Musculoskeletal side effects have included arthralgia, back pain, leg pain, foot pain, muscle cramps, myalgia, arm pain, knee pain, and hip pain. Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Phenytoin: Calcium Channel Blockers may increase the serum concentration of Phenytoin. Phenytoin may decrease the serum concentration of Calcium Channel Blockers. Management: Avoid use of nimodipine or nifedipine with phenytoin. Although 20 mg per day increased the antihypertensive effect of felodipine, a disproportionate increase in side effects, especially those associated with vasodilatory effects, was reported. generic imiquimod kirkland
In addition, the 30 mg capsules also contain propylene glycol. Cmax was increased by 30%. Product Information. Plendil felodipine.
Yohimbine: May diminish the antihypertensive effect of Antihypertensive Agents. ULN at 2 consecutive visits. Using it for long periods or in high doses near the expected delivery date is not recommended because of possible harm to the unborn baby. Discuss the risks and benefits with your doctor. Your blood pressure will need to be checked often. Your kidney function may also need to be checked.
There are no adequate and well-controlled studies in pregnant women. If Felodipine is used during pregnancy, or if the patient becomes pregnant while taking this drug, she should be apprised of the potential hazard to the fetus, possible digital anomalies of the infant, and the potential effects of Felodipine on labor and delivery and on the mammary glands of pregnant females. Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension for example, patients with diabetes or hyperlipidemia and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal.
Inactive ingredients include: propyl gallate, polyoxyl 40 hydrogenated castor oil, cellulose compounds, lactose, aluminum silicate, sodium stearyl fumarate, carnauba wax, and black iron oxide. The tablets are imprinted with an ink of synthetic black iron oxide which contains pharmaceutical glaze in SD-45, n-butyl alcohol, propylene glycol, isopropyl alcohol, ammonium hydroxide, and methyl alcohol. Your doctor or may already be aware of any possible and may be monitoring you for them. not start, stop, or change the dosage of any medicine before checking with them first. Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Following administration of Felodipine extended-release tablets, a reduction in blood pressure generally occurs within 2 to 5 hours. During chronic administration, substantial blood pressure control lasts for 24 hours, with trough reductions in diastolic blood pressure approximately 40 - 50% of peak reductions. The antihypertensive effect is dose dependent and correlates with the plasma concentration of Felodipine. Felodipine extended-release tablets should regularly be taken either without food or with a light meal see . Felodipine extended-release tablets should be swallowed whole and not crushed or chewed.
Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Take this medicine with a full glass of water 8 ounces. Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets. Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Take with a full glass of water 8 ounces or 240 milliliters unless your doctor directs you otherwise. Do not lie down for at least 10 minutes after taking this medication. To help prevent stomach upset, take it with food or milk. Cambell LM, Ross JR, Goves JR, Lees CT, McCullagh A, Barnes P, Timerick SJ, Richardson PD "A dose-finding, placebo-controlled study on extended-release felodipine once daily in treatment of hypertension. While Nicardipine is completely absorbed, it is subject to saturable first pass metabolism and the systemic bioavailability is about 35% following a 30 mg oral dose at steady state. Ocular system side effects have included visual disturbances. Food and Drug Administration. WebMD does not endorse any specific product, service, or treatment. To reduce your risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Hepatic side effects have included elevated ALT SGPT and unspecified serum transaminases. diphenhydramine
