Nisoldipine

A to Z Drug Facts

 Actions Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular smooth muscle and myocardium.

 Indications Treatment of hypertension, alone or in combination with other antihypertensive agents.

 Contraindications Sensitivity to dihydropyridine calcium channel blockers.

 Route/Dosage

ADULTS: PO Initiate therapy with 20 mg once daily, then increase by 10 mg/wk, or at longer intervals, to attain adequate BP control. Doses greater than 60 mg once daily are not recommended.

 Interactions

Azole antifungal agents (eg, ketoconazole), cimetidine, grapefruit juice: May increase nisoldipine concentrations and effects. Hydantoins (eg, phenytoin): May decrease nisoldipine levels and effects.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Vasodilation; palpitation; chest pain. CNS: Headache; dizziness. DERMATOLOGIC: Rash. EENT: Sinusitis; pharyngitis. GI: Nausea. OTHER: Peripheral edema.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Safety and efficacy not established. Increased angina, MI: Occasional patients, particularly those with severe obstructive coronary artery disease, may have increased frequency, duration or severity of angina or acute MI at start of therapy or when dose is increased. CHF: Use drug with caution in patients with CHF. Hepatic impairment: Use drug with caution in patients with severe hepatic dysfunction. Start with doses no greater than 10 mg/day. Elderly: Start with doses no greater than 10 mg in patients over 65 yr.

 Administration/Storage

• Available in extended-release tablets only.
• Have patient swallow tablets whole. Do not allow patient to crush, chew, or divide.
• Administer once daily. Do not administer with a high fat meal. Avoid grapefruit products before and after dosing.
• Start elderly patients over 65 yr and patients with impaired hepatic function with doses no greater than 10 mg/day.
• Store at room temperature (less than 86°F) protected from light and moisture.

 Assessment/Interventions

• Obtain patient history, including drug history, and any known allergies.
• Evaluate hepatic function tests prior to therapy.
• Monitor BP and pulse prior to therapy, during titration, and periodically during therapy.
• Administer SL nitroglycerin for chest pain. Record frequency and duration of anginal attacks and use of SL nitroglycerin.
• Monitor patient for development of peripheral edema, headaches, palpitations, increasing angina. Notify health care provider if present.

 Patient/Family Education

• Instruct patient not to chew, crush, or divide extended-release tablets.
• Advise patient not to take with a high-fat meal and to avoid grapefruit products before and after dosing.
• Advise patient to take the medication once daily as directed even if they have no symptoms.
• Teach patient correct technique for monitoring BP and pulse daily.
• Advise patient not to stop or change the dose unless advised by the health care provider.
• Advise patient that drug may cause dizziness and to use caution while driving or performing other tasks requiring mental alertness.
• Instruct patient to report the following symptoms to health care provider: palpitations; increasing chest pain; swelling of ankles, feet or hands; headache; dizziness.
• Stress the need to comply with the other components of the hypertensive regimen, such as dietary changes, weight loss, and exercise.
• Instruct patient never to stop taking the medication suddenly.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts