Nifedipine instructions for use, contraindications, side effects, reviews. Nifedipine: immediate reduction in blood pressure

Medicine Nifedipine effectively eliminates pain associated with unstable angina, lowers blood pressure to normal, and reduces ischemia in the area of the coronary vessels.
It is taken orally in tablet form. It is quickly absorbed into the bloodstream and has a selective effect on calcium channels, which conventionally belong to the second selective class. Due to the effect of inhibition of calcium metabolism, the process of entry of these ions into the cellular structures of the myocardium slows down. Also, the vascular bed of large arteries gets rid of excess calcium. The tension tone decreases, the vascular wall relaxes and the lumen of the artery and vein increases. According to the instructions, the use of nifedipine can reduce the heart rate.
Against the background of expansion of the coronary and cerebral great vessels, there is an increase in the flow of blood enriched with glucose and oxygen to the tissues of the heart and brain. These processes create favorable conditions for the rapid restoration of cells affected by ischemia. Oxygen saturation increases, anginal symptoms are reduced.

Indications for use

Apply Nifedipine(phenigidine) as an antianginal agent for ischemic heart disease with angina attacks, to reduce blood pressure in various types of hypertension, including renal hypertension. There are indications that nifedipine (and verapamil) in nephrogenic hypertension slows the progression of renal failure.
Also used in complex therapy of chronic heart failure. Previously, it was believed that nifedipine and other calcium ion antagonists are not indicated for heart failure due to the negative inotropic effect. Recently, it has been found that all these drugs, due to their peripheral vasodilator action, improve heart function and help reduce its size in chronic heart failure. There is also a decrease in pressure in the pulmonary artery. However, the possibility of a negative inotropic effect of nifedipine should not be excluded; caution should be exercised in cases of severe heart failure. Recently, reports have appeared about the inappropriateness of using nifedipine for arterial hypertension, due to an increased risk of myocardial infarction, as well as the possibility of an increased risk of death in patients with coronary heart disease with long-term use of idenfat.
This mainly concerns the use of “regular” nifedipine (short-acting), but not its prolonged dosage forms and long-acting dihydropyridines (for example, amlodipine). This question, however, remains debatable.
There is evidence of the positive effect of nifedipine on cerebral hemodynamics and its effectiveness in Raynaud's disease. In patients with bronchial asthma, no significant bronchodilator effect was observed, but the drug can be used in combination with other bronchodilators (sympathomimetics) for maintenance therapy.

Mode of application

Accept Nifedipine orally (regardless of the time of meal) 0.01-0.03 g (10-30 mg) 3-4 times a day (up to 120 mg per day). Duration of treatment is 1-2 months. and more.
To relieve (relieve) a hypertensive crisis (a rapid and sharp rise in blood pressure), and sometimes during attacks of angina, the drug is used sublingually. A tablet (10 mg) is placed under the tongue. Nifedipine tablets, placed unchewed under the tongue, dissolve within a few minutes. To speed up the effect, chew the tablet and hold it under the tongue without swallowing. With this method of administration, patients should remain in a lying position for 30-60 minutes. If necessary, repeat taking the drug after 20-30 minutes; sometimes the dose is increased to 20-30 mg. After stopping the attacks, they switch to taking the drug orally.
Retard tablets are recommended for long-term therapy. Prescribe 20 mg 1-2 times a day; less often 40 mg 2 times a day. Retard tablets are taken after meals, without chewing, with a small amount of liquid.
To relieve (relieve) a hypertensive crisis (a rapid and sharp rise in blood pressure), the drug is recommended to be administered at a dose of 0.005 g for 4-8 hours (0.0104-0.0208 mg/min). This corresponds to 6.3-12.5 ml of solution for infusion per hour. The maximum dose of the drug - 15-30 mg per day - can be used for no more than 3 days.

Side effects

Nifedipine usually well tolerated. However, redness of the face and skin of the upper body, headache, probably associated with a decrease in the tone of the cerebral (cerebral) vessels (mainly capacitive) and their stretching due to increased blood flow through arteriovenous anastomoses (artery and vein connections), are relatively common. In these cases, the dose is reduced or the drug is taken after meals.
Palpitations, nausea, dizziness, swelling of the lower extremities, hypotension (low blood pressure), and drowsiness are also possible.

Contraindications

Severe forms of heart failure, unstable angina, acute myocardial infarction, sick sinus syndrome (heart disease accompanied by rhythm disturbances), severe arterial hypotension (low blood pressure).

Nifedipine is contraindicated during pregnancy and breastfeeding.
Caution is needed when prescribing the drug to transport drivers and people in other professions that require a quick mental and physical reaction.

