Nitroglicerina

Angina Pectoris (Prophylaxis)

ER capsule: Initial 2.5-6.5 mg PO q6-8hr Titrate up to effec dose until limited by SE

Administration
Take on empty stomach Formas de dosificacin & fortalezas Angina de pecho 10 mg (convencional) PO q8hr o PO 30-60 mg (liberacin prolongada) una vez al da al principio; puede incrementarse cada 7-14 das PRN Mantenimiento: 10-20 mg (convencional) PO q8hr hasta 20-30 mg PO q6 - 8 hr; No exceda de 180 mg/da (convencional) o 120 mg/da (liberacin prolongada) Hipertensin 30-60 mg (liberacin prolongada) PO una vez al da; puede incrementarse cada 7-14 das PRN; No debe exceder 90 mg/da (Adalat CC) o 120 mg/da (Procardia XL) Hipertensin pulmonar q12hr PO 30 mg (liberacin prolongada); podr ser aumentada hasta 120-240 mg/da (monitor) Fenmeno de Raynaud (Off-label) 30-120 mg (liberacin prolongada) PO una vez al da Fisuras anales (Off-label) 0,2 q12hr gel/pomada tpica (espontneamente compuesto) % por 3-6 semanas Modificaciones de dosificacin La dilisis peritoneal (DP) o hemodialisis (HD): dosis suplementaria no es necesario Cirrosis: Considerar ajuste de dosis Administracin Tomar con el estmago vaco Interaccion nifedipine will increase the level or effect of astemizole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative. nifedipine increases levels of astemizole by decreasing metabolism. Serious - Use Alternative. Risk of QT interval prolongation.
nifedipina aumentar el nivel o el efecto de astemizol afectando heptico intestinal enzima CYP3A4 metabolismo. Graves - uso alternativa. la nifedipina aumenta los niveles de astemizol reducen el metabolismo. Graves - uso alternativa. Riesgo de prolongacin del intervalo QT

Renal Failure
CrCl: 10-50 mg/min: Administer q24-72hr CrCl<10 mL/min: Administer q72-96hr
Angina de pecho (profilaxis) Cpsula ER: inicial 2.5-6.5 mg PO q6 - 8 horas Valorar hasta effec dosis hasta limitada por SE Insuficiencia renal CrCl: 10-50 mg/min: administrar q24 - 72 horas CrCl < 10 mL/min: administrar q72 - 96 horas

Dosing Forms & Strengths Angina

10 mg (conventional) PO q8hr or 30-60 mg (extended release) PO once daily initially; may be increased every 7-14 days PRN Maintenance: 10-20 mg (conventional) PO q8hr up to 20-30 mg PO q6-8hr; not to exceed 180 mg/day (conventional) or 120 mg/day (extended release)

Hypertension
30-60 mg (extended release) PO once daily; may be increased every 7-14 days PRN; not to exceed 90 mg/day (Adalat CC) or 120 mg/day (Procardia XL)

Pulmonary Hypertension
30 mg (extended-release) PO q12hr; may be increased to 120-240 mg/day (monitor)

Raynaud Phenomenon (Off-label)

30-120 mg (extended release) PO once daily

Anal Fissures (Off-label)

0.2% topical gel/ointment (extemporaneously compounded) q12hr for 3-6 weeks

Dosing Modifications
Peritoneal dialysis (PD) or hemodialysis (HD): Supplemental dose not necessary Cirrhosis: Consider dose adjustment nifedipine increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Serious - Use Alternative. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitor

la nifedipina aumenta los niveles de afatinib por transportador Urticaria (2%) P-glicoprotena (MDR1) emanacin. Graves - uso alternativa. Reducir la dosis diaria afatinib de 10 mg si no toleran cuando Pruritus (2%) coadministrado con inhibidor de la P-gp

Constipation (<2%) Chest pain (<2%) nefazodone will increase the level or effect of nifedipine by affecting hepatic/intestinal enzyme CYP3A4 Frequency Not Defined metabolism. Serious - Use Alternative Gingival hyperplasia
nefazodona aumentar el nivel o el efecto de la nifedipina afectando heptico intestinal enzima CYP3A4 metabolismo. Agranulocytosis Graves - uso alternativa

