Cardiovascular drugs

Anti hypertensive drugs

Drugs for cardiac arrhythmia and cardiac hypertrophy

Drugs for dilation of blood vessels

Drugs for constriction of blood vessels

Cardiac antidepressants

Drugs for congestive heart failure

Enalapril

By M. Younus, BVSc, MVSc, SKUAST-K

Enalapril ( ACE inhibitor)

  • Approved for use in dog.
  • Excreted through kidneys so dose reduction should be considered in animals with severe CHF (reduced renal perfusion) or renal failure.
  • Should not be used as alone in systemic hypertension(>160 mmHg). Best results are when used with arterial dilators.

MOA:

  • Enalapril inhibits angiotensin-converting enzyme thus preventing formation of angiotensin11 from angiotensin1. Angiotensin11 is responsible for vasoconstriction, Na and water retention, and degradation of bradykinin( vasodilator).

Effects:

  • Reduction in blood pressure, and pre load and after load.

Side effects:

  • Common side effects- GIT upset including vomiting and tiredness.
  • Serious side effects- Fever, rash, collapse, weakness ,hypotension, kidney dysfunction, and hyperkaliemia.

Species:

  • Dog and cat.

Indications:

  • CHF in dog and cat.
  • Dog at risk to CHF.
  • Chronic renal failure.
  • Protein loosing nephropathy.
  • CHF secondary to dilated cardiomyopathy (DCM) and myxomatous mitral valve disease (MMDV) in pets.
  • Systemic hypertension( in combination with arterial dilators).

Drug combination:

  • Enalapril and benazepril can be combined with furosemide, pimobendane, digoxin, antiarrhythmics, β-blockers, bronchodilators, and cough suppressants.

Dose:

  • 0.25–0.5 mg/kg PO OD/ BD.

Contra indication:

  • Pregnancy and lactation.
  • Concurrent use of NSAIDS should be avoided.
  • Avoid use of NSAIDS, Potassium, and diuretics except mentioned earlier.
  • Use cautiously in pre-existing renal disease and dehydration.

Brands:

Available as human brands in India.

  • Anze 5mg tab ( Zee lab India).
  • BQL 2.5mg/5mg tab ( Zydus Cadila India).
  • Cavas 2.5mg/5mg tab ( Zydus Cadila India).
  • Clopril 2.5mg tab ( Cloves Pharma India).
  • Dilvas 2.5mg/5mg tab ( Cipla India).

Amlodipine

By M. Younus, BVSc, MVSc, SKUAST-K

Amlodipine ( calcium channel blocker).

  • Extra label drug.
  • Antihypertensive.

MOA:

  • Amlodipine blocks calcium channels in smooth muscles in vessels and cardiac muscles inhibiting influx of calcium.

Effects:

  • Vasodilation, decreased contraction of cardiac muscles and reduced constriction of coronary vessels.

Side effects:

  • Vomiting, Diarrheas’ and loss of appetite in cats.
  • Gingival overgrowth in dogs.

Serious side effects may be very low to very fast heart rate weakness and collapse.

  • Limb swelling , abnormal bleeding and change in urination.

Species :

  • Dogs and Cats.

Indication:

  • Management of systemic hypertension
  • Congestive heart failure.
  • Cardiac arrhythmias.

Dose:

  • 0.2 to 0.4 mg/kg PO OD/BD in dogs.
  • 0.625mg PO OD/BD in cats.

Contraindication:

  • Aortic stenosis.
  • Shock .
  • Liver failure.
  • Heart failure.

Brands:

Available as human brands in India.

  • Amlopress 2.5g tab ( Cipla India).
  • Amlovas 2.5mg tab ( Macleods India).
  • Lupidip 2.5 mg tab(lupin India).
  • Amlokind 5mg tab ( Mankind India).
  • Amcard 5mg tab( Systopic India).
  • Amlip 5mg tab (Cipla India).
  • Amlibon 5mg tab( Novartis India).

Benazapril

By M. Younus, BVSc, MVSc, SKUAST-K

Benazepril (ACE inhibitor).

  • Metabolised into Benzaprilate.

