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Nifediac CC and Alcohol/Food Interactions

There are 4 alcohol/food/lifestyle interactions with Nifediac CC (nifedipine).

Moderate

Nifedipine Alcohol (Ethanol)

Moderate Drug Interaction

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Moderate

Nifedipine Multivitamins With Minerals

Moderate Drug Interaction

MONITOR: Calcium-containing products may decrease the effectiveness of calcium channel blockers by saturating calcium channels with calcium. Calcium chloride has been used to manage acute severe verapamil toxicity.

MANAGEMENT: Management consists of monitoring the effectiveness of calcium channel blocker therapy during coadministration with calcium products.

References

  1. Henry M, Kay MM, Viccellio P (1985) "Cardiogenic shock associated with calcium-channel and beta blockers: reversal with intravenous calcium chloride." Am J Emerg Med, 3, p. 334-6
  2. Moller IW (1987) "Cardiac arrest following intravenous verapamil combined with halothane anaesthesia." Br J Anaesth, 59, p. 522-6
  3. Oszko MA, Klutman NE (1987) "Use of calcium salts during cardiopulmonary resuscitation for reversing verapamil-associated hypotension." Clin Pharm, 6, p. 448-9
  4. Schoen MD, Parker RB, Hoon TJ, et al. (1991) "Evaluation of the pharmacokinetics and electrocardiographic effects of intravenous verapamil with intravenous calcium chloride pretreatment in normal subjects." Am J Cardiol, 67, p. 300-4
  5. O'Quinn SV, Wohns DH, Clarke S, Koch G, Patterson JH, Adams KF (1990) "Influence of calcium on the hemodynamic and anti-ischemic effects of nifedipine observed during treadmill exercise testing." Pharmacotherapy, 10, p. 247
  6. Woie L, Storstein L (1981) "Successful treatment of suicidal verapamil poisoning with calcium gluconate." Eur Heart J, 2, p. 239-42
  7. Morris DL, Goldschlager N (1983) "Calcium infusion for reversal of adverse effects of intravenous verapamil." JAMA, 249, p. 3212-3
  8. Guadagnino V, Greengart A, Hollander G, Solar M, Shani J, Lichstein E (1987) "Treatment of severe left ventricular dysfunction with calcium chloride in patients receiving verapamil." J Clin Pharmacol, 27, p. 407-9
  9. Luscher TF, Noll G, Sturmer T, Huser B, Wenk M (1994) "Calcium gluconate in severe verapamil intoxication." N Engl J Med, 330, p. 718-20
  10. Bar-Or D, Gasiel Y (1981) "Calcium and calciferol antagonise effect of verapamil in atrial fibrillation." Br Med J (Clin Res Ed), 282, p. 1585-6
  11. Lipman J, Jardine I, Roos C, Dreosti L (1982) "Intravenous calcium chloride as an antidote to verapamil-induced hypotension." Intensive Care Med, 8, p. 55-7
  12. McMillan R (1988) "Management of acute severe verapamil intoxication." J Emerg Med, 6, p. 193-6
  13. Perkins CM (1978) "Serious verapamil poisoning: treatment with intravenous calcium gluconate." Br Med J, 2, p. 1127
  14. Moroni F, Mannaioni PF, Dolara A, Ciaccheri M (1980) "Calcium gluconate and hypertonic sodium chloride in a case of massive verapamil poisoning." Clin Toxicol, 17, p. 395-400
View all 14 references

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Moderate

Nifedipine Food

Moderate Food Interaction

GENERALLY AVOID: The consumption of grapefruit juice may be associated with significantly increased plasma concentrations of some calcium channel blockers (CCBs) when they are administered orally. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. The interaction has been reported with the dihydropyridine CCBs (in roughly decreasing order of magnitude) felodipine, nisoldipine, nifedipine, and nimodipine, often with a high degree of interindividual variability. Grapefruit juice caused more than twofold increases in felodipine, nifedipine, and nisoldipine AUCs.

MANAGEMENT: The manufacturers of nifedipine and nisoldipine recommend avoiding grapefruit juice. Patients treated orally with other calcium channel blockers should be advised to avoid consumption of large amounts of grapefruits and grapefruit juice to prevent any undue fluctuations in serum drug levels. Increased effects on blood pressure may persist for up to 4 days after the consumption of grapefruit juice. Monitoring for calcium channel blocker adverse effects (e.g., headache, hypotension, syncope, tachycardia, edema) is recommended.