Erectile dysfunction fosphenytoin will decrease the level or effect of nifedipine by affecting hepatic/intestinal enzyme Postmarketing Reports CYP3A4 metabolism. Serious - Use Alternative. Exfoliative or bullous skin adverse events (eg, erythema Phenytoin (fosphenytoin active metabolite) decreases multiforme, Stevens-Johnson syndrome, toxic systemic exposure of nifedipine by about 70% epidermal necrolysis) fosphenytoin will decrease the level or effect of Photosensitivity reactions nifedipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative. Acute generalized exanthematous pustulosis Phenytoin (fosphenytoin active metabolite) decreases systemic exposure of nifedipine by about 70% EFECTO ADBERSO
conjunto efectos difieren entre accin corta (convencional) y liberacin de las formulaciones, con las preparaciones dverse effects differ between short-acting convencionales con las reacciones adversas ms graves en algunos casos (conventional) and extended-release formulations, with

the conventional preparations having more serious adverse drug reactions in some cases &gt; 10%
Edema perifrico (10-30%)

>10%
Peripheral edema (10-30%) Dizziness (23-27%) Flushing (23-27%) Headache (10-23%) Heartburn (11%)
Nuseas (11%) Mareo (23-27%) Flushing (23-27%) Dolor de cabeza (10-23%) Acidez (11%)

Nausea (11%)

1-10%
Muscle cramps (8%)

1-10% Calambres musculares (8%) Cambio de humor (7%)

Mood change (7%) Nervousness (7%) Cough (6%) Dyspnea (6%) Palpitations (6%) Wheezing (6%) Hypotension, transient (5%)
Hipotensin transitoria (5%) Nerviosismo (7%) Tos (6%) Disnea (6%) Palpitaciones (6%) Sibilancias (6%)

Half-life: Conventional, 2-5 hr; 7 hr in cirrhosis

Urticaria (2%) Prurito (2%) Estreimiento (< 2%) Dolor en el pecho (< 2%) Frecuencia no definido Hiperplasia gingival Agranulocitosis Disfuncin erctil Informes Postmarketing Eventos adversos piel exfoliativa o bulloso (eg., eritema multiforme, sndrome de Stevens - Johnson, necrlisis Absorcin epidrmica txica) Biodisponibilidad: Convencional, 40-77%; liberacin prolongada, 65-89% Reacciones de fotosensibilidad Inicio: Convencional, 20 min; liberacin prolongada, 30 min. Pustulosis exanthematous generalizado agudo 3333 Duracin: 8 horas convencional; liberacin prolongada, 24 horas Mechanism of Action Vasodilatacin con disminucin de la resistencia perifrica y aumento de frecuencia cardaca Mecanismo de accin Bloqueador de canales de calcio; inhibe la afluencia transmembrana de los iones del calcio extracelular a travs de las membranas celulares del msculo liso vascular y del miocardio sin alterar las concentraciones de calcio del suero; Esto da como resultado la inhibicin de la contraccin del msculo liso vascular y cardiaca, as dilatar las arterias coronarias y sistmicas principales

Dialyzable: No dose adjustments necessary in HD or PD Excretion: Urine (60-80%), feces (20-40%)

Calcium-channel blocker; inhibits transmembrane influx Tiempo de pico de plasma: convencional, 30-120 min; of extracellular calcium ions across myocardial and liberacin prolongada, 6 hr (Procardia XL) o 2.5-5 (Adalat CC) vascular smooth muscle cell membranes without changing serum calcium concentrations; this results in Distribucin inhibition of cardiac and vascular smooth muscle Protena enlazada: 92-98% contraction, thereby dilating main coronary and systemic arteries
Vd: 1.42-2.2 L/kg.