MOA:

  • Benazepril inhibits angiotensin converting enzyme, which leads to:
  1. Inhibition of formation of angiotensin11.
  2. inhibition of degradation of bradykinin .
  • This reduces salt retention and increases vasodilation while decreasing vasoconstriction.

Effects:

  • Reduction in preload.
  • Decreased vascular resistance and cardiac filling pressures.
  • Increased cardiac output and exercise tolerance.

Side effects:

  • Gut upset.
  • Hyperkalemia.
  • Increase in kidney values.
  • Hypotension.
  • Weakness and lethargy.

Drug combinations:

  • Benazepril appear safe when used concomitantly with furosemide, pimobendan, digoxin, antiarrhythmics, β-blockers, bronchodilators, and cough suppressants.

Species :

  • Dogs and Cats.

Dose:

  • 0.5- 1mg/kg PO OD.

Indication:

  • Heart Failure.
  • Dilated cardiomyopathy.
  • Feline myopathy.
  • Degeneration of valves.
  • Hypertension.
  • Chronic Kidney failure.
  • Protein loosing nephropathy.

Contraindication:

  • Hyperkalemia.
  • Potassium sparing diuretics
  • Patient on NSAIDS.

Brands:

  • Aceptor-10 tab( Sava Vet India).

Composition: Each tab contains 10mg Benazepril.

  • Robocard tab ( Neo Kumfurt India).

Composition: Each tab contains 10mg Benazepril +5mg Pimobendan .

Human brands in India.

  • Bezil 5mg benazapril tab (Solarium Pharmaceuticals India).
  • Benace 10mg benazapril tab( Novartis India).
  • Benazapril 10 mg tab ( Aamneal pharmaceuticals India).

Prazosin

By M. Younus, BVSc, MVSc, SKUAST-K

Prazosin (synthetic piperazine derivative)

MOA:

  • Prazosin binds to and inhibits alpha-1 adrenergic receptors found in the peripheral blood vessels.

Effect:

  • Pronounced decrease in large vessel resistance leading to reduced systemic vascular resistance (SVR) without causing reflex tachycardia.
  • Reducing the tone of the bladder sphincter to alleviate urinary issues linked to benign prostatic hypertrophy.

Side effects:

  • Tachycardia, hyperactivity, or hyperthermia.

Dose:

  • 0.5–2 mg per animal, PO BD-TD or 0.07 mg/kg, PO, BD-TD.

Species:

  • Dog and Cat.

Indication:

  • An idiopathic cystitis blockage in Cats.
  • Bladder or prostate tumors or with spinal disease.
  • High blood pressure
  • Management of congestive heart failure.

Contraindication:

  • Animals having low BP.
  • Dogs with ABCB1 mutation.

Brands:

Available as human brands:

  • Cyber-Cr 5mg tab( Raptakos Bret and Co India).

Composition: Each tab contains 5mg Prazosin.

  • Prazopress 2mg tab ( Sun Pharma India).

Composition: Each tab contains 2mg prazosin.

  • Minipress 2.5mg tab ( Pfizer India).

Composition: Each tab contains 2.5mg prazosin

  • Prazocip 1mg tab( Cipla India).

Composition: Each tab contains 1mg prazosin.

Atenolol

By M. Younus, BVSc, MVSc, SKUAST-K

Atenolol ( synthetic isopropylamino-propanol derivative).

  • Extra label drug used in dogs and cats.
  • Not approved by FDA.
  • Increased risk for low heart rate or hypotension when combined with other drugs (acepromazine, amlodipine, diltiazem, enalapril/ benazepril).

MOA:

  • Atenolol selectively blocks Beta 1 receptors.
  • It also blocks the action of epinephrine on heart and blood vessels.

Effects:

  • Fall in blood pressure, heart rate and strain on heart.

Side effects:

  • Slowed heart rate.
  • Lethargy.
  • Low blood pressure.
  • Vomiting.
  • Diarrhea.

Species :

  • 0.5-1mg /kg PO OD in dogs.

