/ml inj.
9. Mephentermine: 10–20 mg oral/i.m., also by i.v. infusion. MEPHENTINE 10 mg tab, 15 mg in 1 ml amp, 30 mg/ml in 10 ml vial.
10. Amphetamine: 5–15 mg oral.
11. Dexamphetamine: 5–10 mg (children 2.5–5 mg) oral.
12. Methamphetamine: 5–10 mg oral
13. Sibutramine: Start with 10 mg OD, increase to 15 mg OD if needed.
14. Xylometazoline: 0.05%–0.1% topically in nose; OTRIVIN 0.05% (pediatric), 0.1% (adult) nasal drops and nasal spray.
15. Oxymetazoline: 0.025–0.05% topically in nose; NASIVION, SINAREST 0.025% (pediatric), 0.05% (adult) nasal drops.
16. Naphazoline: 0.1% topically in nose; PRIVINE 0.1% nasal drops.
17. Pseudoephedrine: 30–60 mg oral TDS; SUDAFED 60 mg tab, 30 mg/5 ml syrup; in SINAR- EST 60 mg with chlorpheniramine 2 mg + caffeine 30 mg + paracetamol 500 mg tab; in CHESTON 30 mg with chlorpheniramine 2 mg + bromhexine 4 mg per tab and per 5 ml syr; in ACTICOLD 60 mg with chlorpheniramine 4 mg + paracetamol 500 mg tab; in CODYLEX 60 mg with chlorpheniramine 4 mg + ibuprofen 400 mg tab.
18. Phenylpropanolamine: 25–50 mg TDS; In ACTIFED 25 mg with triprolidine 2.5 mg tab; in ESKOLD 50 mg with diphenylpyraline 5 mg spansule; in FLUCOLD 25 mg with chlorpheniramine 2 mg + paracetamol 500 mg tab.
19. Ritodrine: 50–200 µg/min i.v. infusion, 10 mg i.m./oral 4–6 hourly;
YUTOPAR, RITROD 10 mg/ml inj (5 ml amp), 10 mg tab. RITODINE 10 mg tab, 10 mg in 1 ml inj.
20. Isoxsuprine: 5–10 mg oral, i.m. 4–6 hourly,
DUVADILAN 10 mg tab, 40 mg SR cap, 10 mg/2 ml inj
1. Phenoxybenzamine: 20–60 mg/day oral, 1 mg/kg slow i.v. infusion over 1 hour; FENOXENE 10 mg cap, 50 mg/ml inj, BIOPHENOX 50 mg/ml inj.
2. Ergotamine: For migraine 1–3 mg oral/sublingual, repeat as required (max 6 mg in a day); rarely 0.25–0.5 mg i.m. or s.c.; ERGOTAMINE, GYNERGEN, INGAGEN 1 mg tab, 0.5 mg/ml and 1 mg/ml inj.
3. Dihydroergotamine: For migraine 2–6 mg oral (max 10 mg/day), 0.5–1 mg i.m., s.c. repeat hourly (max 3 mg); DIHYDERGOT, DHE 1 mg tab, MIGRANIL 1 mg/ml inj.
4. Dihydroergotoxine (codergocrine): For dementia 1–1.5 mg oral or sublingual, 0.15–0.6 mg i.m., HYDERGINE 1.5 mg tab, CERELOID 1 mg tab.
5. Phentolamine: 5 mg i.v. repeated as required; REGITINE, FENTANOR 10 mg/ml inj.
6. Prazosin: Start with 0.5–1 mg at bedtime; usual dose 1–4 mg BD or TDS;
PRAZOPRES 0.5, 1.0 and 2.0 mg tabs. MINIPRESS XL: PRAZOSIN GITS 2.5 mg and 5 mg tablets; 1 tab OD.
7. Terazosin: Usual maintenance dose 2–10 mg OD;
HYTRIN, TERALFA, OLYSTER 1, 2, 5 mg tab.
8. Doxazosin: 1 mg OD initially, increase upto 8 mg BD;
DOXACARD, DURACARD, DOXAPRESS 1, 2, 4 mg tabs.
