OTHER BRAND NAMES
Calcium channel blocker (CCB) (dihydropyridine)
Management of vasospastic angina and chronic stable angina (effort-associated angina) w/o evidence of vasospasm in patients who remain symptomatic despite adequate doses of β-blockers and/or organic nitrates, or who cannot tolerate those agents.
Vasospastic Angina/Chronic Stable Angina (Effort-Associated Angina):
Initial: 10mg tid
Usual Range: 10-20mg tid, or 20-30mg tid-qid in patients w/ evidence of coronary artery spasm
Titrate: Adjust dose over a 7- to 14-day period; may increase dose from 10mg tid to 20mg tid, then 30mg tid over a 3-day period based on physical activity level, attack frequency, and SL nitroglycerin consumption. May increase in 10mg increments over 4- to 6-hr periods in hospitalized patients to control pain and arrhythmias due to ischemia; single dose should rarely exceed 30mg
Decrease dose gradually w/ close supervision
Other Important Considerations
Avoid coadministration w/ grapefruit juice
Swallow cap whole.
Cap: 20mg; (Procardia) 10mg
May cause hypotension; monitor BP initially and w/ titration. Should not be used for acute reduction of BP or control of essential HTN. May increase frequency, duration and/or severity of angina or acute myocardial infarction (AMI), particularly w/ severe obstructive coronary artery disease (CAD). Avoid w/ acute coronary syndrome (when infarction may be imminent) and w/in the 1st week or 2 after MI. May develop heart failure (HF) after beginning therapy; increased risk w/ tight aortic stenosis. Mild to moderate peripheral edema associated w/ arterial vasodilation may occur; differentiate peripheral edema from the effects of increasing left ventricular dysfunction in patients w/ angina complicated by congestive heart failure (CHF). Transient elevations of enzymes (eg, alkaline phosphatase, CPK, LDH, SGOT, SGPT), cholestasis w/ or w/o jaundice, and allergic hepatitis reported (rare). May decrease platelet aggregation and increase bleeding time. Positive direct Coombs test w/ or w/o hemolytic anemia reported. Reversible elevations in BUN and SrCr reported rarely in patients w/ chronic renal insufficiency.
Dizziness, lightheadedness, giddiness, flushing, heat sensation, headache, weakness, nausea, heartburn, muscle cramps, tremor, peripheral edema, nervousness, mood changes, palpitation.
β-blockers may increase the likelihood of CHF, severe hypotension, or angina exacerbation; avoid abrupt β-blocker withdrawal. Severe hypotension and/or increased fluid volume requirements reported together w/ β-blockers and fentanyl or other narcotic analgesics; if condition permits, allow sufficient time (at least 36 hrs) for nifedipine to be washed out prior to surgery w/ fentanyl. May increase digoxin levels; monitor when initiating, adjusting, and discontinuing therapy to avoid possible over- or under-digitalization. May decrease plasma levels of quinidine. May increase PT w/ coumarin anticoagulants. Cimetidine may increase levels; caution during titration. Phenytoin may lower systemic exposure to nifedipine; avoid w/ phenytoin or any known CYP3A4 inducer. CYP3A inhibitors (eg, fluconazole, itraconazole, clarithromycin) may increase exposure; monitor carefully and consider initiating nifedipine at lowest dose available. Increased plasma concentrations w/ grapefruit juice. Monitor w/ other medications known to lower BP.
PREGNANCY AND LACTATION
Category C, caution in nursing.
MECHANISM OF ACTION
Calcium channel blocker (dihydropyridine); inhibits Ca2+ ion influx into cardiac muscle and smooth muscle. Angina: has not been established; believed to act by relaxation and prevention of coronary artery spasm and reduction of oxygen utilization.
Absorption: Rapid and fully absorbed; Tmax=30 min. Distribution: Plasma protein binding (92-98%); found in breast milk. Metabolism: Liver, extensive. Elimination: Kidneys (80%); T1/2=2 hrs.
Assess for acute coronary syndrome, severe obstructive CAD, aortic stenosis, hepatic/renal impairment, recent β-blocker withdrawal, hypersensitivity to the drug, pregnancy/nursing status, and possible drug interactions.
Monitor for excessive hypotension, increased frequency, duration and/or severity of angina and/or AMI, peripheral edema, HF, cholestasis w/ or w/o jaundice, allergic hepatitis, and other adverse reactions. Monitor BP, CPK, LFTs, BUN, SrCr, for decreased platelet aggregation, and increased bleeding time.
Inform about potential risks/benefits of drug. Instruct to notify physician if pregnant/nursing or if any adverse reactions occur.
15-25°C (59-77°F). Protect from light and moisture.
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