wikidoc - Recent changes [en]

Congestive heart failure pharmacotherapy

2026-05-10T17:14:19Z

Overview

← Older revision		Revision as of 17:14, 10 May 2026
Line 4:		Line 4:

	== Overview ==		== Overview ==
			Management of heart failure is guided by [[ejection fraction]] phenotype ([[HFrEF]] vs HFmrEF/[[HFpEF]]), clinical stage, congestion status, and underlying etiology, with the goals of improving symptoms, reducing hospitalization, and improving survival. Contemporary care prioritizes rapid initiation and optimization of GDMT (foundational 4-drug therapy in [[HFrEF]]; SGLT2 inhibitor–centered, comorbidity-driven therapy with selective ARNI/[[ARB]]/MRA in HFmrEF/[[HFpEF]]) alongside diuretics for relief of congestion. Longitudinal management requires structured reassessment of symptoms, vitals, renal function/electrolytes, and cardiac function to guide titration, add-on therapies, and candidacy for [[Implantable cardioverter defibrillator\|ICD]]/[[Cardiac resynchronization therapy\|CRT]] or structural interventions, with referral for advanced HF therapies when progression occurs. Effective implementation is strengthened by multidisciplinary HF programs, patient education and lifestyle interventions, and coordinated transitions of care.

	== Management of [[patients]] with heart failure with reduced ejection fraction ([[HFrEF]])==		== Management of [[patients]] with heart failure with reduced ejection fraction ([[HFrEF]])==

Congestive heart failure with preserved EF pharmacotherapy

2026-05-10T16:38:28Z

← Older revision		Revision as of 16:38, 10 May 2026
(2 intermediate revisions by the same user not shown)
Line 49:		Line 49:
	\| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center \|'''Recommedation for patients with NYHA class 2-4 heart failure with mildly reduced ejection fraction		\| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center \|'''Recommedation for patients with NYHA class 2-4 heart failure with mildly reduced ejection fraction
	\|-		\|-
	\|style="font-size: 100; padding: 0 5px; background: #~~B8B8B8~~" align=left \|''' [[Diuretics]] ([[ESC guidelines classification scheme\|Class I, Level of Evidence C]]):'''		\|style="font-size: 100; padding: 0 5px; background: #EDFAED" align=left \|''' [[Diuretics]] ([[ESC guidelines classification scheme\|Class I, Level of Evidence C]]):'''
	\|-		\|-
	\|style="padding: 0 5px; font-size: 100%; background: ~~#F5F5F5~~; width: 70%" align=left\|		\|style="padding: 0 5px; font-size: 100%; background: LightGreen; width: 70%" align=left\|
	❑ [[Diuretics]] are recommended in [[patients]] with [[congestion]] and [[HFmrEF]] in order reduce [[symptoms]] and [[signs]]<br>		❑ [[Diuretics]] are recommended in [[patients]] with [[congestion]] and [[HFmrEF]] in order reduce [[symptoms]] and [[signs]]<br>
	\|-		\|-
	\|style="font-size: 100; padding: 0 5px; background: #~~B8B8B8~~" align=left \|''' [[ACEI]] ([[ESC guidelines classification scheme\|Class IIb, Level of Evidence C]]):'''		\|style="font-size: 100; padding: 0 5px; background: #EDFAED" align=left \|''' [[ACEI]] ([[ESC guidelines classification scheme\|Class IIb, Level of Evidence C]]):'''
	\|-		\|-
	\|style="padding: 0 5px; font-size: 100%; background: ~~#F5F5F5~~; width: 70%" align=left\|		\|style="padding: 0 5px; font-size: 100%; background: LemonChiffon; width: 70%" align=left\|
	❑ [[ACE-I]] may be considered for patients with [[HFmrEF]] to reduce the risk of [[HF]] hospitalization and death<br>		❑ [[ACE-I]] may be considered for patients with [[HFmrEF]] to reduce the risk of [[HF]] hospitalization and death<br>
	❑ [[ARB]] may be indicated for [[patients]] with [[HFmrEF]] to reduce the risk of [[HF]] hospitalization and death<br>		❑ [[ARB]] may be indicated for [[patients]] with [[HFmrEF]] to reduce the risk of [[HF]] hospitalization and death<br>
Line 64:		Line 64:
	\|}		\|}
	{\|		{\|
	! colspan="2" style="background: PapayaWhip;" align="center" + \|The above table adopted from 2021 ESC Guideline		! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above table is adopted from 2021 ESC Guideline</small>''<ref name="pmid34447992">{{cite journal \|vauthors=McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A \|title=2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure \|journal=Eur Heart J \|volume=42 \|issue=36 \|pages=3599–3726 \|date=September 2021 \|pmid=34447992 \|doi=10.1093/eurheartj/ehab368 \|url=}}</ref>
	\|-		\|-
	\|}<ref name="pmid34447992">{{cite journal \|vauthors=McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A \|title=2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure \|journal=Eur Heart J \|volume=42 \|issue=36 \|pages=3599–3726 \|date=September 2021 \|pmid=34447992 \|doi=10.1093/eurheartj/ehab368 \|url=}}</ref>		\|}


Line 89:		Line 89:
	\|}		\|}
	{\|		{\|
	! colspan="2" style="background: PapayaWhip;" align="center" + \|The above table adopted from 2022 AHA Guideline		! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above table is adopted from 2022 AHA Guideline</small>''<ref name="pmid35363500">{{cite journal\| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM \| display-authors=etal\| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. \| journal=Circulation \| year= 2022 \| volume= 145 \| issue= 18 \| pages= e876-e894 \| pmid=35363500 \| doi=10.1161/CIR.0000000000001062 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500 }} </ref>
	\|-		\|-
	\|}<ref name="pmid35363500">{{cite journal\| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM \| display-authors=etal\| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. \| journal=Circulation \| year= 2022 \| volume= 145 \| issue= 18 \| pages= e876-e894 \| pmid=35363500 \| doi=10.1161/CIR.0000000000001062 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500 }} </ref>		\|}

	==[[Heart failure]] With Improved [[Ejection Fraction]] ([[HFimpEF]])==		==[[Heart failure]] With Improved [[Ejection Fraction]] ([[HFimpEF]])==
Line 113:		Line 113:
	\|}		\|}
	{\|		{\|
	! colspan="2" style="background: PapayaWhip;" align="center" + \|The above tables adopted from 2022 AHA Guideline		! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above tables is adopted from 2022 AHA Guideline</small>''
	\|-		\|-
	\|}<ref name="pmid35363500">{{cite journal\| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM \| display-authors=etal\| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. \| journal=Circulation \| year= 2022 \| volume= 145 \| issue= 18 \| pages= e876-e894 \| pmid=35363500 \| doi=10.1161/CIR.0000000000001062 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500 }} </ref>		\|}<ref name="pmid35363500">{{cite journal\| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM \| display-authors=etal\| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. \| journal=Circulation \| year= 2022 \| volume= 145 \| issue= 18 \| pages= e876-e894 \| pmid=35363500 \| doi=10.1161/CIR.0000000000001062 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500 }} </ref>
Line 169:		Line 169:
	{{familytree/end}}		{{familytree/end}}
	{\|		{\|
	! colspan="2" style="background: PapayaWhip;" align="center" + \|The above tables adopted from 2022 AHA Guideline		! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above tables is adopted from 2022 AHA Guideline</small>''<ref name="pmid35363500">{{cite journal\| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM \| display-authors=etal\| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. \| journal=Circulation \| year= 2022 \| volume= 145 \| issue= 18 \| pages= e876-e894 \| pmid=35363500 \| doi=10.1161/CIR.0000000000001062 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500 }} </ref>
	\|-		\|-
	\|}<ref name="pmid35363500">{{cite journal\| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM \| display-authors=etal\| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. \| journal=Circulation \| year= 2022 \| volume= 145 \| issue= 18 \| pages= e876-e894 \| pmid=35363500 \| doi=10.1161/CIR.0000000000001062 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500 }} </ref>		\|}


Line 184:		Line 184:

	\|-		\|-
	\|style="font-size: 100; padding: 0 5px; background: #~~B8B8B8~~" align=left \|'''([[ESC guidelines classification scheme\|Class I, Level of Evidence C]]):'''		\|style="font-size: 100; padding: 0 5px; background: #EDFAED" align=left \|'''([[ESC guidelines classification scheme\|Class I, Level of Evidence C]]):'''
	\|-		\|-
	\|style="padding: 0 5px; font-size: 100%; background: ~~#F5F5F5~~; width: 70%" align=left\|		\|style="padding: 0 5px; font-size: 100%; background: LightGreen; width: 70%" align=left\|
	❑ Screening, treatment, investigation of underlying etiologies, and		❑ Screening, treatment, investigation of underlying etiologies, and
	[[cardiovascular]] and non-[[cardiovascular]] comorbidities is recommended in [[patients]] with [[HFpEF]]<br>		[[cardiovascular]] and non-[[cardiovascular]] comorbidities is recommended in [[patients]] with [[HFpEF]]<br>
Line 192:		Line 192:
	\|}		\|}
	{\|		{\|
	! colspan="2" style="background: PapayaWhip;" align="center" + \|The above table adopted from 2021 ESC Guideline		! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above table is adopted from 2021 ESC Guideline</small>''<ref name="pmid34447992">{{cite journal \|vauthors=McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A \|title=2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure \|journal=Eur Heart J \|volume=42 \|issue=36 \|pages=3599–3726 \|date=September 2021 \|pmid=34447992 \|doi=10.1093/eurheartj/ehab368 \|url=}}</ref>
	\|-		\|-
	\|}<ref name="pmid34447992">{{cite journal \|vauthors=McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A \|title=2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure \|journal=Eur Heart J \|volume=42 \|issue=36 \|pages=3599–3726 \|date=September 2021 \|pmid=34447992 \|doi=10.1093/eurheartj/ehab368 \|url=}}</ref>		\|}


