Nifedipine pharmacology. Nifedipine: immediate reduction in blood pressure. Sublingual administration of nifedipine

Nifedipine has been used since the 1970s to treat hypertension and cardiovascular disease. These tablets belong to the group. Until now, nifedipine remains one of the most “popular” drugs in cardiology, that is, doctors prescribe it very often. Nifedipine has become an even more sought-after drug since the introduction of 24-hour tablets of the drug in the 2000s. They can be taken once a day, and not 2-4 times a day, as it was before.

There are fast-acting nifedipine tablets, as well as "extended" dosage forms. Long-acting nifedipine begins to act later, but it lowers blood pressure smoothly and for a long time, i.e. for 12-24 hours.

Since 1998, articles began to appear in medical journals that fast-acting nifedipine increases the overall mortality of patients, as well as the incidence of heart attacks and strokes. This means that only long-acting nifedipine tablets are suitable for long-term treatment of hypertension and coronary heart disease. The most popular of these are OSMO-Adalat and Corinfar UNO, which we will discuss in detail below in the article. Fast-acting nifedipine is only suitable for. Unfortunately, few patients and doctors know about this. Hundreds of thousands of people continue to be treated regularly. Patients - if you want to live longer, then use extended-release nifedipine tablets, not "fast".

Nifedipine - instruction

This article consists of instructions for nifedipine supplemented by information from domestic and foreign medical journals. The official instructions for the use of nifedipine tablets for pressure and for the treatment of heart problems are written in detail, but not too clear. We have tried to provide information conveniently so that you can quickly find answers to questions that interest you.

Instructions for the drug nifedipine, as well as any other materials on the Internet or in print publications, are intended for specialists. Patients - do not use this information for self-treatment. The side effects of self-medication with nifedipine can be harmful to your health, even fatal. This drug should only be taken as directed by your doctor. The instructions for nifedipine contain an extensive list of this medication. Doctors in practice know that these side effects are observed very often.

Separately, it is worth noting that it is almost impossible to choose the dosage of nifedipine on your own. It will either be too low or too high. In both cases, there will be no benefit from taking the pills, but only harm. Therefore, treatment with this drug should only take place under the supervision of an experienced qualified doctor.

Indications for use

The main indications for the use of nifedipine are hypertension (arterial hypertension), as well as angina pectoris in patients who suffer from chronic coronary heart disease. Nifedipine belongs to the group of calcium antagonists, derivatives of dihydropyridine. In accordance with all international recommendations, drugs in this group are included in the list of drugs for hypertension of the first choice, that is, the main ones.

Read about the treatment of diseases associated with hypertension:

Additional indications for the appointment of nifedipine:

• advanced age of the patient;
• atherosclerosis of peripheral arteries (in the legs) and / or carotid artery;
• pregnancy.

Contraindications

Contraindications to the appointment of nifedipine are:

• hypotension (excessively low blood pressure);
• cardiogenic shock;
• hypersensitivity to the drug.

It is not recommended to prescribe this medicine for unstable coronary heart disease, after myocardial infarction.

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Side effects

Nifedipine does not adversely affect the level of cholesterol and uric acid in the blood. The most common side effects of this drug are:

• swelling of the legs;
• headache;
• skin redness;
• dizziness
• heartbeat (tachycardia).

Back in 1982, the results of a large-scale study of the side effects of nifedipine were published, in which more than 3 thousand patients took part. Of these patients, 2147 had severe angina resistant to treatment with beta-blockers and nitrates at normal doses. Therefore, the range of dosages of nifedipine that were used was wide - from 10 to 240 mg per day. Patients were prescribed nifedipine tablets, which act quickly, but not for long, since prolonged forms of this drug had not yet been invented.

It turned out that nifedipine had side effects in almost 40% of patients:

• dizziness - 12.1%;
• swelling in the legs - 7.7%;
• feeling hot - 7.4%;
• complaints from the gastrointestinal tract - 7.5%;
• increased angina - 1.2%.

To improve tolerance and eliminate unwanted effects, it is advisable to combine nifedipine with or. Read the note "" for more details. If edema appears as a result of taking nifedipine, then when treatment is discontinued, they most often quickly disappear.

Nifedipine and other calcium antagonists

Nifedipine belongs to the group of drugs that are derivatives of dihydropyridine. Two other subgroups of calcium antagonists are benzothiazepines () and phenylalkylamines (). Medicines of the dihydropyridine group have the following advantages:

• more pronounced ability to relax blood vessels;
• there is no effect on the function of the sinus node of the heart and atrioventricular conduction;
• reduced ability to inhibit the contractility of the left ventricle of the heart.

These differences largely determine the features of the practical application of dihydropyridine calcium antagonists in general and nifedipine in particular.

What are the dosage forms of this drug

The efficacy and safety of the use of nifedipine to a large extent depends on the dosage form in which the patient takes it. Rapid-acting nifedipine tablets and capsules have been used since the 1970s. In the late 1990s, extended dosage forms appeared. Nifedipine, which sharply lowers blood pressure and is rapidly eliminated from the body, is less effective and less well tolerated than one that works smoothly for 12-24 hours.

The action of nifedipine depends on how much its concentration in the blood fluctuates, how quickly it rises and falls. Conventional nifedipine tablets differ in that they sharply lower blood pressure. In response to this, a reflex release of adrenaline and other “stimulating” hormones occurs. These hormones can cause tachycardia (palpitations), headache, feeling hot, and redness of the skin. Since short-acting nifedipine is rapidly eliminated from the body, a “rebound” phenomenon may occur. This means that sometimes blood pressure jumps even higher than it was before taking the pill.

What other disadvantages do “fast” dosage forms of nifedipine have:

• they need to be taken several times a day, which is inconvenient for patients, and therefore patients often refuse treatment;
• the effect of drugs is not stable during the day and changes due to meals;
• these pills act very differently on different people, depending on genetic characteristics, age and preservation of kidney function;
• under the influence of these drugs, blood pressure fluctuates like a roller coaster, which is why atherosclerosis rapidly develops in the blood vessels.

Currently, "fast" nifedipine is recommended only for the relief of hypertensive crises. It is not intended for long-term treatment because it does not improve or even worsen the long-term prognosis for patients. Long-acting nifedipine is suitable for continuous use in hypertension and cardiovascular diseases.

Extended form and its benefits

Dosage forms of nifedipine of prolonged action provide a slow flow of the active substance into the blood. Peak levels of nifedipine in the blood are much lower than if you use fast-acting tablets. At the same time, blood pressure decreases for a period of 12-24 hours and much more smoothly. Therefore, there is no reflex release of “stimulating” hormones into the blood. Accordingly, tachycardia (palpitations) and other side effects of nifedipine are observed several times less often and are less pronounced. Long-acting forms of nifedipine are not effective for the relief of a hypertensive crisis. But they rarely have negative side effects and, most importantly, improve the long-term prognosis for patients.