Indication:

  • Cardiac arrhythmias and slow Sinus rate in Dog.
  • Premature heart beats.
  • Ventricular tachycardia.
  • Hyperthyroidism.
  • Hypertrophic cardiomyopathy and hyperthyroidism in cat.

Dose:

  • 6.25 mg total dose PO for first three days then BD in cats.

Contra indication:

  • Left side heart failure in cats.
  • Low heart rate.
  • Metabolic syndrome like dysglycaemia , deranged lipid profile.
  • Liver failure.

Brands:

Available as Human brands in India:

  • Tenolol 12.5mg/25mg tab( Ipca India).
  • Hipres 12.5mg/25mg tab ( Cipla India).
  • Atenova 25mg tab ( Lupin India).

Isoxsuprine

By M. Younus, BVSc, MVSc, SKUAST-K

Isoxsuprine ( Tocolytic agent).

MOA:

  • Isoxsuprine acts as beta -2 adrenoceptor agonist.
  • Increases intra cellular cCAM in smooth muscles.

Effects:

  • Relaxation of myometrium.
  • Dilation of blood vessels.

Side effects:

  • Hypotension, tachycardia and digestive tract problems.

Species:

  • Horse, Sheep, Goat, Cattle and Swine.

Indication:

  • For uterus relaxation to perform obstetrical procedure in domestic animals.
  • Navicular disease and laminitis in horse.

Dose:

  • 0.45-2.4 mg /kg PO X several weeks in horse.
  • 46.3-231.6 mg/animal IM in sheep , goat ,cow , horse and pig.

Contraindication:

  • Should not be used in females immediately after delivery of foetus.
  • Animals which are actively bleeding.
  • Pre detached placenta.

Brands:

  • Soxurine 20ml Inj vial (Carus Laboratories India).

Composition: Each ml. contains 5 mg Isoxsuprine.

Pentoxifylline

By M. Younus, BVSc, MVSc, SKUAST-K

Pentoxifylline ( methylxanthine derivative).

  • Also known as hemorrheologic agent.
  • During treatment blood clotting time (PT), arterial blood pressure, and liver enzymes should be monitored.

MOA:

  • Pentoxifylline is nonselective inhibitor of the cyclic nucleotide phosphodiesterases that increase the rate of breakdown of cAMP and cGMP
  • Pentoxifylline increase microvascular blood flow, thereby enhancing oxygenation of ischemic tissue.
  • Pentoxifylline also has inhibitory effect on lymphocytes and keratinocytes for synthesis of proinflammatory cytokines (IL-1, IL-6, IL-12, TNF-a).
  • It may also inhibit neutrophil, T and B lymphocytes and NK cell activity.

Effects:

  • Increased erythrocyte membrane deformability leading to increasing microvascular blood flow, thereby enhancing oxygenation of ischemic tissue.
  • Vasodilation.
  • Reduced erythrocyte and platelet aggregation and enhanced fibrinolysis
  • Immunomodulation.

Drug combination:

  • Pentoxifylline and prednisone for the management of cutaneous rabies vaccine-induced vasculitis in dogs.

Side effects:

  • Cardiac arrhythmias, edema and hypotension, dyspnea.
  • Vomiting, intestinal gas/bloat, tremor.
  • Liver dysfunction.
  • Anxiety.
  • Nasal congestion, pruritus and urticaria .

Species:

  • Dog , Cat and Horse

Indication:

  • Navicular disease and laminitis.
  • Endotoxic shock.
  • Atopic dermatitis.
  • Contact allergies.
  • Ulcerative dermatosis and ear margin necrosis.
  • Canine dermatomyositis.
  • Renal vasculitis.
  • Thromboembolism.
  • Frost bite.

Dose:

  • 400 mg/dog OD x 2-3months in large dogs.
  • 200 mg/dog OD x 2-3months in small dogs.
  • 10 mg/kg OD PO x 2-3months for dogs with contact dermatitis or atopic dermatitis.
  • 100 mg per animal OD PO in cats.
  • 10mg/kg PO BD×2-5 weeks in horses .