Some of the side effects that can occur with felodipine may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. Following oral administration, felodipine is almost completely absorbed and undergoes extensive first-pass metabolism; the systemic bioavailability of felodipine ER is approximately 20%. Psychiatric system side effects have included depression, anxiety disorders, irritability, nervousness, and decreased libido. Some antihypertensive drugs have smaller blood pressure effects as monotherapy in black patients, and many antihypertensive drugs have additional approved indications and effects eg, on angina, heart failure, or diabetic kidney disease. These considerations may guide selection of therapy. In vitro studies show that the effects of Felodipine on contractile processes are selective, with greater effects on vascular smooth muscle than cardiac muscle. In patients with chronic kidney disease CKD regardless of race or diabetes status, the use of an ACE inhibitor ACEI or angiotensin receptor blocker ARB as initial therapy is recommended to improve kidney outcomes. In the general nonblack population without CKD including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic, calcium channel blocker, ACEI, or ARB. In the general black population without CKD including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic or a calcium channel blocker instead of an ACEI or ARB. If you have diabetes, do not use amlodipine and valsartan together with any medication that contains aliskiren Amturnide, Tekturna, Tekamlo, Valturna. I31' on one side and plain on other side. Enalapril has been used concomitantly with methyldopa, nitrates, hydralazine, and prazosin without evidence of clinically significant adverse interactions. Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than 1 drug to achieve blood pressure goals. CDC. About High Blood Pressure. cheapest hydroxyzine buy store canada hydroxyzine
Plasma concentrations of felodipine increase with advancing age. Clearance of felodipine in elderly hypertensive patients was 45% of that observed in young volunteers. Steady-state mean area under curve in young patients was 39% of that observed in elderly patients. Iron excretion was predominantly fecal. Approximately 99% of felodipine is bound to plasma proteins. The dose of Nicardipine hydrochloride should be individually adjusted according to the blood pressure response beginning with 20 mg three times daily. The effective doses in clinical trials have ranged from 20 mg to 40 mg three times daily. The maximum blood pressure lowering effect occurs approximately 1 to 2 hours after dosing. To assess the adequacy of blood pressure response, the blood pressure should be measured at trough 8 hours after dosing. Because of the prominent peak effects of Nicardipine, blood pressure should be measured 1 to 2 hours after dosing, particularly during initiation of therapy. Inhibition of ACE results in decreased plasma angiotensin II, which leads to decreased vasopressor activity and to decreased aldosterone secretion. Although the latter decrease is small, it results in small increases of serum potassium. This combination medication is used to treat tension headaches. Aspirin helps to decrease the pain from the headache. Caffeine helps increase the effects of aspirin. Butalbital is a sedative that helps to decrease anxiety and cause sleepiness and relaxation. Clopidogrel: Calcium Channel Blockers may diminish the therapeutic effect of Clopidogrel. The 5 mg tablet is a light yellow colored, circular shaped, biconvex, film coated tablet de-bossed with 'I32' on one side and plain on other side. Herbs Hypotensive Properties: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Nicardipine is not a beta-blocker and therefore gives no protection against the dangers of abrupt beta-blocker withdrawal; any such withdrawal should be by gradual reduction of the dose of beta-blocker, preferably over 8 to 10 days. Important: The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, blogs, or WebMD Answers are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. In clinical studies, one of two episodes of elevated serum transaminases decreased following drug discontinuation; no follow-up was available for the second patient. Six metabolites, which account for 23% of the oral dose, have been identified; none has significant vasodilating activity. generic amaryl order store europe
Leydig cell tumors was observed in treated male rats. These tumors were not observed in a similar study in mice at doses up to 138. Rifamycin Derivatives: May decrease the serum concentration of Calcium Channel Blockers. This primarily affects oral forms of calcium channel blockers. Management: The labeling for some US and Canadian calcium channel blockers contraindicate use with rifampin, however recommendations vary. Consult appropriate labeling. Urogenital: Impotence, urinary frequency, urinary urgency, dysuria, polyuria. Neither enalapril maleate nor the active diacid was mutagenic in the Ames microbial mutagen test with or without metabolic activation. Enalapril was also negative in the following genotoxicity studies: rec-assay, reverse mutation assay with E. coli, sister chromatid exchange with cultured mammalian cells, and the micronucleus test with mice, as well as in an in vivo cytogenic study using mouse bone marrow. No dosage adjustment necessary. Other Concomitant Therapy - In healthy subjects there were no clinically significant interactions when Felodipine was given concomitantly with indomethacin or spironolactone.
