Adalat CC (nifedipine)
OTHER BRAND NAMES
Nifediac CC, Afeditab CR
Calcium channel blocker (CCB) (dihydropyridine)
Treatment of HTN alone or in combination with other antihypertensive agents.
Initial: 30mg qd
Titrate: Increase dose over a 7- to 14-day period based on therapeutic efficacy and safety
Maint: 30-60mg qd
Max: 90mg qd
Start at low end of dosing range
Decrease dose gradually w/ close physician supervision
Take PO on empty stomach
Swallow tab whole; do not chew, crush, or divide
Tab, Extended-Release: (Adalat CC) 30mg, 60mg, 90mg, (Afeditab CR) 30mg, 60mg, (Nifediac CC) 30mg, 60mg, 90mg
(Adalat CC) Cardiogenic shock and concomitant use with strong P450 inducers (eg, rifampin).
May cause hypotension; monitor BP initially or with titration. May increase frequency, duration, and/or severity of angina or acute myocardial infarction (MI) upon starting or at time of dose increase, particularly with severe obstructive coronary artery disease (CAD). May develop congestive heart failure (CHF), especially with tight aortic stenosis or β-blockers. Peripheral edema may occur; rule out peripheral edema caused by left ventricular dysfunction if HTN is complicated by CHF. Transient elevations of enzymes (eg, alkaline phosphatase, CPK, LDH, SGOT, SGPT), cholestasis with/without jaundice, and allergic hepatitis reported rarely. May decrease platelet aggregation and increase bleeding time. Lab test interactions may occur. Reversible elevations in BUN and SrCr reported rarely in patients with chronic renal insufficiency. Caution with renal/hepatic impairment and in elderly. Adalat CC: Reduced clearance in cirrhosis; initiate lowest dose possible. Contains lactose; avoid with hereditary galactose intolerance problems, Lapp lactase deficiency, and glucose-galactose malabsorption. Nifediac CC: Contains tartrazine, which may cause allergic-type reactions in certain susceptible persons (eg, patients with aspirin hypersensitivity).
Peripheral edema, headache, flushing, heat sensation, dizziness, fatigue, asthenia, nausea, constipation.
See Contraindications. β-blockers may increase risk of CHF, severe hypotension, or angina exacerbation; avoid abrupt β-blocker withdrawal. Severe hypotension and/or increased fluid volume may occur with β-blockers and fentanyl or other narcotic analgesics. May increase plasma levels of digoxin; monitor digoxin levels when initiating, adjusting, and discontinuing therapy. May increase PT with coumarin anticoagulants. Monitor with other medications known to lower BP. Enhanced hypotensive effect with benazepril and timolol. Avoid with grapefruit juice; stop grapefruit juice intake at least 3 days prior to therapy. Increased exposure with CYP3A inhibitors (eg, ketoconazole, itraconazole, fluconazole, erythromycin, clarithromycin, nefazodone, fluoxetine, diltiazem, verapamil, cimetidine, quinupristin/dalfopristin, amprenavir, atazanavir, delavirdine, fosamprenavir, indinavir, nelfinavir, ritonavir, saquinavir), valproic acid, and doxazosin; monitor BP and consider dose reduction. Increased levels with quinidine; monitor HR and adjust dose if necessary. Monitor blood glucose levels and consider dose adjustment with acarbose. May increase plasma levels of metformin. May increase exposure of tacrolimus; monitor blood levels and consider dose reduction. May decrease doxazosin levels; monitor BP and reduce dose. May inhibit metabolism of CYP3A substrates. Afeditab CR/Nifediac CC: Decreased exposure with CYP3A4 inducers (eg, rifampin, rifapentine, phenytoin, phenobarbitone, carbamazepine, St. John's wort); monitor BP and consider dose adjustment. Adalat CC: May increase the BP-lowering effects of diuretics, PDE-5 inhibitors, and α-methyldopa. Magnesium sulfate IV in pregnant women may cause excessive fall in BP. Increased plasma concentrations with cisapride.
PREGNANCY AND LACTATION
Category C, not for use in nursing.
MECHANISM OF ACTION
Calcium channel blocker (dihydropyridine); inhibits the transmembrane influx of Ca2+ ions into vascular smooth muscle and cardiac muscle. Involves peripheral arterial vasodilation and reduction in peripheral vascular resistance, resulting in reduced arterial BP.
Absorption: Complete; Tmax=2.5-5 hrs; (90mg) Cmax=115ng/mL. Distribution: Plasma protein binding (92-98%); found in breast milk. Metabolism: Liver via CYP3A4. Elimination: Urine (60-80%, metabolite; <0.1%, unchanged); feces (metabolite); T1/2=7 hrs.
Assess for previous hypersensitivity to the drug, CHF, severe obstructive CAD, aortic stenosis, hepatic/renal impairment, pregnancy/nursing status, and possible drug interactions. (Adalat CC) Assess for cirrhosis, hereditary galactose intolerance problems, Lapp lactase deficiency, and glucose-galactose malabsorption. (Nifediac CC) Assess for susceptibility for tartrazine hypersensitivity (eg, aspirin hypersensitivity).
Monitor for excessive hypotension, increased frequency, duration and/or severity of angina and/or acute MI (especially during initiation and dose titration), CHF, peripheral edema, cholestasis with/without jaundice, and allergic hepatitis. Monitor BP, LFTs, BUN, SrCr, and increased bleeding time.
Inform about potential benefits/risks of therapy. Instruct to notify physician if pregnant/nursing or if any adverse reactions occur. (Afeditab CR) Advise patients that empty matrix "ghost" tab may pass via colostomy or in the stool and this should not be a concern.
Adalat CC/Afeditab CR: <30°C (86°F). Nifediac CC: 25°C (77°F); excursions permitted to 15-30°C (59-86°F). Protect from light and moisture.
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