9. Alfuzosin: 2.5 BD-QID or 10 mg OD as modified release tab. ALFUSIN, ALFOO 10 mg ER tab.
10. Tamsulosin: URIMAX, DYNAPRES 0.2, 0.4 mg MR cap; CONTIFLO-OD 0.4 mg cap; 1 cap (max 2) in the morning with meals.
11. Yohimbine: 2 mg oral; YOHIMBINE 2 mg tab.
INDERAL, CIPLAR 10, 40, 80 mg tab, 1 mg/ml inj., BETABLOC 10, 40 mg tab.
2. Sotalol: 80 mg BD–160 mg TDS oral; SOTAGARD 40, 80 mg tabs.
3. Pindolol: 5–15 mg BD; PINADOL 5 mg tab, VISKEN 10, 15 mg tab.
4. Metoprolol: 25 mg BD–100 mg QID oral, 5–15 mg slow i.v. inj; BETALOC 25, 50, 100 mg tab, 5 mg/ml inj., LOPRESOR, METOLAR 50, 100 mg tab.
5. S(–) Metoprolol: 12.5 mg BD–50 mg QID; METPURE–XL 12.5, 25, 50 mg ER tabs.
6. Atenolol: 25 mg OD–50 mg BD; BETACARD, ATEN, TENORMIN 25, 50, 100 mg tabs.
7. S(–) Atenolol: 12.5–50 mg OD; ATPURE, ADBETA 12.5, 25, 50 mg tabs.
8. Acebutolol: 200 mg BD–400 mg TDS oral; 20–40 mg slow i.v. injection;
SECTRAL 200, 400 mg tabs, 10 mg/2 ml amp.
9. Bisoprolol: 2.5–10 mg OD; CONCOR, CORBIS 5 mg tab.
10. Esmolol: 0.5 mg/kg i.v. injection followed by 0.05–0.2 mg/kg/min i.v. infusion; MINIBLOCK 100 mg/10 ml, 250 mg/10 ml inj.
11. Celiprolol: 100 mg OD–300 mg BD; CELIPRES 100, 200 mg tab.
12. Nebivolol: 5 mg OD (start with 2.5 mg OD in elderly); NODON 5 mg tab, NEBICARD 2.5, 5 mg tabs.
13. Labetalol: Start with 50 mg BD, increase to 100–200 mg TDS oral. In hypertensive emergencies 20–40 mg slow i.v. injection every 10 min till desired response is obtained. NORMADATE 50, 100, 200 mg tab; LABESOL, LABETA 50 mg tab, 20 mg/4 ml inj.
14. Carvedilol: for CHF: Start with 3.125 mg BD for 2 weeks, if well tolerated, gradually increase to max. of 25 mg BD. for hypertension/angina: 6.25 mg BD initially, titrate to max. of 25 mg BD. CARVIL, CARLOC, CARVAS 3.125, 6.25, 12.5, 25 mg tabs; ORICAR 12.5, 25 mg tabs.
Preparations (Alpha adrenergic blocking agents)
1. Phenoxybenzamine: 20–60 mg/day oral, 1 mg/kg slow i.v. infusion over 1 hour; FENOXENE 10 mg cap, 50 mg/ml inj, BIOPHENOX 50 mg/ml inj.
2. Ergotamine: For migraine 1–3 mg oral/sublingual, repeat as required (max 6 mg in a day); rarely 0.25–0.5 mg i.m. or s.c.; ERGOTAMINE, GYNERGEN, INGAGEN 1 mg tab, 0.5 mg/ml and 1 mg/ml inj.
3. Dihydroergotamine: For migraine 2–6 mg oral (max 10 mg/day), 0.5–1 mg i.m., s.c. repeat hourly (max 3 mg); DIHYDERGOT, DHE 1 mg tab, MIGRANIL 1 mg/ml inj.
4. Dihydroergotoxine (codergocrine): For dementia 1–1.5 mg oral or sublingual, 0.15–0.6 mg i.m., HYDERGINE 1.5 mg tab, CERELOID 1 mg tab.
