Details About Generic Salt ::  Nifedipi

Main Medicine Class:: Calcium channel blocker   

(nye-FED-ih-peen)

Adalat

Capsules: 10 mg

Capsules: 20 mg

Adalat CC

Tablets, extended-release: 30 mg

Tablets, extended-release: 60 mg

Tablets, extended-release: 90 mg

Nifedical XL

Tablets, extended-release: 30 mg

Tablets, extended-release: 60 mg

Procardia

Capsules: 10 mg

Capsules: 20 mg

Procardia XL

Tablets, extended-release: 30 mg

Tablets, extended-release: 60 mg

Tablets, extended-release: 90 mg

Adalat PA

Adalat PA 10

Adalat PA 20

Adalat XL

Apo-Nifed

Apo-Nifed PA

Gen-Nifedipine

Novo-Nifedin

Nu-Nifed

Taro-Nifedipine

Class: Calcium channel blocker

 Indications Treatment of vasospastic (Prinzmetal’s or variant) angina, chronic stable angina, hypertension (sustained-release tablets only).

 Contraindications Sick sinus syndrome; second- or third-degree AV block, except with functioning pacemaker.

 Route/Dosage

Capsules: ADULTS: PO 10 mg tid (usual dose range, 10 to 20 mg tid); swallow whole. Some patients (eg, coronary artery spasm) respond only to higher doses administered more frequently (eg, 20 to 30 mg tid to qid; max 180 mg/day). In hospitalized patients, under close observation, dose may be increased in 10 mg increments throughout 4- to 6-hr periods as required to control pain and arrhythmias caused by ischemia. A single dose rarely exceeds 30 mg. Extended-release tablets: ADULTS: PO Procardia XL and Nifedical XL: 30 or 60 mg once daily, titrated over 7- to 14-day period (max, 120 mg/day). Adalat CC (hypertension): Start with 30 mg/day and titrate dose over 7- to 14-day period (max, 90 mg/day).

 Interactions

Barbiturates, rifampin: May reduce nifedipine levels, decreasing the therapeutic effect. Cimetidine: May increase bioavailability of nifedipine. Cisapride, diltiazem: May elevate nifedipine levels, increasing the risk of side effects. Fentanyl, parenteral magnesium: Hypotension may occur. Melatonin: May interfere with the antihypertensive effects of nifedipine. Tacrolimus: Tacrolimus trough concentrations may be elevated, increasing the risk of toxicity. Other hypertensive agents: May have additive effects.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Peripheral edema; hypotension; palpitations; syncope; CHF; MI; arrhythmia; pulmonary edema; angina; tachycardia. CNS: Dizziness; lightheadedness; giddiness; nervousness; headache; sleep disturbances; insomnia; abnormal dreams; blurred vision; equilibrium disturbances; weakness; jitteriness; paresthesia; somnolence; malaise; anxiety. DERMATOLOGIC: Dermatitis; rash; pruritus; urticaria; Stevens-Johnson syndrome. EENT: Tinnitus; sinusitis; rhinitis. GI: Nausea; diarrhea; constipation; abdominal discomfort; cramps; dyspepsia; dry mouth; flatulence. GU: Micturition disorders; sexual difficulties. HEPATIC: Hepatitis; hepatotoxicity; elevations of LFT enzymes. HEMATOLOGIC: Anemia; leukopenia; thrombocytopenia; bruising; positive Coombs’ test with or without hemolytic anemia. RESPIRATORY: Nasal or chest congestion; shortness of breath; wheezing; cough; respiratory infection. OTHER: Flushing; gingival hyperplasia; sweating; muscle cramps, pain and inflammation; joint stiffness, pain, or arthritis; chills; fever; thirst.

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk in small amounts. CHILDREN: Safety and efficacy not established. ELDERLY: May experience greater hypotensive effects. Acute hepatic injury: In rare instances, nifedipine has been associated with significant elevations in liver enzymes, symptoms consistent with acute hepatic injury, cholestasis with or without jaundice and allergic hepatitis. Antiplatelet effects: Nifedipine decreases platelet aggregation and can increase bleeding time in some patients. Beta-blocker withdrawal: Patients withdrawn from beta-blockers while taking nifedipine may experience increased angina. CHF: Use drug with caution in patients with CHF. Edema: Nifedipine has been associated with edema in some cases and should be distinguished from fluid retention secondary to heart failure. Hepatic impairment: Use drug with caution in patients with impaired hepatic function, reduced hepatic blood flow, or hepatic cirrhosis. Increased angina: Occasional patients may have increased frequency, duration, or severity of angina at start of therapy or when dose is increased. Withdrawal: Abrupt withdrawal may cause increased frequency and duration of angina.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

• Taper initiation and discontinuation of drug over 7 to 14 days.
• May be administered without regard to meals.
• Have patient swallow sustained-release tablets whole; do not allow patient to chew, divide, or crush.
• Procardia XL and Adalat CC are not rated as generic equivalents; do not be interchanged without health care provider’s authorization.
• If beta-blockers are being withdrawn while patient is taking nifedipine, gradually taper beta-blocker dose.
• Start patients with impaired hepatic function with low doses.
• When using immediate-release capsules for treatment of hypertensive emergencies, puncture capsules, and squeeze liquid contents under tongue, or puncture capsule several times and have patient chew.
• Store capsules at room temperature and protect from light and moisture.

