Mecamylamine HCl

A to Z Drug Facts

 Action Potent ganglionic blocking agent.

 Indications Treatment of moderately severe to severe essential hypertension; uncomplicated malignant hypertension.

 Contraindications Coronary insufficiency; recent MI; uremia; patients receiving antibiotics and sulfonamides; glaucoma; organic pyloric stenosis; mild, moderate, or labile hypertension; uncooperative patients; hypersensitivity to any component of product.

 Route/Dosage

Adults: PO Initial dose: 2.5 mg bid. Adjust dose in increments of 2.5 mg at intervals of at least 2 days until the desired BP response occurs.

 Interactions

Anesthetics, other antihypertensives, alcohol May potentiate the effects of mecamylamine.

Antibiotics, sulfonamides Patients receiving these drugs generally should not be treated with ganglionic blocking agents.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Orthostatic dizziness; syncope; postural hypotension. CNS: Weakness; fatigue; sedation; paresthesia; tremor; choreiform movements; mental aberrations; convulsions.EENT: Glossitis; dilated pupils; blurred vision. GI: Anorexia; dry mouth; nausea; vomiting; constipation; ileus. GU: Decreased libido; impotence; urinary retention. RESPIRATORY: Interstitial pulmonary edema; fibrosis.

 Precautions

Pregnancy Category C. Lactation Discontinue nursing or discontinue the drug. Children Safety and efficacy not established. Discontinuation of therapy To prevent hypertension, fatal cerebral vascular accidents or acute CHF, withdraw drug gradually, and substitute other antihypertensive therapy. Potentiation of effects Mecamylamine's effects may be potentiated by excessive heat, fever, infection, hemorrhage, pregnancy, anesthesia, surgery, vigorous exercise, other antihypertensive agents, alcohol, salt depletion, vomiting, excessive sweating, or diuretics. Renal or cardiovascular function: Give with caution, if at all, in patients with renal insufficiency, manifested by a rising or elevated BUN. Use with caution in patients with marked cerebral and coronary arteriosclerosis or after recent cerebral vascular accident. Urinary retention: Because urinary retention may occur, use with caution in patients with prostatic hypertrophy, bladder neck obstruction, and urethral stricture.

 Administration/Storage

• Give dose 2 to 4 times a day as prescribed.
• Administer after meals or snacks to slow absorption of medication and provide smoother control of BP.
• Administer alone or in combination with other antihypertensives.
• Store tablets at controlled room temperature (59° to 86°F).

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note renal impairment and concurrent use of antibiotics or sulfonamides.
• Review patient's health history for any condition that could contraindicate mecamylamine therapy: recent MI, coronary insufficiency, uremia, glaucoma, or pyloric stenosis.
• Monitor and record BP and pulse with patient in erect position. Should hypotension, dizziness, lightheadedness or fainting result, hold medication and notify health care provider.
• Take safety precautions if orthostatic hypotension occurs.
• Monitor patient for GI, CV, CNS, psychiatric, and general body side effects. Inform health care provider if noted and significant.

 Patient/Family Education

• Explain name, dose, action, and potential side effects of drug.
• Advise patient that dose may be increased slowly until maximum benefit is obtained.
• Advise patient to take every day as prescribed. Advise patient to take after meals or snacks to slow absorption of medication and provide smoother control of BP.
• Advise patient to take each dose at about the same time each day.
• Inform patient that drug controls but not does cure hypertension and to continue taking drug as prescribed even when BP is not elevated.
• Caution patient not to change the dose or stop taking unless advised by health care provider.
• Instruct patient to continue taking other BP medications as prescribed by health care provider.
• Instruct patient in BP and pulse measurement skills.
• Advise patient to monitor and record BP and pulse at home in a standing position and to inform health care provider should abnormal measurements be noted. Also advise patient to take record of BP and pulse to each follow-up visit.
• Advise patient that dizziness, lightheadedness, or fainting can occur, especially when rising from a lying or sitting position. Inform patient that getting up slowly from a lying or sitting position will reduce the chance of this occurring.
• Caution patient that alcohol ingestion, excessive heat, vigorous exercise, inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to excessive fall in BP resulting in dizziness, lightheadedness, or fainting.
• Instruct patient to lie or sit down if they experience dizziness or lightheadedness when standing.
• Advise patient to stop taking the medication and immediately inform their health care provider if any of the following occur: fainting; frequent loose bowel movements with stomach distention and “rumbling” sounds in the intestines; difficult urination; inability to urinate; mood changes or changes in thoughts; tremors or uncontrollable muscle movements.
• Emphasize to hypertensive patient importance of other modalities on BP: weight control, regular exercise, smoking cessation and moderate intake of alcohol and salt.
• Instruct female patient to notify health care provider if pregnant, planning on becoming pregnant, or are breastfeeding.
• Caution patient to not take any prescription or OTC medication or dietary supplements unless advised by health care provider.
• Advise patient that follow-up visits and lab tests may be required to monitor therapy and to keep appointments.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts