Nitrendipine

Indications
 Oral
Hypertension
Adult: 20 mg daily as a single dose or in 2 divided doses; may be increased to 20 mg bid as necessary to control resistant hypertension.
Elderly: Initially, 10 mg daily.
Hepatic impairment: Initially, 5-10 mg once daily.

Special Populations: Patients with hepatic impairment: Initially, 10 mg daily.
Contraindications
 Unstable angina pectoris, actue MI (<4 wk). Pregnancy and lactation.
Warnings / Precautions
 Elderly, hepatic impairment.
Adverse Reactions
 Hypotension, flushing, oedema, dizziness, palpitation, fatigue, headache, nausea, bloating, diarrhoea, paraesthesias, tachycardia, asthenia, drowsiness, angina, MI, irritability, respiratory disorders, hypersensitivity reactions, increased urine output, elevated LFTs, myalgia, tremor, blood count changes, gingival hyperplasia.
Overdose Reactions
 Symptoms: Flushing, headache, BP reduction with circulatory collapse, changes in heart rate (tachycardia, bradycardia). Management: Initially, gastric lavage with subsequent activated charcoal. Dopamine or noradrenaline may be used for excessive hypotension. Atropine or orciprenaline may be used for bradycardia.
Drug Interactions
 Effects may be enhanced by other antihypertensives. Increased sodium excretion with diuretics at the start of treatment. May prolong effects of pancuronium, vecuronium. May increase digoxin levels. Reduced levels/effects with rifampicin, phenytoin, carbamazepine or phenobarbitone. Levels/effects may be increased with cimetidine, valproic acid, erythromycin, troleandomycin, clarithromycin, roxithromycin, ketoconazole, itraconazole, fluconazole, nefazodone, protease inhibitors, quinupristin or dalfopristin.
See Below for More nitrendipine Drug Interactions
Lab Interactions
 Increases plasma catecholamine, urinary aldosterone levels and alkaline phosphatase levels.
Food Interactions
 Concentration may be increased with grapefruit juice.
Mechanism of Actions
 Nitrendipine relaxes coronary vascular smooth muscles by inhibiting calcium ions from entering the slow channels or select voltage-sensitive areas of vascular smooth muscles and myocardium during depolarisation. It also increases myocardial oxygen delivery in patients with vasospastic angina.
Absorption: Well absorbed from the GI tract (oral).
Distribution: Protein-binding: 98%.
Metabolism: Extensive first-pass effect.
Excretion: Via urine (as metabolites), via faeces (remaining dose); 10-22 hr (elimination half-life).
Administration
 Should be taken with food. (Take after meals.)
Storage Conditions
 Oral: Protect from light.
ATC Classification
 C08CA08 - nitrendipine ; Belongs to the class of dihydropyridine derivative selective calcium-channel blockers with mainly vascular effects. Used in the treatment of cardiovascular diseases.
Storage
 Oral: Protect from light.
Available As
  • Nitrendipine 10 mg
  • Nitrendipine 20 mg

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