Glaucoma is a progressive optic neuropathy associated with increased intraocular pressure (IOP; normal range 8-22 mm Hg), which is the only disease-related factor that can be modified. Topical drugs that lower IOP are the first line of treatment for open-angle glaucoma.

Isradipine (DynaCirc - Sandoz), a dihydropyridine calcium-channel blocker chemically related to nicardipine (Cardene) and nifedipine (Procardia, and others), was recently approved by the US Food and Drug Administration for oral treatment of hypertension.

Every pharmaceutical drug is a dose-dependent poison. This article describes the clinical presentation and treatment of some dangerous overdoses commonly reported in adults.

Dorzolamide hydrochloride (Trusopt - Merck), a thienothio-pyran-2-sulfonamide carbonic anhydrase inhibitor, was recently approved by the US Food and Drug Administration in a 2% ophthalmic solution for treatment of elevated intraocular pressure in patients with ocular hypertension or open-angle glaucoma.

Ziac (Lederle), a combination of the beta-blocker bisoprolol fumarate and a very low dose (6.25 mg) of the diuretic hydrochlorothiazide, has been approved for treatment of hypertension by the US Food and Drug Administration (FDA). Bisoprolol, a new cardioselective beta-blocker with no intrinsic sympathomimetic activity, has also been marketed as a single drug (Zebeta - Lederle). The manufacturer is promoting the combination for initial treatment of hypertension with the claim that the low doses of the two drugs used together are effective in lowering blood pressure, but are each too low ...

View the Comparison Chart: Some Drugs for HFrEF

Lantaoprost, a prostaglandin F2-alpha analog, has been approved by the FDA for topical treatment of elevated intraocular pressure in patients with open-angle glaucoma and ocular hypertension refractory to other drugs.

Spironolactone, an aldosterone receptor antagonist, has been FDA-approved for many years for treatment of edema, hypertension and primary hyperaldosteronism. Recently, it was reported to improve morbidity and mortality in patients with severe heart failure.

American College of Cardiology/American Heart Association (ACC/AHA) guidelines for treatment of hypertension were last published in 2018. Treatment of hypertensive urgencies and emergencies is not discussed here.

Pharmacologic management of chronic heart failure (HF) is primarily determined by the patient's left ventricular ejection fraction (LVEF) and severity of symptoms. Patients with chronic HF who have an LVEF ≤40% are considered to have heart failure with reduced ejection fraction (HFrEF) and those with an LVEF ≥50% are considered to have heart failure with preserved ejection fraction (HFpEF). Patients with an LVEF of 41-49% have heart failure with mildly reduced or mid-range ejection fraction.