Line 243:		Line 243:
	\|}		\|}
	{\|		{\|
	! colspan="2" style="background: PapayaWhip;" align="center" + \|The above tables adopted from 2022 AHA Guideline		! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above tables is adopted from 2022 AHA Guideline</small>''<ref name="pmid35363500">{{cite journal\| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM \| display-authors=etal\| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. \| journal=Circulation \| year= 2022 \| volume= 145 \| issue= 18 \| pages= e876-e894 \| pmid=35363500 \| doi=10.1161/CIR.0000000000001062 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500 }} </ref>
	\|-		\|-
	\|}<ref name="pmid35363500">{{cite journal\| author=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM \| display-authors=etal\| title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. \| journal=Circulation \| year= 2022 \| volume= 145 \| issue= 18 \| pages= e876-e894 \| pmid=35363500 \| doi=10.1161/CIR.0000000000001062 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35363500 }} </ref>		\|}

	==External Link==		==External Link==

Congestive heart failure chronic pharmacotherapy

2026-05-10T16:24:34Z

Show changes

Congestive heart failure pharmacotherapy

2026-05-10T06:57:07Z

← Older revision		Revision as of 06:57, 10 May 2026
(One intermediate revision by the same user not shown)
Line 31:		Line 31:
	<span style="font-size:85%">'''''ARNi:''''' ''[[Angiotensin receptor-neprilysin inhibitor\|Angiotensin Receptor-Neprilysin inhibitor]]; '''ACEi:''' [[Angiotensin-converting enzyme inhibitor\|Angiotensin-Converting Enzyme inhibitor]]; '''ARB:''' [[Angiotensin-II receptor blocker\|Angiotensin II Receptor Blocker]]; '''MRA:''' Mineralocorticoid Receptor Antagonist; '''SGLT2i:''' Sodium Glucose Cotransporter 2 inhibitors; '''ICD:''' [[Implantable cardioverter-defibrillator\|Implantable Cardioverter-Defibrillator]]; '''CRT-D:''' [[cardiac resynchronization therapy\|Cardiac Resynchronization Therapy]] with [[Defibrillator]]; '''CRT-P:''' [[ cardiac resynchronization therapy\| Cardiac Resynchronization Therapy]] with [[Pacemaker]]; '''MCS:''' [[Mechanical circulatory support\|Mechanical Circulatory Support]]; '''LVAD:''' [[Left ventricular assist device\|Left Ventricular Assist Device]]''		<span style="font-size:85%">'''''ARNi:''''' ''[[Angiotensin receptor-neprilysin inhibitor\|Angiotensin Receptor-Neprilysin inhibitor]]; '''ACEi:''' [[Angiotensin-converting enzyme inhibitor\|Angiotensin-Converting Enzyme inhibitor]]; '''ARB:''' [[Angiotensin-II receptor blocker\|Angiotensin II Receptor Blocker]]; '''MRA:''' Mineralocorticoid Receptor Antagonist; '''SGLT2i:''' Sodium Glucose Cotransporter 2 inhibitors; '''ICD:''' [[Implantable cardioverter-defibrillator\|Implantable Cardioverter-Defibrillator]]; '''CRT-D:''' [[cardiac resynchronization therapy\|Cardiac Resynchronization Therapy]] with [[Defibrillator]]; '''CRT-P:''' [[ cardiac resynchronization therapy\| Cardiac Resynchronization Therapy]] with [[Pacemaker]]; '''MCS:''' [[Mechanical circulatory support\|Mechanical Circulatory Support]]; '''LVAD:''' [[Left ventricular assist device\|Left Ventricular Assist Device]]''
	{\|		{\|
	! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above algorithm is adopted from 2022 AHA/ACC/HFSA Guidelines for Management of Heart Failure</small>''		! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above algorithm is adopted from 2022 AHA/ACC/HFSA Guidelines for Management of Heart Failure</small>''<ref name="pmid35363499">{{cite journal \|vauthors=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW \|title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines \|journal=Circulation \|volume=145 \|issue=18 \|pages=e895–e1032 \|date=May 2022 \|pmid=35363499 \|doi=10.1161/CIR.0000000000001063 \|url=}}</ref>
	\|-		\|-
	\|}		\|}
Line 52:		Line 52:
	<span style="font-size:85%">'''''ARNi:''''' ''[[Angiotensin receptor-neprilysin inhibitor\|Angiotensin Receptor-Neprilysin inhibitor]]; '''ACEi:''' [[Angiotensin-converting enzyme inhibitor\|Angiotensin-Converting Enzyme inhibitor]]; '''ARB:''' [[Angiotensin-II receptor blocker\|Angiotensin II Receptor Blocker]]; '''SGLT2i:''' Sodium Glucose Cotransporter 2 inhibitors''		<span style="font-size:85%">'''''ARNi:''''' ''[[Angiotensin receptor-neprilysin inhibitor\|Angiotensin Receptor-Neprilysin inhibitor]]; '''ACEi:''' [[Angiotensin-converting enzyme inhibitor\|Angiotensin-Converting Enzyme inhibitor]]; '''ARB:''' [[Angiotensin-II receptor blocker\|Angiotensin II Receptor Blocker]]; '''SGLT2i:''' Sodium Glucose Cotransporter 2 inhibitors''
	{\|		{\|
	! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above algorithm is adopted from 2021 AHA/ACC Guideline</small>''		! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above algorithm is adopted from 2021 AHA/ACC Guideline</small>''<ref name="pmid33446410">{{cite journal \|vauthors=Maddox TM, Januzzi JL, Allen LA, Breathett K, Butler J, Davis LL, Fonarow GC, Ibrahim NE, Lindenfeld J, Masoudi FA, Motiwala SR, Oliveros E, Patterson JH, Walsh MN, Wasserman A, Yancy CW, Youmans QR \|title=2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee \|journal=J Am Coll Cardiol \|volume=77 \|issue=6 \|pages=772–810 \|date=February 2021 \|pmid=33446410 \|doi=10.1016/j.jacc.2020.11.022 \|url=}}</ref>
	\|-		\|-
	\|}		\|}
Line 62:		Line 62:
	<span style="font-size:85%">'''''ARNi:''' [[Angiotensin receptor-neprilysin inhibitor\|Angiotensin Receptor-Neprilysin inhibitor]]; '''ACEi:''' [[Angiotensin-converting enzyme inhibitor\|Angiotensin-Converting Enzyme inhibitor]]; '''ARB:''' [[Angiotensin-II receptor blocker\|Angiotensin II Receptor Blocker]]; '''MRA:''' Mineralocorticoid Receptor Antagonist; '''SGLT2i:''' Sodium Glucose Cotransporter 2 inhibitors''		<span style="font-size:85%">'''''ARNi:''' [[Angiotensin receptor-neprilysin inhibitor\|Angiotensin Receptor-Neprilysin inhibitor]]; '''ACEi:''' [[Angiotensin-converting enzyme inhibitor\|Angiotensin-Converting Enzyme inhibitor]]; '''ARB:''' [[Angiotensin-II receptor blocker\|Angiotensin II Receptor Blocker]]; '''MRA:''' Mineralocorticoid Receptor Antagonist; '''SGLT2i:''' Sodium Glucose Cotransporter 2 inhibitors''
	{\|		{\|
	! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above algorithm is adopted from 2022 AHA/ACC/HFSA Guidelines for Management of Heart Failure</small>''		! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above algorithm is adopted from 2022 AHA/ACC/HFSA Guidelines for Management of Heart Failure</small>''<ref name="pmid35363499"></ref>
	\|-		\|-
	\|}		\|}

	==Congestive heart failure treatment summary based on 2021 AHA/ACC Guideline<ref name="~~pmid33755495~~">{{cite journal \|vauthors=Bozkurt B, Hershberger RE, Butler J, Grady KL, Heidenreich PA, Isler ML, Kirklin JK, Weintraub WS \|title=2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure) \|journal=Circ Cardiovasc Qual Outcomes \|volume=14 \|issue=4 \|pages=e000102 \|date=April 2021 \|pmid=33755495 \|pmc=8059763 \|doi=10.1161/HCQ.0000000000000102 \|url=}}</ref>==		==Congestive heart failure treatment summary based on 2021 AHA/ACC Guideline<ref name="pmid33446410"></ref>==
	{\| border="1" cellpadding="2"		{\| border="1" cellpadding="2"
	!width="50"\|Pathophysiology		!width="50"\|Pathophysiology
Line 96:		Line 96:
	\|}		\|}
	{\|		{\|
	! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above table is adopted from 2021 AHA/ACC Guideline</small>''		! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above table is adopted from 2021 AHA/ACC Guideline</small>''<ref name="pmid33446410"></ref>
	\|-		\|-
	\|}		\|}
Line 281:		Line 281:
	{{clear}}		{{clear}}
	{\|		{\|
	! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above table adopted from 2021 AHA/ACC Guideline</small>''<ref name="~~pmid33755495~~">{{cite journal \|vauthors=Bozkurt B, Hershberger RE, Butler J, Grady KL, Heidenreich PA, Isler ML, Kirklin JK, Weintraub WS \|title=2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure) \|journal=Circ Cardiovasc Qual Outcomes \|volume=14 \|issue=4 \|pages=e000102 \|date=April 2021 \|pmid=33755495 \|pmc=8059763 \|doi=10.1161/HCQ.0000000000000102 \|url=}}</ref>		! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above table adopted from 2021 AHA/ACC Guideline</small>''<ref name="pmid33446410"></ref>