Each of the non-placebo combinations was significantly more effective than placebo in reducing seated systolic and diastolic blood pressure at peak 3 to 5 hours after dosing and trough 24 hours after dosing. Enalapril and felodipine contributed additively to the effect, so that each active-active combination was significantly more effective than either of its component monotherapies. Most of the drug effect seen at peak was still present at trough. The efficacy of combination therapy relative to monotherapy was not significantly affected by race, sex, or age. Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers. The two components of LEXXEL enalapril maleate-felodipine have complementary actions. Enalapril is a pro-drug; following oral administration, it is bioactivated by hydrolysis of the ethyl ester to enalaprilat, which is the active ACE inhibitor. Enalaprilat inhibits angiotensin-converting enzyme in humans and animals. This adverse event generally occurs within 2-3 weeks of the initiation of treatment. Angioedema associated with laryngeal edema may be fatal. You should not use this medicine if you are allergic to amlodipine Norvasc or valsartan Diovan. Peripheral edema was generally mild, but it was age and dose related and resulted in discontinuation of therapy in about 3% of the enrolled patients. Discontinuation of therapy due to any clinical adverse event occurred in about 6% of the patients receiving Felodipine extended-release tablets, principally for peripheral edema, headache, or flushing. These represent events considered probably drug-related by the investigator. Where the frequency of adverse effects for Nicardipine and placebo is similar, causal relationship is uncertain. The only dose-related effect was pedal edema. Use with caution. The effects may be increased because of slower removal of the medicine from the body. Check the labels on all your medicines such as or -and-cold products because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely. Hypersensitivity to felodipine or any component of the formulation. Irritation of the rectal area may occur. If this effect persists or worsens, notify your doctor or promptly. buy motilium in store
Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC. The effective half-life of enalaprilat following multiple doses of enalapril maleate is prolonged at this level of renal insufficiency. MI in patients with obstructive coronary disease especially in the absence of concurrent beta-blockade. St John's Wort: May decrease the serum concentration of CYP3A4 Substrates. Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. The clinical significance of these observations is unknown. Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly. Silvestre JF, Albares MP, Carnero L, Botella R "Photodistributed felodipine-induced facial telangiectasia. Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company. Before having surgery, tell your doctor or dentist that you are taking this medication. When used in pregnancy during the second and third trimesters, ACE inhibitors can cause injury and even death to the developing fetus. When pregnancy is detected, LEXXEL should be discontinued as soon as possible. FDA product labels and may differ in countries outside the USA. Every effort has been made to ensure that the information provided on this page is accurate, up-to-date and complete, but no guarantee is made to that effect. Drugs. Hence, increasing the dose from 20 to 30 mg every 8 hours more than doubled C max and increasing the dose from 20 to 40 mg every 8 hours increased C max more than 3-fold. A similar disproportionate increase in AUC with dose was observed. Considerable inter-subject variability in plasma levels was also observed. One ingredient in this product is acetaminophen. Taking too much acetaminophen may cause serious possibly fatal liver disease. Adults should not take more than 4000 milligrams 4 grams of acetaminophen a day. People with liver problems and children should take less acetaminophen. Ask your doctor or pharmacist how much acetaminophen is safe to take. However, dystocia, reduced birth weights, reduced neonatal survival and reduced neonatal weight gain were noted. There are no adequate and well-controlled studies in pregnant women. Nicardipine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Use and dose must be determined by your doctor. epot.info furosemide
Grapefruit Juice - Co-administration of Felodipine with grapefruit juice resulted in more than 2-fold increase in the AUC and C max, but no prolongation in the half-life of Felodipine. Clinical studies of Nicardipine did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Safety and effectiveness in pediatric patients have not been established. The information contained in the Truven Health Micromedex products as delivered by Drugs. Monitor blood counts in all patients. omifin
