Nisoldipine

Indications

Nisoldipine is used for: Angina pectoris, Hypertension

Adult Dose

Oral Angina pectoris, Hypertension Adult: Immediate-release: Initially, 5 or 10 mg bid increased if necessary at intervals of no less than 1 wk to max of 20 mg bid. Modified-release: Initially, 17 mg once daily, increased by 8.5 mg/wk (or longer intervals). Max: 34 mg once daily. Elderly: Immediate-release: Initially, 5 or 10 mg once daily. Modified-release: Initially, 8.5 mg once daily. Hepatic impairment: Immediate-release: Initially, 5 or 10 mg once daily. Modified-release: Initially, 8.5 mg once daily.

Child Dose

Renal Dose

Administration

Contra Indications

Concomitant use w/ CYP3A4 inducers.

Precautions

Patients w/ severe aortic stenosis, heart failure, hypertrophic cardiomyopathy (HCM) w/ outflow tract obstruction. Hepatic impairment. Elderly. Pregnancy and lactation. Monitoring Parameters Monitor BP carefully during the initial admin or if there is subsequent upward dose adjustment.

Pregnancy-Lactation

Pregnancy Category: C Lactation: not known if excreted in breast milk, use caution

Interactions

May increase serum levels w/ CYP3A4 inhibitors. Increased levels w/ cimetidine. Increased antihypertensive effect w/ atenolol. Propranolol attenuated heart rate increase following intake of immediate-release nisoldipine. Reduced bioavailability w/ quinidine. Increased quinidine levels w/ immediate-release nisoldipine. Potentially Fatal: Concomitant use w/ potent CYP3A4 inducers (e.g. phenytoin) may decrease nisoldipine plasma concentration to undetectable levels.

Adverse Effects

Side effects of Nisoldipine : >10% Headache (22%) Peripheral edema (22%) 1-10% Dizziness (5%) Palpitation (3%) Vasodilation (4%) Increased severity of angina (1.5%) Nausea (2%) Pharyngitis (5%) Sinusitis (3%) < 1% Gingival hyperplasia Colitis Anemia Alopecia Anorexia Anxiety Ischemia Diabetes mellitus Dyspepsia Dysphagia

Mechanism of Action

Nisoldipine is a dihydropyridine Ca channel blocker. It inhibits the movement of Ca ions into vascular smooth muscle and cardiac muscle. It reversibly competes w/ other dihydropyridines for binding to the Ca channel.