Mosby's 2014 Nursing Drug Reference (290 page)

NIFEdipine (Rx)

(nye-fed′i-peen)

Adalat CC, Afeditab CR, Apo-Nifed
, Apo-Nifed PA
, Nifediac CC, Nifedical XL, Procardia, Procardia XL

Func. class.:
Calcium channel blocker, antianginal, antihypertensive

Chem. class.:
Dihydropyridine

Do not confuse:
NIFEdipine
/niCARdipine/niMODipine

ACTION:

Inhibits calcium ion influx across cell membrane during cardiac depolarization; relaxes coronary vascular smooth muscle; dilates coronary arteries; increases myocardial oxygen delivery in patients with vasospastic angina; dilates peripheral arteries

USES:

Chronic stable angina pectoris, vasospastic angina, hypertension

Unlabeled uses:
Migraines, preterm labor, chronic/acute hypertension (pediatrics), diabetic nephropathy, proteinuria, hiccups

CONTRAINDICATIONS:

Hypersensitivity to this product or dihydropyridine; cardiogenic shock

Precautions:
Pregnancy (C), breastfeeding, children, CHF, hypotension, sick sinus syndrome, 2nd-/3rd-degree heart block, hypotension <90 mm Hg systolic, hepatic injury, renal disease, acute MI, aortic stenosis, GERD, heart failure

DOSAGE AND ROUTES
Calculator

• Adult:
PO
Immediate release 10 mg tid, increase in 10-mg increments q7-14days, max 180 mg/24 hr or single dose of 30 mg;
SUS REL
30-60 mg/day, may increase q7-14days, max 90 mg/day

Hypertension

• Adult:
PO EXT REL
30-60 mg daily, titrate upward as needed, max 90 mg/day (Adalat CC), 120 mg/day (Procardia XL)

• Child/adolescent (unlabeled):
PO EXT REL
0.25-0.5 mg/kg/day, max 3 mg/kg/day

Acute hypertensive episodes in pediatric patients (unlabeled)

• Adolescent/child/infant:
PO
0.2-0.5 mg/kg/dose up to 10 mg (total dose)

Migraine prophylaxis (unlabeled)

• Adult:
PO
30-180 mg/day

Preterm labor (unlabeled)

• Pregnant female:
PO
Immediate release (Procardia, Adalat) 30-mg loading dose then 10-20 mg q4-6hr; use in monitored settings

Available forms:
Caps 5
, 10, 20 mg; ext rel tabs (CC, XL) 10
, 20
, 30, 60, 90 mg; tabs 10 mg

Administer:

• 
Do not break, crush, or chew ext rel tabs, do not use immediate release caps within 7 days of MI, coronary syndrome

• 
Without regard to meals; avoid grapefruit juice

• 
Protect caps from direct light, keep in dry area, do not freeze

SIDE EFFECTS

CNS:
Headache
, fatigue, drowsiness,
dizziness
, anxiety, depression, weakness, insomnia, light-headedness, paresthesia, tinnitus, blurred vision, nervousness, tremor,
flushing

CV:
Dysrhythmias,
edema, hypotension, palpitations, tachycardia

GI:
Nausea, vomiting, diarrhea, gastric upset, constipation, increased LFTs, dry mouth, flatulence, gingival hyperplasia

GU:
Nocturia, polyuria

HEMA:
Bruising, bleeding, petechiae

INTEG:
Rash, pruritus, flushing, hair loss,
Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis

MISC:
Sexual difficulties, cough, fever, chills

PHARMACOKINETICS

Metabolized by liver; excreted in urine 60%-80% (metabolites), feces 15%; protein binding 90%-98%

PO:
Onset 20 min, peak 0.5-6 hr, duration 6-8 hr, half-life 2-5 hr, well absorbed

PO-ER:
Duration 24 hr

INTERACTIONS

 
Contraindicated with strong CYP3A4 inducers

Increase:
level of digoxin, phenytoin, cycloSPORINE, prazosin, carBAMazepine

 
Increase:
NIFEdipine, toxicity—cimetidine, ranitidine

Increase:
effects of β-blockers, antihypertensives

Decrease:
antihypertensive effect—NSAIDs

Decrease:
effects of quiNIDine

Decrease:
NIFEdipine level—smoking

Drug/Herb

Increase:
effect—ginkgo biloba, ginseng, hawthorn

Decrease:
effect—ephedra, melatonin, St. John’s wort, yohimbe

Drug/Food

Increase:
NIFEdipine level—grapefruit juice

Drug/Lab Test

Increase:
CPK, LDH, AST

Positive:
ANA, direct Coombs’ test

NURSING CONSIDERATIONS
Assess:

• 
Anginal pain:
location, intensity, duration, character, alleviating, aggravating factors

• 
Cardiac status: B/P, pulse, respiration, ECG at baseline and periodically, in those taking antihypertensives, β-blockers, monitor B/P often

• 
Potassium, renal, hepatic studies periodically during treatment

• 
For bruising, petechiae, bleeding

• 
GI obstruction:
Ext rel products have been associated with rare reports of obstruction in those with strictures and no known GI disease

• 
Serious skin disorders:
rash that starts suddenly, fever, cutaneous lesions that may have pustules present; discontinue product

Evaluate:

• 
Therapeutic response: decreased anginal pain, B/P, activity tolerance

Teach patient/family:

• 
To avoid hazardous activities until stabilized on product, dizziness is no longer a problem

• 
To limit caffeine consumption; to avoid alcohol products

• 
To avoid OTC products unless directed by prescriber without regard to meals, Adelat CC should be taken on empty stomach

• 
That empty tab shells may appear in stools and is not significant

• 
Hypertension:
to comply with all areas of medical regimen: diet, exercise, stress reduction, product therapy

• 
To change position slowly because orthostatic hypotension is common

 
To notify prescriber of dyspnea, edema of extremities, nausea, vomiting, severe ataxia, severe rash; changes in pattern, frequency, severity of angina

• 
To increase fluid intake to prevent constipation

• 
To check for gingival hyperplasia and report promptly

• 
Not to discontinue abruptly; to gradually taper

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