A young man with severe resistant hypertension is started on oral minoxidil along with a beta-blocker and a loop diuretic. Which combination of adverse effects is characteristic of minoxidil?
- A Dry cough, angioedema, taste disturbance
- B Hyperkalemia, metabolic acidosis, nephrolithiasis
- C Hypertrichosis, pericardial effusion, reflex tachycardia and fluid retention ✓
- D Gingival hyperplasia, hirsutism, pedal edema
Explanation
Minoxidil opens ATP-sensitive potassium channels in vascular smooth muscle, causing potent arteriolar dilation. Reflex sympathetic activation drives tachycardia and increased renin release, mandating co-administration of a beta-blocker; sodium and water retention mandates a loop diuretic. Hypertrichosis is a well-known cosmetic adverse effect, and pericardial effusion occurs especially in renal failure patients. Gingival hyperplasia belongs to phenytoin and nifedipine, hyperkalemia to potassium-sparing diuretics, and cough with angioedema to ACE inhibitors.
Reference: Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed.
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