Hypertension: Oral: Initial: 2.5 mg twice daily; may increase in increments of 2.5 mg/day at intervals ≥2 days until desired BP response is achieved; if divided doses are not the same, give the smaller dose in the morning and larger dose(s) in the afternoon; average dose: 25 mg/day (usually in 3 divided doses, but more frequent dosing may be required). Note: Avoid abrupt discontinuation; gradual tapering is recommended.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution; use with extreme caution, if at all, if renal impairment is manifested by a rising or elevated BUN. Use is contraindicated in uremia.
There are no dosage adjustments provided in the manufacturer's labeling
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Tablet, Oral, as hydrochloride:
Vecamyl: 2.5 mg
No
Oral: The morning dose should be relatively small and, in some instances, may even be omitted; the larger dose should be given at noon time and possibly in the evening. Administration after meals may cause a more gradual absorption and smoother control of excessively high BP; timing of relationship to meals should be consistent.
Hypertension: Management of moderately severe to severe hypertension and in uncomplicated malignant hypertension.
Sound-alike/look-alike issues:
Mecamylamine may be confused with mesalamine
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Cardiovascular: Orthostatic hypotension, syncope
Central nervous system: Altered mental status, choreiform movements, convulsions, fatigue, orthostatic dizziness, paresthesia, sedation
Endocrine & metabolic: Decreased libido
Gastrointestinal: Anorexia, constipation (sometimes preceded by small, frequent stools), glossitis, intestinal obstruction, nausea, vomiting, xerostomia
Genitourinary: Impotence, urinary retention
Neuromuscular & skeletal: Tremor, weakness
Ophthalmic: Blurred vision, mydriasis
Respiratory: Pulmonary edema, pulmonary fibrosis
Hypersensitivity to mecamylamine or any component of the formulation; mild, moderate, labile hypertension (may not be suitable for uncooperative patients); coronary insufficiency or recent myocardial infarction; uremia; glaucoma; organic pyloric stenosis; coadministration with antibiotics or sulfonamides
Concerns related to adverse effects:
• CNS effects: CNS effects, including tremor, choreiform movements, mental aberrations, and convulsions may occur (rarely), especially with large doses or in patients with cerebral or renal insufficiency. In addition, dizziness, lightheadedness, or fainting may also occur.
• Paralytic ileus: Discontinue if signs of paralytic ileus occur (eg, frequent loose bowel movements with abdominal distention, decreased borborygmi)
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with marked cerebral and coronary arteriosclerosis or after a recent cerebral accident.
• Prostatic hyperplasia/urinary stricture: Use with caution in patients with prostatic hyperplasia, bladder obstruction, or urethral stricture; may cause urinary retention.
• Renal impairment: Use with caution in patients with renal impairment. When renal impairment is manifested by a rising or elevated BUN, use with extreme caution, if at all. Since mecamylamine is excreted unchanged in the urine, renal impairment may reduce elimination and increase the risk of adverse effects including hypotension; the risk for neurological adverse effects is increased especially when large doses are administered to patients with renal impairment.
Other warnings/precautions:
• Abrupt discontinuation: Do not abruptly discontinue.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Alcohol (Ethyl): May enhance the adverse/toxic effect of Mecamylamine. Risk C: Monitor therapy
Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Alkalinizing Agents: May increase the serum concentration of Mecamylamine. Risk C: Monitor therapy
Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification
Aminoglycosides: May enhance the neuromuscular-blocking effect of Mecamylamine. Risk X: Avoid combination
Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy
Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy
Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination
Capreomycin: May enhance the neuromuscular-blocking effect of Mecamylamine. Risk X: Avoid combination
Colistimethate: May enhance the neuromuscular-blocking effect of Mecamylamine. Risk X: Avoid combination
Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy
Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy
Flunarizine: May enhance the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy
Herbal Products with Blood Pressure Increasing Effects: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy
Levodopa-Containing Products: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. Risk C: Monitor therapy
Lincosamide Antibiotics: May enhance the neuromuscular-blocking effect of Mecamylamine. Risk X: Avoid combination
Loop Diuretics: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy
Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification
Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy
Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Polymyxin B: May enhance the neuromuscular-blocking effect of Mecamylamine. Risk X: Avoid combination
Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Sulfonamides: May enhance the adverse/toxic effect of Mecamylamine. Risk X: Avoid combination
Tetracyclines: May enhance the neuromuscular-blocking effect of Mecamylamine. Risk X: Avoid combination
Thiazide and Thiazide-Like Diuretics: May enhance the adverse/toxic effect of Mecamylamine. Management: Consider avoiding the use of mecamylamine and thiazide diuretics. If combined, mecamylamine prescribing information suggests reducing the mecamylamine dose by 50% in order to avoid excessive hypotension. Risk D: Consider therapy modification
Urinary Acidifying Agents: May decrease the serum concentration of Mecamylamine. Risk C: Monitor therapy
Vasopressin: Mecamylamine may enhance the therapeutic effect of Vasopressin. Specifically, the effect of vasopressin on mean arterial blood pressure may be increased. Risk C: Monitor therapy
Mecamylamine crosses the placenta.
Due to the potential for serious adverse reactions in the nursing infant, the manufacturer recommends a decision be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of treatment to the mother.
Take after meals. Concomitant use of alcohol may potentiate the effects of mecamylamine.
Monitor BP (assess in the erect position before initiation and with dose increases), orthostatic vital signs, and heart rate.
Mecamylamine inhibits acetylcholine at the autonomic ganglia, causing a decrease in blood pressure. The blood pressure lowering effect is predominantly orthostatic; the supine blood pressure is also significantly decreased.
Onset: 0.5 to 2 hours
Duration: 6 to ≥12 hours
Absorption: Almost complete
Excretion: Urine (unchanged); rate of elimination is significantly affected by the pH of the urine. Acidic urine promotes excretion; alkalinization reduces excretion
Tablets (Vecamyl Oral)
2.5 mg (per each): $75.84
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