Interaction with other drugs

When used simultaneously Nifedipine with antihypertensive drugs, diuretics, phenothiazine derivatives, the antihypertensive effect of nifedipine is enhanced.
When used simultaneously with anticholinergic drugs, memory and attention problems may occur in elderly patients.
When used simultaneously with beta-blockers, severe arterial hypotension may develop; in some cases - the development of heart failure.
When used simultaneously with nitrates, the antianginal effect of nifedipine is enhanced.
When used simultaneously with calcium preparations, the effectiveness of nifedipine decreases due to an antagonistic interaction caused by an increase in the concentration of calcium ions in the extracellular fluid.
Cases of the development of muscle weakness have been described when used simultaneously with magnesium salts.
When used simultaneously with digoxin, it is possible to slow down the excretion of digoxin from the body and, consequently, increase its concentration in the blood plasma.
When used simultaneously with diltiazem, the antihypertensive effect is enhanced.
When used simultaneously with theophylline, changes in the concentration of theophylline in the blood plasma are possible.
Rifampin induces the activity of liver enzymes, accelerating the metabolism of nifedipine, which leads to a decrease in its effectiveness.
When used simultaneously with phenobarbital, phenytoin, carbamazepine, the concentration of nifedipine in the blood plasma decreases.
There are reports of an increase in the concentration of nifedipine in the blood plasma and an increase in its AUC when used simultaneously with fluconazole and itraconazole.
When used simultaneously with fluoxetine, the side effects of nifedipine may increase.
In some cases, when used simultaneously with quinidine, a decrease in the concentration of quinidine in the blood plasma is possible, and when nifedipine is discontinued, a significant increase in the concentration of quinidine is possible, which is accompanied by a prolongation of the QT interval on the ECG.
The concentration of nifedipine in blood plasma may increase moderately.
Cimetidine and, to a lesser extent, ranitidine, increase the concentration of nifedipine in the blood plasma and, thus, enhance its antihypertensive effect.
Ethanol may enhance the effect of nifedipine (excessive hypotension), which causes dizziness and other undesirable reactions.

Pregnancy

Adequate and strictly controlled safety studies Nifedipine not performed during pregnancy. The use of nifedipine during pregnancy is not recommended.
Since nifedipine is excreted in breast milk, its use should be avoided during lactation or breastfeeding should be discontinued during treatment.
Experimental studies revealed the embryotoxic, fetotoxic and teratogenic effects of nifedipine.

Overdose

Symptoms of drug overdose Nifedipine: severe bradycardia, bradyarrhythmia, arterial hypotension, in severe cases - collapse, conduction slowdown. When taking a large number of retard tablets, signs of intoxication appear no earlier than after 3-4 hours and can additionally be expressed in loss of consciousness up to coma, cardiogenic shock, convulsions, hyperglycemia, metabolic acidosis, hypoxia.
Treatment: gastric lavage, taking activated charcoal, administering norepinephrine, calcium chloride or calcium gluconate in atropine solution (iv). Hemodialysis is ineffective.

Storage conditions

List B. In a place protected from light.

Release form

Film-coated tablets containing 0.01 g (10 mg) of the drug. Long-acting tablets nifedipine retard, 0.02 g (20 mg). Solution for infusion (1 ml contains 0.0001 g of nifedipine) in 50 ml bottles complete with a “Perfusor” (or “Injectomat”) syringe and a “Perfusor” (or “Injectomat”) polyethylene tube. Solution for intracoronary administration (1 ml contains 0.0001 g of nifedipine) in syringes of 2 ml in a package of 5 pieces.

Compound

2,6-Dimethyl-4-(2-nitrophenyl)-1,4-dihydropyridine-3,5-dicarboxylic acid dimethyl ester.
Yellow crystalline powder. Practically insoluble in water, slightly soluble in alcohol.
Nifedipine (phenigidine) is the main representative of calcium ion antagonists - 1,4-dihydropyridine derivatives.

Synonyms

Adalat, Cordafen, Cordipin, Corinfar, Nifangin, Nifecard, Nifcard, Adarat, Calcigard, Nifacard, Nifelat, Procardia, Phenigidin, Cordaflex, Nifesan, Apo-Nifed, Depin E, Dignokonstant, Nifadil, Nifebene, Nifehexal, Nifedipat, Novo-Nifidin , Pidilat, Ronian, Sanfidipin, Fenamon, Ecodipin.

Additionally

Nifedipine is also included in the drug Kalbeta.
Nifedipine corresponds to the domestic drug - phenigidine (Phenyhydinum; Phenigidin, Phenihidin).

Main settings

Name:	NIFEDIPINE
ATX code:	C08CA05 -

Hypertensive crisis, the sudden appearance of chest pain, requires urgent intervention. Nifedipine - the instructions for use of which stipulate the effective action of the drug as an ambulance, helps lower blood pressure and relieve an attack. What is the principle of action of the medicine, in what cases does it help to cope with the disease, are there any contraindications for use - more about this in the instructions for use.

What is Nifedipine

The drug Nifedipine is an antihypertensive drug for vascular and cardiac therapy. This is a representative of the group of calcium channel blockers. The instructions describe the features of the drug, which:

relaxes the smooth muscles of blood vessels;
dilates arteries;
reduces the heart's need for oxygen;
increases blood flow;
reduces heart rate.

The advantage of Nifedipine, as stated in the instructions for use, is that the product:

used for chronic diseases and as emergency aid;
has antihypertensive properties - lowers blood pressure;
at the same time has an antianginal effect - reduces chest pain;
quickly restores cells damaged by ischemia.

pharmachologic effect

According to the instructions, the use of Nifedipine blocks the activity of slow calcium channels in the cell membrane. This action reduces the flow of calcium ions into the muscles, heart arteries, and peripheral vessels. Processes occur at the cellular level. As a result:

activation of blood circulation in the heart;
increase in the lumen of coronary and arterial vessels;
increased blood flow in the kidneys;
decreased blood pressure;
reduction of vascular resistance to blood flow in the periphery.

The medicine does not accumulate in the body. After using Nifedipine orally:

the active substance is absorbed from the gastrointestinal mucosa;
enters the blood, binds to plasma proteins, stays in the body for a long time;
the composition is metabolized in the liver, forming breakdown products;
the remains are excreted from the body in the urine - half the dose during the day;
bioavailability increases after eating.

Compound

Instructions for use specify the composition of the drug. The main active ingredient is nifedipine. Auxiliary components:

potato starch;
milk sugar;
povidone 25;
microcrystalline cellulose;
magnesium stearate;
sodium lauryl sulfate;
twin 80;
hypromelose;
titanium dioxide E171;
talc;
macrogol 6000;
quinoline yellow E 104.

Release form

The instructions for use of Nifedipine stipulate that the drug is available in several forms. Each has features of use and action. Doctors prescribe:

Dragees are balls with a pleasant taste. They can be swallowed, but for a quick effect it is better to dissolve them under the tongue. Used as an ambulance to relieve symptoms.
Solution for intravenous administration - used in clinical settings of cardiology departments, in intensive care.
Syringes with composition for intracoronary administration.
Gel for the treatment of hemorrhoids.

A special conversation about Nifedipine tablets. According to the instructions, two types are used:

Short action. The medicine is used to urgently reduce high blood pressure and eliminate chest pain for patients in whom attacks are rare.
Long-acting nifedipine. The drug is prescribed for daily use in order to maintain a stable condition of a patient with arterial hypertension and coronary heart disease. It is easy to choose an individual course of compensatory therapy - tablets are available in a variety of dosages.

Indications for use

According to the instructions for use, Nifedipine is used to treat high blood pressure. When used, a hypertensive crisis quickly stops. Nifedipine may be recommended in case of:

angina pectoris;
spasm of the coronary arteries;
Raynaud's syndrome;
congestive cardiopulmonary failure;
arterial hypertension of any degree;
hypertrophic cardiomyopathy.

The drug Nifedipine has excellent reviews from cardiologists and therapists. In accordance with the instructions, its use is effective in diagnosing:

pulmonary hypertension;
cerebrovascular accidents;
hypertensive crisis;
blockage of blood vessels;
heart failure;
stagnation of blood;
coronary heart disease;
atherosclerosis of peripheral arteries;
bronchospasms.

Instructions for use of Nifedipine

The manual for the drug specifies the composition, indications for use, contraindications and side effects. The instructions for Nifedipine warn:

the maximum dosage should not exceed 30 mg per day;
Women during pregnancy are allowed to take the medicine from the 16th week under the supervision of a doctor, so as not to harm the fetus;
duration of treatment, dosage prescribed by the doctor;
Nifedipine during breastfeeding requires switching to artificial nutrition for the duration of treatment.

Side effects

When increasing the dosage of Nifedipine, according to the instructions for use, side effects may occur. The changes affect the entire body. Observed from the system:

cardiovascular - tachycardia, low blood pressure, palpitations, chest pain, fainting, angina attacks;
central nervous system – dizziness, drowsiness, fatigue, headache, swallowing problems, depression.

The drug Nifedipine at high dosages can cause allergic reactions, itching, dermatitis, anaphylactic shock, Quincke's edema. Side effects from other body systems are observed:

respiratory – development of shortness of breath, cough, bronchospasms;
digestive – nausea, increased appetite, diarrhea, constipation, dry mouth, liver dysfunction;
urinary – deterioration of kidney function;
musculoskeletal system – hand tremors, joint swelling, myalgia;
hematopoietic organs – thrombocytopenia, leukopenia, anemia.

Contraindications

Instructions for use warn of the presence of contraindications. A doctor should prescribe the medication to eliminate the risk of complications. Since the drug greatly reduces blood pressure, caution must be exercised. It is prohibited to use Nifedipine in the following cases:

acute myocardial infarction;
severe form of heart failure;
unstable angina;
arterial hypotension;
cardiogenic shock;
narrowing of the mitral valve;
tachycardia;
bradycardia.

Although the drug is available and inexpensive, according to the instructions, treatment with the drug is contraindicated if:

pregnancy;
lactation;
hypersensitivity to components;
allergic reactions;
heart rhythm disturbances;
liver, kidney failure;
gastrointestinal obstruction;
cerebrovascular accidents;
elderly, children - up to 18 years.

Interaction

When prescribing the drug, the doctor should study the instructions for use in order to know the interaction of Nifedipine with other drugs. This is important for the patient's health. When used simultaneously with:

Rifampicin – effectiveness decreases;
Fluoxetine – more side effects;
nitrates – tachycardia increases;
ethanol – pressure reduction is activated;
beta-blockers - heart failure develops.

special instructions

The instructions stipulate special points that are important when using Nifedipine. These include treatment of elderly people, when a lower dose is required, and careful monitoring of renal function. Factors to consider:

it is necessary to give up alcohol for the period of treatment;
it is necessary to limit work that requires quick reaction and concentration;
exclude the use of vehicles.

Important points when using Nifedipine - necessity:

gradual withdrawal of the drug;
regular treatment, even if the condition improves, if a long-acting medication is prescribed;
reducing the dose of the drug in patients with liver dysfunction and cerebrovascular accident;
informing the anesthesiologist if there is a need for surgery under general anesthesia.

Nifedipine tablets are necessary for hypertensive patients and are a common remedy for pressure , eliminating pain and reducing ischemia.

The drug is available in several versions:

adalat – solution for intravenous administration;
short-acting tablets that canrelieve crisis (cordaflex, nifedipine, cordafen, cordipine, phenigidine);
long-acting drug takenlong-term (Cordaflex RD, Corinfar, Nifekar Chl, Calcigard Retard, Osmo-Adalat).

Listed medications for pressure combines the active substance, the mechanism of action on the body and the pharmacological effect. Differ from lowering Blood pressure drugs, the duration of the result obtained, the speed of onset of the effect from the moment of taking/administering the medication. Given the differences, each form has its own indications, which the doctor must be aware of.

How does nifedipine affect the body?

Tells more about Nifedipine instructions for use, at what pressureand how to take it, what are the side effects and contraindications. However, it is not necessary to understand medical terminology. The active substance is classified as a Ca channel blocker. This means that the channels in the cell wall through which calcium enters are blocked.

There are many calcium channels in the muscles, including the heart. Penetrating into the cell, calcium provokes excitation, causing muscle tissue to contract.

When calcium channels are blocked, not much calcium will enter the cell, which means that the lumen in the vessels will expand, because their walls and circular muscle fibers will not actively contract under the influence of calcium.

Due to the expansion of the heart arteries, blood flow to the myocardium improves, and the increased lumen of distant arteries ensures a decrease in pressure . The vascular walls relax, the lumen of the veins and arteries increases, the frequency of myocardial contractions is possible reduce.

The dilated blood vessels that carry blood to the heart and brain provide blood flow to the major organs and supply glucose and oxygen. Against the background of such favorable conditions, cells affected by ischemia and pathologies are poorly restored.

When is Nifedipine prescribed?

Blood pressure medication prescribed for various pathologies, each time selecting the appropriate form of medication:

as a prophylaxis for angina pectoris in patients with coronary artery disease;
in order to reduce vascular spasms in patients with Prinzmetal's angina;
for lowering pain in the chest, if nitroglycerin is not possible accept ;
to control blood pressure in hypertensive patients in the long term;
to quickly stop hypertensive crisis;
for Raynaud's syndrome to relieve spasms of distant blood vessels.

The liquid form of the drug is administered intravenously in a hospital if the patient is in serious condition. Short-acting tablets capable of fast reduce blood pressure, used in case of an acute attack of angina and hypertension.

For long-term treatment of hypertension indicators pressure normalized with long-acting tablets.

Dosage of the drug

If the patient has read the instructions and knows what dosagereduces blood pressure, in case of hypertension, act according to the principle: “what I want, that’s what I want.” I drink "It can be dangerous. A doctor can prescribe pills; they work individually for each patient.

The standard daily dosage is 30-80 g. If short-acting tablets are taken, then the daily dose is divided into 3-4 doses, and if long-acting tablets are prescribed, take them 1-2 times a day. In case of severe hypertension and variant angina, the daily dosage can be increased to 120 mg for some time, but only as prescribed by a doctor and when the drug is well tolerated. The maximum daily dose is 120 mg.

When you need to remove a pressure surge, a 10-20 mg tablet is placed under the tongue, which will act within 15 minutes. Do the same in case of pain in the sternum. In the hospital, an angina attack or crisis is stopped by intravenous administration of Nifedipine in a volume of 5 mg/hour, the daily dose being 30 mg.