Overdosage with a 600 mg single dose 15 to 30 times normal clinical dose has been reported. Marked hypotension blood pressure unobtainable and bradycardia heart rate 20 bpm in normal sinus rhythm occurred, along with drowsiness, confusion and slurred speech. Supportive treatment with a vasopressor resulted in gradual improvement with normal vital signs approximately 9 hours post treatment. Keep container tightly closed. Protect from moisture and light. Dispense in a tight container, if product package is subdivided. At least three days should be allowed before increasing the Nicardipine dose to ensure achievement of steady state plasma drug concentrations. LEXXEL enalapril maleate-felodipine is warranted. Aprepitant: May increase the serum concentration of CYP3A4 Substrates. There are many different dosage forms for products. Ask your doctor or for recommendations on the best product for you. ACE inhibitors can cause marked renal impairment in patients whose renal function depends on the activity of the renin-angiotensin-aldosterone system. In addition, symptomatic and sometimes excessive hypotension can occur in susceptible individuals, particularly during the initiation of treatment, which may compromise renal and myocardial perfusion. When Nicardipine was administered one 1 or three 3 hours after a high fat meal, the mean C max and mean AUC were lower 20% to 30% than when Nicardipine hydrochloride was given to fasting subjects. These decreases in plasma levels observed following a meal may be significant but the clinical trials establishing the efficacy and safety of Nicardipine hydrochloride were done in patients without regard to the timing of meals. Thus the results of these trials reflect the effects of meal-induced variability. It is very important that your doctor check your progress at regular visits to make sure felodipine is working properly and to check for unwanted effects. Palbociclib: May increase the serum concentration of CYP3A4 Substrates. No long-term carcinogenicity tests have been performed with the combination. Enalapril-felodipine was not mutagenic with or without metabolic activation in vitro in the Ames microbial mutation assay, the V-79 mammalian cell forward mutation assay, the alkaline elution assay with rat hepatocytes or the CHO mammalian cell assay. An in vivo mouse bone marrow cytogenetics assay was also negative. It has not been established whether Felodipine can be removed from the circulation by hemodialysis. See USP Controlled Room Temperature. If oligohydramnios is observed, LEXXEL enalapril maleate-felodipine should be discontinued unless it is considered lifesaving for the mother. Contraction stress testing CST a non-stress test NST or biophysical profiling BPP may be appropriate, depending upon the week of pregnancy. Patients and physicians should be aware, however, that oligohydramnios may not appear until after the fetus has sustained irreversible injury. American Heart Association. Why Blood Pressure Matters.
Safety has not been established in patients with heart failure. Felodipine should be used with caution in patients with heart failure or compromised ventricular function, especially when coadministered with a beta-blocker. The frequency and severity of the changes appeared dose related and were noted even at the lowest dose. These changes have been shown to occur with other members of the dihydropyridine class and are possibly a result of compromised uterine blood flow. Similar fetal anomalies were not observed in rats given Felodipine. Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. LEXXEL enalapril maleate-felodipine 1, 5-5 on one side and no markings on the other. Each tablet contains 5 mg of enalapril maleate and 5 mg of felodipine as an extended-release formulation. Patients should be instructed to take Felodipine extended-release tablets whole and not to crush or chew the tablets. They should be told that mild gingival hyperplasia gum swelling has been reported. Good dental hygiene decreases its incidence and severity. In most patients, achievement of optimal blood pressure reduction may require several weeks of therapy. The antihypertensive effects of enalapril have continued during long-term therapy. Abrupt withdrawal of enalapril has not been associated with a rapid increase in blood pressure. In hemodynamic studies in patients with essential hypertension, blood pressure reduction was accompanied by a reduction in peripheral arterial resistance with an increase in and little or no change in heart rate. Following administration of enalapril maleate, there is an increase in renal blood flow; glomerular filtration rate is usually unchanged. The effects appear to be similar in patients with renovascular hypertension. There is little or no effect on normal myocardium, suggesting the improvement is mainly by indirect mechanisms such as afterload reduction, and reduced ischemia. Nicardipine has no negative effect on myocardial relaxation at therapeutic doses. The clinical consequences of these properties are as yet undemonstrated. If any of these effects persist or worsen, notify your doctor or promptly. Calcium channel blockers CCBs may have varying degrees of negative inotropic effect. Congestive heart failure CHF worsening of CHF, and pulmonary edema have occurred in some patients treated with a CCB, primarily verapamil. Some CCBs have also caused mild to moderate peripheral edema due to localized vasodilation of dependent arterioles and small blood vessels, which can be confused with the effects of increasing left ventricular dysfunction. ER causal relationship unknown. Although preliminary hemodynamic studies in patients with congestive heart failure have shown that Nicardipine reduced afterload without impairing myocardial contractility, it has a negative inotropic effect in vitro and in some patients. Caution should be exercised when using the drug in congestive heart failure patients, particularly in combination with a beta-blocker. The AUC and Cmax of metoprolol, however, were