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Adalat (Nifedipine) is one of the best researched blood-lowering drugs. Clinical studies such as, INSIGHT and ACTION have clearly shown that nifedipine can help optimize blood pressure control and prevent long-term cardiovascular damage.

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Uses

Nifedipine contains the active ingredient nifedipine, which is a type of medicine called a calcium channel blocker. This type of medicine acts on the heart and blood vessels.
Nifedipine works by slowing the movement of calcium through the muscle cells that are found in the walls of blood vessels. It does this by blocking 'calcium channels' in these muscle cells. Calcium is needed by muscle cells in order for them to contract, so by depriving them of calcium, nifedipine causes the muscle cells to relax.

How to take

Nifedipine can be taken with or without food. Nifedipine is metabolized mainly by the liver and dosages may need to be lowered in patients with liver dysfunction.
Dosage should be adjusted according to each patient's needs. It is recommended that nifedipine be administered orally once daily on an empty stomach. Nifedipine is an extended release dosage form and tablets should be swallowed whole, not bitten or divided. In general, titration should proceed over a 7-14 day period starting with 30 mg once daily. Upward titration should be based on therapeutic efficacy and safety. The usual maintenance dose is 30 mg to 60 mg once daily. Titration to doses above 90 mg daily is not recommended.

Side effects

This drug may cause dizziness and lightheadedness especially during the first few days. Avoid activities requiring alertness. When you sit or lie down for a while, get up slowly to minimize dizziness and allow your body to adjust. You may also experience bloating, heartburn, nausea, blurred vision, muscle cramps, headache, flushing, sweating and sleep disturbances. These effects should disappear as your body adjusts to the medication. Inform your doctor if they become bothersome. Notify your doctor if you develop: swelling of hands or feet, irregular heartbeat. In the unlikely event you have an allergic reaction to this drug, seek medical attention immediately. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist

Precaution

Hypotension: Because nifedipine decreases peripheral vascular resistance, careful monitoring of blood pressure during the initial administration and titration of nifedipine is suggested. Close observation is especially recommended for patients already taking medications that are known to lower blood pressure.

Peripheral Edema: Immediate-Release Capsules: Mild to moderate peripheral edema, typically associated with arterial vasodilatation and not due to left ventricular dysfunction, occurs in about 1 in 10 patients treated with nifedipine. This edema occurs primarily in the lower extremities and usually responds to diuretic therapy. With patients whose angina is complicated by congestive heart failure, care should be taken to differentiate this peripheral edema from the effects of increasing left ventricular dysfunction. Extended-Release Tablets: Mild to moderate peripheral edema occurs in a dose dependent manner with an incidence ranging from approximately 10% to about 30% at the highest dose studied (180 mg). It is a localized phenomenon thought to be associated with vasodilatation of dependent arterioles and small blood vessels and not due to left ventricular dysfunction or generalized fluid retention. With patients whose angina or hypertension is complicated by congestive heart failure, care should be taken to differentiate this peripheral edema from the effects of increasing left ventricular dysfunction.

Additional Information for Extended-Release Tablets: As with any other non-deformable material, caution should be used when administering nifedipine in patients with preexisting severe gastrointestinal narrowing (pathologic or iatrogenic). There have been rare reports of obstructive symptoms in patients with known strictures in association with the ingestion of nifedipine.

Drug interactions

Nifedipine is mainly eliminated by metabolism and is a substrate of CYP3A. Inhibitors and inducers of CYP3A4 can impact the exposure to nifedipine and consequently its desirable and undesirable effects. In vitro and in vivo data indicate that nifedipine can inhibit the metabolism of drugs that are substrates of CYP3A, thereby increasing the exposure to other drugs. Nifedipine is a vasodilator, and co-administration of other drugs affecting blood pressure may result in pharmacodynamic interactions.

Missed dose

If you miss a dose, take as soon as remembered; do not take if it is almost time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

Storage

Store at room temperature, avoid light and moisture.