Contraindication:

  • Pregnant animals.
  • Cerebral hemorrhage.
  • Retinal hemorrhage.
  • Liver insufficiency.

Brands:

Available as Human brands:

  • Kinetal 400mg tab ( Protec India).

Composition: Each tab contains 400mg Pentoxifylline.

  • Kinetal 15 ml inj vial( Protec India).

Composition: Each ml contains 20mg Pentoxifylline.

  • Flexital 400mg tab( Sun Pharma India).

Composition: Each tab contains 400mg Pentoxifylline.

  • Flexital 15 ml inj vial( Sun Pharma India).

Composition: Each ml contains 20mg Pentoxifylline.

  • Trental 400- SR tab( Sanofi Aventis India).

Composition: Each tab contains 400mg Pentoxifylline.

  • Trental15 ml inj vial ( Sanofi Aventis India).

Composition: Each ml contains 20mg Pentoxifylline.

Phenylpropanolamine

By M. Younus, BVSc, MVSc, SKUAST-K

Phenylpropanolamine( Sympathomimetic amine ).

  • Also called as PPA.
  • Extra-Label drug.

MOA:

  • Phenylpropanolamine releases norepinephrine from nerves. Norepinephrine stimulates alpha-adrenergic and beta-adrenergic receptors in a number of organs.

Effects:

  • Constriction of blood vessels, increased heart rate and increased blood pressure.
  • Constriction of blood vessels in the nasal cavity resulting reduction in nasal congestion.
  • An increase in the tone of sphincter muscles, primarily of the bladder, occurs after repeated administration.

Side effects:

  • Vomiting, diarrhea and lack of appetite.
  • increased thirst, restlessness, irritability, and difficult urination.
  • Serious side effects include seizures, collapse, or stroke-like sign

Species:

  • Dog and Cat.

Indication:

  • Urinary inconsistency.
  • Nasal bleeding.

Dose:

  • 3 mg/kg body PO OD or 1.5 mg/kg PO BID or 1.0 mg/kg PO TID.

Contraindications:

Use cautiously in following conditions:

  • Glaucoma
  • Seizure disorders (convulsions)
  • High blood pressure
  • Thyroid, kidney, or liver disease

Brands:

  • Proin 25mg/50mg/75mg tab ( PRN Pharmacal USA).

Composition: Each tab contains 25mg/50mg/75mg phenylpropanolamine.

Vatinoxan

By M. Younus, BVSc, MVSc, SKUAST-K

Vatinoxan (selective α2-adrenoceptor antagonist).

  • Penetrates poorly into the mammalian CNS.
  • Used in combination with Medetomidine to prevent cardiac depression.

MOA:

  • Vatinoxan blocks alpha2-adrenoceptors in the heart and blood vessels, minimising unwanted cardiovascular effects of  dexmedetomidine. 

Effects:

  • Prevents vasoconstriction and cardiovascular depression.

Side effects:

  • Diarrhea ,colitis and muscle tremors.
  • Hypothermia.
  • Slow heartbeat and rapid heartbeat.

Species:

  • Dog.

Drug combination:

  • Medetomidine is administered with vatinoxan to reduce the cardiovascular depression caused by medetomidine.

Dose:

  • 1 mg medetomidine /m2 body surface area + 20mg Vatinoxan/m2 body surface area IM.

Indication:

  • Prevention of cardiac depression caused by Medetomidine.

Contraindication:

  • Hypersensitivity.
  • Hypoglycemia.
  • Stress due to extreme heat, cold or fatigue.

Brands:

Imported brand:

  • Zenalpha 10ml inj vial (Dechra USA).

Composition: Each ml contains 0.5mg Medetomidine and 10mg Vatinoxan.

Pimobendan

By M. Younus, BVSc, MVSc, SKUAST-K

Pimobendan (inodilator)

  • Positive inotrope.
  • Approved for congestive heart failure in dogs.

MOA:

  • Pimobendan sensitizes and increases the binding efficiency of cardiac troponin in the myofibril to the calcium ions.
  • Pimobendan also causes peripheral vasodilation by inhibiting the function of PDE3.