Characteristics of "extended" dosage forms of nifedipine

The original preparation of nifedipine was developed by the German company Bayer AG and was called Adalat. In the form of fast-acting capsules, it is no longer available. Currently on the pharmaceutical market are:

• Adalat-SL - valid for 12-16 hours, prescribed for admission 2 times a day;
• OSMO-Adalat - maintains a stable concentration of nifedipine in the blood for more than 24 hours, is prescribed 1 time per day.

OSMO-Adalat is a dosage form of nifedipine with a significantly prolonged action. It is called GITS or GITS - Gastrointerstitial (Gastrointestinal) Therapeutic System. It has the most favorable effect due to its ability to maintain a uniform concentration of nifedipine in the blood.

Prolonged tablets of nifedipine act 12-24 hours and are prescribed 1-2 times a day. Their pharmacokinetics are independent of food intake. Osmo-Adalat and Corinfar Uno are the most popular nifedipine preparations, because with a single dose they provide a more or less stable concentration of the drug in the blood for a whole day. This increases the effectiveness of treatment, reduces damage to target organs (heart, kidneys, eyes, and others), and reduces the frequency of complications of hypertension. In addition, patients are more willing to be treated with pressure pills, which are enough to take once a day.

Attention! Nifedipine extended-release tablets require special handling. They cannot be crushed, dissolved or absorbed in the oral cavity. These medicines should be swallowed immediately with water. It is forbidden to divide a tablet in order to reduce the dosage, unless the instructions say that you can do this.

Analogies and synonyms of nifedipine

Nifedipine (adalat, cordafen, cordaflex, corinfar, cordipin, nicardia, nifebene, procardia, farmadipine, fenigidin, etc.) is available in tablets and capsules of 10 and 20 mg, farmadipine - in drops. Prolonged forms - adalat-SL, Corinfar Uno, Corinfar-retard, cordipin-retard, nifebene-retard, nifedipine SS and others - are available in slow-release tablets of 20, 30, 40, 60 and 90 mg. As you can see, there are almost two dozen synonyms for nifedipine. Many pharmaceutical companies produce fast-acting and extended-release nifedipine analogues because this drug is in high demand.

Short-acting nifedipine is no longer recommended for the long-term treatment of hypertension and cardiovascular disease. It is recommended to take it only for emergency care for hypertensive crises. Nevertheless, in the CIS countries it still accounts for more than half of sales. A cheap, fast-acting drug is most often produced in tablets, which are called nifedipine. For example, nifedipine-Darnitsa.

Nifedipine with a gastrointestinal therapeutic system (GITS or GITS) is produced under the name OSMO-Adalat in capsules with a special membrane, through the hole in which the drug is gradually released over 24 hours. In this regard, it can be prescribed once a day, like Corinfar Uno .

Nifedipine for pressure

As tablets for pressure, 3 subgroups of drugs from the class of calcium antagonists are used:

• phenylalkylamines ();
• benzothiazepines ();
• dihydropyridines, which include nifedipine.

Dihydropyridine calcium antagonists (, isradipine, and the most popular among them nifedipine) are most often prescribed for pressure. Because they are characterized by a minimal effect on the conduction function of the heart and the function of the sinus node. Also, these drugs relax the blood vessels well.

In 1995, articles began to appear in American medical journals that nifedipine in the treatment of hypertension did not improve, but even worsened the prognosis for patients, i.e., increased the likelihood of a heart attack or stroke. Later studies showed that this only applies to fast-acting nifedipine tablets. A - useful for lowering blood pressure, improve the prognosis and are well tolerated by patients. Nifedipine retard, which lasts 12-16 hours, and even better - nifedipine in the form of GITS (GITS), one tablet of which lowers blood pressure by as much as 24 hours, have been confirmed to be effective, and it is enough to take it once a day.

In 2000, the results of the large INSIGHT study were published, which compared the efficacy of 24-hour-acting nifedipine with diuretic drugs for the treatment of hypertension. More than 6300 patients participated in this study. Half of them took nifedipine, and the other half -. It turned out that nifedipine in the form of GITS (GITS) and diuretics approximately equally reduce blood pressure, overall and cardiovascular mortality. At the same time, among patients who were treated with nifedipine, new cases of diabetes mellitus, gout and atherosclerosis of the vessels of the legs were less common.

Nifedipine and its “relatives” (dihydropyridine calcium antagonists) play a particularly important role in the treatment of hypertension in patients with diabetes and metabolic syndrome (prediabetes). Because these drugs do not impair metabolism, that is, they do not affect blood sugar, cholesterol and triglycerides. Nifedipine 24-hour GITS is the drug of choice for blood pressure control in patients with diabetes, metabolic syndrome and high cardiovascular risk.

Nifedipine 24-hour action in the treatment of hypertension not only lowers blood pressure, but also largely protects the internal organs. The organoprotective effect of nifedipine is manifested in the following:

• decrease in remodeling of the left ventricle of the heart;
• optimization of tissue blood supply;
• beneficial effect on kidney function;
• improvement of the functional state of the retina.

In the treatment of hypertension, nifedipine goes well with almost all groups of “pressure” drugs that are currently used:

Isolated systolic hypertension in the elderly

Among the elderly, at least 40-50% suffer from high blood pressure. In older patients, isolated systolic hypertension is especially common. High blood pressure reduces life expectancy, often causing a heart attack, stroke, or the development of chronic kidney failure. An effective drug for the treatment of hypertension in elderly patients should not only lower blood pressure, but also protect against target organ damage. Nifedipine (only in a long-acting formulation!) is one suitable drug in this case.

In 2008, specialists from the Medical Institute of Penza State University published an article on the results of a study on the effectiveness of the treatment of hypertension with long-acting nifedipine in 48 elderly patients. Of these 48 patients:

• 20 people suffered from isolated systolic hypertension;
• 28 had increased both “upper” and “lower” blood pressure.

The results of blood pressure reduction were assessed by measuring it with a tonometer at a doctor's appointment. In addition, each of the patients underwent 24-hour blood pressure monitoring at the beginning and after 24 weeks of treatment. Also, the authors of the study found out whether the “extended” nifedipine has the ability to protect target organs from damage. To do this, participants underwent echocardiography (heart), and they were tested for microalbuminuria - protein excretion in the urine - an important indicator for assessing kidney function.

The dynamics of the decrease in "upper" and "lower" blood pressure in elderly patients during treatment with nifedipine tablets of 24-hour action

Note to the table. All values ​​were obtained from the results of 24-hour blood pressure monitoring. The authors of the study found that as a result of the "white coat effect" at the doctor's office, systolic pressure is increased by an average of 13-15 mm Hg. Art.

Participants in the study noted that their blood pressure began to steadily decrease as early as the 2nd week of treatment, and this effect increased in the following weeks and months. The table shows that in patients with isolated systolic hypertension, nifedipine lowers the “upper” pressure significantly, and the “lower” pressure is much less. This suggests that nifedipine is the drug of choice for the treatment of isolated systolic hypertension in the elderly, because there is no excessive decrease in diastolic pressure.