increased approximately 31% and 38%, respectively. In controlled clinical trials, however, beta blockers including metoprolol were concurrently administered with felodipine and were well tolerated. Therapy was discontinued due to adverse drug events in about 6% of patients, primarily for peripheral edema, headache or flushing. Itraconazole - Co-administration of another extended-release formulation of Felodipine with itraconazole resulted in approximately 8-fold increase in the AUC, more than 6-fold increase in the C max, and 2-fold prolongation in the half-life of Felodipine. Blood pressure should be carefully monitored during initial titration and any subsequent dosage adjustment, especially in geriatric patients and patients with impaired liver function. Felodipine should be used with caution in these patients. canada pharmacy online condyline
Keep out of the reach of children. It is not known whether this drug is secreted in human milk and because of the potential for serious adverse reactions from Felodipine in the infant, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Netupitant: May increase the serum concentration of CYP3A4 Substrates. Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Cimetidine: May increase the serum concentration of Calcium Channel Blockers. Management: Consider alternatives to cimetidine. Child-Pugh C hepatic impairment. It has not been established whether felodipine can be removed from the circulation by hemodialysis. epoetin-alfa
Simeprevir: May increase the serum concentration of CYP3A4 Substrates. ACE is identical to kininase, an enzyme that degrades bradykinin. Whether increased levels of bradykinin, a potent vasodepressor peptide, play a role in the therapeutic effects of enalapril maleate remains to be elucidated. USP dissolution test pending. The most frequently observed clinical adverse events considered related to treatment with the combination were headache, edema or swelling, and dizziness. Lowering blood pressure lowers the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including Felodipine. Though very unlikely, abnormal drug-seeking behavior addiction is possible with this medication. To lessen the risk of becoming addicted, do not increase your dose, take it more frequently, or take it for a longer time than prescribed. Use the smallest effective dose. Properly stop the medication when so directed. Herbs Hypertensive Properties: May diminish the antihypertensive effect of Antihypertensive Agents. ACE inhibitors can also worsen renal function in some patients by blocking the effect of angiotensin II-mediated efferent arteriolar vasoconstriction, thereby decreasing glomerular filtration. Therapy with ACE inhibitors should be administered cautiously in patients with preexisting renal dysfunction, particularly those with renovascular disease. Patients with moderate to severe renal impairment usually require lower or less frequent doses and smaller increments in dose. In addition, a dosage reduction or discontinuation of any concomitantly administered diuretics may be helpful. Fosinopril probably does not require dosage adjustments unless hepatic function is also significantly impaired. elimite
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Patients in titration studies may have been exposed to more than one level of Felodipine extended-release tablets. The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some products that may interact with this drug include: darunavir, sodium oxybate, drugs affecting liver enzymes that remove this medication from your body such as macrolide antibiotics including erythromycin, cimetidine, disulfiram, valproic acid, fluvoxamine, MAO inhibitors including isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine isoniazid, lithium, phenothiazines such as chlorpromazine. generic eskazole purchase pharmacy europe
Co-administration of an antacid containing 600 mg aluminum hydroxide and 300 mg magnesium hydroxide had no effect on Nicardipine absorption. Nicardipine on thyroid function plasma T4 and TSH in man. Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Six metabolites, which account for 23% of the oral dose, have been identified; none has significant vasodilating activity. Following oral administration of the immediate-release formulation, the plasma levels of felodipine declined polyexponentially with a mean terminal half-life of 11 to 16 hours.
Remember that felodipine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You might have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease. There was no evidence of a mutagenic potential of Nicardipine in a battery of genotoxicity tests conducted on microbial indicator organisms, in micronucleus tests in mice and hamsters, or in a sister chromatid exchange study in hamsters.
They are available in cartons of 30 sachets. Because Nicardipine decreases peripheral resistance, careful monitoring of blood pressure during the initial administration and titration of Nicardipine is suggested. Nicardipine, like other calcium channel blockers, may occasionally produce symptomatic hypotension. Caution is advised to avoid systemic hypotension when administering the drug to patients who have sustained an acute cerebral infarction or hemorrhage. Because of prominent effects at the time of peak blood levels, initial titration should be performed with measurements of blood pressure at peak effect 1 to 2 hours after dosing and just before the next dose.