	\|-		\|-

Mitral regurgitation overview

2026-05-10T06:51:29Z

Show changes

Sandbox

2026-05-10T06:45:55Z

← Older revision	Revision as of 06:45, 10 May 2026
(One intermediate revision by the same user not shown)
(No difference)

Congestive heart failure pharmacotherapy

2026-05-10T06:24:48Z

Show changes

Sandbox

2026-05-10T06:01:19Z

← Older revision		Revision as of 06:01, 10 May 2026
(3 intermediate revisions by the same user not shown)
Line 5:		Line 5:

	== Management of [[patients]] with [[heart failure reduced ejection fraction\|heart failure with reduced ejection fraction]] ([[HFrEF]])==		== Management of [[patients]] with [[heart failure reduced ejection fraction\|heart failure with reduced ejection fraction]] ([[HFrEF]])==
	<span style="font-size:85%">'''''ARNi:''''' ''[[Angiotensin receptor-neprilysin inhibitor\|Angiotensin Receptor-Neprilysin inhibitor]]; '''ACEi:''' [[Angiotensin-converting enzyme inhibitor\|Angiotensin-Converting Enzyme inhibitor]]; '''ARB:''' [[Angiotensin-II receptor blocker\|Angiotensin II Receptor Blocker]]; '''MRA:''' Mineralocorticoid Receptor Antagonist; '''SGLT2i:''' Sodium Glucose Cotransporter 2 inhibitors; '''ICD:''' [[Implantable cardioverter-defibrillator\|Implantable Cardioverter-Defibrillator]]; '''CRT-D:''' [[cardiac resynchronization therapy\|Cardiac Resynchronization Therapy]] with [[Defibrillator]]; '''CRT-P:''' [[ cardiac resynchronization therapy\| Cardiac Resynchronization Therapy]] with [[Pacemaker]]; '''MCS:''' [[Mechanical circulatory support\|Mechanical Circulatory Support]]; '''LVAD:''' [[Left ventricular assist device\|Left Ventricular Assist Device]]''

	~~===~~ 2022 AHA/ACC/HFSA ~~Guidelines~~ for ~~the Management~~ of ~~Heart Failure ===~~
			The 2022 AHA/ACC/HFSA approach to chronic stage C HFrEF (LVEF ≤40%) emphasizes early initiation of the 4 pillars of guideline-directed medical therapy (GDMT), including ARNI (preferred) or ACEi/ARB, an evidence-based beta-blocker, a MRA in eligible patients, and an SGLT2 inhibitor, alongside diuretics for relief of congestion, with subsequent dose uptitration to target as tolerated. In parallel, patients should be evaluated for device and interventional therapies (e.g., ICD/CRT in appropriate candidates) and referred to an HF specialty team if progressing to advanced/refractory symptoms despite optimized GDMT.

	{{familytree/start \|summary=HFrEF Management Algorithm (2022 AHA/ACC Guidelines)}}		{{familytree/start \|summary=HFrEF Management Algorithm (2022 AHA/ACC Guidelines)}}

Line 29:		Line 30:

	{{familytree/end}}		{{familytree/end}}
			<span style="font-size:85%">'''''ARNi:''''' ''[[Angiotensin receptor-neprilysin inhibitor\|Angiotensin Receptor-Neprilysin inhibitor]]; '''ACEi:''' [[Angiotensin-converting enzyme inhibitor\|Angiotensin-Converting Enzyme inhibitor]]; '''ARB:''' [[Angiotensin-II receptor blocker\|Angiotensin II Receptor Blocker]]; '''MRA:''' Mineralocorticoid Receptor Antagonist; '''SGLT2i:''' Sodium Glucose Cotransporter 2 inhibitors; '''ICD:''' [[Implantable cardioverter-defibrillator\|Implantable Cardioverter-Defibrillator]]; '''CRT-D:''' [[cardiac resynchronization therapy\|Cardiac Resynchronization Therapy]] with [[Defibrillator]]; '''CRT-P:''' [[ cardiac resynchronization therapy\| Cardiac Resynchronization Therapy]] with [[Pacemaker]]; '''MCS:''' [[Mechanical circulatory support\|Mechanical Circulatory Support]]; '''LVAD:''' [[Left ventricular assist device\|Left Ventricular Assist Device]]''
			{\|
			! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above algorithm is adopted from 2022 AHA/ACC/HFSA Guidelines for Management of Heart Failure</small>''
			\|-
			\|}

	===Treatment Algorithm for [[Guideline-Directed Medical Therapy]] Including Novel Therapies===		===Treatment Algorithm for [[Guideline-Directed Medical Therapy]] Including Novel Therapies===

	{{familytree/start}}		{{familytree/start}}
	{{familytree \| \| \| \| \| \| \| \| \| \| A01 \| \| \| \| \| \|A01=[[Heart failure ]] reduced [[EF]], stage C, treatment}}		{{familytree \| \| \| \| \| \| \| \| \| \| A01 \| \| \| \| \| \|A01=[[Heart failure ]] reduced [[EF]], stage C, treatment}}
Line 43:		Line 50:
	{{familytree \| \| G0 \| \| \|G2 \| \| G3\| \| G4 \| \| G5 \| \| \|G0=[[Aldosterone antagonist]]\|G2= [[SGLT2 inhibitor]]\|G3=[[Diuretic]] agents\|G4= [[Hydralazine]] + [[Isosorbide dinitrate]]\|G5=[[Ivabradine]]}}		{{familytree \| \| G0 \| \| \|G2 \| \| G3\| \| G4 \| \| G5 \| \| \|G0=[[Aldosterone antagonist]]\|G2= [[SGLT2 inhibitor]]\|G3=[[Diuretic]] agents\|G4= [[Hydralazine]] + [[Isosorbide dinitrate]]\|G5=[[Ivabradine]]}}
	{{familytree/end}}		{{familytree/end}}
			<span style="font-size:85%">'''''ARNi:''''' ''[[Angiotensin receptor-neprilysin inhibitor\|Angiotensin Receptor-Neprilysin inhibitor]]; '''ACEi:''' [[Angiotensin-converting enzyme inhibitor\|Angiotensin-Converting Enzyme inhibitor]]; '''ARB:''' [[Angiotensin-II receptor blocker\|Angiotensin II Receptor Blocker]]; '''SGLT2i:''' Sodium Glucose Cotransporter 2 inhibitors''
	{\|		{\|
	! colspan="2" style="background: PapayaWhip;" align="center" + \|The above algorithm adopted from 2021 AHA/ACC Guideline		! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above algorithm is adopted from 2021 AHA/ACC Guideline</small>''
	\|-		\|-
	\|}		\|}

	== Management of [[patients]] with [[heart failure with preserved ejection fraction]] ([[HFrEF]])==		== Management of [[patients]] with [[heart failure with preserved ejection fraction]] ([[HFrEF]])==
	~~<span style="font-size:85%">'''Abbreviations:''' '''ARNi:''' [[Angiotensin receptor-neprilysin~~ inhibitor\|Angiotensin Receptor-Neprilysin inhibitor]]; '''ACEi:''' [[Angiotensin-converting enzyme inhibitor\|Angiotensin-Converting Enzyme inhibitor]]; '''ARB:''' [[Angiotensin-II receptor blocker\|Angiotensin II Receptor Blocker]]; '''MRA:''' Mineralocorticoid Receptor Antagonist; '''SGLT2i:''' Sodium Glucose Cotransporter 2 inhibitors		HFpEF management in the 2022 AHA/ACC/HFSA framework recommends optimizing comorbidities (especially hypertension), using diuretics for congestion, initiating an SGLT2 inhibitor to reduce HF hospitalizations and CV mortality, and selectively adding MRAs, ARBs, or ARNI to reduce hospitalizations, particularly when LVEF is at the lower end of the preserved range.

