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Nifedipine Disease Interactions

There are 9 disease interactions with nifedipine:

Ccbs (Includes Nifedipine) ↔ Aortic Stenosis

Severe Potential Hazard, High plausibility

Applies to: Aortic Stenosis

The use of some calcium channel blockers (CCBs) is contraindicated in patients with advanced aortic stenosis. CCBs whose pharmacologic effect is partially dependent on their ability to reduce afterload (e.g., diltiazem, nicardipine, nifedipine, verapamil) may be of less benefit in these patients due to a fixed impedance to flow across the aortic valve and may, in fact, worsen rather than improve myocardial oxygen balance. Rarely, heart failure has developed following the initiation of these CCBs, particularly in patients receiving concomitant beta-blocker therapy.

References

  1. "Product Information. Adalat (nifedipine)." Bayer, West Haven, CT.
  2. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc, Palo Alto, CA.
  3. "Product Information. Procardia (nifedipine)." Pfizer US Pharmaceuticals, New York, NY.

Ccbs (Includes Nifedipine) ↔ Cardiogenic Shock/Hypotension

Severe Potential Hazard, High plausibility

Applies to: Cardiogenic Shock, Hypotension

In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.

References

  1. "Product Information. Calan (verapamil)." Searle, Skokie, IL.
  2. Stehle G, Buss J, Eibach J, et al "Cardiogenic shock associated with verapamil in a patient with liver cirrhosis." Lancet 336 (1990): 1079
  3. "Product Information. Vascor (bepridil)." McNeil Pharmaceutical, Raritan, NJ.
View all 6 references

Ccbs (Includes Nifedipine) ↔ Coronary Artery Disease

Severe Potential Hazard, Low plausibility

Applies to: Ischemic Heart Disease

Increased frequency, duration, and/or severity of angina, as well as acute myocardial infarction, have rarely developed during initiation or dosage increase of calcium channel blockers (CCBs), particularly in patients with severe obstructive coronary artery disease and those treated with immediate-release formulations. The mechanism of this effect is not established. Therapy with CCBs should be administered cautiously in patients with significant coronary artery disease.

References

  1. Kloner RA "Nifedipine in ischemic heart disease." Circulation 92 (1995): 1074-8
  2. Myrhed M, Wiholm B-E "Nifedipine: a survey of adverse effects." Acta Pharmacol Toxicol (Copenh) 58 (1986): 133-6
  3. Thomassen AR, Bagger JP, Nielsen TT "Hemodynamic and cardiac metabolic changes during nicardipine-induced myocardial ischemia." Cathet Cardiovasc Diagn 14 (1988): 41-3
View all 15 references

Ccbs (Includes Nifedipine) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Calcium channel blockers (CCBs) are extensively metabolized by the liver. The half-lives of CCBs may be prolonged substantially in patients with severe hepatic impairment, with the potential for significant drug accumulation. In addition, the use of some CCBs has been associated with elevations in serum transaminases, both with and without concomitant elevations in alkaline phosphatase and bilirubin. While these effects may be transient and reversible, several patients have developed cholestasis or hepatocellular injury that was proven by rechallenge. Therapy with CCBs should be administered cautiously and often at reduced dosages in patients with significantly impaired hepatic function. Periodic monitoring of liver function and for excessive pharmacologic effects (e.g., abnormal prolongation of PR interval) is advised, and the dosage adjusted if necessary.

References

  1. Stern EH, Pitchon R, King BD, Wiener I "Possible hepatitis from verapamil." N Engl J Med 306 (1982): 612-3
  2. Giacomini KM, Massoud N, Wong FM, Giacomini JC "Decreased binding of verapamil to plasma proteins in patients with liver disease." J Cardiovasc Pharmacol 6 (1984): 924-8
  3. "Product Information. Calan (verapamil)." Searle, Skokie, IL.
View all 53 references

Nifedipine (Includes Nifedipine) ↔ Hypertension

Severe Potential Hazard, High plausibility

Applies to: Hypertension

For the long-term treatment of hypertension, only the extended-release formulations of nifedipine should be used. The US National Heart, Lung, and Blood Institute and the FDA Cardiovascular and Renal Drug Advisory Committee have issued warnings against the use of immediate-release nifedipine for this purpose based on review of three epidemiologic studies of patients with hypertension and unstable angina who were treated with calcium channel blockers (CCBs) and at least two meta-analyses of randomized, controlled trials that included patients receiving CCBs. Two of the case-control studies found an increased risk of myocardial infarction (MI) in patients taking immediate-release nifedipine, although the third did not.
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<br />The use of immediate-release nifedipine (orally or sublingually) is also contraindicated for acute reduction of blood pressure. Profound hypotension, acute myocardial infarction, and deaths have been reported when nifedipine was used in this manner.