 Assessment/Interventions

• Obtain history, including drug history and any known allergies. Evaluate cardiac, endocrine, respiratory, hepatic, CNS, renal, and GI systems.
• Obtain baseline and follow-up vital signs; assess for chest pain.
• If drug is used as antihypertensive, routinely monitor BP and note any orthostatic hypotension.
• Inspect skin for rashes.
• Assess for any unusual bruising or bleeding.
• Check BP at least once daily when patient is taking both nifedipine and cimetidine. If possible, another H₂ antagonist may be prescribed instead of cimetidine.
• Administer sublingual nitroglycerin if breakthrough chest pain occurs. Record frequency and duration of anginal attacks and use of sublingual nitroglycerin.
• If any changes from baseline vital signs occur, notify health care provider.

OVERDOSAGE: SIGNS & SYMPTOMS   Hypotension, nausea, weakness, dizziness, drowsiness, confusion, slurred speech, second- or third-degree AV block, marked and prolonged hypotension and bradycardia, decreased cardiac output, functional rhythms

 Patient/Family Education

• Remind patient that sustained-release capsules must be swallowed whole, not chewed, divided, or crushed.
• Teach patient the importance of good dental care, and advise that patient visit dentist on routine basis because gum swelling may occur.
• Instruct patient to maintain increased fluid intake (if not contraindicated) to avoid constipation.
• Instruct patient that medication must be used chronically to obtain benefit and to notify health care provider if at least 2 doses are missed.
• Teach patient/family to notify health care provider of any changes from baseline evaluation (ie, chest pain, shortness of breath).
• Inform patient that there may be increased chest pain at start of medication and with dose changes, but that this effect is transient. If it persists, notify health care provider.
• If health care provider prescribes coadministration of sublingual nitroglycerin, teach patient how to take nitroglycerin sublingually.
• Explain that when sustained-release form is used, partially undigested tablet may appear in feces but that this effect is no cause for concern.
• Instruct patient to report the following symptoms to the health care provider: ringing in ears, swollen gums, respiratory changes, inability to sleep, fever, or chills.
• Advise patient that drug may cause dizziness, lightheadedness, and blurred vision, and to use caution while driving or performing other tasks requiring mental alertness.

Drugs Class ::

Indications for Drugs ::

 Indications Treatment of vasospastic (Prinzmetal’s or variant) angina, chronic stable angina, hypertension (sustained-release tablets only).

Drug Dose ::

 Route/Dosage

Capsules: ADULTS: PO 10 mg tid (usual dose range, 10 to 20 mg tid); swallow whole. Some patients (eg, coronary artery spasm) respond only to higher doses administered more frequently (eg, 20 to 30 mg tid to qid; max 180 mg/day). In hospitalized patients, under close observation, dose may be increased in 10 mg increments throughout 4- to 6-hr periods as required to control pain and arrhythmias caused by ischemia. A single dose rarely exceeds 30 mg. Extended-release tablets: ADULTS: PO Procardia XL and Nifedical XL: 30 or 60 mg once daily, titrated over 7- to 14-day period (max, 120 mg/day). Adalat CC (hypertension): Start with 30 mg/day and titrate dose over 7- to 14-day period (max, 90 mg/day).

Contraindication ::

 Contraindications Sick sinus syndrome; second- or third-degree AV block, except with functioning pacemaker.

Drug Precautions ::

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk in small amounts. CHILDREN: Safety and efficacy not established. ELDERLY: May experience greater hypotensive effects. Acute hepatic injury: In rare instances, nifedipine has been associated with significant elevations in liver enzymes, symptoms consistent with acute hepatic injury, cholestasis with or without jaundice and allergic hepatitis. Antiplatelet effects: Nifedipine decreases platelet aggregation and can increase bleeding time in some patients. Beta-blocker withdrawal: Patients withdrawn from beta-blockers while taking nifedipine may experience increased angina. CHF: Use drug with caution in patients with CHF. Edema: Nifedipine has been associated with edema in some cases and should be distinguished from fluid retention secondary to heart failure. Hepatic impairment: Use drug with caution in patients with impaired hepatic function, reduced hepatic blood flow, or hepatic cirrhosis. Increased angina: Occasional patients may have increased frequency, duration, or severity of angina at start of therapy or when dose is increased. Withdrawal: Abrupt withdrawal may cause increased frequency and duration of angina.