Vasodilation with decreased peripheral resistance and Metabolismo increased heart rate

Se metaboliza en el hgado por CYP3A4 Metabolitos: Anlogo Nitropyridine (inactivo) Eliminacin Half-Life: Convencional, 2-5 horas; 7 hr en la cirrosis

Absorption
Bioavailability: Conventional, 40-77%; extended release, 65-89%

Onset: Conventional, 20 min; extended release, 30 min

PD

Dialyzable: No hay ajustes de las dosis necesarios de HD o Duration: Conventional, 8 hr; extended release, 24 hr

Peak plasma time: Conventional, 30-120 min; extended release, 6 hr (Procardia XL) or 2.5-5 hr (Adalat CC) Excrecin: Orina (60-80%), heces (20-40%)

Distribution
Protein bound: 92-98%

Educacin Patient Education

Vd: 1.42-2.2 L/kg

Metabolism
Metabolized in liver by CYP3A4 Metabolites: Nitropyridine analogue (inactive)

nifedipine Oral IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual

Elimination

medical advice and does not substitute for the advice increase of your dose. Follow your doctor's instructions your health care professional. Always ask your health carefully. care professional for complete information about this product and your specific health needs. Avoid eating grapefruit or drinking grapefruit juice while taking this medication unless your doctor instructs you otherwise. Grapefruit can increase the amount of certain medications in your bloodstream. Consult your doctor or pharmacist for more details.

NIFEDIPINE - ORAL (nye-FED-i-peen) COMMON BRAND NAME(S): Procardia USES:

This medication is used to prevent certain types of chest pain (angina). It may allow you to exercise more and decrease the frequency of angina attacks. Nifedipine belongs to a class of medications known as calcium channel blockers. It works by relaxing blood Tell your doctor if your condition worsens (for example, vessels so blood can flow more easily. This medication your chest pain worsens or is more frequent). must be taken regularly to be effective. It should not be used to treat attacks of chest pain when they occur. Use other medications (such as sublingual nitroglycerin) to relieve attacks of chest pain as directed SIDE EFFECTS: by your doctor. Consult your doctor or pharmacist for details. Dizziness, flushing, weakness, swelling ankles/feet, and headache may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. OTHER USES: This section contains uses of this drug that are not To reduce dizziness and lightheadedness, get up slowly listed in the approved professional labeling for the drug when rising from a sitting or lying position. but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious This medication may also be used to treat a certain side effects. blood circulation disorder (Raynaud's syndrome).

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.

Tell your doctor immediately if any of these unlikely but serious side effects occur: fast/irregular/pounding heartbeat, fainting. Take this medication by mouth, usually 3 times daily with or without food or as directed by your doctor. Swallow this medication whole. Do not crush, chew, or break the capsule. Tell your doctor immediately if any of these rare but very serious side effects occur: vision changes. HOW TO USE: The dosage is based on your medical condition and response to treatment. Your doctor may gradually

Although this medication is effective in preventing chest pain (angina), some people who already have severe heart disease may rarely develop worsening chest pain Before using this medication, tell your doctor or or a heart attack after starting this medication or pharmacist your medical history, especially of: liver increasing the dose. Get medical help right away if you problems, kidney problems. experience: worsening chest pain, symptoms of a heart attack (such as chest/jaw/left arm pain, shortness of breath, unusual sweating). Before having surgery, tell your doctor or dentist that you are taking this medication. A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, This drug may make you dizzy. Do not drive, use including: rash, itching/swelling (especially of the machinery, or do any activity that requires alertness face/tongue/throat), severe dizziness, trouble breathing. until you are sure you can perform such activities safely. Limit alcoholic beverages. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your During pregnancy, this medication should be used only doctor or pharmacist. when clearly needed. Discuss the risks and benefits with your doctor. In the US This medication passes into breast milk. Consult your doctor before breast-feeding. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. DRUG INTERACTIONS: See also the How to Use section. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.

PRECAUTIONS:

Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: phenytoin, quinidine, tacrolimus.

This medication should not be used if you have a certain medical condition. Before using this medicine, consult your doctor or pharmacist if you have: certain Other medications can affect the removal of nifedipine heart problems (such as congestive heart failure, aortic from your body, which may affect how nifedipine works. stenosis). Examples include cimetidine, azole antifungals (such as itraconazole), macrolide antibiotics (such as

erythromycin), rifamycins (such as rifabutin), St. John's it is near the time of the next dose, skip the missed wort, drugs used to treat seizures (such as dose and resume your usual dosing schedule. Do not carbamazepine), among others. double the dose to catch up.