5. Phentolamine: 5 mg i.v. repeated as required; REGITINE, FENTANOR 10 mg/ml inj.
6. Prazosin: Start with 0.5–1 mg at bedtime; usual dose 1–4 mg BD or TDS;
PRAZOPRES 0.5, 1.0 and 2.0 mg tabs. MINIPRESS XL: PRAZOSIN GITS 2.5 mg and 5 mg tablets; 1 tab OD.
7. Terazosin: Usual maintenance dose 2–10 mg OD;
HYTRIN, TERALFA, OLYSTER 1, 2, 5 mg tab.
8. Doxazosin: 1 mg OD initially, increase upto 8 mg BD;
DOXACARD, DURACARD, DOXAPRESS 1, 2, 4 mg tabs.
9. Alfuzosin: 2.5 BD-QID or 10 mg OD as modified release tab. ALFUSIN, ALFOO 10 mg ER tab.
10. Tamsulosin: URIMAX, DYNAPRES 0.2, 0.4 mg MR cap; CONTIFLO-OD 0.4 mg cap; 1 cap (max 2) in the morning with meals.
11. Yohimbine: 2 mg oral; YOHIMBINE 2 mg tab.
β Adrenergic Blockers (Preparation)
1. Propranolol: Oral—10 mg BD to 160 mg QID (average 40–160 mg/day). Start with a low dose and gradually increase according to need; i.v.—2 to 5 mg injected over 10 min with constant monitoring. It is not injected s.c. or i.m. because of irritant property.INDERAL, CIPLAR 10, 40, 80 mg tab, 1 mg/ml inj., BETABLOC 10, 40 mg tab.
2. Sotalol: 80 mg BD–160 mg TDS oral; SOTAGARD 40, 80 mg tabs.
3. Pindolol: 5–15 mg BD; PINADOL 5 mg tab, VISKEN 10, 15 mg tab.
4. Metoprolol: 25 mg BD–100 mg QID oral, 5–15 mg slow i.v. inj; BETALOC 25, 50, 100 mg tab, 5 mg/ml inj., LOPRESOR, METOLAR 50, 100 mg tab.
5. S(–) Metoprolol: 12.5 mg BD–50 mg QID; METPURE–XL 12.5, 25, 50 mg ER tabs.
6. Atenolol: 25 mg OD–50 mg BD; BETACARD, ATEN, TENORMIN 25, 50, 100 mg tabs.
7. S(–) Atenolol: 12.5–50 mg OD; ATPURE, ADBETA 12.5, 25, 50 mg tabs.
8. Acebutolol: 200 mg BD–400 mg TDS oral; 20–40 mg slow i.v. injection;
SECTRAL 200, 400 mg tabs, 10 mg/2 ml amp.
9. Bisoprolol: 2.5–10 mg OD; CONCOR, CORBIS 5 mg tab.
10. Esmolol: 0.5 mg/kg i.v. injection followed by 0.05–0.2 mg/kg/min i.v. infusion; MINIBLOCK 100 mg/10 ml, 250 mg/10 ml inj.
11. Celiprolol: 100 mg OD–300 mg BD; CELIPRES 100, 200 mg tab.
12. Nebivolol: 5 mg OD (start with 2.5 mg OD in elderly); NODON 5 mg tab, NEBICARD 2.5, 5 mg tabs.
13. Labetalol: Start with 50 mg BD, increase to 100–200 mg TDS oral. In hypertensive emergencies 20–40 mg slow i.v. injection every 10 min till desired response is obtained. NORMADATE 50, 100, 200 mg tab; LABESOL, LABETA 50 mg tab, 20 mg/4 ml inj.
14. Carvedilol: for CHF: Start with 3.125 mg BD for 2 weeks, if well tolerated, gradually increase to max. of 25 mg BD. for hypertension/angina: 6.25 mg BD initially, titrate to max. of 25 mg BD. CARVIL, CARLOC, CARVAS 3.125, 6.25, 12.5, 25 mg tabs; ORICAR 12.5, 25 mg tabs.
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