Drug Side Effects ::

 Adverse Reactions

CARDIOVASCULAR: Peripheral edema; hypotension; palpitations; syncope; CHF; MI; arrhythmia; pulmonary edema; angina; tachycardia. CNS: Dizziness; lightheadedness; giddiness; nervousness; headache; sleep disturbances; insomnia; abnormal dreams; blurred vision; equilibrium disturbances; weakness; jitteriness; paresthesia; somnolence; malaise; anxiety. DERMATOLOGIC: Dermatitis; rash; pruritus; urticaria; Stevens-Johnson syndrome. EENT: Tinnitus; sinusitis; rhinitis. GI: Nausea; diarrhea; constipation; abdominal discomfort; cramps; dyspepsia; dry mouth; flatulence. GU: Micturition disorders; sexual difficulties. HEPATIC: Hepatitis; hepatotoxicity; elevations of LFT enzymes. HEMATOLOGIC: Anemia; leukopenia; thrombocytopenia; bruising; positive Coombs’ test with or without hemolytic anemia. RESPIRATORY: Nasal or chest congestion; shortness of breath; wheezing; cough; respiratory infection. OTHER: Flushing; gingival hyperplasia; sweating; muscle cramps, pain and inflammation; joint stiffness, pain, or arthritis; chills; fever; thirst.

Drug Mode of Action ::  

Drug Interactions ::

 Interactions

Barbiturates, rifampin: May reduce nifedipine levels, decreasing the therapeutic effect. Cimetidine: May increase bioavailability of nifedipine. Cisapride, diltiazem: May elevate nifedipine levels, increasing the risk of side effects. Fentanyl, parenteral magnesium: Hypotension may occur. Melatonin: May interfere with the antihypertensive effects of nifedipine. Tacrolimus: Tacrolimus trough concentrations may be elevated, increasing the risk of toxicity. Other hypertensive agents: May have additive effects.

Drug Assesment ::

 Assessment/Interventions

• Obtain history, including drug history and any known allergies. Evaluate cardiac, endocrine, respiratory, hepatic, CNS, renal, and GI systems.
• Obtain baseline and follow-up vital signs; assess for chest pain.
• If drug is used as antihypertensive, routinely monitor BP and note any orthostatic hypotension.
• Inspect skin for rashes.
• Assess for any unusual bruising or bleeding.
• Check BP at least once daily when patient is taking both nifedipine and cimetidine. If possible, another H₂ antagonist may be prescribed instead of cimetidine.
• Administer sublingual nitroglycerin if breakthrough chest pain occurs. Record frequency and duration of anginal attacks and use of sublingual nitroglycerin.
• If any changes from baseline vital signs occur, notify health care provider.

Drug Storage/Management ::

 Administration/Storage

• Taper initiation and discontinuation of drug over 7 to 14 days.
• May be administered without regard to meals.
• Have patient swallow sustained-release tablets whole; do not allow patient to chew, divide, or crush.
• Procardia XL and Adalat CC are not rated as generic equivalents; do not be interchanged without health care provider’s authorization.
• If beta-blockers are being withdrawn while patient is taking nifedipine, gradually taper beta-blocker dose.
• Start patients with impaired hepatic function with low doses.
• When using immediate-release capsules for treatment of hypertensive emergencies, puncture capsules, and squeeze liquid contents under tongue, or puncture capsule several times and have patient chew.
• Store capsules at room temperature and protect from light and moisture.

Drug Notes ::

 Patient/Family Education

• Remind patient that sustained-release capsules must be swallowed whole, not chewed, divided, or crushed.
• Teach patient the importance of good dental care, and advise that patient visit dentist on routine basis because gum swelling may occur.
• Instruct patient to maintain increased fluid intake (if not contraindicated) to avoid constipation.
• Instruct patient that medication must be used chronically to obtain benefit and to notify health care provider if at least 2 doses are missed.
• Teach patient/family to notify health care provider of any changes from baseline evaluation (ie, chest pain, shortness of breath).
• Inform patient that there may be increased chest pain at start of medication and with dose changes, but that this effect is transient. If it persists, notify health care provider.
• If health care provider prescribes coadministration of sublingual nitroglycerin, teach patient how to take nitroglycerin sublingually.
• Explain that when sustained-release form is used, partially undigested tablet may appear in feces but that this effect is no cause for concern.
• Instruct patient to report the following symptoms to the health care provider: ringing in ears, swollen gums, respiratory changes, inability to sleep, fever, or chills.
• Advise patient that drug may cause dizziness, lightheadedness, and blurred vision, and to use caution while driving or performing other tasks requiring mental alertness.

Disclaimer ::

The Information available on this site is for only Informational Purpose , before any use of this information please consult your Doctor .Price of the drugs indicated above may not match to real price due to many possible reasons may , including local taxes etc.. These are only approximate indicative prices of the drug.