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Nifedipine

 

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MILTON NIFEDIPINE 20MG SR BY 30’S
ITS  Calcium-channel blocking agent; dihydropyridine derivative
Uses for Nifedipine
Angina
Used in the management of Prinzmetal variant angina and chronic stable angina pectoris.a
Calcium-channel blockers considered the drugs of choice in management of Prinzmetal variant angina.a
Appears to be as effective as β-adrenergic blocking agents (e.g., propranolol) and/or oral nitrates in the management of chronic stable angina pectoris; however, generally should be used only when the patient cannot tolerate adequate doses of or is refractory to these drugs.a
Hypertension
Management of hypertension (alone or in combination with other classes of antihypertensive agents).126 309 342 343 344 345 348 351 500
Only extended-release formulations currently are recommended for management of hypertension.121 126 178 181 183 184 191 192 193 197 201 202 204 205 206 207 208 209 210 211 212 213 225 226 264 309 342 344 348 500 (See Cautions.)
Calcium-channel blockers are recommended as one of several preferred agents for the initial management of hypertension; other options include ACE inhibitors, angiotensin II receptor antagonists, and thiazide diuretics.501 502 503 504 While there may be individual differences with respect to specific outcomes, these antihypertensive drug classes all produce comparable effects on overall mortality and cardiovascular, cerebrovascular, and renal outcomes.501 502 503 504 Individualize choice of therapy; consider patient characteristics (e.g., age, ethnicity/race, comorbidities, cardiovascular risk) as well as drug-related factors (e.g., ease of administration, availability, adverse effects, cost).
Calcium-channel blockers may be preferred in hypertensive patients with certain coexisting conditions (e.g., ischemic heart disease) and in geriatric patients, including those with isolated systolic hypertension.
Black hypertensive patients generally respond better to monotherapy with calcium-channel blockers or thiazide diuretics than to other antihypertensive drug classes (e.g., ACE inhibitors, angiotensin II receptor antagonists) However, diminished response to these other drug classes is largely eliminated when administered concomitantly with a calcium-channel blocker or thiazide diuretic.
The optimum BP threshold for initiating antihypertensive drug therapy is controversial.Further study needed to determine optimum BP thresholds/goals; individualize treatment decisions

Raynaud’s Phenomenon

Drug of choice for the management of Raynaud’s phenomenon, preferably administered as extended-release formulations.

Preterm Labor

Has been used in selected women to inhibit uterine contractions in preterm labor (tocolysis) and prolong gestation when beneficial

Nifedipine Dosage and Administration

Adminisration

Extended-release Tablets

Administer orally once daily.
Extended-release tablets should be swallowed intact and should not be chewed, crushed, or broken.
Whenever extended-release tablets are dispensed or administered, care should be taken to ensure that the extended-release dosage form actually was prescribed.
Dosage of extended-release nifedipine tablets should be decreased gradually with close clinical supervision when discontinuance of the drug is required.
FOR ANGINA

Extended-release Tablets

Oral
Initially, 30 or 60 mg once daily.
Increase dosage gradually at 7- to 14-day intervals until optimum control of angina is obtained.
Dosage may be increased more rapidly to 90 mg daily in increments of 30 mg daily after steady state is achieved (usually achieved on the second day of therapy with a given dose) if symptoms so warrant and patient’s tolerance and response are frequently assessed.
In some patients, especially those with evidence of coronary artery spasm, higher dosages may be necessary. However, experience with antianginal dosages exceeding 90 mg once daily as extended-release tablets is limited and should be employed with caution and only when clinically necessary.
Extended-release tablets can be substituted for the conventional capsules at the nearest equivalent total daily dose.
FOR HYPERTENSION

Extended-release Tablets

Oral
Initially, 30 or 60 mg once daily.
Increase dosage gradually at 7- to 14-day intervals until optimum control of BP is obtained.
Dosage may be increased more rapidly, if symptoms so warrant and the patient’s tolerance and response to therapy are frequently assessed.
Usual maintenance dosage is 30–60 mg once daily.
If intolerable adverse effects occur, consider dosage reduction; if adverse effects worsen or fail to resolve, may need to discontinue and switch to another antihypertensive drug class

Nifedipine Pharmacokinetics

Absorption

Bioavailability

Following oral administration of conventional capsules, approximately 90% of a dose is absorbed with peak serum concentrations usually attained within 0.5–2 hours.
Oral bioavailability of extended-release tablets is approximately 75–89% of that achieved with same doses as conventional capsules.
Peak plasma concentrations for extended-release tablets are attained within about 2.5–6 hours.

Food

Food decreases the rate but not extent of absorption from conventional capsules.
Food can increase the early rate of GI absorption of extended-release tablets but does not affect overall bioavailability

Distribution

Extent

Nifedipine is distributed into milk.

Plasma Protein Binding

Approximately 92–98%.

Special Populations

Plasma protein binding may be decreased in patients with renal or hepatic impairment.

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