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Dose
. Initially 20 mg 3 times daily,
increased,
after at least
three days,
to 30 mg 3 times daily (usual range 60–
120 mg daily)
Nicardipine
(Non-proprietary) A
Capsules
, nicardipine hydrochloride 20 mg, net price
56-cap pack = £4.03;
30 mg,
56-cap pack = £5.16
Cardene
c
(Astellas) A
Capsules
,
nicardipine hydrochloride 20 mg (blue/
white),
net price 56-cap pack = £6.00;
30 mg (blue/
pale blue),
56-cap pack = £6.96
Modified release
Cardene SR
c
(Astellas) A
Capsules
,
m/r,
nicardipine hydrochloride 30 mg,
net
price 56-cap pack = £7.15; 45 mg (blue), 56-cap pack
= £10.40.
Label:
25
Dose
mild to moderate hypertension, initially 30 mg twice daily;
usual effective dose 45 mg twice daily (range 30–60 mg twice
daily)
NIFEDIPINE
Indications
prophylaxis of angina;
hypertension;
Raynaud’s phenomenon
Cautions
see notes above; also withdraw if ischaemic
pain occurs or existing pain worsens shortly after
initiating treatment; poor cardiac reserve; heart failure
or significantly impaired left ventricular function
(heart failure deterioration observed);
severe hypo-
tension;
elderly;
diabetes mellitus; avoid grapefruit
juice (may affect metabolism); acute porphyria (but
see section 9.8.2); interactions: Appendix 1 (calcium-
channel blockers)
Contra-indications
cardiogenic shock;
advanced aor-
tic stenosis;
within 1 month of myocardial infarction;
unstable or acute attacks of angina
Hepatic impairment
dose reduction may be required
in severe liver disease
Pregnancy
may inhibit labour;
manufacturer advises
avoid before week 20; risk to fetus should be balanced
against risk of uncontrolled maternal
hypertension;
use only if other treatment options are not indicated
or have failed
Breast-feeding
amount too small to be harmful but
manufacturers advise avoid
Side-effects
gastro-intestinal disturbance;
hypo-
tension,
oedema, vasodilatation,
palpitation;
head-
ache,
dizziness,
lethargy,
asthenia;
less commonly
tachycardia, syncope,
chills,
nasal congestion,
dys-
pnoea,
anxiety,
sleep disturbance,
vertigo,
migraine,
paraesthesia,
tremor,
polyuria, dysuria, nocturia,
erectile dysfunction, epistaxis, myalgia, joint swelling,
visual disturbance,
sweating,
hypersensitivity reac-
tions (including angioedema,
jaundice,
pruritus, urti-
caria,
and rash);
rarely
anorexia,
gum hyperplasia,
mood disturbances,
hyperglycaemia,
male infertility,
purpura, and photosensitivity reactions; also reported
dysphagia,
intestinal obstruction,
intestinal ulcer,
bezoar formation (with some modified-release pre-
parations),
gynaecomastia,
agranulocytosis,
and
anaphylaxis
Dose
. See preparations below
Nifedipine
(Non-proprietary) A
Capsules
,
nifedipine 5 mg,
net price 84-cap pack =
£2.97;
10 mg,
84-cap pack = £4.00
Dose
angina prophylaxis (but not recommended,
see notes
above) and Raynaud’s phenomenon,
initially 5 mg 3 times daily,
adjusted according to response to 20 mg 3 times daily
Hypertension,
not recommended therefore no dose stated
Adalat
c
(Bayer Schering) A
Capsules
,
orange,
nifedipine 5 mg,
net price 90-cap
pack = £5.73;
10 mg,
90-cap pack = £7.30
Dose
angina prophylaxis (but not recommended,
see notes
above) and Raynaud’s phenomenon,
initially 5 mg 3 times daily,
adjusted according to response to max.
20 mg 3 times daily
Hypertension,
not recommended therefore no dose stated
Modified release
Note
Different versions of modified-release preparations may
not have the same clinical effect.
To avoid confusion between
these different formulations of nifedipine, prescribers should
specify the brand to be dispensed. Modified-release formula-
tions may not be suitable for dose titration in hepatic disease
Adalat
c
LA
(Bayer Schering) A
LA 20 tablets
,
m/r,
f/c,
pink,
nifedipine 20 mg,
net
price 28-tab pack = £4.97.
Label:
25
LA 30 tablets
,
m/r,
f/c,
pink,
nifedipine 30 mg,
net
price 28-tab pack = £6.85.
Label:
25
LA 60 tablets
,
m/r,
f/c,
pink,
nifedipine 60 mg,
net
price 28-tab pack = £9.03.
Label:
25
Counselling
Tablet membrane may pass through gastro-intestinal
tract unchanged,
but being porous has no effect on efficacy
Cautions
dose form not appropriate for use in hepatic impair-
ment or where there is a history of oesophageal or gastro-intes-
tinal
obstruction,
decreased lumen diameter of the gastro-intes-
tinal
tract,
or inflammatory bowel disease (including Crohn’s
disease)
Dose
hypertension,
20–30 mg once daily, increased if necessary
to max.
90 mg once daily
Angina prophylaxis, 30 mg once daily,
increased if necessary to
max.
90 mg once daily
Adalat
c
Retard
(Bayer Schering) A
Retard 10 tablets
,
m/r,
f/c,
grey-pink,
nifedipine
10 mg,
net price 56-tab pack = £7.34.
Label:
25
Retard 20 tablets
,
m/r,
f/c,
grey-pink,
nifedipine
20 mg,
net price 56-tab pack = £8.81.
Label:
25
Dose
hypertension and angina prophylaxis, 10 mg twice daily,
adjusted according to response to 40 mg twice daily
Adipine
c
MR
(Chiesi) A
Tablets
, m/r, nifedipine 10 mg (pink), net price 56-tab
pack = £3.73;
20 mg (pink), 56-tab pack = £5.21.
Label:
25
Dose
hypertension and angina prophylaxis, 10 mg twice daily,
adjusted according to response to 40 mg twice daily
Adipine
c
XL
(Chiesi) A
Tablets
,
m/r,
red,
nifedipine 30 mg,
net price 28-tab
pack = £4.70;
60 mg,
28-tab pack = £7.10.
Label:
25
Dose
hypertension and angina prophylaxis, 30 mg once daily,
increased if necessary;
max.
90 mg once daily
Coracten SR
c
(UCB Pharma) A
Capsules
,
m/r,
nifedipine 10 mg (grey/pink,
enclos-
ing yellow pellets),
net price 60-cap pack = £3.90;
20 mg (pink/brown, enclosing yellow pellets), 60-cap
pack = £5.41.
Label:
25
Dose
hypertension and angina prophylaxis, initially 10 mg twice
daily,
increased if necessary to max.
40 mg twice daily
132
2.6.2 Calcium-channel blockers
BNF 61
2
Cardiovascular system