An overdose of the drug is manifested by swelling of the face, headache, prolonged drop in pressure, bradycardia, bradyarrhythmia and absence of pulse in distant arteries. In case of severe intoxication, loss of consciousness and collapse are possible.

To provide first aid, you need to do a gastric lavage, then prescribe activated charcoal at the rate of 1 tablet per 10 kg of body weight. The drug antidote for Nifedipine is calcium; to help the patient, calcium chloride or calcium gluconate in a 10% solution is administered.

Adverse reactions

Like other blood pressure pills, Nifedipine causes adverse reactions in the body:

from the gastrointestinal tract: diarrhea, nausea, heartburn and liver failure. If you take the drug in large doses for a long time, this will affect the liver in the form of cholestasis or increased transaminases;
from the cardiovascular system: swelling of the skin and limbs, severe drop in pressure, feeling of warmth, asystole, tachycardia, bradycardia, angina pectoris;
from the central and peripheral nervous system: headaches, with long-term use muscle pain, sleep problems, tremors and visual disturbances;
from the genitourinary system: increased diuresis, with long-term use - failure of the kidneys;
from the side of hematopoiesis: leukopenia and thrombocytopenia;
from the endocrine system - a manifestation of gynecomastia.

An allergy to the components of Nifedipine may result in a skin rash or burning sensation at the injection site. With intravenous administration, an increase in the frequency of myocardial contractions and the development of hypotension is possible.

Contraindications

Nifedipine is not prescribed for hypotension, collapse, severe aortic stenosis, cardiogenic shock, severe heart failure, acute infarction, tachycardia, and minors.

Nifedipine is not recommended for pregnant and lactating women, although in gynecological practice there are cases when the medicine was necessary in case of ineffectiveness of the drugs. In such cases, the doctor weighs the risks, and may prescribe the drug in the later stages of pregnancy in order to stop the hypertensive crisis and normalize the condition of the expectant mother.

In pregnant women, Nifedipine reduces uterine tone, but no clinical studies have been conducted on this issue. Pregnant women are strictly prohibited from taking the medicine on their own; the decision must be made by a doctor.

A similar prescription should be used with caution in patients with diabetes mellitus, malignant arterial hypertension, serious cerebral circulatory disorders, and kidney and liver dysfunction.

Efficacy of Nifedipine

Since the development of the drug, sufficient international studies of effectiveness have been conducted; reports on the benefits, safety and advisability of prescribing Nifedipine have been presented. In 2000, the results of the INSIGHT study were presented, according to which the drug is safe, effectively helps with hypertension, is well tolerated compared to diuretics, and helps reduce the risk of heart attack and stroke in hypertensive patients.

The results of the Action study confirmed the safety of long-term Nifedipine and its ability to reduce the need for coronary artery bypass grafting and coronary angiography. In combination with other drugs, Nifedipine improves the prognosis in hypertensive patients and patients with angina pectoris, including the condition after myocardial infarction.

The recommendations of the European Society of Cardiology contain notes on the positive effect of long-acting Nifedipine on the health of patients with stable angina, both in monotherapy and in combination with nitrates and beta-blockers.

Tablets with short-term effects are recommended as an emergency treatment for hypertensive crisis; if taken for a long time, this is fraught with complications.

Drug interactions

Before prescribing blood pressure pills, the doctor will assess the patient’s condition, refer for diagnostics, and select a dosage and treatment regimen. You should tell your doctor if you are taking medications, since Nifedipine does not combine well with all of them.

The combined use of Nifedipine with diuretics, nitrates, tricyclic antidepressants leads to accumulation of the effect and an increase in the blood pressure-lowering effect.

In combination with beta blockers, the hypotensive effect is enhanced and heart failure develops. Cimetidine, together with Nifedipine, increases the concentration of the latter in the blood plasma. If you take Rifampin along with Nifedipine, the metabolism of the latter will accelerate and the effectiveness of its action on the body will decrease.

It is important to consider that long-term treatment of patients with high blood pressure or coronary artery disease is carried out with long-acting drugs. It is valid for 12-24 hours. As for short-term tablets, they should be used as an ambulance for a hypertensive crisis, when you need to effectively and quickly reduce blood pressure.

According to research and practice, if you use short-acting Nifedipine for a long time, this is fraught with a stroke or heart attack.

The doctor selects the dosage of tablets individually in each individual case. It is not worth treating yourself, relying on the instructions for the drug, as this can lead to dangerous consequences.

Selective class II calcium channel blocker, dihydropyridine derivative
Drug: NIFEDIPINE

Active substance of the drug: nifedipine
ATX coding: C08CA05
KFG: Calcium channel blocker
Registration number: P No. 015233/01
Registration date: 05/12/08
Owner reg. credential: BALKANPHARMA-DUPNITZA AD (Bulgaria)

Nifedipine release form, drug packaging and composition.