	~~=== 2022 AHA/ACC/HFSA Guidelines for the Management of Heart Failure ===~~
	{{familytree/start \|summary=2022 AHA/ACC/HFSA HFpEF Management Algorithm}} {{familytree \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| A01 \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \|A01='''Symptomatic HF'''<br/>LVEF ≥50%}} {{familytree \| \| \| \|,\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|^\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|.\| }} {{familytree \| \| \| B01 \| \| \| \| \| \| \| \| \| \| \| B02 \| \| \| \| \| \| B03 \| \| \| \| \| \| \| \| B04 \| \| \| \| \| \| B05 \| \|B01='''Diuretics,'''<br/>'''as needed'''<br/>(Class I)\|B02='''SGLT2i'''<br/>(Class IIa)\|B03='''ARNi'''<br/>(Class IIb)\|B04='''MRA'''<br/>(Class IIb)\|B05='''ARB'''<br/>(Class IIb)}} {{familytree/end}} <small>Greater benefit in patients with LVEF closer to 50%.</small>		{{familytree/start \|summary=2022 AHA/ACC/HFSA HFpEF Management Algorithm}} {{familytree \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| A01 \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \| \|A01='''Symptomatic HF'''<br/>LVEF ≥50%}} {{familytree \| \| \| \|,\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|^\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|-\|.\| }} {{familytree \| \| \| B01 \| \| \| \| \| \| \| \| \| \| \| B02 \| \| \| \| \| \| B03 \| \| \| \| \| \| \| \| B04 \| \| \| \| \| \| B05 \| \|B01='''Diuretics,'''<br/>'''as needed'''<br/>(Class I)\|B02='''SGLT2i'''<br/>(Class IIa)\|B03='''ARNi'''<br/>(Class IIb)\|B04='''MRA'''<br/>(Class IIb)\|B05='''ARB'''<br/>(Class IIb)}} {{familytree/end}} <small>Greater benefit in patients with LVEF closer to 50%.</small>
			<span style="font-size:85%">'''ARNi:''' [[Angiotensin receptor-neprilysin inhibitor\|Angiotensin Receptor-Neprilysin inhibitor]]; '''ACEi:''' [[Angiotensin-converting enzyme inhibitor\|Angiotensin-Converting Enzyme inhibitor]]; '''ARB:''' [[Angiotensin-II receptor blocker\|Angiotensin II Receptor Blocker]]; '''MRA:''' Mineralocorticoid Receptor Antagonist; '''SGLT2i:''' Sodium Glucose Cotransporter 2 inhibitors
			{\|
			! colspan="2" style="background: PapayaWhip;" align="center" + \|''<small>The above algorithm is adopted from 2022 AHA/ACC/HFSA Guidelines for Management of Heart Failure</small>''
			\|-
			\|}

	== Congestive heart failure treatment summary based on 2021 AHA/ACC Guideline <ref name="pmid33755495">{{cite journal \|vauthors=Bozkurt B, Hershberger RE, Butler J, Grady KL, Heidenreich PA, Isler ML, Kirklin JK, Weintraub WS \|title=2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure) \|journal=Circ Cardiovasc Qual Outcomes \|volume=14 \|issue=4 \|pages=e000102 \|date=April 2021 \|pmid=33755495 \|pmc=8059763 \|doi=10.1161/HCQ.0000000000000102 \|url=}}</ref> ==		== Congestive heart failure treatment summary based on 2021 AHA/ACC Guideline <ref name="pmid33755495">{{cite journal \|vauthors=Bozkurt B, Hershberger RE, Butler J, Grady KL, Heidenreich PA, Isler ML, Kirklin JK, Weintraub WS \|title=2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure) \|journal=Circ Cardiovasc Qual Outcomes \|volume=14 \|issue=4 \|pages=e000102 \|date=April 2021 \|pmid=33755495 \|pmc=8059763 \|doi=10.1161/HCQ.0000000000000102 \|url=}}</ref> ==
Line 84:		Line 96:
	\|}		\|}
	{\|		{\|
	! colspan="2" style="background: PapayaWhip;" align="center" + \|The above table adopted from 2021 AHA/ACC Guideline		! colspan="2" style="background: PapayaWhip;" align="center" + \|The above table is adopted from 2021 AHA/ACC Guideline
	\|-		\|-
	\|}		\|}

Mitral stenosis overview

2026-05-10T04:24:50Z

Show changes

Sandbox

2026-05-09T14:33:53Z

Management of patients with heart failure with reduced ejection fraction (HFrEF)

← Older revision		Revision as of 14:33, 9 May 2026
Line 5:		Line 5:

	== Management of [[patients]] with [[heart failure reduced ejection fraction\|heart failure with reduced ejection fraction]] ([[HFrEF]])==		== Management of [[patients]] with [[heart failure reduced ejection fraction\|heart failure with reduced ejection fraction]] ([[HFrEF]])==
	<span style="font-size:85%">'''~~Abbreviations:~~''' '''~~ARNi:~~''' [[Angiotensin receptor-neprilysin inhibitor\|Angiotensin Receptor-Neprilysin inhibitor]]; '''ACEi:''' [[Angiotensin-converting enzyme inhibitor\|Angiotensin-Converting Enzyme inhibitor]]; '''ARB:''' [[Angiotensin-II receptor blocker\|Angiotensin II Receptor Blocker]]; '''MRA:''' Mineralocorticoid Receptor Antagonist; '''SGLT2i:''' Sodium Glucose Cotransporter 2 inhibitors; '''ICD:''' [[Implantable cardioverter-defibrillator\|Implantable Cardioverter-Defibrillator]]; '''CRT-D:''' [[cardiac resynchronization therapy\|Cardiac Resynchronization Therapy]] with [[Defibrillator]]; '''CRT-P:''' [[ cardiac resynchronization therapy\| Cardiac Resynchronization Therapy]] with [[Pacemaker]]; '''MCS:''' [[Mechanical circulatory support\|Mechanical Circulatory Support]]; '''LVAD:''' [[Left ventricular assist device\|Left Ventricular Assist Device]]		<span style="font-size:85%">'''''ARNi:''''' ''[[Angiotensin receptor-neprilysin inhibitor\|Angiotensin Receptor-Neprilysin inhibitor]]; '''ACEi:''' [[Angiotensin-converting enzyme inhibitor\|Angiotensin-Converting Enzyme inhibitor]]; '''ARB:''' [[Angiotensin-II receptor blocker\|Angiotensin II Receptor Blocker]]; '''MRA:''' Mineralocorticoid Receptor Antagonist; '''SGLT2i:''' Sodium Glucose Cotransporter 2 inhibitors; '''ICD:''' [[Implantable cardioverter-defibrillator\|Implantable Cardioverter-Defibrillator]]; '''CRT-D:''' [[cardiac resynchronization therapy\|Cardiac Resynchronization Therapy]] with [[Defibrillator]]; '''CRT-P:''' [[ cardiac resynchronization therapy\| Cardiac Resynchronization Therapy]] with [[Pacemaker]]; '''MCS:''' [[Mechanical circulatory support\|Mechanical Circulatory Support]]; '''LVAD:''' [[Left ventricular assist device\|Left Ventricular Assist Device]]''

	=== 2022 AHA/ACC/HFSA Guidelines for the Management of Heart Failure ===		=== 2022 AHA/ACC/HFSA Guidelines for the Management of Heart Failure ===

Aortic regurgitation overview

2026-05-08T23:56:28Z

Overview

Show changes

Aortic stenosis overview

2026-05-08T22:20:25Z

Classification

Show changes

SANDBOX:HT

2026-05-08T13:48:11Z

Blanked the page

Show changes

User:Bezalel Hakkeem

2026-05-07T20:46:21Z

User account Bezalel Hakkeem was created by Joseph Nasr and password was sent by email New Scholar

User:Monish TM

2026-05-07T20:45:18Z

User account Monish TM was created by Joseph Nasr and password was sent by email New Scholar

Heart failure resident survival guide

2026-05-06T22:22:38Z

Show changes

Congestive heart failure Management of Acute heart failure

2026-05-06T22:03:50Z

Show changes

Atrial fibrillation

2026-05-06T21:56:33Z

Show changes

User:Nehal Eid

2026-05-06T21:15:22Z

← Older revision		Revision as of 21:15, 6 May 2026
Line 1:		Line 1:
	[[User:Nehal Eid\|Nehal Eid, M.D.]][mailto:nehalelsaeed98@gmail.com]		[[User:Nehal Eid\|Nehal Eid, M.D.]][mailto:nehalelsaeed98@gmail.com]'''Wikidoc contributions:'''

	'''Wikidoc contributions:'''

	[[Intravenous drug use (recreational)]]		[[Intravenous drug use (recreational)]]
Line 14:		Line 12:

	[[Congestive heart failure Management of Acute heart failure]]		[[Congestive heart failure Management of Acute heart failure]]

			[[atrial fibrillation]]

	[[Sudden cardiac death]]		[[Sudden cardiac death]]

Thoracic aortic aneurysm surgery

2026-05-05T22:21:13Z

Show changes

Ischemic stroke medical therapy

2026-05-05T16:05:16Z

← Older revision		Revision as of 16:05, 5 May 2026
Line 4:		Line 4:

	==Overview==		==Overview==
	Acute ischemic stroke therapy is primarily directed to rapid reperfusion with intravenous thrombolysis (alteplase or tenecteplase) in eligible patients and endovascular thrombectomy (EVT) in eligible patients with large vessel occlusion (LVO); these treatments should be considered in parallel and should not delay each other.		Acute ischemic stroke therapy is primarily directed to rapid reperfusion with intravenous thrombolysis (alteplase or tenecteplase) in eligible patients and endovascular thrombectomy (EVT) in eligible patients with large vessel occlusion (LVO); these treatments should be considered in parallel and should not delay each other.<ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref>

	Antiplatelet therapy (usually aspirin) is recommended within 24–48 hours after onset in most patients who are not receiving IV thrombolysis, and is generally delayed until 24 hours after thrombolysis.		Antiplatelet therapy (usually aspirin) is recommended within 24–48 hours after onset in most patients who are not receiving IV thrombolysis, and is generally delayed until 24 hours after thrombolysis.<ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref>

	Secondary prevention includes antiplatelets or anticoagulation depending on etiology (eg, atrial fibrillation), lipid-lowering therapy, and risk-factor management.		Secondary prevention includes antiplatelets or anticoagulation depending on etiology (eg, atrial fibrillation), lipid-lowering therapy, and risk-factor management.<ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref>