Normally, in a healthy person, blood pressure decreases at night during sleep. The daily dynamics of blood pressure fluctuations can be tracked by the results of 24-hour monitoring using a special device. If it turns out that the patient’s blood pressure does not decrease at night, and even more so if it rises, then this is called an “abnormal blood pressure profile” and means that the risk of heart attack or stroke is significantly increased. In the study whose results we are discussing, 80% of patients with isolated systolic hypertension initially had an abnormal blood pressure profile. In the group of patients with systolic-diastolic hypertension, these were 65%. Treatment with 24-hour nifedipine appeared to improve the circadian blood pressure profile in many patients.

Microalbuminuria - the excretion of protein in the urine - at the beginning of the study was determined in 11 of 26 patients with systolic-diastolic hypertension and in all 20 (100%) patients with isolated systolic hypertension. Taking long-acting nifedipine tablets for 24 weeks led to the fact that in the first group the number of patients with microalbuminuria decreased from 11 to 9, and in the second - from 20 to 8. Thus, it was confirmed that nifedipine protects the kidneys.

Left ventricular hypertrophy is a way for the heart to adapt to the increased workload that occurs due to arterial hypertension. If studies show that the patient has a change in the shape (remodeling) of the heart, then this significantly worsens his prognosis. Because the risk of a heart attack increases. In a study on the treatment of hypertension in elderly patients, the effect of nifedipine therapy on the degree of left ventricular hypertrophy was tested. According to the results of echocardiography, it was found that taking 24-hour nifedipine reduced the thickness of the walls of the heart, improved systolic and diastolic function of the left ventricle, and reduced total peripheral vascular resistance. Thus, hypertrophy of the left ventricle of the heart regressed in many patients.

Since nifedipine had a positive effect on the function of the heart and kidneys, it can be argued that it not only lowers blood pressure, but also protects target organs from damage in elderly patients. In the group of patients with isolated systolic hypertension, all 20 people (100%) completed the study. In the group of patients in whom both “upper” and “lower” blood pressure were elevated, 2 people dropped out due to side effects of nifedipine. They had flushes of blood to the skin of the face and swelling.

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Nifedipine is widely used to treat coronary heart disease. It clearly reduces pain in the heart, reduces the frequency of angina attacks in patients and reduces the need for nitroglycerin. All of this has been proven in clinical studies since the early 1980s. Against the background of taking nifedipine in a dosage form of prolonged action, exercise tolerance increases. This drug is not inferior to beta-blockers and nitrates in terms of effectiveness for heart problems.

In accordance with international recommendations, they are the main group of drugs for prescription in coronary heart disease. In the practice of a doctor, the question often arises: which drug is better to add to them? Which additional drug will provide a more pronounced antianginal effect - nitrates or nifedipine?

In the recommendations of the American Heart Association for the treatment of stable angina pectoris, the effectiveness of nitrates and dihydropyridine calcium antagonists was recognized as equal. However, it is advised to give preference to extended-life nifedipine because it remains effective for 24 hours. Another advantage of dihydropyridine calcium antagonists compared to nitrates is that patients are much less likely to develop addiction to them.

In the practical work of a doctor, dihydropyridine calcium antagonists, including nifedipine, become the drugs of choice if the appointment of beta-blockers is contraindicated. These situations include:

• sick sinus syndrome;
• atrioventricular block;
• bronchial asthma.

Also, dihydropyridines can sometimes be prescribed in cases where verapamil and diltiazem, non-dihydropyridine calcium antagonists, are contraindicated. This occurs if the patient has sick sinus syndrome or severe atrioventricular block.

In 2004, the results of the large-scale ACTION study were published, in which 7665 patients with coronary heart disease or myocardial infarction took part. The aim of this study was to investigate the effect of adding nifedipine 24-hour GITS (see “ ”) to the conventional regimen. Patients were treated prior to the start of the study and continued to be treated with statins and aspirin. They were divided into two groups. Those who entered the first group were added nifedipine to the treatment, and patients from the second group received a placebo for control.

The doctors followed up all the study participants for 5 years. It turned out that nifedipine in the form of GITS did not improve or worsen overall and cardiovascular mortality, as well as the incidence of new cases of myocardial infarction. But he reduced the number of new cases of heart failure by 29%, strokes by 22%, and the need for coronary artery bypass surgery by 14%. Among patients in whom coronary heart disease was combined with hypertension, the results were even better, by about 1.5 times. There were no more side effects from taking it than from placebo. The authors of the study explained the effectiveness of nifedipine by the fact that it additionally lowered blood pressure in patients, and also inhibited the development of atherosclerosis.

Kidney Protection in Hypertension and Diabetes

If the patient has kidney damage due to diabetes or other reasons, then the target blood pressure level for him will be 130/80 mm Hg. Art., and not 140/90, as for people with healthy kidneys. If proteinuria (protein excretion in the urine) is more than 1 g per day, then the target blood pressure level is even lower - 125/75 mm Hg. Art. To protect the kidneys in hypertension, you need to ensure strict control of blood pressure, stop smoking and try to normalize blood cholesterol levels.

Obviously, regular intake of blood pressure pills can significantly slow down the development of kidney failure. With intensive treatment, the likelihood increases that the patient's own kidneys will last the rest of his life, and he will not have to experience the “charms” of dialysis or a kidney transplant. Studies have shown that all major classes of hypertension drugs reduce kidney damage. But which drugs do it better than others?

Calcium antagonists relax and dilate the blood vessels that feed the kidneys. Under the action of nifedipine, renal blood flow, levels of glomerular filtration and filtration fraction increase. Calcium antagonists slow down the development of nephrosclerosis. Long-acting (not short-acting) nifedipine reduces microalbuminuria. This medicine preserves kidney function in patients with diabetes mellitus and diabetic nephropathy. Nifedipine protects the kidneys both directly and by lowering blood pressure.

Nifedipine and other calcium antagonists are especially often used to inhibit the development of renal failure if the patient has hypertension and diabetes. Because in such cases it is contraindicated to prescribe diuretic drugs or beta-blockers. But which drugs protect the kidneys better - calcium antagonists, or? This issue has not yet been fully elucidated and requires further research.

In 2000, the results of a large study were published, which showed that nifedipine prevented kidney failure more effectively than diuretics (diuretics). We also mention that this medicine to some extent increases the sensitivity of tissues to insulin. Thus, the course of hypertension in diabetes improves.

Slowing the progression of atherosclerosis

Back in the 1990s, studies using short-acting nifedipine showed that the drug had a beneficial effect on metabolism and, to some extent, slowed down the development of atherosclerosis. An indicator that characterizes the risk of cardiovascular complications is the thickness of the intima-media complex (IMT) of the carotid arteries. It is measured using ultrasound. The greater this thickness, the higher the patient's risk of heart attack or stroke. Studies have reliably shown that taking nifedipine slows down the growth of IMT. Moreover, this effect of the drug does not depend on its action to lower blood pressure.

