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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Cardura XL

Pfizer continue to experience stock problems with Cardura XL. This problem appears to be affecting the 4mg to a greater extent than the 8mg strength.

Before considering switching back to immediate release (IR) doxazosin it may be worth considering if the patient should be on doxazosin anyway. It is a fourth / fifth line drug for hypertension now, especially after its arm in the ALLHAT study was stopped early. This is an ideal opportunity to review patients who are on this drug and optimise therapy to current thinking.

For those patients who are on a cocktail of antihypertensives and need to stay on doxazosin, Pfizer are suggesting using a lower dose to avoid postural hypotension (ie, Cardura 4mg XL to Doxazosin 2mg tablets) and review regularly, increasinging the dose (maximum 16mg od) until BP is at target or the patient can't take any more becuase of side effects.

Another possible approach would be to switch to an equivalent dose (ie, Cardura 4mg XL to Doxazosin 4mg tablets). The patient can be counselled regarding BP related problems, perhaps with a recommendation to half tablets for the first few days

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