References

  1. Edgar B, Bailey D, Bergstrand R, Johnsson G, Regardh CG (1992) "Acute effects of drinking grapefruit juice on the pharmacokinetics and dynamics of felodipine--and its potential clinical relevance." Eur J Clin Pharmacol, 42, p. 313-7
  2. (2002) "Product Information. Plendil (felodipine)." Merck & Co., Inc
  3. (2002) "Product Information. Procardia (nifedipine)." Pfizer U.S. Pharmaceuticals
  4. Bailey DG, Arnold JM, Munoz C, Spence JD (1993) "Grapefruit juice--felodipine interaction: mechanism, predictability, and effect of naringin." Clin Pharmacol Ther, 53, p. 637-42
  5. Bailey DG, Arnold JMO, Spence JD (1994) "Grapefruit juice and drugs - how significant is the interaction." Clin Pharmacokinet, 26, p. 91-8
  6. Bailey DG, Arnold JM, Strong HA, Munoz C, Spence JD (1993) "Effect of grapefruit juice and naringin on nisoldipine pharmacokinetics." Clin Pharmacol Ther, 54, p. 589-94
  7. Yamreudeewong W, Henann NE, Fazio A, Lower DL, Cassidy TG (1995) "Drug-food interactions in clinical practice." J Fam Pract, 40, p. 376-84
  8. (1995) "Grapefruit juice interactions with drugs." Med Lett Drugs Ther, 37, p. 73-4
  9. (2001) "Product Information. Sular (nisoldipine)." Astra-Zeneca Pharmaceuticals
  10. Josefsson M, Zackrisson AL, Ahlner J (1996) "Effect of grapefruit juice on the pharmacokinetics of amlodipine in healthy volunteers." Eur J Clin Pharmacol, 51, p. 189-93
  11. Bailey DG, Malcolm J, Arnold O, Spence JD (1998) "Grapefruit juice-drug interactions." Br J Clin Pharmacol, 46, p. 101-10
  12. Bailey DG, Kreeft JH, Munoz C, Freeman DJ, Bend JR (1998) "Grapefruit juice felodipine interaction: Effect of naringin and 6',7'-dihydroxybergamottin in humans." Clin Pharmacol Ther, 64, p. 248-56
  13. Fuhr U, Maier-Bruggemann A, Blume H, et al. (1998) "Grapefruit juice increases oral nimodipine bioavailability." Int J Clin Pharmacol Ther, 36, p. 126-32
  14. Gunston GD, Mehta U (2000) "Potentially serious drug interactions with grapefruit juice." S Afr Med J, 90, p. 41
  15. Takanaga H, Ohnishi A, Maatsuo H, et al. (2000) "Pharmacokinetic analysis of felodipine-grapefruit juice interaction based on an irreversible enzyme inhibition model." Br J Clin Pharmacol, 49, p. 49-58
  16. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR (2000) "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther, 68, p. 468-77
  17. Ho PC, Ghose K, Saville D, Wanwimolruk S (2000) "Effect of grapefruit juice on pharmacokinetics and pharmacodynamics of verapamil enantiomers in healthy volunteers." Eur J Clin Pharmacol, 56, p. 693-8
  18. Fuhr U, Muller-Peltzer H, Kern R, et al. (2002) "Effects of grapefruit juice and smoking on verapamil concentrations in steady state." Eur J Clin Pharmacol, 58, p. 45-53
  19. Cerner Multum, Inc. "UK Summary of Product Characteristics."
View all 19 references

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Major

Nifedipine High Blood Pressure (Hypertension)

Major Potential Hazard, High plausibility

nifedipine - 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. 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. Aromatorio GJ, Uretsky BF, Reddy PS (1985) "Hypotension and sinus arrest with nifedipine in pulmonary hypertension." Chest, 87, p. 265-7
  2. Zangerle KF, Wolford R (1985) "Syncope and conduction disturbances following sublingual nifedipine for hypertension." Ann Emerg Med, 14, p. 1005-6
  3. Schwartz M, Naschitz JE, Yeshurun D, et al. (1990) "Oral nifedipine in the treatment of hypertensive urgency: cerebrovascular accident following a single dose." Arch Intern Med, 150, p. 686-7
  4. Woodmansey P, Channer KS (1991) "Nifedipine and hypotension." Lancet, 338, p. 763-4
  5. Wachter RM (1987) "Symptomatic hypotension induced by nifedipine in the acute treatment of severe hypertension." Arch Intern Med, 147, p. 556-8
  6. (2002) "Product Information. Adalat (nifedipine)." Bayer
  7. (2002) "Product Information. Procardia (nifedipine)." Pfizer U.S. Pharmaceuticals
  8. American Health Consultants (1995) "Do calcium-channel blockers increase the risk of myocardial infarctions?" Internal Medicine Alert, 17, p. 49-50
  9. Carpi J (1995) "Calcium channel blocker debate refuses to die." Internal Medicine News, June 15, 1(col4),2(col3)
  10. Psaty BM, Heckbert SR, Koepsell TD, et al. (1995) "The risk of myocardial infarction associated with antihypertensive drug therapies." JAMA, 274, p. 620-5
  11. Buring JE, Glynn RJ, Hennekens CH (1995) "Calcium channel blockers and myocardial infarction: a hypothesis formulated but not yet tested." JAMA, 274, p. 654-5
  12. Marwick C (1996) "FDA gives calcium channel blockers clean bill of health but warns of short-acting nifedipine hazards." JAMA, 275, p. 423-4
  13. Miller JL (1996) "FDA committee recommends stronger warning against inappropriate use of immediate-release nifedipine: no changes for other calcium-channel blockers." Am J Health Syst Pharm, 53, p. 599-600
  14. Jick H, Derby LE, Gurewich V, Vasilakis C (1996) "The risk of myocardial infarction associated with antihypertensive drug treatment in persons with uncomplicated essential hypertension." Pharmacotherapy, 16, p. 321-6
  15. Miller JL (1996) "FDA committee recommends stronger warnings against inappropriate use of immediate-release nifedipine." Am J Health Syst Pharm, 53, p. 599-600
  16. Grossman E, Messerli FH, Grodzicki T, Kowey P (1996) "Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies?" JAMA, 276, p. 1328-31
  17. Bloomfield RL, Carter J (1996) "Hypertensive urgencies: how to give a low dose of short-acting nifedipine." Geriatrics, 51, p. 10
  18. Bradbury J (1996) "Sublingual short-acting nifedipine causes serious side-effects." Lancet, 348, p. 1159
  19. Kloner RA (1996) "The issue of the cardiovascular safety of dihydropyridines." Am J Hypertens, 9, s182-6
  20. Peters FP, de Zwaan C, Kho L (1997) "Prolonged QT interval and ventricular fibrillation after treatment with sublingual nifedipine for malignant hypertension" Arch Intern Med, 157, p. 2665-6
View all 20 references

Nifediac CC drug interactions

There are 608 drug interactions with Nifediac CC (nifedipine).

Nifediac CC disease interactions

There are 9 disease interactions with Nifediac CC (nifedipine) which include:

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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