Dragee of regular shape, yellow color; on the fracture there is a yellow core of a fine-grained structure. 1 tablet nifedipine 10 mg
Excipients: lactose, wheat starch, microcrystalline cellulose, talc, gelatin, magnesium stearate, sugar coating.
10 pieces. - blisters (5) - cardboard packs.

DESCRIPTION OF THE ACTIVE SUBSTANCE.
All information provided is provided for information only about the drug; you should consult your doctor about the possibility of use.

Pharmacological action Nifedipine

Selective class II calcium channel blocker, dihydropyridine derivative. Inhibits the flow of calcium into cardiomyocytes and vascular smooth muscle cells. Has antianginal and hypotensive effects. Reduces the tone of vascular smooth muscles. Dilates coronary and peripheral arteries, reduces peripheral vascular resistance, blood pressure and slightly reduces myocardial contractility, reduces afterload and myocardial oxygen demand. Improves coronary blood flow. It has virtually no antiarrhythmic activity. Does not inhibit myocardial conductivity.

Pharmacokinetics of the drug.

When taken orally, it is quickly absorbed from the gastrointestinal tract. It is metabolized during the “first pass” through the liver. Protein binding is 92-98%. Metabolized in the liver to form inactive metabolites. T1/2 - about 2 hours. Excreted mainly by the kidneys in the form of metabolites and in trace amounts unchanged; 20% is excreted through the intestines in the form of metabolites.

Indications for use:

Prevention of angina attacks (including vasospastic angina), in some cases - relief of angina attacks; arterial hypertension, hypertensive crises; Raynaud's disease.

Dosage and method of administration of the drug.

Individual. For oral administration, the initial dose is 10 mg 3-4 times a day. If necessary, the dose is gradually increased to 20 mg 3-4 times a day. In special cases (variant angina, severe arterial hypertension), for a short time the dose can be increased to 30 mg 3-4 times a day. To relieve a hypertensive crisis, as well as an attack of angina, 10-20 mg (rarely 30 mg) can be used sublingually.
IV to relieve an attack of angina or hypertensive crisis - 5 mg for 4-8 hours.
Intracoronary to relieve acute spasms of the coronary arteries, a bolus of 100-200 mcg is administered. For stenosis of large coronary vessels, the initial dose is 50-100 mcg.
Maximum doses: when taken orally - 120 mg/day, when administered intravenously - 30 mg/day.

Side effects of Nifedipine:

From the cardiovascular system: hyperemia of the skin, sensation of warmth, tachycardia, arterial hypotension, peripheral edema; rarely - bradycardia, ventricular tachycardia, asystole, increased attacks of angina.
From the digestive system: nausea, heartburn, diarrhea; rarely - deterioration of liver function; in isolated cases - gum hyperplasia. With long-term use in high doses, dyspeptic symptoms, increased activity of liver transaminases, and intrahepatic cholestasis are possible.
From the central nervous system and peripheral nervous system: headache. With long-term use in high doses, paresthesia, muscle pain, tremors, mild visual disturbances, and sleep disturbances are possible.
From the hematopoietic system: in isolated cases - leukopenia, thrombocytopenia.
From the urinary system: increased daily diuresis. With long-term use in high doses, renal dysfunction is possible.
From the endocrine system: in isolated cases - gynecomastia.
Allergic reactions: skin rash.
Local reactions: with intravenous administration, a burning sensation at the injection site is possible.
Within 1 minute after intracoronary administration, the negative inotropic effect of nifedipine, an increase in heart rate, and arterial hypotension may occur; these symptoms gradually disappear after 5-15 minutes.

Contraindications to the drug:

Arterial hypotension (systolic blood pressure below 90 mm Hg), collapse, cardiogenic shock, severe heart failure, severe aortic stenosis; hypersensitivity to nifedipine.

Use during pregnancy and lactation.

Adequate and strictly controlled studies of the safety of nifedipine during pregnancy have not been conducted. The use of nifedipine during pregnancy is not recommended.
Since nifedipine is excreted in breast milk, its use should be avoided during lactation or breastfeeding should be discontinued during treatment.
Experimental studies revealed the embryotoxic, fetotoxic and teratogenic effects of nifedipine.

Special instructions for the use of Nifedipine.