	==Medical Therapy==		==Medical Therapy==

	*~~The reported cases~~ of ~~treatment for [[~~COVID-~~19]]-associated [[~~stroke~~]] have followed the same guidelines as patients with no [[COVID-19]] infection. The following recommendations are mainly based on the current guidelines of management for~~ stroke ~~of the AHA 2019.~~		*Treatment of COVID-19–associated ischemic stroke generally follows standard acute ischemic stroke pathways.<ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref>
	*[[Alteplase\|IV alteplase]] is always preferred over mechanical [[thrombectomy]] when there are no contraindications.<ref name="~~SaverGoyal2016~~">{{cite journal\|~~last1=Saver\|first1=Jeffrey L.\|last2=Goyal\|first2=Mayank\|last3=van der Lugt\|first3=Aad\|last4~~=Menon~~\|first4=Bijoy K.\|last5=Majoie\|first5=Charles~~ B~~. L.~~ M.\|~~last6~~=~~Dippel~~\|~~first6~~=~~Diederik W.~~\|~~last7~~=~~Campbell~~\|~~first7~~=~~Bruce C.~~\|~~last8~~=~~Nogueira~~\|~~first8~~=~~Raul G.~~\|~~last9~~=~~Demchuk~~\|~~first9~~=~~Andrew M~~.\|~~last10~~=~~Tomasello\|first10=Alejandro\|last11=Cardona\|first11=Pere\|last12=Devlin\|first12=Thomas G~~.~~\|last13~~=~~Frei~~\|~~first13~~=~~Donald F.\|last14=du Mesnil~~ de ~~Rochemont~~\|~~first14~~=~~Richard\|last15=Berkhemer\|first15=Olvert~~ A.\|~~last16~~=~~Jovin~~\|~~first16=Tudor G.\|last17~~=~~Siddiqui~~\|~~first17~~=~~Adnan H.~~\|~~last18~~=~~van Zwam~~\|~~first18~~=~~Wim H.~~\|~~last19~~=~~Davis~~\|~~first19~~=~~Stephen M~~.~~\|last20=Castaño\|first20=Carlos\|last21=Sapkota\|first21=Biggya L~~.\|~~last22~~=~~Fransen\|first22=Puck S~~.~~\|last23~~=~~Molina~~\|~~first23~~=~~Carlos~~\|~~last24~~=~~van Oostenbrugge~~\|~~first24~~=~~Robert J.~~\|~~last25~~=~~Chamorro~~\|~~first25~~=~~Ángel~~\|~~last26~~=~~Lingsma~~\|~~first26~~=~~Hester~~\|~~last27~~=~~Silver~~\|~~first27~~=~~Frank L~~.\|~~last28~~=~~Donnan~~\|~~first28~~=~~Geoffrey A.~~\|~~last29~~=~~Shuaib~~\|~~first29~~=~~Ashfaq~~\|~~last30~~=~~Brown~~\|~~first30~~=~~Scott~~\|~~last31~~=~~Stouch~~\|~~first31~~=~~Bruce~~\|~~last32~~=~~Mitchell~~\|~~first32~~=~~Peter J~~.\|~~last33~~=~~Davalos\|first33~~=~~Antoni~~\|~~last34~~=~~Roos\|first34=Yvo~~ B~~. W.~~ E. M~~.\|last35=Hill\|first35=Michael D.~~\|title=~~Time to Treatment With Endovascular~~ Thrombectomy ~~and Outcomes From Ischemic~~ Stroke~~: A Meta-analysis~~\|journal=~~JAMA~~\|volume=~~316~~\|issue=12\|~~year~~=~~2016~~\|~~pages~~=~~1279~~\|~~issn~~=~~0098-7484~~\|doi=10.~~1001~~/~~jama.2016.13647~~}}</ref>		*In patients with suspected or confirmed LVO, evaluation for EVT should occur urgently, and IV thrombolysis should be given when eligible without delaying EVT.<ref name="pmid41582814">{{cite journal \|vauthors=Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Pérez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S \|title=2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association \|journal=Stroke \|volume= \|issue= \|pages= \|date=January 2026 \|pmid=41582814 \|doi=10.1161/STR.0000000000000513 \|url=}}</ref>
			*EVT indications include appropriately selected patients within 0–6 hours, and in selected patients within 6–24 hours based on imaging/clinical criteria; recent randomized trials also support EVT in selected large ischemic core anterior circulation strokes.<ref name="pmid38759664">{{cite journal \|vauthors=Hilkens NA, Casolla B, Leung TW, de Leeuw FE \|title=Stroke \|journal=Lancet \|volume=403 \|issue=10446 \|pages=2820–2836 \|date=June 2024 \|pmid=38759664 \|doi=10.1016/S0140-6736(24)00642-1 \|url=}}</ref> <ref name="pmid38265667">{{cite journal \|vauthors= \|title=Trial of Endovascular Thrombectomy for Large Ischemic Strokes \|journal=N Engl J Med \|volume=390 \|issue=4 \|pages=388 \|date=January 2024 \|pmid=38265667 \|doi=10.1056/NEJMx230009 \|url=}}</ref> <ref name="pmid38718358">{{cite journal \|vauthors=Costalat V, Jovin TG, Albucher JF, Cognard C, Henon H, Nouri N, Gory B, Richard S, Marnat G, Sibon I, Di Maria F, Annan M, Boulouis G, Cardona P, Obadia M, Piotin M, Bourcier R, Guillon B, Godard S, Pasco-Papon A, Eker OF, Cho TH, Turc G, Naggara O, Velasco S, Lamy M, Clarençon F, Alamowitch S, Renu A, Suissa L, Brunel H, Gentric JC, Timsit S, Lamy C, Chivot C, Macian-Montoro F, Mounayer C, Ozkul-Wermester O, Papagiannaki C, Wolff V, Pop R, Ferrier A, Chabert E, Ricolfi F, Béjot Y, Lopez-Cancio E, Vega P, Spelle L, Denier C, Millán M, Arenillas JF, Mazighi M, Houdart E, Del Mar Freijo M, Duhamel A, Sanossian N, Liebeskind DS, Labreuche J, Lapergue B, Arquizan C \|title=Trial of Thrombectomy for Stroke with a Large Infarct of Unrestricted Size \|journal=N Engl J Med \|volume=390 \|issue=18 \|pages=1677–1689 \|date=May 2024 \|pmid=38718358 \|doi=10.1056/NEJMoa2314063 \|url=}}</ref>
	*The usefulness of [[anticoagulants]] such as [[thrombin]] inhibitors ([[dabigatran]]) and [[factor Xa]] inhibitors ([[rivaroxaban]], [[apixaban]], [[edoxaban]]) is not well established in the acute setting of [[stroke]].<ref name="GioiaKate2016">{{cite journal\|last1=Gioia\|first1=Laura C.\|last2=Kate\|first2=Mahesh\|last3=Sivakumar\|first3=Leka\|last4=Hussain\|first4=Dulara\|last5=Kalashyan\|first5=Hayrapet\|last6=Buck\|first6=Brian\|last7=Bussiere\|first7=Miguel\|last8=Jeerakathil\|first8=Thomas\|last9=Shuaib\|first9=Ashfaq\|last10=Emery\|first10=Derek\|last11=Butcher\|first11=Ken\|title=Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation\|journal=Stroke\|volume=47\|issue=7\|year=2016\|pages=1917–1919\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.013491}}</ref>		*The usefulness of [[anticoagulants]] such as [[thrombin]] inhibitors ([[dabigatran]]) and [[factor Xa]] inhibitors ([[rivaroxaban]], [[apixaban]], [[edoxaban]]) is not well established in the acute setting of [[stroke]].<ref name="GioiaKate2016">{{cite journal\|last1=Gioia\|first1=Laura C.\|last2=Kate\|first2=Mahesh\|last3=Sivakumar\|first3=Leka\|last4=Hussain\|first4=Dulara\|last5=Kalashyan\|first5=Hayrapet\|last6=Buck\|first6=Brian\|last7=Bussiere\|first7=Miguel\|last8=Jeerakathil\|first8=Thomas\|last9=Shuaib\|first9=Ashfaq\|last10=Emery\|first10=Derek\|last11=Butcher\|first11=Ken\|title=Early Rivaroxaban Use After Cardioembolic Stroke May Not Result in Hemorrhagic Transformation\|journal=Stroke\|volume=47\|issue=7\|year=2016\|pages=1917–1919\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.013491}}</ref>
	*The use of [[thrombolysis]] via ultrasound waves concomitant to [[Fibrinolysis\|IV fibrinolysis]] is not recommended.<ref name="NacuKvistad2017">{{cite journal\|last1=Nacu\|first1=Aliona\|last2=Kvistad\|first2=Christopher E.\|last3=Naess\|first3=Halvor\|last4=Øygarden\|first4=Halvor\|last5=Logallo\|first5=Nicola\|last6=Assmus\|first6=Jörg\|last7=Waje-Andreassen\|first7=Ulrike\|last8=Kurz\|first8=Kathinka D.\|last9=Neckelmann\|first9=Gesche\|last10=Thomassen\|first10=Lars\|title=NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study)\|journal=Stroke\|volume=48\|issue=2\|year=2017\|pages=335–341\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.014644}}</ref>		*The use of [[thrombolysis]] via ultrasound waves concomitant to [[Fibrinolysis\|IV fibrinolysis]] is not recommended.<ref name="NacuKvistad2017">{{cite journal\|last1=Nacu\|first1=Aliona\|last2=Kvistad\|first2=Christopher E.\|last3=Naess\|first3=Halvor\|last4=Øygarden\|first4=Halvor\|last5=Logallo\|first5=Nicola\|last6=Assmus\|first6=Jörg\|last7=Waje-Andreassen\|first7=Ulrike\|last8=Kurz\|first8=Kathinka D.\|last9=Neckelmann\|first9=Gesche\|last10=Thomassen\|first10=Lars\|title=NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study)\|journal=Stroke\|volume=48\|issue=2\|year=2017\|pages=335–341\|issn=0039-2499\|doi=10.1161/STROKEAHA.116.014644}}</ref>

SANDBOX:HT

2026-05-05T01:55:26Z

Show changes

Suzetrigene

2026-05-04T21:23:41Z

← Older revision		Revision as of 21:23, 4 May 2026
Line 36:		Line 36:
	* When JOURNAVX is administered to patients taking moderate CYP3A inhibitors reduce the JOURNAVX dose, as described below:		* When JOURNAVX is administered to patients taking moderate CYP3A inhibitors reduce the JOURNAVX dose, as described below:

	1. Dose 1: The recommended starting dose of JOURNAVX is 100 mg orally. Take the starting dose on an empty stomach at least 1 hour before or 2 hours after food. Clear liquids may be consumed during this time (e.g., water, apple juice, vegetable broth, tea, black coffee).		Dose 1: The recommended starting dose of JOURNAVX is 100 mg orally. Take the starting dose on an empty stomach at least 1 hour before or 2 hours after food. Clear liquids may be consumed during this time (e.g., water, apple juice, vegetable broth, tea, black coffee).
	2. Doses 2, 3, and 4: Starting 12 hours after the initial dose, take 50 mg of JOURNAVX orally every 12 hours. Take these doses with or without food.
	3. Dose 5 and Subsequent Doses: Starting 12 hours after Dose 4, take 50 mg of JOURNAVX orally every 24 hours. Take these dose(s) with or without food.		Doses 2, 3, and 4: Starting 12 hours after the initial dose, take 50 mg of JOURNAVX orally every 12 hours. Take these doses with or without food.
	4. Avoid food or drink containing grapefruit during treatment with JOURNAVX.
			Dose 5 and Subsequent Doses: Starting 12 hours after Dose 4, take 50 mg of JOURNAVX orally every 24 hours. Take these dose(s) with or without food.

			Avoid food or drink containing grapefruit during treatment with JOURNAVX.
	\|warnings=FDA reported warnings and precautions associated with the JOURNAVX are as follows:		\|warnings=FDA reported warnings and precautions associated with the JOURNAVX are as follows:

Suzetrigene

2026-05-04T21:21:39Z

Created page with "{{DrugProjectFormSinglePage |authorTag={{AIJ}} |genericName=JOURNAVX |aOrAn=a |drugClass=sodium channel blocker |indicationType=treatment |indication=of moderate to severe pain acute pain, including postoperative pain, in adults. |adverseReactions=pruritus, muscle spasms, increased creatine phosphokinase, and rash. Add table 2 |blackBoxWarningTitle='''TITLE''' |blackBoxWarningBody=''Condition Name:</span..."

New page

{{DrugProjectFormSinglePage
|authorTag={{AIJ}}
|genericName=JOURNAVX
|aOrAn=a
|drugClass=sodium channel blocker
|indicationType=treatment
|indication=of moderate to severe pain acute pain, including postoperative pain, in adults.
|adverseReactions=pruritus, muscle spasms, increased creatine phosphokinase, and rash.

Add table 2
|blackBoxWarningTitle='''TITLE'''
|blackBoxWarningBody=''Condition Name:'' There is limited information regarding Black Box Warning of Suzetrigene in adult patients.
|fdaLIADAdult=Adult Indications.
JOURNAVX is indicated for the treatment of moderate to severe acute pain, including postoperative pain, in adults. Use JOURNAVX for the shortest duration, consistent with individual patient treatment goals. Use of JOURNAVX for the treatment of moderate to severe acute pain has not been studied beyond 14 days.

Recommended Dosage and Administration:
* The recommended starting dose of JOURNAVX is 100 mg orally.
* Take the starting dose on an empty stomach at least 1 hour before or 2 hours after food to avoid delay in onset of action.
* Clear liquids may be consumed during this time (e.g., water, apple juice, vegetable broth, tea, black coffee).
* Starting 12 hours after the initial dose, take 50 mg of JOURNAVX orally every 12 hours.
* Avoid food or drink containing grapefruit during treatment with JOURNAVX.

Dosage Form.
* Tablets: 50 mg, blue, film-coated, oblong tablets debossed with "VX50" on one side and plain on the other.

Recommedations regarding Missed Doses.
For patients on the standard recommended dosing schedule:
* If a dose is missed, take the missed dose as soon as possible and then take the next scheduled dose at the recommended time.
* If two or more doses are missed, take 100 mg and then take the next scheduled dose at the recommended time.
|offLabelAdultGuideSupport=There is limited information regarding ''Off-Label Guideline-Supported Use'' of Suzetrigene in adult patients.
|offLabelAdultNoGuideSupport=There is limited information regarding ''Off-Label Non–Guideline-Supported Use'' of Suzetrigene in adult patients.
|fdaLIADPed=There is limited information regarding indications and dosage of Suzetrigene in pediatric patients.
|offLabelPedGuideSupport=There is limited information regarding ''Off-Label Guideline-Supported Use'' of Suzetrigene in pediatric patients.
|offLabelPedNoGuideSupport=There is limited information regarding ''Off-Label Non–Guideline-Supported Use'' of Suzetrigene in pediatric patients.
|contraindications=* JOURNAVX is contraindicated in patients taking strong CYP3A inhibitors.
* When JOURNAVX is administered to patients taking moderate CYP3A inhibitors reduce the JOURNAVX dose, as described below:

1. Dose 1: The recommended starting dose of JOURNAVX is 100 mg orally. Take the starting dose on an empty stomach at least 1 hour before or 2 hours after food. Clear liquids may be consumed during this time (e.g., water, apple juice, vegetable broth, tea, black coffee).
2. Doses 2, 3, and 4: Starting 12 hours after the initial dose, take 50 mg of JOURNAVX orally every 12 hours. Take these doses with or without food.
3. Dose 5 and Subsequent Doses: Starting 12 hours after Dose 4, take 50 mg of JOURNAVX orally every 24 hours. Take these dose(s) with or without food.
4. Avoid food or drink containing grapefruit during treatment with JOURNAVX.
|warnings=FDA reported warnings and precautions associated with the JOURNAVX are as follows:

'''Increased Risk of Adverse Reactions with Concomitant Use with Strong or Moderate CYP3A Inhibitors'''
Strong and moderate CYP3A inhibitors increase suzetrigine and M6-SUZ (active metabolite) exposures which may cause JOURNAVX adverse reactions. Concomitant use of JOURNAVX with strong CYP3A inhibitors is contraindicated. Reduce the JOURNAVX dosage with moderate CYP3A inhibitors.

'''Risk of Drug Interactions with Certain CYP3A Substrates'''
Suzetrigine is an inducer of CYP3A. If JOURNAVX is used concomitantly with sensitive CYP3A substrates or CYP3A substrates where minimal concentration changes may lead to loss of efficacy, refer to the Prescribing Information for the CYP3A substrates for dosing instructions. Dosage adjustment of the concomitant CYP3A substrates may be required when initiating or discontinuing JOURNAVX.

'''Risk of Drug Interactions with Certain Hormonal Contraceptives'''
JOURNAVX-treated patients taking concomitant hormonal contraceptives containing progestins other than levonorgestrel and norethindrone should use additional nonhormonal contraceptives (such as condoms) or use alternative contraceptives (e.g., a combined oral contraceptive containing ethinyl estradiol as the estrogen and levonorgestrel or norethindrone as the progestin, an intrauterine system) during JOURNAVX treatment and for 28 days after discontinuation of JOURNAVX.

'''Risk of Adverse Reactions in Patients with Moderate and Severe Hepatic Impairment'''
Patients with moderate hepatic impairment have higher systemic exposures of suzetrigine and M6-SUZ (active metabolite) than those with normal hepatic function which may increase the risk of JOURNAVX related adverse reactions.Avoid use of JOURNAVX in patients with severe hepatic impairment (Child-Pugh Class C). The recommended JOURNAVX dosage is lower in patients with moderate hepatic impairment (Child-Pugh Class B) than those with normal hepatic function.
|clinicalTrials=The safety profile of JOURNAVX is primarily based on data from the pooled, double-blind, placebo- and active-controlled trials in 874 adult patients with moderate to severe acute pain following full abdominoplasty (Trial 1) and bunionectomy (Trial 2), with supportive safety data from one single arm trial in 256 adult patients with moderate to severe acute pain in a broad range of acute pain conditions (Trial 3).

'''Nausea and Vomiting'''

In Trial 1, the incidence of patients who experienced either nausea or vomiting was 20% in JOURNAVX-treated patients, 33% in HB/APAP-treated patients, and 25% in placebo-treated patients. In Trial 2, the incidence of patients who experienced either nausea or vomiting was 9% in JOURNAVX-treated patients, 16% in HB/APAP-treated patients, and 12% in placebo-treated patients.

'''Laboratory Abnormalities'''

Creatine Phosphokinase Elevations: In Trials 1 and 2, 2.9% of JOURNAVX-treated patients and 1.2% of placebo-treated patients had a creatine phosphokinase (CPK) level > 3 times the upper limit of normal. The incidence of increased blood CPK was 1.1% in JOURNAVX-treated patients and 0.5% in placebo-treated patients. All reports of CPK elevations occurred in the post-surgical setting. There were no associated signs or symptoms, no serious adverse reactions, and no patients required treatment discontinuation or interruption.