Another important risk factor is calcium deposits in atherosclerotic plaques on the walls of arteries. Calcium makes them hard and looks like limescale on water pipes. The process of calcium accumulation in atherosclerotic plaques is called calcification. It turned out that nifedipine, although slightly, slows down the calcification of the coronary (heart-feeding) arteries.

It is now believed that nifedipine slows down the development of atherosclerosis better than other calcium antagonists. At the same time, one should not hope to completely slow down atherosclerosis with the help of nifedipine alone. We recommend taking tests for atherosclerosis risk factors, which are listed in the article “”. It also indicates what measures effectively help protect blood vessels from atherosclerosis.

Nifedipine during pregnancy

With long-term therapy with nifedipine, started in early pregnancy, cases of intrauterine fetal death and skeletal anomalies in newborns are described. It is believed that nifedipine and other dihydropyridine calcium antagonists (with the exception of) are unsafe in the first trimester of pregnancy, so they are not recommended for women of childbearing age. At the same time, some studies have shown that nifedipine is able to effectively control arterial hypertension in women in late pregnancy (not earlier than 18-21 weeks), without adversely affecting fetal development.

Nifedipine, administered sublingually and orally, has proven to be particularly useful in the treatment of hypertensive crises in pregnant women. There are separate reports in the literature on the safety of the use of dihydropyridine calcium antagonists in late pregnancy. However, there are few of them, and therefore, for the time being, nifedipine is not recommended in pharmacological reference books for use during pregnancy. Doctors prescribe it only in severe cases, when they believe that the benefits of taking the pills will be greater than the risks.

Do not take nifedipine without permission during pregnancy! Consult a doctor!

In 2008, specialists from the Medical Institute of the State University of the Ukrainian city of Sumy published the results of their small study on the efficacy and safety of nifedipine in the treatment of chronic hypertension, preeclampsia and gestational hypertension during pregnancy. Under their supervision there were 50 pregnant women with hypertension, who were divided into three groups:

• group 1 included 20 pregnant women with gestational hypertension (which began during pregnancy);
• group 2 - 20 pregnant women with preeclampsia;
• in the 3rd group - 10 pregnant women with chronic hypertension, which they had before pregnancy.

Comprehensive examination of pregnant women was repeated regularly to assess changes. It included a general clinical examination, an assessment of the state of the fetus according to functional methods (determination of the biophysical profile of the fetus), a Doppler study. Determination of the biophysical profile of the fetus was performed by transabdominal scanning using an ultrasonic portable scanner "Aloka SSD - 1800 (Toshiba, Japan) with a sensor from 3.5 to 10 MHz. The assessment of the biophysical profile of the fetus was carried out on the basis of an assessment of the data of fetometry, antenatal cardiotocography, the results of the study of the tone, respiratory and motor activity of the fetus, ultrasound placentometry, determination of the volume of amniotic fluid. The condition of newborns was assessed on the basis of a general clinical examination, examination by a geneticist, and ultrasound examination.

Nifedipine has been used in gestational hypertension and preeclampsia, as well as chronic hypertension in pregnancy as an effective fast-acting agent and for long-term therapy at 12-38 weeks of gestation. The indication for prescribing short-acting nifedipine tablets was an increase in blood pressure to a level of 150/100 mm Hg. and higher. The drug was administered orally in single doses of 5 and 10 mg and sublingually 10 and 20 mg. Daily doses ranged from 30 to 120 mg. The dose of the drug for each patient was selected individually.

Studies have noted a rapid and significant decrease in blood pressure (systolic by the 30th minute, diastolic by the 20th minute when taken orally), which persisted for 2-4 hours. An even faster action was observed when the drug was applied under the tongue. The severity of the effect on lowering blood pressure was almost the same in pregnant women who did not receive any prior treatment, and in those patients who received methyldopa therapy before the appointment of nifedipine. Carrying out daily monitoring of blood pressure, revealed that the drug has a powerful effect. At the same time, in pregnant women with chronic hypertension, after dose selection, the effect remained the same over a 24-hour period. Their blood pressure did not exceed 120/90 mmHg.

A similar picture was observed in the group of women with gestational hypertension. In women with preeclamisia, blood pressure was less stable during the day, the effect of taking nifedipine was especially pronounced in the evening and at night. In some cases, nifedipine therapy was supplemented by the introduction of clonidine (clophelin). Five pregnant women were admitted to the hospital during a hypertensive crisis. In order to stop the latter, nifedipine 10 mg under the tongue was used. A positive result was achieved by taking the drug twice in 30 minutes.

Side effects of nifedipine during pregnancy

In pregnant women who received nifedipine, side effects were noted from:

• fetal heart rate (unstable heart rate - in 14.0%, tachycardia - in 8.0%);
• respiratory movements of the fetus (an increase in the number of episodes of respiratory movements - in 14.0%, a violation of the form of the respiratory movements of the fetus - movements of the gasps type - in 10.0%);
• motor activity of the fetus (increased motor activity - in 6.0%);
• fetal tone (decrease - in 6.0%).

Retardation of intrauterine development of the fetus was observed quite often - in 60.0%, polyhydramnios - in 20.0% of pregnant women, oligohydramnios - in another 20.0%.

When studying the structure of the placenta in 10.0% of pregnant women, there was a decrease in the intervillous space. In pregnant women who received pressure pills, placental hypertrophy (12.0%) was observed less frequently than hypoplastic changes (30.0%). During the study, a lag in its maturation of 18.0% was revealed. Destructive changes in the placenta were observed rarely - 2.0%. Placental abruption was diagnosed in 2 (4.0%) pregnant women.

In 7 women (14.0%) with signs of intrauterine infection of the fetus, changes in the structure of the placenta were accompanied by a violation of the nature of the fetal heartbeat (tachycardia, unstable heart rate), in 4 (8.0%) women - a change in the motor activity of the fetus, in 9 (18 .0%) - a violation of respiratory activity and in 3 (6.0%) - a decrease in fetal tone. When assessing the biophysical profile of the fetus, it was noted that in pregnant women treated with nifedipine, it was 4.6±0.3 points. Signs of a compensated form of fetoplacental insufficiency (4 points) were determined in 80.0% of pregnant women of the main group, subcompensated form (3 points) - in 20.0%.

All newborns had an Apgar score of 8-10 at birth, while the maximum score was 10. Examination of newborns by a geneticist and an ultrasound study showed that the use of nifedipine by women during pregnancy did not lead to the appearance of fetal malformations. Thus, nifedipine, according to clinical studies, is not only an effective, but also a fairly safe drug for the treatment of pregnant women.

Prevention and treatment of acute and chronic coronary insufficiency, angina pectoris, postinfarction conditions, hypertension.

Release form of the drug Nifedipine

tablets 10 mg; blister pack 10, box (box) 2 or 5;
prolonged-release tablets, film-coated 20 mg; blister pack 10, carton pack 5 or 10;
coated tablets 10 mg; blister 10, box (box) 5;
film-coated tablets 10 mg; blister pack 10, carton pack 1;

Pharmacodynamics of the drug Nifedipine

It blocks calcium channels, inhibits the transmembrane entry of calcium ions into the smooth muscle cells of arterial vessels and cardiomyocytes. Expands peripheral, mainly arterial, vessels, incl. coronary, lowers blood pressure (possible slight reflex tachycardia and increased cardiac output), reduces peripheral vascular resistance and afterload on the heart. Increases coronary blood flow, reduces the force of heart contractions, the work of the heart and myocardial oxygen demand. Improves myocardial function and helps to reduce the size of the heart in chronic heart failure. Lowers pressure in the pulmonary artery, has a positive effect on cerebral hemodynamics. It inhibits platelet aggregation, has anti-atherogenic properties (especially with prolonged use), improves post-stenotic circulation in atherosclerosis. Increases the excretion of sodium and water, lowers the tone of the myometrium (tocolytic effect). Long-term use (2-3 months) is accompanied by the development of tolerance. For long-term therapy of arterial hypertension, it is advisable to use fast-acting dosage forms at a dose of up to 40 mg / day (with an increase in the dose, the development of concomitant reflex reactions is more likely). In patients with bronchial asthma, it can be used with other bronchodilators (sympathomimetics) for maintenance treatment.

Pharmacokinetics of the drug Nifedipine

When taken orally, it is rapidly and completely absorbed. The bioavailability of all dosage forms is 40-60% due to the "first pass" effect through the liver. About 90% of the administered dose binds to plasma proteins. With intravenous administration, T1 / 2 is 3.6 hours, the volume of distribution is 3.9 l / kg, plasma Cl is 0.9 l / min, and the constant concentration is 17 ng / ml. After oral administration, Cmax in plasma is created after 30 minutes, T1 / 2 - 2-4 hours. About 80% is excreted by the kidneys in the form of inactive metabolites and approximately 15% with feces. In small quantities, it passes through the BBB and the placental barrier, penetrates into breast milk. In patients with impaired liver function, the total Cl decreases and T1 / 2 increases. When capsules are taken orally, the effect appears after 30-60 minutes (chewing accelerates the development of the effect) and lasts 4-6 hours, with sublingual use, it occurs after 5-10 minutes and reaches a maximum within 15-45 minutes. The effect of tablets with a two-phase release develops after 10-15 minutes and lasts 21 hours. It does not have mutagenic and carcinogenic activity.

Use of Nifedipine during pregnancy

Contraindicated in pregnancy.
At the time of treatment should stop breastfeeding.

Contraindications to the use of the drug Nifedipine

Hypersensitivity, acute period of myocardial infarction (first 8 days), cardiogenic shock, severe aortic stenosis, heart failure in the stage of decompensation, severe arterial hypotension, tachycardia, pregnancy, breastfeeding.

Side effects of the drug Nifedipine

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis: often (at the beginning of treatment) - flushing of the face with a feeling of heat, palpitations, tachycardia; rarely - hypotension (up to fainting), pain similar to angina pectoris, very rarely - anemia, leukopenia , thrombocytopenia, thrombocytopenic purpura.

From the nervous system and sensory organs: at the beginning of treatment - dizziness, headache, rarely - stupor, very rarely - changes in visual perception, impaired sensitivity in the arms and legs.

From the digestive tract: often - constipation, rarely - nausea, diarrhea, very rarely - gingival hyperplasia (with long-term treatment), increased activity of hepatic transaminases.

From the respiratory system: very rarely - bronchospasm.

From the musculoskeletal system: very rarely - myalgia, tremor.

Allergic reactions: itching, urticaria, exanthema, rarely - exfoliative dermatitis.

Others: often (at the beginning of treatment) - swelling and redness of the hands and feet, very rarely - photodermatitis, hyperglycemia, gynecomastia (in elderly patients), burning sensation at the injection site (with intravenous administration).

Dosing and Administration of Nifedipine

Inside, the dose and course of treatment are set individually.

The initial dose is 10 mg 2 times a day, if necessary, the dose can be increased to 20 mg 2 times a day. In some cases, for a short time, the dose can be increased to 20 mg 4 times a day. The maximum daily dose is 80 mg.

Overdose of Nifedipine

Symptoms: severe bradycardia, bradyarrhythmia, arterial hypotension, in severe cases - collapse, slow conduction. When taking a large number of retard tablets, signs of intoxication appear no earlier than after 3-4 hours and can additionally be expressed in loss of consciousness up to coma, cardiogenic shock, convulsions, hyperglycemia, metabolic acidosis, hypoxia.

Treatment: gastric lavage, activated charcoal, the introduction of norepinephrine, calcium chloride or calcium gluconate in atropine solution (in/in). Hemodialysis is ineffective.

Interactions of the drug Nifedipine with other drugs

Nitrates, beta-blockers, diuretics, tricyclic antidepressants, fentanyl, alcohol - enhance the hypotensive effect. Increases theophylline activity, reduces the renal clearance of digoxin. Enhances the side effects of vincristine (reduces excretion). Increases the bioavailability of cephalosporins (cefixime). Cimetidine and ranitidine increase plasma levels. Diltiazem slows down metabolism (necessary dose reduction of nifedipine). Incompatible with rifampicin (accelerates biotransformation and does not allow creating effective concentrations). Grapefruit juice (large amount) increases bioavailability.

Precautions while taking Nifedipine

Elderly patients are advised to reduce the daily dose (decreased metabolism). Use with caution during work for drivers of vehicles and people whose profession is associated with increased concentration of attention. The drug should be discontinued gradually (possibly the development of a withdrawal syndrome).

Special instructions for taking the drug Nifedipine

In patients with stable angina at the beginning of treatment, a paradoxical increase in anginal pain may occur, with severe coronary sclerosis and unstable angina, aggravation of myocardial ischemia. It is not recommended to use short-acting drugs for the long-term treatment of angina pectoris or arterial hypertension, because. development of unpredictable changes in blood pressure and reflex angina is possible.

Storage conditions of the drug Nifedipine

List B.: In a dry, dark place, at a temperature not exceeding 25 ° C.

Shelf life of the drug Nifedipine

Belonging of the drug Nifedipine to the ATX classification:

C Cardiovascular system

C08 Calcium channel blockers

C08C Selective calcium channel blockers with predominantly vascular effects

C08CA Dihydropyridine derivatives

Nifedipine - has antianginal and antihypertensive effects. It relaxes vascular smooth muscles (relieves spasm), dilates coronary and peripheral (mainly arterial) vessels, lowers blood pressure and peripheral vascular resistance, and reduces afterload. Possessing the action of a cardioprotector, it reduces the need for oxygen in the heart muscle. Increases coronary blood flow.