References

  1. Grossman E, Messerli FH, Grodzicki T, Kowey P "Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies?" JAMA 276 (1996): 1328-31
  2. Schwartz M, Naschitz JE, Yeshurun D, et al "Oral nifedipine in the treatment of hypertensive urgency: cerebrovascular accident following a single dose." Arch Intern Med 150 (1990): 686-7
  3. American Health Consultants "Do calcium-channel blockers increase the risk of myocardial infarctions?" Internal Medicine Alert 17 (1995): 49-50
View all 20 references

Nifedipine (Includes Nifedipine) ↔ Myocardial Infarction

Severe Potential Hazard, High plausibility

Applies to: Myocardial Infarction

Clinical trials studying the use of immediate-release nifedipine in patients who had just sustained myocardial infarctions have not demonstrated any benefit. In fact, in some trials, patients who received immediate-release nifedipine had significantly worse outcomes than patients who received placebo. The manufacturers state that immediate-release formulations of nifedipine should not be administered for 1 week after myocardial infarction. They should also be avoided in the setting of acute coronary syndrome, when infarction may be imminent.

References

  1. "Product Information. Adalat (nifedipine)." Bayer, West Haven, CT.
  2. Kloner RA "Nifedipine in ischemic heart disease." Circulation 92 (1995): 1074-8
  3. Abernathy DR, Schwrtz JB "Calcium-antagonist drugs." N Engl J Med 341 (1999): 1447-57
View all 6 references

Ccbs (Includes Nifedipine) ↔ Chf/Ami

Moderate Potential Hazard, Moderate plausibility

Applies to: Congestive Heart Failure, Myocardial Infarction

Calcium channel blockers (CCBs) may have varying degrees of negative inotropic effect. Congestive heart failure (CHF), worsening of CHF, and pulmonary edema have occurred in some patients treated with a CCB, primarily verapamil. Some CCBs have also caused mild to moderate peripheral edema due to localized vasodilation of dependent arterioles and small blood vessels, which can be confused with the effects of increasing left ventricular dysfunction. Although some CCBs have been used in the treatment of CHF, therapy with CCBs should be administered cautiously in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, caution is advised in patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened by administration of a CCB.

References

  1. Batlouni M, Armaganijan D, Ghorayeb N, Magliano MF "Clinical efficacy and tolerability of isradipine in the treatment of mild-to-moderate hypertension in young and elderly patients." J Cardiovasc Pharmacol 19 (1992): s53-7
  2. Sleight P "Calcium antagonists during and after myocardial infarction." Drugs 51 (1996): 216-25
  3. Brogden RN, Sorkin EM "Isradipine: an update of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy in the treatment of mild to moderate hypertension." Drugs 49 (1995): 618-49
View all 29 references

Nifedipine (Includes Nifedipine) ↔ Renal Dysfunction

Moderate Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Although the clearance of nifedipine is not dependent on renal function, use of the drug in patients with uremia has been associated with enhanced pharmacologic effects, possibly due to increased sensitivity to the drug or reduced protein binding. Rarely, reversible elevations in BUN and serum creatinine have been reported in patients with preexisting chronic renal insufficiency given nifedipine, although a causal relationship has not been established. Nephritis and renal failure have also been observed. Therapy with nifedipine should be administered cautiously in patients with significantly impaired renal function.

References

  1. Zucchelli P, Zuccala A, Borghi M, et al "Long-term comparison between captopril and nifedipine in the progression of renal insufficiency." Kidney Int 42 (1992): 452-8
  2. Echizen H, Eichelbaum M "Clinical pharmacokinetics of verapamil, nifedipine and diltiazem." Clin Pharmacokinet 11 (1986): 425-49
  3. Cacoub P, Deray JY, Deray G, et al "Nifedipine-induced acute renal failure." Clin Nephrol 29 (1988): 272-3
View all 17 references

Nifedipine Xl (Includes Nifedipine) ↔ Gi Narrowing

Moderate Potential Hazard, Moderate plausibility

Applies to: Gastrointestinal Obstruction

The extended-release formulation of nifedipine (Procardia XL) contains a non-deformable material. There have been rare reports of obstructive symptoms in patients with known strictures following the ingestion of similar sustained-release products. Therapy with the extended-release formulation of nifedipine should be administered cautiously in patients with preexisting severe gastrointestinal narrowing or obstruction, whether pathologic or iatrogenic.

References

  1. "Product Information. Procardia (nifedipine)." Pfizer US Pharmaceuticals, New York, NY.
  2. Smitz S, Bonnet V, Delporte JP "Severe gastrointestinal dysfunction and retention of extended release nifedipine tablets." J Am Geriatr Soc 46 (1998): 656-7

You should also know about...

nifedipine drug Interactions

There are 587 drug interactions with nifedipine

nifedipine alcohol/food Interactions

There are 3 alcohol/food interactions with nifedipine

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2014 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

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