Check the labels on all your medicines (such as coughSTORAGE: and-cold products, diet aids) because they may contain ingredients that could increase your heart rate and Store at room temperature between 59-77 degrees F worsen chest pain (including caffeine, (15-25 degrees C) away from light and moisture. Do not pseudoephedrine, phenylephrine). Ask your pharmacist store in the bathroom. Keep all medicines away from about using these products safely. children and pets.

Cimetidine is a nonprescription drug that is commonly Do not flush medications down the toilet or pour them used to treat extra stomach acid. Because cimetidine into a drain unless instructed to do so. Properly discard may interact with nifedipine, ask your pharmacist about this product when it is expired or no longer needed. other products to treat extra stomach acid. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product. This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. MEDICAL ALERT: Your condition can cause Keep a list of all your medications with you, and share complications in a medical emergency. For information the list with your doctor and pharmacist. about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

OVERDOSE: Information last revised March 2013. Copyright(c) 2013 If overdose is suspected, contact a poison control First Databank, Inc. center or emergency room immediately. US residents Educacin del paciente can call their local poison control center at 1-800-2221222. Canada residents can call a provincial poison nifedipina Oral IMPORTANTE: Cmo usar esta informacin: este es un control center. resumen y no tiene toda la informacin posible acerca de este
producto. Esta informacin no garantiza que este producto es seguro, eficaz o apropiado para usted. Esta informacin no es un consejo mdico individual y no sustituye el asesoramiento de profesionales del cuidado de su salud. Siempre pregunta a su profesional de cuidado de la salud para obtener informacin completa sobre este producto y las necesidades de tu salud especfico.

NOTES: Do not share this medication with others.

NIFEDIPINA - ORAL (nye-FED-i-Pea) NOMBRE comn de la marca (S): Procardia Laboratory and/or medical tests (such as blood USOS: pressure, liver/kidney tests, electrocardiogram) may Este be medicamento se usa para prevenir ciertos tipos de dolor performed from time to time to monitor your progress or de pecho (angina). Podr permitirle hacer ms ejercicio y check for side effects. Consult your doctor for more disminuir la frecuencia de los ataques de angina de pecho. details. Nifedipina pertenece a una clase de medicamentos conocidos como bloqueadores del canal de calcio. Funciona al relajar los vasos sanguneos para que la sangre fluya ms fcilmente. Este medicamento debe tomarse regularmente para ser eficaz. No debe utilizarse para tratar los ataques de MISSED DOSE: dolor en el pecho cuando ocurren. Utilizar otros medicamentos (como la nitroglicerina sublingual) para aliviar los If you miss a dose, take it as soon as you remember. If ataques de dolor en el pecho como lo indique su mdico.

Consulte a su mdico o farmacutico para obtener ms detalles.