Decreased Estimated Glomerular Filtration Rate: In Trials 1 and 2, 2.5% of JOURNAVX-treated patients and 0.9% of placebo-treated patients had a decrease in estimated glomerular filtration rate (eGFR) of ≥ 25% but < 50%. Follow-up eGFR data for these controlled trials was not available after treatment discontinuation. Similar decreases in eGFR also occurred in Trial 3 (the open-label Phase 3 study) and appeared to resolve to baseline by the final safety follow-up visit. There was no control arm for comparison. There were no adverse reactions of eGFR decrease in JOURNAVX-treated patients.

'''Adverse Reactions from the Open-Label Study (Trial 3)'''

* In an open-label study of patients with moderate to severe acute pain following a surgical procedure or nonsurgical condition [NCT05661734], a total of 256 adult patients received at least one dose of JOURNAVX. Patients received 100 mg as a first dose, then 50 mg every 12 hours and continued to receive JOURNAVX for up to 14 days or until their pain resolved. Rescue medication of 650 mg of acetaminophen and 400 mg of ibuprofen together every 6 hours was permitted as needed for pain relief. The patients' perceptions of pain control was captured by patient global assessment (PGA). The mean duration of treatment with JOURNAVX was 9.6 days. The majority of patients were female (68%), and the median age was 43 years (range: 18 to 78).

* In Trial 3, a total of 222 (87%) patients received JOURNAVX for post-surgical pain; orthopedic surgery was the most common (e.g., ligament operation, arthrodesis), followed by plastic surgery (e.g., liposuction, mammoplasty), otorhinolaryngologic surgery (e.g., nasal septal operation, turbinoplasty), and general and urologic surgery (e.g., inguinal hernia repair). Thirty-four (13%) patients received JOURNAVX for non-surgical pain (e.g., arthralgias, limb pain, and sprains/strains).

* The proportion of patients who discontinued study drug prematurely was 2% due to adverse events (arrhythmia [0.4%], nausea [0.4%], somnolence [0.4%], rash [0.4%]) and 1.6% due to lack of efficacy.

* The safety profile of JOURNAVX in Trial 3 was consistent with that observed in Trials 1 and 2.
|drugInteractions=====Effect of Other Drugs on JOURNAVX====
* Food or drink containing grapefruit should be avoided during treatment with JOURNAVX.

Table 3.

====Effect of JOURNAVX on Other Drugs====

'''CYP3A Substrates'''

* If JOURNAVX is used concomitantly with sensitive CYP3A substrates or CYP3A substrates where minimal concentration changes may lead to loss of efficacy, refer to the Prescribing Information for the CYP3A substrates for dosing instructions. Dosage modification of the concomitant CYP3A substrates may be required when initiating or discontinuing JOURNAVX.

'''Hormonal Contraceptives'''

* JOURNAVX-treated patients using hormonal contraceptives containing progestins other than levonorgestrel and norethindrone should use additional nonhormonal contraceptives (such as condoms), or use alternative contraceptives (such as a combined oral contraceptive containing ethinyl estradiol as the estrogen and levonorgestrel or norethindrone as the progestin, or an intrauterine system) during treatment with JOURNAVX and for 28 days after discontinuation of JOURNAVX.
* JOURNAVX did not result in clinically significant changes in the pharmacokinetics of ethinyl estradiol and levonorgestrel when used concomitantly with an oral contraceptive containing ethinyl estradiol and levonorgestrel.
|useInPregnancyFDA='''Risk Summary'''

* There are no available data on the use of JOURNAVX during pregnancy to evaluate for a drug-associated risk of major birth defects, miscarriage or other adverse maternal or fetal outcomes.
* In animal reproduction studies in rats, effects on implantation and maintenance of pregnancy occurred at oral suzetrigine doses of ≥ 2.2-times the maximum recommended human dose (MRHD) when administered during early embryonic development or throughout organogenesis.
* In a pre- and postnatal development study, reduced mean gestation length and increased postnatal pup mortality were observed at maternal rat exposures of 1.6-times the MRHD and decreased rat pup body weights were observed during the period of birth to weaning at maternal exposures of 2.2-times the MRHD.
* No malformations were observed when suzetrigine was administered orally to rats and rabbits during the period of organogenesis at doses up to 2.2- and 5.9-times, respectively, the MRHD. The clinical relevance of these findings is unclear.
* The background risk of major birth defects and miscarriage in patients with moderate to severe acute pain is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes.
* In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.
|useInNursing='''Risk Summary'''

* There are no data on the presence of suzetrigine or its metabolites in human milk, the effects on the breastfed infant, or the effects on milk production.
* Suzetrigine is present in animal milk. When a drug is present in animal milk, it is likely that the drug will be present in human milk.
* The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for JOURNAVX and any potential adverse effects on the breastfed child from JOURNAVX or from the underlying maternal condition.
|useInPed=The safety and effectiveness of JOURNAVX has not been established in pediatric patients.
|useInGeri=* Of the total 1130 patients with moderate to severe acute pain who received JOURNAVX in the Phase 3 studies, 71 patients (6.3%) were 65 years of age and older.
* Clinical studies of JOURNAVX did not include sufficient numbers of patients aged 65 years and older to determine whether they respond differently from younger patients. However, based on population pharmacokinetic analyses in patients with ages ranging from 18 to 75 years, age does not have a clinically relevant impact on suzetrigine exposure.
|useInRenalImpair=* JOURNAVX has not been studied in patients with renal impairment of eGFR < 15 mL/min.
* Avoid use of JOURNAVX in patients with renal impairment of eGFR < 15 mL/min.
* The recommended dosage in patients with eGFR > 15 mL/min is the same as those with normal kidney function.
|useInHepaticImpair=* Avoid use of JOURNAVX in patients with severe hepatic impairment (Child-Pugh Class C.
* The recommended JOURNAVX dosage is lower in patients with moderate hepatic impairment (Child-Pugh Class B) than those with normal hepatic function.
* The recommended dosage in patients with mild hepatic impairment (Child-Pugh Class A) is the same as those with normal hepatic function.
* Patients with moderate hepatic impairment had greater suzetrigine and M6-SUZ (the active metabolite) exposure than those with normal hepatic function, which may increase the risk of suzetrigine adverse reactions.

Add table 1
|useInReproPotential='''Contraception'''

* Advise patients using hormonal contraceptives containing progestins other than levonorgestrel and norethindrone to use an additional nonhormonal contraceptive or to use alternative contraceptives during JOURNAVX treatment and for 28 days after discontinuation of JOURNAVX.

'''Infertility'''
* In a female fertility study in rats, increased pre-implantation loss was observed at oral suzetrigine doses of ≥ 2.2-times the MRHD when administered prior to mating and through Gestation Day 7.
* Following discontinuation of suzetrigine for 4 weeks, the increased pre-implantation loss in rats was not observed.
* The finding in rats may be explained by the effect of suzetrigine on the rat progesterone receptor, which was more sensitive to suzetrigine than the human progesterone receptor based on in vitro studies.
* JOURNAVX may reversibly impact the likelihood of females of reproductive potential to become pregnant while on treatment. Patients using contraceptives should continue to use contraceptives.
|overdose=* No specific antidote is available for overdose with JOURNAVX. Treatment of overdose consists of general supportive measures including monitoring of vital signs and observation of the clinical status of the patient. Consider contacting the Poison Help line (1-800-222-1222) or a medical toxicologist for additional overdose management recommendations.
|mechAction=Suzetrigine is a selective blocker of the NaV1.8 voltage-gated sodium channel, compared to other known voltage-gated sodium channels (NaV1.1 through 1.9). NaV1.8 is expressed in peripheral sensory neurons including dorsal root ganglion neurons, where its role is to transmit pain signals (action potentials). By selectively inhibiting NaV1.8 channels, suzetrigine inhibits transmission of pain signals to the spinal cord and brain. M6-SUZ, a major active metabolite, is a less potent inhibitor of NaV1.8 than suzetrigine by 3.7-fold.
|structure=The active ingredient in JOURNAVX (suzetrigine) tablets is suzetrigine, a sodium channel blocker, which has the following chemical name:

4-[(2R,3S,4S,5R)-3-(3,4-difluoro-2-methoxyphenyl)-4,5-dimethyl-5-(trifluoromethyl)oxolane-2-amido]pyridine-2-carboxamide. Its molecular formula is C21H20F5N3O4.

Add structure image.
|PD='''Cardiac Electrophysiology'''

At 2 times the exposure of the maximum recommended JOURNAVX dose, clinically significant QTc prolongation was not observed.
|nonClinToxic='''Carcinogenesis'''

* Long-term animal studies have not been completed to evaluate the carcinogenic potential of suzetrigine.

'''Mutagenesis'''

* Suzetrigine was not mutagenic in the bacterial reverse mutation assay (Ames test), or clastogenic in the in vitro micronucleus assay with a human TK6 lymphoblastoid cell line, or in the in vivo rat bone marrow micronucleus assay.

