Atenoprilovan

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atpsynthase

atpsynthase

Protons and Pumps, Baby!
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  1. Pharmacist
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An interesting topic that I seem to find quite common now days is the which antihypertensive agent to use topic. ACE inhibitors, beta blockers, ARBs? I know Diovan, an ARB is rather expensive and many people on it seem to want to find cheaper alternatives. Thoughts?
 
atpsynthase said:
An interesting topic that I seem to find quite common now days is the which antihypertensive agent to use topic. ACE inhibitors, beta blockers, ARBs? I know Diovan, an ARB is rather expensive and many people on it seem to want to find cheaper alternatives. Thoughts?
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A better question would be, why do you want Diovan in the first place? Tons of much cheaper options available, even in the same class there are cheaper options.

Selecting the correct antihypertensive agent is all about co-morbidities. Diabetes? ACE-i. Heart Failure? Beta Blocker. Pretty much everyone gets HCTZ. I can't think of the other obvious ones right now, but I think you see what I mean. It's not like there is one best drug to use, you have to look at the whole picture of what the patient has going on.
 
owlegrad said:
A better question would be, why do you want Diovan in the first place? Tons of much cheaper options available, even in the same class there are cheaper options.

Selecting the correct antihypertensive agent is all about co-morbidities. Diabetes? ACE-i. Heart Failure? Beta Blocker. Pretty much everyone gets HCTZ. I can't think of the other obvious ones right now, but I think you see what I mean. It's not like there is one best drug to use, you have to look at the whole picture of what the patient has going on.
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Genetics and race also play a factor in which antihypertensives to choose.
 
Sparda29 said:
Genetics and race also play a factor in which antihypertensives to choose.
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I will give you race, but what genetic concerns do you look at for consideration of an antihypertensive?
 
owlegrad said:
I will give you race, but what genetic concerns do you look at for consideration of an antihypertensive?
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Pharmacogenetics/Pharmacogenomics is a new field but I think there are some polymorphisms that can affect the pharmacodynamics/pharmacokinetics of anti-HTN drugs. I don't have the articles on this computer though.
 
Nobody starts on Diovan... It's usually HCTZ then bump up to lisinopril/HCTZ. Both cheap. Diovan gets thrown in if the patient can't tolerate the side effects of the ACEI or if it's not working.
 
Sparda29 said:
Pharmacogenetics/Pharmacogenomics is a new field but I think there are some polymorphisms that can affect the pharmacodynamics/pharmacokinetics of anti-HTN drugs. I don't have the articles on this computer though.
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Right, but it's really really really really expensive to find out for each person. And it takes a long time.

Warfarin is worse, but we don't test people for a genetic profile before starting them on it.
 
Chris co2012 said:
Nobody should start on Diovan... It's usually HCTZ then bump up to lisinopril/HCTZ. Both cheap. Diovan gets thrown in if the patient can't tolerate the side effects of the ACEI or if it's not working.
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Fixed that for you. Sometimes doctors have samples to give out, etc. Per guidelines, evidence based medicine, and just good sense, no one starts on Diovan.:laugh:
 
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