Effects:

  • Increase in cardiac output and reduction in the cardiac preload and afterload.

Side effects:

  • Decreased appetite, and diarrhea.
  • lethargy and difficulty in breathing.

Drug combinations:

  • Pimobendan is frequently prescribed alongside other cardiac drugs like furosemide, digoxin, and/or enalapril.

Dose:

  • 0.2 to 0.6 mg/kg PO empty stomach OD which is then divided into two doses that are given 12 hours apart.
  • Treatment is lifelong and effect is seen with in a month.

Species:

  • Dog

Indication:

  • Treatment of congestive heart failure, especially in cases due to chronic valvular heart disease.

Contraindication:

  • Hypertrophic cardiomyopathy, or aortic stenosis.

Brands:

  • Safe heart 1.25mg/ 2.5mg/5mg tab( Savavet India).

Composition: Each tab contains 1.25mg/ 2.5mg/5mg Pimobendan.

Tranexamic acid

By M. Younus, BVSc, MVSc, SKUAST-K

Tranexamic acid ( Lysine analog drug)

  • Primary drug option for bleeding when hyperfibrinolysis is confirmed or likely suspected.
  • Used successfully in dogs to stop bleeding.
  • Used alongside standard treatments for other bleeding disorders (e.g., factor VIII deficiency in hemophilia A).
  • Early administration (within < 3 hours) reduces mortality.

MOA:

  • Tranexamic acid binds to lysine sites on plasminogen, temporarily stopping it from attaching to the fibrin clot. This action prevents plasminogen from binding, which in turn stops the breakdown of the blood clot by plasmin.

Effects:

  • Fibrinolysis is stopped.
  • Hemostasis is achieved.

Side Effects:

  • Vomiting in dogs: Using maropitant before treatment reduces the risk of vomiting.
  • Blood clots in the urinary bladder can occur after taking tranexamic acid for urinary tract bleeding, which may block normal urine flow.

Species:

  • Dogs

Dose:

  • Start with a 10 mg/kg IV bolus dose, then give a constant infusion of 10 mg/kg/h for 3 hours. This is safe for healthy dogs.

Indication:

  • Bleeding (traumatic and non-traumatic).

Contraindication:

  • Use carefully in urinary tract bleeding and watch for signs of urine retention.

Brands:

  • Zakshot 50 ml( 100mg tranexamic acid /ml) inj vial( Carus Labs India).
  • Blood off 10ml ( 10mg tranexamic acid /ml) inj vial( Provet India).
  • Redstop 20 ml inj vial ( Care Vet Pharma India).

Epsilon-aminocaproic acid

By M. Younus, BVSc, MVSc, SKUAST-K

Epsilon-aminocaproic acid ( Lysine analog drug).

  • Primary drug option for bleeding when hyperfibrinolysis is confirmed or likely suspected.
  • Used successfully in dogs to stop bleeding.
  • Used alongside standard treatments for other bleeding disorders (e.g., factor VIII deficiency in hemophilia A).
  • Early administration (within < 3 hours) reduces mortality.
  • Less potent than tranexamic acid.
  • Has no effect on dogs with severe low platelet counts (e.g., immune-mediated thrombocytopenia).

MOA:

  • Epsilon-aminocaproic acid binds to lysine sites on plasminogen, temporarily stopping it from attaching to the fibrin clot. This action prevents plasminogen from binding, which in turn stops the breakdown of the blood clot by plasmin.

Effects:

  • Fibrinolysis is stopped.
  • Hemostasis is achieved.

Side Effects:

  • Blood clots in the urinary bladder can occur after taking tranexamic acid for urinary tract bleeding, which may block normal urine flow.

Species:

  • Dogs

Dose:

  • 50 to 100 mg/kg IV every 6 hours, with 100 mg/kg being more effective at stopping fibrinolysis

Indication:

  • Bleeding (traumatic and non-traumatic).

Contraindication:

  • Use carefully in urinary tract bleeding and watch for signs of urine retention.

Brands:

  • Homstat 20ml ( Epsilon-aminocaproic acid 5mg/ml) inj vial ( Samarth Life Science India).