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CARDIOVASCULAR SYSTEM › CALCIUM CHANNEL BLOCKERS › CALCIUM CHANNEL BLOCKERS AND DIURETICS › Calcium channel blockers and diuretics
nifedipine and diuretics
C08GA01
Forms & Strengths
- Combination product containing nifedipine (calcium channel blocker) and various diuretics (e.g., thiazides) in fixed-dose tablets or capsules
- Strengths vary by specific manufacturer and regional availability
Adult Dosing
- Hypertension: Titrate individual components first; usual maintenance is one tablet daily of the fixed-dose combination
- Maximum dose determined by individual component limits to prevent excessive hypotension
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established; use is generally not recommended
Indications
- Management of essential hypertension, particularly when combination therapy with a calcium channel blocker and a diuretic is indicated
Mechanism of Action
- Nifedipine inhibits transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle, causing peripheral arterial vasodilation and reduced blood pressure
- Diuretics (such as thiazides) inhibit sodium reabsorption in the distal renal tubules, increasing sodium and water excretion to reduce blood volume and blood pressure
Contraindications
- Hypersensitivity to nifedipine, other dihydropyridines, sulfonamide-derived drugs, or any component of the formulation
- Cardiogenic shock
- Concomitant use with strong CYP3A4 inducers (e.g., rifampin)
- Anuria or severe renal impairment (depending on the diuretic component)
Adverse Reactions
- Peripheral edema
- Dizziness, headache, and flushing due to vasodilation
- Hypotension
- Electrolyte disturbances (hypokalemia, hyponatremia) related to the diuretic component
- Palpitations and tachycardia
- Gastrointestinal disturbances (nausea, constipation)
Drug Interactions
- Strong CYP3A4 inhibitors (e.g., ketoconazole, erythromycin) increase nifedipine exposure and risk of hypotension
- Strong CYP3A4 inducers (e.g., rifampin, carbamazepine) decrease nifedipine efficacy
- Concomitant antihypertensives or nitrates potentiate blood pressure-lowering effects
- Diuretics may increase lithium toxicity by reducing its renal clearance
- NSAIDs may attenuate the antihypertensive and diuretic efficacy
Curated Content: Needs Vetting Before Put to Clinical Use