Nifedipine effectively reduces pressure, and also helps relieve muscle spasms. Without affecting the heart rhythm, it significantly lowers blood pressure. After taking Nifedipine begins to act after 20 minutes. (chewing accelerates the effect) and lasts up to 12 hours.

Active ingredient - tablets and capsules 0.005 and 0.01 g. Dragee 0.01 g. Retard tablets 0.02 and 0.04 g.

Nifedipine - indications for use

Prevention of angina attacks (including Prinzmetal's angina pectoris). As part of combination therapy, the drug is used in the treatment of coronary heart disease (stable angina pectoris, vasospastic angina pectoris) and arterial hypertension.

To lower blood pressure in various types of hypertension (including of unknown etiology), including renal hypertension.

In some cases, it is used for Raynaud's disease and as part of the combined treatment of CHF.

Currently, there are data on the inappropriateness of the therapeutic use of nifedipine in arterial hypertension - this is due to an increased risk of developing myocardial infarction, as well as deaths in patients with coronary heart disease with long-term use of Nifedipine.

Take nifedipine at what pressure?
The instructions for use of the drug clearly indicate that nifedipine is used for high blood pressure to reduce blood pressure. Nifedipine for pressure is taken according to the general scheme indicated below, unless otherwise directed by the attending physician.

Nifedipine during pregnancy and uterine tone

What is nifedipine prescribed for during pregnancy with tone? The drug relieves spasm and relaxes smooth muscles (including the uterus), is used to suppress premature contractions.

The dosage of nifedipine with tone in particular, and use during pregnancy in general, should be strictly under medical supervision. Instructions for use prohibits treatment with the drug during pregnancy and lactation. Self-prescribe nifedipine with uterine tone is strictly prohibited! See below for details.

Nifedipine: instructions for use and dosage

How to take Nifedipine tablets? Doses and duration of treatment are set by the attending physician individually, taking into account the patient's condition and the specific dosage form of the drug.

The tablet form of Nifedipine is taken orally with a sufficient amount of water. Long-acting Nifedipine is recommended for a long course of treatment.

The initial dose is 10 mg 2 times a day, if necessary, the dose can be increased to 20 mg 2 times a day. If necessary, the dose is gradually increased to 20 mg of nifedipine 3-4 times a day. The maximum daily dose is 80 mg.

With arterial hypertension, nifedipine tablets are taken 3 times a day, 10 mg each, if necessary, the dose is increased to 20-30 mg (3 times a day).

Accelerated action in crises - a tablet of nifedipine is kept unchewed, without swallowing, under the tongue. The drug is absorbed within a few minutes. With this method, the patient must lie down for half an hour, due to a possible sharp decrease in blood pressure.

In elderly patients and burdened with other diseases, the maximum daily dose should be reduced.

In case of impaired liver function, in patients with severe cerebrovascular accident, the dose should be reduced.

It is necessary to stop taking nifedipine gradually, gradually reducing the daily dose by half.

How long can you take? The course of treatment is prescribed by a doctor and can be up to 2 months.

During the period of treatment, alcohol intake is strictly prohibited. The regularity of therapy is important, regardless of the state of health, the patient may not feel the symptoms of arterial hypertension.

Contraindications when using Nifedipine

• severe disorders of cerebral circulation,
• arterial hypotension (systolic blood pressure below 90 mm Hg),
• vascular and cardiogenic shock,
• first week of acute myocardial infarction,
• severe heart failure
• liver failure, renal failure (especially patients on hemodialysis),
• pregnancy and lactation,
• hypersensitivity to nifedipine and other components of the drug.
• children under 18 years of age (efficacy and safety of use have not been studied).

It is forbidden to use Nifedipine tablets in patients with lactose intolerance.

The use of Nifedipine during pregnancy is prohibited. Experimental studies conducted on animals have revealed the risk of growth retardation and retardation in the development of the fetus and the occurrence of miscarriage.

Taking the drug Nifedipine during pregnancy with uterine tone is justified in case of an increased risk of angina pectoris, heart attack, as well as congestive heart failure, heart rhythm disturbances, lack of oxygen in the tissues (hypoxia) and renal failure.

Analogues of Nifedipine, list

This is a very popular medicine, and it may not be available in pharmacies, but there are analogues of Nifedipine tablets:

• Adalat SL
• Kordafen
• Vero-Nifedipine
• Cordaflex
• Nifadil
• Nifesan
• Sanfidipin
• Fenigidin

Long-acting nifedipine analogues:

• Corinfar Uno;
• Nifedipine SS;
• Cordipin-retard;
• Nifebene retard.

Many well-known pharmaceutical companies are producing an analogue of the drug Nifedipine. Patient reviews say that most of them are in no way inferior to him in terms of effectiveness.

Be careful - the instructions for use of Nifedipine, the price and reviews of analogues may not correspond, due to differences in the concentration of the active ingredient and other excipients. When choosing an analogue, it is recommended to consult a doctor.

14.05.2017

Nifedipine tablets are necessary for hypertensive patients and are a common remedy for pressure , eliminating pain, reducing ischemia.

The drug is produced in several versions:

• adalat - solution for intravenous administration;
• short acting tabletsremove the crisis (cordaflex, nifedipine, cordafen, cordipin, fenigidin);
• long-acting drug that is drunklong-term (cordaflex rd, corinfar, nifecar chl, calciguard retard, osmo-adalat).

Listed medicines for pressure combines the active substance, the mechanism of action on the body and the pharmacological effect. Differ from downgrading AD drugs by the duration of the result obtained, the speed of the onset of the effect from the moment of taking / administering the medication. Given the differences, each form has its own indications, which the doctor must know about.

How does nifedipine affect the body?

Learn more about Nifedipine instructions for use, at what pressureand how to take, what side effects and contraindications. However, it is not necessary to understand medical terminology. The active substance is classified as a Ca-channel blocker. This means that the channels in the cell wall through which calcium enters are blocked.

Many calcium channels in the muscles, including the heart. Penetrating into the cell, calcium provokes excitation, causing a contraction of muscle tissue.

Under conditions of blocking calcium channels, much of it will not enter the cell, which means that the lumen in the vessels will expand, because their walls of their circular muscle fibers will not actively contract under the influence of calcium.

Due to the expansion of the cardiac arteries, blood flow to the myocardium improves, and the increased lumen of distant arteries provides a decrease pressure . The vascular walls relax, the lumen of the veins and arteries increases, the frequency of myocardial contractions succeeds reduce.

Dilated blood vessels, through which blood circulates to the heart and brain, provide blood flow to the main organs, the supply of glucose and oxygen. Against the background of such favorable conditions, cells affected by ischemia and pathologies are poorly restored.