'''Impairment of Fertility'''

* In a female fertility study, female rats were treated orally with suzetrigine at 5, 10, and 15 mg/kg/day for a minimum of 14 days prior to mating, throughout mating, and through Gestation Day 7. These doses are approximately 0.57, 1.6, and 2.2-times the steady state MRHD exposure based on AUC. Increased pre-implantation loss was observed at 15 mg/kg (approximately 2.2-times the MRHD based on AUC).
* In a male fertility study, male rats were treated orally with suzetrigine at 200, 600, and 1000 mg/kg/day for a minimum of 28 days prior to mating and through mating. These doses are 3.6, 9.7, and 13.8-times the steady state MRHD exposure based on AUC, respectively. Suzetrigine had no effects on sperm parameters (motility, concentration, or morphology), reproductive performance or uterine parameters (number of implants, viable implants, pre-implantation loss, early resorptions, and post-implantation loss) at any dose.
|clinicalStudies='''Overview of Clinical Studies'''

* The efficacy of JOURNAVX in the treatment of moderate to severe acute pain in adults was established in two randomized, double-blind, placebo and active-controlled trials of acute pain, one following full abdominoplasty (Trial 1) [see Clinical Studies (14.2)] and the other following bunionectomy (Trial 2) [see Clinical Studies (14.3)].
* In each trial, pain intensity was measured using a patient-reported 11-point numeric pain rating scale (NPRS), ranging from 0 to 10, where zero corresponds to no pain and 10 corresponds to the worst pain imaginable.
* Patients were eligible for study participation if they had moderate to severe pain on the verbal categorical rating system (VRS) and a pain score of ≥ 4 on the NPRS, within 4 hours of the abdominoplasty completion (Trial 1) or during the 9-hour period after discontinuation of regional anesthesia following bunionectomy (Trial 2).
* Once eligible, patients were randomized to receive oral JOURNAVX, placebo, or hydrocodone bitartrate/acetaminophen (HB/APAP) for a duration of 48 hours.
* For the JOURNAVX treatment regimen, patients received an initial loading dose of 100 mg JOURNAVX, followed by 50 mg every 12 hours.
* For the HB/APAP-control regimen, patients received 5 mg/325 mg every 6 hours. * For both studies, 400 mg of ibuprofen every 6 hours, as needed for pain relief, was permitted as a rescue medication.

'''Moderate to Severe Acute Pain Following Full Abdominoplasty'''
* Trial 1 [NCT05558410] evaluated the efficacy of JOURNAVX over 48 hours in 1,118 adult patients with moderate to severe acute pain following a full abdominoplasty procedure (JOURNAVX n = 447, placebo n = 223, and hydrocodone bitartrate/acetaminophen (HB/APAP) n = 448).
* The majority of patients were female (98%), and the mean age was 42 years (range: 18 to 69).
* The study population consisted of 70% White participants, 27% Black or African American participants, 1% Asian participants, 0.8% Native Hawaiian or other Pacific Islander participants, 0.5% American Indian or Alaska Native participants, and 0.9% Other or Multiracial participants, among which 34% identified as Hispanic or Latino. The mean pain score at baseline was 7.4 (range: 4 to 10).
* All baseline characteristics, including NPRS, VRS, and BMI were generally balanced across treatment arms.
* In Trial 1, 89% of patients in the JOURNAVX group completed the treatment period (compared to 75% of patients in the placebo group and 85% of patients in the HB/APAP group), and 9% of patients in the JOURNAVX group discontinued due to lack of efficacy (compared to 22% of patients in the placebo group and 13% of patients in the HB/APAP group).
* Efficacy was evaluated by the time-weighted sum of the pain intensity difference from 0 to 48 hours (SPID48) in the JOURNAVX group compared to the placebo group and then to the HB/APAP group. Treatment with JOURNAVX demonstrated statistically significant superior reduction in pain compared to treatment with placebo.
* The median time to meaningful pain relief (defined as a ≥ 2-point reduction in NPRS) was 119 minutes for patients in the JOURNAVX group and 480 minutes for patients in the placebo group. The median time to onset of perceptible pain relief (defined as a ≥ 1-point reduction in NPRS) for patients in the JOURNAVX group was 34 minutes.

add figure

'''Moderate to Severe Acute Pain Following Bunionectomy'''
* Trial 2 [NCT05553366] evaluated the efficacy of JOURNAVX over 48 hours in 1,073 adult patients with moderate to severe acute pain following bunionectomy (JOURNAVX n = 426, placebo n = 216, and HB/APAP n = 431).
* The majority of patients were female (85%), and the mean age was 48 years (range: 18 to 75).
* The study population consisted of 71% White participants, 24% Black or African American participants, 2% Asian participants, 0.2% Native Hawaiian or other Pacific Islander participants, 1% American Indian or Alaska Native participants, and 1% Other or Multiracial participants, and 0.3% with race missing, among which 34% identified as Hispanic or Latino.
* The mean pain score at baseline was 6.8 (range: 4 to 10). All baseline characteristics, including NPRS, VRS, and BMI were generally balanced across treatment arms.
* In Trial 2, 87% of patients in the JOURNAVX group completed the treatment period (compared to 82% of patients in the placebo group and 90% of patients in the HB/APAP group), and 12% of patients in the JOURNAVX group discontinued due to lack of efficacy (compared to 16% of patients in the placebo group and 8% of patients in the HB/APAP group).
* Efficacy was evaluated by the time-weighted sum of the pain intensity difference from 0 to 48 hours (SPID48) in the JOURNAVX group compared to the placebo group and then to the HB/APAP group.
* In an exploratory analysis, the time-weighted sum of the pain intensity difference from 0 to 24 hours (SPID24) reported using the least square mean was 30.6 in the JOURNAVX group and 19.8 in the placebo group.

add table 6 and figure 2

'''Time to Onset of Pain Relief'''

The median time to meaningful pain relief (defined as ≥ 2-point reduction in NPRS) was 240 minutes for patients in the JOURNAVX group and 480 minutes in the placebo group. The median time to onset of perceptible pain relief (defined as a ≥ 1-point reduction in NPRS) for patients in the JOURNAVX group was 60 minutes.
|howSupplied=JOURNAVX (suzetrigine) tablets are supplied as blue, film-coated, oblong tablets containing 50 mg of suzetrigine. Each tablet is debossed with the characters "VX50" on one side and plain on the other, and is packaged as follows:

* 30-count bottle NDC 51167-548-30
* 100-count bottle NDC 51167-548-31
* 100-count Hospital Unit Dose Carton (10 blister cards, each containing 10 tablets) NDC 51167-548-34
|storage=* Store at 68°F to 77°F (20°C to 25°C); excursions permitted to 59°F to 86°F (15°C to 30°C).
|fdaPatientInfo='''Drug Interactions'''

* Ask patients to tell you all the medications they are taking, including any herbal supplements or vitamins.
* Food or drink containing grapefruit should be avoided.
* When used concomitantly with hormonal contraceptives containing a progestin other than levonorgestrel or norethindrone, advise patients to use an additional nonhormonal contraceptive (such as condoms) or use alternative contraceptives during JOURNAVX treatment and for 28 days after discontinuation of JOURNAVX.

'''Females of Reproductive Potential'''
* Advise females of reproductive potential that JOURNAVX may reversibly impact the likelihood to become pregnant while on treatment.
* Patients using contraceptives should continue to use contraceptives.

'''Use in Patients with Hepatic Impairment'''
* Inquire and/or assess whether patients have hepatic impairment.

'''Administration Instructions'''
* Advise patients to take the starting dose of JOURNAVX on an empty stomach at least 1 hour before or 2 hours after food to avoid delay in onset of action.
* Clear liquids may be consumed (such as water, apple juice, vegetable broth, tea, or black coffee) during this time.
* Avoid food or drink containing grapefruit during treatment with JOURNAVX.
* Subsequent doses of JOURNAVX can be taken with or without food.
* Patients should be instructed to swallow JOURNAVX tablets whole (do not chew or crush).
* Inform patients about what to do in the event they miss a dose of JOURNAVX.
|alcohol=Alcohol-Suzetrigene interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
|brandNames=JOURNAVX
|lookAlike=There is limited information regarding Look-Alike Drug Names to JOURNAVX.
}}

Sandbox

2026-05-04T16:09:28Z

ACEI / ARB

Show changes

Ischemic stroke medical therapy

2026-05-03T15:59:28Z

Overview

← Older revision		Revision as of 15:59, 3 May 2026
Line 4:		Line 4:

	==Overview==		==Overview==
	~~The medical therapy of [[~~ischemic stroke]] is ~~mainly~~ directed to ~~fibrinolysis of clot by r-tPA~~ with in ~~3 to 4~~.5 hours ~~of symptom~~ onset~~. Acute treatment with antiplatelets may have a role if given within~~ 24~~-48~~ hours ~~of stroke onset~~. ~~Long term management with statins,~~ antiplatelets, ~~anticoagulants~~, ~~antihypertensive and antidiabetic agents may help prevent the recurrence.<ref>{{cite journal \|author=Hackam DG~~, Spence JD \|title=Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modeling study \|journal=Stroke \|volume=38 \|issue=6 \|pages=1881–5 \|year=2007 \|pmid=17431209 \|doi=10.1161/STROKEAHA.106.475525}}</ref>		Acute ischemic stroke therapy is primarily directed to rapid reperfusion with intravenous thrombolysis (alteplase or tenecteplase) in eligible patients and endovascular thrombectomy (EVT) in eligible patients with large vessel occlusion (LVO); these treatments should be considered in parallel and should not delay each other.
	~~Acute treatment to control blood pressure, blood glucose~~ and ~~fever may help prevent the complications and have a prognostic significance~~.
			Antiplatelet therapy (usually aspirin) is recommended within 24–48 hours after onset in most patients who are not receiving IV thrombolysis, and is generally delayed until 24 hours after thrombolysis.

			Secondary prevention includes antiplatelets or anticoagulation depending on etiology (eg, atrial fibrillation), lipid-lowering therapy, and risk-factor management.

	==Medical Therapy==		==Medical Therapy==

Sandbox

2026-05-03T14:43:03Z

Show changes