Nifedipine should be used only in a clinical setting under the strict supervision of a physician for acute myocardial infarction, severe cerebrovascular accidents, diabetes mellitus, liver and kidney dysfunction, malignant arterial hypertension and hypovolemia, as well as in patients on hemodialysis. In patients with impaired liver and/or kidney function, the use of nifedipine in high doses should be avoided. Elderly patients are more likely to have decreased cerebral blood flow due to acute peripheral vasodilation.
When taken orally, nifedipine can be chewed to accelerate the effect.
If chest pain occurs during treatment, nifedipine should be discontinued. Nifedipine should be discontinued gradually, since withdrawal syndrome may develop if it is suddenly stopped (especially after long-term treatment).
When administered intracoronarily in the presence of stenosis of two vessels, nifedipine cannot be administered into the third open vessel due to the danger of a pronounced negative inotropic effect.
During the course of treatment, avoid drinking alcohol due to the risk of excessive reduction in blood pressure.
Impact on the ability to drive vehicles and operate machinery
At the beginning of treatment, you should avoid driving vehicles and other potentially dangerous activities that require rapid psychomotor reactions. In the process of further treatment, the degree of restrictions is determined depending on the individual tolerance of nifedipine.

Interaction of Nifedipine with other drugs.

When used simultaneously with antihypertensive drugs, diuretics, phenothiazine derivatives, the antihypertensive effect of nifedipine is enhanced.
When used simultaneously with anticholinergic drugs, memory and attention problems may occur in elderly patients.
When used simultaneously with beta-blockers, severe arterial hypotension may develop; in some cases - the development of heart failure.
When used simultaneously with nitrates, the antianginal effect of nifedipine is enhanced.
When used simultaneously with calcium preparations, the effectiveness of nifedipine decreases due to an antagonistic interaction caused by an increase in the concentration of calcium ions in the extracellular fluid.
Cases of the development of muscle weakness have been described when used simultaneously with magnesium salts.
When used simultaneously with digoxin, it is possible to slow down the excretion of digoxin from the body and, consequently, increase its concentration in the blood plasma.
When used simultaneously with diltiazem, the antihypertensive effect is enhanced.
When used simultaneously with theophylline, changes in the concentration of theophylline in the blood plasma are possible.
Rifampin induces the activity of liver enzymes, accelerating the metabolism of nifedipine, which leads to a decrease in its effectiveness.
When used simultaneously with phenobarbital, phenytoin, carbamazepine, the concentration of nifedipine in the blood plasma decreases.
There are reports of an increase in the concentration of nifedipine in the blood plasma and an increase in its AUC when used simultaneously with fluconazole and itraconazole.
When used simultaneously with fluoxetine, the side effects of nifedipine may increase.
In some cases, when used simultaneously with quinidine, a decrease in the concentration of quinidine in the blood plasma is possible, and when nifedipine is discontinued, a significant increase in the concentration of quinidine is possible, which is accompanied by a prolongation of the QT interval on the ECG.
The concentration of nifedipine in blood plasma may increase moderately.
Cimetidine and, to a lesser extent, ranitidine, increase the concentration of nifedipine in the blood plasma and, thus, enhance its antihypertensive effect.
Ethanol may enhance the effect of nifedipine (excessive hypotension), which causes dizziness and other undesirable reactions.

Extensive The medicine belongs to the group of drugs that block calcium channels and have pronounced antihypertensive properties.

But the medicine not only reduces blood pressure, it has an anti-ischemic effect. This article will tell you what the medicine Nifedipine is, what these tablets are prescribed for and in what dosages.

Nifedipine not only reduces, but also protects the myocardium from lack of oxygen, as well as overloads that occur with high peripheral vascular resistance. The drug reduces the stretching of the heart muscle, enhancing metabolic processes in it.

The drug Nifedipine has the following indications for use:

hypertension syndrome;
chronic heart failure;
angiospathic cerebral circulatory disorders;
ischemia;
bradycardia and angina pectoris;
spasm of blood vessels in the inner ear and retina.

Extended-release nifedipine in combination with bronchodilators is prescribed as maintenance therapy for bronchial asthma and Raynaud's disease.

Efficacy in hypertension

The hypotensive effect of Nifedepine is expressed in slowing down the movement of calcium through the membrane of the smooth muscle cells of the arteries.

Calcium ions spasm blood vessels and increase their contraction, and the medicine blocks their flow.

It ensures expansion of the lumen of the coronary and peripheral branches of the arterial network, while reducing the resistance of the vascular walls and reducing the load on the heart. The drug is well absorbed into the digestive tract, thereby its effect begins in the first ten minutes after use, which is especially important during a hypertensive crisis.

Composition and forms of the medicinal product

The international nonproprietary name of the drug Nifedipine (INN) is Nifedipine.

Nifedipine is available in various dosage forms:

film-coated tablets. They contain 10 mg of nifedipine, and long-acting tablets contain 20 mg. Excipients: corn starch - 58.25 mg, polysorbate - 2 mg, lactose monohydrate - 36.2 mg, hypromellose - 2.4 mg, microcrystalline cellulose - 51 mg, magnesium stearate - 150 mcg. The film shell contains: talc, hypromellose – 4.2 mg, macrogol – 1.4 mg, titanium dioxide – 1 mg, red oxide – 200 mcg;
capsules of 5 mg and 10 mg;
solution for infusion. The volume of the bottles is 50 ml. One milliliter in 1 ml contains 0.0001 g of nifedipine;
solution for intracoronary administration is available in syringes of 2 ml, in 1 ml - 0.0001 g of nifedipine.