cardiopatas severas pueden desarrollar raramente empeora el dolor de pecho o un ataque al corazn despus de iniciar este medicamento o aumentar la dosis. Busque atencin mdica de inmediato si experimenta: empeoramiento de los OTROS USOS: sntomas de un ataque al corazn, dolor en el pecho (tales Esta seccin contiene los usos de esta droga que no figuran como dolor de pecho/mandbula izquierda/brazo, falta de en el etiquetado profesional aprobado por la droga, pero que aliento, sudoracin inusual). pueden ser recetados por su mdico. Utilice este medicamento para una condicin que aparece en esta seccin slo si se le ha as recetado por su profesional deUna muy grave reaccin alrgica a este medicamento es cuidado de la salud. rara. Sin embargo, busque atencin mdica inmediatamente si nota cualquier sntoma de una reaccin alrgica grave, sarpullido, picazn/inflamacin (especialmente de Este medicamento tambin puede ser utilizado para tratarincluyendo: un la cara/lengua/garganta), mareos intensos, dificultad para cierto circulacin trastorno sanguneo (sndrome de respirar. Raynaud). Esto no es una lista completa de efectos secundarios. Si CMO UTILIZAR: Tome este medicamento por va oral, generalmente tres usted nota otros efectos no mencionados, comunquese con veces al da con o sin alimentos o segn lo dirigido por susu mdico o farmacutico. mdico. Este medicamento tragar entero. No triture, mastique o rompa la cpsula. En los Estados UnidosLa dosificacin se basa en su condicin mdica y respuesta Llame a su mdico para consejos mdicos sobre los efectos al tratamiento. Su mdico puede aumentar gradualmente su secundarios. Usted puede reportar efectos secundarios a la dosis. Siga cuidadosamente las instrucciones de su mdico. FDA al 1-800-FDA-1088. Evite comer toronja o beber jugo de toronja mientras est En Canad - llame a su mdico para consejos mdicos sobre tomando este medicamento a menos que su mdico le indica los efectos secundarios. Usted puede reportar efectos lo contrario. Toronja puede aumentar la cantidad de ciertos secundarios a la salud de Canad al 1-866-234-2345. medicamentos en su torrente sanguneo. Consulte a su mdico o farmacutico para obtener ms detalles. PRECAUCIONES: Antes de tomar este medicamento, dgale al doctor o a su Use este medicamento regularmente para obtener el mayor farmacutico si usted es alrgico a l; o si tiene otras beneficio de ella. Para ayudarle a recordar, tmelo a la misma alergias. Este producto puede contener ingredientes hora cada da. inactivos, que pueden causar reacciones alrgicas u otros problemas. Hable con su farmacutico para obtener ms Dgale a su mdico si su condicin empeora (por ejemplo,detalles. dolor torcico empeora o es ms frecuente). Este medicamento no debe utilizarse si usted tiene una cierta condicin mdica. Antes de usar este medicamento, consulte EFECTOS SECUNDARIOS: a su mdico o farmacutico si usted tiene: ciertos problemas Pueden ocurrir mareos, rubor, debilidad, inflamacin tobillos/pies y dolor de cabeza. Si alguno de estos efectos(por ejemplo, insuficiencia cardaca congestiva, estenosis artica) del corazn. persisten o empeoran, Dile a tu doctor o farmacutico puntualmente. Antes de usar este medicamento, dgale al doctor o a su su historial mdico, especialmente de: Para reducir mareos y aturdimiento, levntese lentamentefarmacutico al problemas hepticos, problemas renales. levantarse de una posicin de estar sentada o acostada. Antes de someterse a ciruga, dgale a su doctor o dentista Recuerde que su mdico le ha prescrito este medicamento porque l o ella ha juzgado que el beneficio para usted esque usted est tomando este medicamento. mayor que el riesgo de efectos secundarios. Mucha gente usando este medicamento no tiene efectos secundarios Este medicamento puede causarle mareos. No conduzca, graves. utilice machin Dgale a su mdico inmediatamente si se presenta cualquiera de estos efectos secundarios graves pero poco probable: Propranolol latido del corazn irregular/rpido/golpes, desmayos. Dgale a su mdico inmediatamente si se presenta cualquiera de estos efectos secundarios raros pero muy graves: los 2 Interactions Found cambios de la visin. Significant - Monitor Closely Aunque este medicamento es eficaz en la prevencin del nifedipine increases levels of propranolol by decreasing dolor de pecho (angina), algunas personas que ya tienen

nifedipine + propranolol

elimination. Significant - Monitor Closely. propranolol + nifedipine propranolol and nifedipine both increase antihypertensive channel blocking. Significant - Monitor Closely.
2 Interacciones encontradas Importante - vigilar de cerca nifedipina + propranolol la nifedipina aumenta los niveles de propranolol al disminuir la eliminacin. Importante - vigilar de cerca. propranolol + nifedipine propranolol y nifedipina aumentan el bloqueo de canal antihypertensive. Importante - vigilar de cerca.

aspirin + propranolol aspirin decreases effects of propranolol by pharmacodynamic antagonism. Significant - Monitor Closely. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
aspirina + propranolol aspirina disminuye los efectos del propranolol por antagonismo farmacodinmico. Importante - vigilar de cerca. A largo plazo (&gt; 1 semana) uso de AINE. Los AINEs disminuyen la sntesis de prostaglandinas.