In one study in healthy adults, concomitant administration of ethanol with a single 20-mg oral dose of nifedipine capsules resulted in a 54% increase in the AUC of nifedipine.Nefazodone, an inhibitor of the CYP3A isoenzyme, may inhibit the metabolism of nifedipine and increase nifedipine exposure; blood pressure should be monitored, and a reduction of nifedipine dosage should be considered in patients receiving nefazodone concomitantly with nifedipine.St. You’ll have to typically submit a reimbursement claims form with: For additional information on possible risks, Nifedipine shares the toxic potentials of the calcium-channel blocking agents, and the usual precautions of these agents should be observed.Because nifedipine decreases peripheral vascular resistance and occasionally causes excessive and poorly tolerated hypotension, blood pressure should be monitored carefully, especially during initiation of therapy and titration or upward adjustment of dosage. (For additional information on the use of antihypertensive drugs in women with preeclampsia, Nifedipine has been used effectively in the management of Raynaud's phenomenon and is considered a drug of choice for the management of this condition. 1. Administration of diltiazem 30- or 90-mg doses 3 times daily followed by a single 20-mg dose of nifedipine in healthy individuals increased nifedipine AUC values by 2.2 or 3.1 times, respectively, and peak plasma nifedipine concentrations by 2 or 1.7 times, respectively.Nifedipine has been shown to inhibit the formation of oxidized metabolites of irbesartan in vitro; however, concomitant nifedipine therapy had no effect on irbesartan pharmacokinetics in clinical studies.In addition, since candesartan is not substantially metabolized by the CYP isoenzyme system, no substantial drug interaction has been reported in individuals receiving nifedipine concomitantly with candesartan.Concomitant use of nifedipine with ketoconazole, itraconazole, or fluconazole may affect the pharmacokinetics of nifedipine, possibly secondary to the inhibition of the CYP3A isoenzyme, and increased exposure of nifedipine may occur.
{* backButton *} Therapy should be initiated with the 10 mg capsule. Nifedipine also has been used orally in the hospital setting for urgent lowering of blood pressure in severely hypertensive pregnant women, including those with preeclampsia. In most cases, the laboratory test abnormalities were not associated with clinical symptoms; however, cholestasis (with or without jaundice) has been reported. Results of a case-control study indicate dose-dependent increases in the risk of myocardial infarction (by about 60%) in hypertensive patients (with or without diagnosed cardiovascular disease, but excluding myocardial infarction or heart failure) receiving a short-acting calcium-channel blocking agent (e.g., nifedipine, diltiazem, verapamil) compared with those receiving a diuretic or a β-adrenergic blocking agent. The bioavailability of nifedipine as Adalat CC extended-release tablets relative to conventional nifedipine capsules is about 84-89%. You can submit for FSA reimbursement in two ways: Patients receiving the drugs concomitantly should be monitored for signs and symptoms of digoxin toxicity and dosage of the cardiac glycoside reduced if necessary.Since nifedipine may produce hyperglycemia which may lead to loss of glycemic control, glucose concentrations should be carefully monitored and adjustment of nifedipine dosage should be considered in patients receiving concomitant therapy with nifedipine and acarbose.Nifedipine appears to enhance absorption of metformin. Some experts recommend a usual dosage range of 30-60 mg once daily.If nifedipine is used for the management of hypertension in children, some experts recommend a usual initial dosage of 0.25-0.5 mg/kg daily, administered as extended-release tablets once daily or in 2 divided doses daily. Delivery of nifedipine from the formulation depends on the existence of an osmotic gradient between the fluid in the GI tract and the osmotically active core of the tablet, with drug delivery remaining approximately constant as long as the gradient is maintained and then declining parabolically to zero as the concentration inside the tablet falls below saturation. Administration of Adalat CC extended-release tablets immediately after a high-fat meal increases peak plasma nifedipine concentrations by 60% and delays the time to peak plasma concentrations; however, no substantial changes in AUC occur. Adalat CC extended-release tablets should be used with caution in patients with renal impairment because absorption of the drug may be altered in such patients. In women who are already receiving antihypertensive therapy prior to pregnancy, ACOG states there are insufficient data to make recommendations regarding the continuance or discontinuance of such therapy; treatment decisions should be individualized in these situations. The manufacturers warn that short-acting nifedipine should be avoided in patients with acute coronary syndrome when myocardial infarction may be imminent. Because orally administered nifedipine undergoes extensive metabolism on first pass through the liver, bioavailability of the drug from extended-release tablets is increased substantially in patients with liver cirrhosis and may be particularly increased in those with portacaval shunts.
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