Use of the drug and dose

The recommended dose of the drug is 20 mg twice a day. If the required effect was not achieved, it is increased to 40 mg twice a day. The maximum norm is 80 mg. For liver problems, it should not exceed 40 mg.

Tablets Nifedipine 10 mg

Rules for using Nifedipine:

The tablet is taken half an hour before breakfast at the same time;
Take the medicine only with clean water;
Do not chew or split long-acting tablets.

You cannot stop taking Nifedipine on your own; if you need to reduce the dose of the medication, your doctor should adjust the treatment regimen.

For blood pressure, Nifedipine can be taken regardless of meals. It will enter the bloodstream more slowly, but its effectiveness will not decrease.

The use of medicine requires compliance with certain rules:

the drug is used only under the supervision of a doctor. Take the medicine with caution in case of diabetic disease, severe forms of cerebrovascular accidents, kidney and liver problems, hypovolemia;
During treatment with Nifedipine, you should completely abstain from alcohol. At the beginning of treatment, it is not recommended to drive;
it is necessary to consider which medications the drug can be combined with and which it should not be combined with. Nifedipine with tricyclic antidepressants, diuretics, nitrates, and blood pressure-lowering agents enhances the hypotensive effect. Combination use of the drug with beta-blockers may contribute to the development of heart failure. Combined use with cimetidine increases the concentration of the drug in the blood. Rifampicin accelerates the metabolism of nifedipine, which reduces its effectiveness.

Short-acting tablets are taken three times, those that are eliminated within 12 hours are taken twice a day, long-acting ones are taken once. It is advisable to administer the drug intravenously only in a hospital.

The drug intake depends on its half-life.

Contraindications

For collapse, cardiogenic shock, tachycardia, aortic stenosis, acute stage of infarction, severe heart failure, sensitivity to medication components. This medicine is not prescribed to children and patients under 18 years of age.

The drug may cause side effects:

from the digestive organs: diarrhea, heartburn, nausea, liver dysfunction. With long-term use of the drug with the prescription of high doses, the manifestation of dyspeptic symptoms and the development of intrahepatic cholestasis are possible;
from the hematopoietic organs: thrombocytopenia, leukopenia;
from the heart and blood vessels: redness of the skin, a feeling of heat, the appearance of edema, a sharp decrease in pressure, tachycardia, angina pectoris, bradycardia;
from the genitourinary organs: increased urine output, kidney dysfunction;
from the central nervous system: headaches, sleep disturbances, visual disturbances, tremors of extremities;
from the endocrine system: gynecomastia;
from the skin: rash.

If the dose exceeds 120 mg of the drug, a 10% solution of calcium gluconate or calcium chloride is administered intravenously.

When the drug is injected intravenously, a burning sensation may occur at the injection site. When the drug is administered intracoronarily, the pressure may drop in the first minutes and the heart rate may increase.

To improve the tolerability of the drug and eliminate its side effects, it is necessary to take Nifedipine in combination with beta blockers. Swelling that occurs while taking the medication quickly disappears after its discontinuation.

In case of an overdose, headaches appear, blood pressure drops sharply, the face swells, bradycardia occurs, and the pulse in the peripheral arteries disappears.

In severe cases, collapse develops, the patient loses consciousness, and the functions of the sinus node are significantly inhibited. If these symptoms are detected, the patient's stomach is washed and activated charcoal is prescribed.

Analogs

The appearance of Nifedipine analogues on the pharmaceutical market is associated with its popularity.

Drug analogues:

Adalat;
Cordiline;
Calcigard retard;
Cordafen.

Most of the analogues are not inferior to Nifedepine in effectiveness. The doctor will determine which drug the patient needs: short-acting or long-acting.

A quick-acting medicine is not prescribed for long-term treatment of arterial hypertension and heart disease; it will be very useful in a hypertensive crisis.

Before choosing a medicine, you should carefully study the instructions and consult your doctor about possible side effects.

Video on the topic

The video will tell you what Nifedipine tablets are for, at what pressure to take them and when they are contraindicated:

Nifedipine is a drug whose main therapeutic effect is aimed at treating hypertension. When taken, the coronary and peripheral arteries dilate, peripheral vascular resistance decreases, and the flow of calcium into vascular smooth muscle cells slows down. Nifedipine has also found use in the treatment of CHF, ischemia, angina and bradycardia.

The medicine does not affect myocardial conductivity and heart rate. Side effects include the appearance of a skin rash, tachycardia, and impaired renal function. Fast-acting tablets are prescribed to relieve a hypertensive crisis, and long-acting Nifedipine is used for long-term therapy. You can get more information about Nifedipine blood pressure pills in the RLS - Register of Medicines of Russia.