When is Nifedipine prescribed?

pressure medication prescribed for various pathologies, each time selecting the appropriate form of medication:

• as a prophylaxis of angina pectoris in patients with ischemic disease;
• in order to reduce vasospasm in patients with Prinzmetal's angina;
• for downhill pain in the chest if nitroglycerin is not possible accept ;
• to control blood pressure in hypertensive patients in the long term;
• to quickly to stop a hypertensive crisis;
• with Raynaud's syndrome to relieve spasms of distant blood vessels.

An intravenous liquid form of the drug is administered in a hospital if the patient is in serious condition. Short acting tablets fast reduce blood pressure, used in case of an acute attack of angina pectoris and hypertension.

For long-term treatment of hypertension, indicators pressure normalized with prolonged-release tablets.

Dosage of the drug

If the patient has read the instructions and knows what dosagereduces pressure, with hypertension, act according to the principle: “what I want, then I drink ' is dangerous. The doctor can prescribe pills, they act individually for each patient.

The standard daily dosage is 30-80 g. If short-acting tablets are taken, then the daily dose is divided into 3-4 doses, and if long-acting tablets are prescribed, they are taken 1-2 times a day. In case of severe hypertension and variant angina pectoris, the daily dosage can be increased to 120 mg for some time, but as prescribed by the doctor and when the drug is well tolerated. The maximum daily dose is 120 mg.

When you need to remove the pressure surge, put a 10-20 mg tablet under the tongue, which will work for 15 minutes. Do the same for chest pain. In the hospital, an attack of angina pectoris or a crisis is stopped by intravenous administration of Nifedipine in a volume of 5 mg / h, the daily rate is 30 mg.

An overdose of the drug is manifested by facial swelling, headache, prolonged pressure drop, bradycardia, bradyarrhythmia and the absence of a pulse in distant arteries. In case of severe intoxication, loss of consciousness and collapse are possible.

To provide first aid, you need to do a gastric lavage, then prescribe activated charcoal at the rate of 1 tablet per 10 kg of body weight. Nifedipine's drug antidote is calcium; calcium chloride or calcium gluconate in a 10% solution is administered to help the patient.

Adverse reactions

Like other pressure pills, Nifedipine causes side reactions in the body:

• from the gastrointestinal tract: diarrhea, nausea, heartburn and liver failure. If you take the drug for a long time in high doses, this will affect the liver in the form of cholestasis or an increase in transaminases;
• from the side of the cardiovascular system: swelling of the skin and extremities, a strong drop in pressure, a feeling of warmth, asystole, tachycardia, bradycardia, angina pectoris;
• from the side of the central and peripheral nervous system: headaches, with prolonged use, muscle pain, sleep problems, tremors and visual disturbances;
• from the genitourinary system: increased diuresis, against the background of long-term use - failure of the kidneys;
• on the part of hematopoiesis: leukopenia and thrombocytopenia;
• from the endocrine system - a manifestation of gynecomastia.

As an allergy to the components of Nifedipine, a rash on the skin, burning at the injection site is possible. With intravenous administration, an increase in the frequency of myocardial contractions and the development of hypotension are possible.

Contraindications

Nifedipine is not prescribed for hypotension, collapse, severe aortic stenosis, cardiogenic shock, severe heart failure, acute myocardial infarction, tachycardia, minors.

Pregnant and lactating Nifedipine is not recommended, although in gynecological practice there are cases when the drug was necessary in case of ineffectiveness of the drugs. In such cases, the doctor weighs the risks, and may prescribe the drug in late pregnancy in order to stop the hypertensive crisis and normalize the condition of the expectant mother.

In pregnant women, Nifedipine reduces the tone of the uterus, but clinical studies on this issue have not been conducted. It is strictly forbidden for pregnant women to drink the medicine on their own, the decision should be made by the doctor.

A similar appointment with caution applies to patients with diabetes mellitus, malignant arterial hypertension, serious circulatory disorders in the brain, malfunctions of the kidneys and liver.

The effectiveness of Nifedipine

Since the development of the drug, there have been enough international studies on the effectiveness, according to the results, reports are presented on the benefits, safety and feasibility of prescribing Nifedipine. In 2000, the results of the INSIGHT study were presented, according to which the drug is safe, effectively helps with hypertension, is well tolerated compared to diuretics, and helps reduce the risk of heart attack and stroke in hypertensive patients.

The results of the Action study confirmed the safety of long-acting nifedipine, its ability to reduce the need for coronary artery bypass grafting and coronary angiography. In combination with other drugs, Nifedipine improves the prognosis in hypertensive patients and patients with angina pectoris, including the state after myocardial infarction.

In the recommendations of the European Society of Cardiology there are notes on the positive effect of long-acting nifedipine on the health of patients with stable angina, both in monotherapy and in combination with nitrates and beta-blockers.

Short-term tablets are recommended as a means of emergency care for a hypertensive crisis, if taken for a long time, this is fraught with complications.

Drug Interactions

Before prescribing pills for pressure, the doctor will assess the patient's condition, refer him for diagnosis, select the dosage and regimen of therapy. You need to tell your doctor if you are taking medications, as Nifedipine does not work well with all of them.

The combined use of Nifedipine with diuretics, nitrates, tricyclic antidepressants leads to an accumulation of the effect and an increase in the pressure-reducing effect.

In combination with beta-blockers, the hypotensive effect increases, heart failure develops. Cimetidine together with Nifedipine increases the concentration of the latter in the blood plasma. If you take Rifampicin against the background of Nifedipine, then the metabolism of the latter will accelerate, the effectiveness of its action on the body will decrease.

It is important to consider that long-term treatment of patients with high blood pressure or coronary artery disease is carried out with long-acting drugs. It is valid for 12-24 hours. As for short-term tablets, they should be used as an ambulance for a hypertensive crisis, when you need to effectively and quickly reduce blood pressure.

According to research and practice, if you use short-acting Nifedipine for a long time, this is fraught with a stroke or heart attack.

The doctor selects the dosage of tablets individually in each individual case. Self-treatment, relying on the instructions for the drug - is not worth it, this can lead to dangerous consequences.

Antianginal and antihypertensive drugs are Nifedipine tablets. What helps this drug? The agent effectively reduces pressure, has a pronounced anti-ischemic effect, improves coronary blood supply. Capsules "Nifedipine" instructions for use suggest taking with high blood pressure, angina pectoris, Raynaud's disease and angiospastic disorders of cerebral circulation.

Release form and composition

1. long-acting tablets containing 20 mg "Nifedipin" a (Retard);
2. coated tablets containing 10 mg of the active substance;
3. solution for intracoronary administration (in 1 ml - 0.0001 g), which is sold in 2 ml syringes;
4. solution for infusion, 1 ml of which contains 0.0001 g of the active substance (in 50 ml vials);

Nifedipine gel is also produced, but its indications for use and composition are different. This form is intended for local treatment of manifestations of internal and external hemorrhoids (including pain, itching, anal fissures, hemorrhoids, bleeding). The composition includes: "Nifedipine" (0.2%), lidocaine (2%) and the Dead Sea biocomplex in the form of trace elements.

Pharmacological properties

The drug "Nifedipine", instructions for use indicates this, is a selective blocker of slow calcium channels, a derivative of 1,4-dihydropyridine. It has antianginal and antihypertensive action. Reduces the flow of extracellular calcium ions into cardiomyocytes and smooth muscle cells of the coronary and peripheral arteries.

Reduces spasm and dilates coronary and peripheral (mainly arterial) vessels, lowers blood pressure, total peripheral vascular resistance, reduces afterload and myocardial oxygen demand. Increases coronary blood flow.

Negative chrono-, dromo- and inotropic effects are overridden by reflex activation of the sympathoadrenal system in response to peripheral vasodilation. Enhances renal blood flow, causes moderate natriuresis. The onset of the clinical effect is 20 minutes, the duration of the clinical effect is 4-6 hours.

Tablets "Nifedipine": what does the medicine help with when prescribed

Apply according to the following indications:

• coronary heart disease, accompanied by an angina attack;
• spasm of the vessels of the inner ear and retina; hypertension and hypertensive crisis;
• angiospastic circulatory disorders of the brain;
• chronic heart failure.

Why is Nifedipine prescribed yet? In combination with bronchodilator drugs, tablets are prescribed for maintenance therapy in bronchial asthma. It is also used in Raynaud's disease.

The drug "Nifedipine": instructions for use and dosage

Dragee or tablets

The dosage regimen is set individually, depending on the severity of the disease and the patient's response to therapy. It is recommended to take the drug during or after a meal with a small amount of water. Initial dose: 1 tablet (tablet) (10 mg) 2-3 times a day.

If necessary, the dose of the drug can be increased to 2 tablets or dragees (20 mg) - 1-2 times a day. The maximum daily dose is 40 mg. In elderly patients or patients receiving combined (antanginal or antihypertensive) therapy, as well as in violation of liver function, in patients with severe cerebrovascular accident, the dose should be reduced.

Retard tablets

inside. Tablets should be swallowed whole, without chewing, during or after a meal, with a small amount of water. The recommended dose of the drug is 20 mg 2 times a day. With insufficient severity of the effect, it is possible to increase the dose of the drug to 40 mg 2 times a day.

The maximum daily dose is 80 mg. In case of impaired liver function, the daily dose should not exceed 40 mg. In elderly patients or patients receiving combined (antanginal or antihypertensive) therapy, smaller doses are usually prescribed. The duration of treatment is determined in each case individually.

injections

To remove a patient from a hypertensive crisis, Nifedipine is recommended to be administered at a dosage of 0.005 g for 4-8 hours, which corresponds to 6.3-12.5 ml of infusion solution per hour. The maximum dosage of Nifedipine according to the instructions is 30 mg per day.

Why is Nifedipine prescribed during pregnancy?

The instructions indicate that the medication is contraindicated during pregnancy and lactation. However, Nifedipine tablets are still used in pregnant women with heart disease. Very often, this medicine is prescribed to relieve uterine hypertonicity in order to reduce the threat of miscarriage. But they take it only after 16 weeks. In the first three months of pregnancy, they try not to use the medicine, because doctors are not sure of its safety for the baby at this stage.

Nifedipine is also prescribed for unstable blood pressure during pregnancy. Its regular use allows you to establish control over pressure in order to reduce the risk of exacerbation of cardiovascular diseases. This issue cannot be ignored, since cardiovascular diseases can cause either premature birth or the death of a future mother.

Absolute and relative contraindications

The use of the drug "Nifedipine" is strictly contraindicated if:

• Idiopathic hypertrophic subaortic stenosis.
• Lactation.
• Pregnancy.
• Severe aortic and mitral stenosis.
• Period 4 weeks after acute myocardial infarction.
• Arterial hypotension with systolic blood pressure below 90 mm Hg.
• Cardiogenic shock, collapse.
• Tachycardia.
• Sick sinus syndrome.
• Age up to 18 years.
• Hypersensitivity to dihydropyridine derivatives or the drug "Nifedipine", from which tablets can cause side effects.
• Decompensated heart failure.

The drug should be used with caution due to the risk of complications if the patient is diagnosed with:

• Severe disorders of cerebral circulation.
• Severe impairment of kidney and liver function.
• Malignant arterial hypertension.
• Chronic heart failure.
• Diabetes.

Caution requires medication by patients on hemodialysis.

Side effect

• headache;
• pronounced decrease in blood pressure;
• hives;
• pulmonary edema (difficulty breathing, coughing, stridor breathing);
• development or aggravation of the course of chronic heart failure;
• tachycardia;
• nervousness;
• anemia, leukopenia, thrombocytopenia, thrombocytopenic purpura, agranulocytosis;
• asthenia;
• toxic epidermal necrolysis;
• nose bleed;
• fainting;
• chest pain (angina pectoris) up to the development of myocardial infarction;
• visual impairment (including transient loss of vision against the background of the maximum concentration of "Nifedipin" in the blood plasma);
• constipation;
• increased fatigue;
• nausea;
• chills;
• Pain in the eyes;
• galactorrhea;
• angioedema;
• tremor;
• photosensitivity;
• drowsiness;
• muscle cramps;
• symptoms of vasodilation (reddening of the skin of the face, a feeling of heat);
• arrhythmias;
• skin itching;
• dyspnea;
• gynecomastia (in elderly patients; completely disappearing after discontinuation of the drug);
• erectile dysfunction;
• myalgia;
• dryness of the oral mucosa;
• mood lability;
• peripheral edema (feet, ankles, legs);
• deterioration of kidney function (in patients with renal insufficiency);
• weight gain;
• diarrhea;
• increased appetite;
• pain in the stomach and intestines;
• dizziness;
• nasal congestion;
• swelling of the joints;
• cardiopalmus.

What are the analogues of the drug "Nifedipine"

Full analogues for the active substance:

1. Sponif 10.
2. Nifesan.
3. Sanfidipin.
4. Corinfar.
5. Nifehexal.
6. Vero Nifedipine.
7. Nifelat.
8. Nifebene.
9. Kordafen.
10. Nifedicap.
11. Nifadil.
12. Nifecard.
13. Fenigidin.
14. Nikardia.
15. Nifedicor.
16. Cordaflex.
17. Calciguard retard.
18. Cordipin.
19. Nifedex.
20. Cordaflex RD.
21. Adalat.
22. Osmo Adalat.

Holiday conditions and price

From pharmacies, the drug is dispensed by prescription. The average price of Nifedipine, 10 mg tablets (Moscow), is 26 rubles. In Minsk, pharmacies offer the drug for 3-6 bel. ruble. In Kyiv, the medicine costs 15 hryvnia, in Kazakhstan - 380 tenge.